Warning over plan to bypass colleges for IMG assessment

A proposal to shift the assessment of international medical graduates (IMGs) away from specialist colleges has raised concerns around the potential for unintended impacts on patient safety.
 
The suggestion is included in the Independent review of overseas health practitioner regulatory settings, widely known as the ‘Kruk report’ after the former senior public servant tasked with overseeing it, Robyn Kruk. 
 
The interim report, published in April, recommends moving equivalence assessments from specialist colleges to the Australian Medical Council (AMC), a move the author says ‘could drive greater consistency in performance and outcomes and reduce costs’.
 
Under the suggestion, the involvement of the specialist colleges would be limited to a more advisory role, including providing documentation, as well as standards for assessment and curriculum.
 
‘The MBA, AHPRA and the AMC should determine the transition path and timeline in consultation with specialist colleges, given their ongoing advisory role,’ the report recommends.
 
However, the proposal has raised the spectre of what has happened previously when the role of specialist colleges is diminished.
 
One specific example cited by RACGP President Dr Nicole Higgins focuses on past failures in her home state of Queensland in the oversight of overseas medical practitioners.
 
In 2005, the Queensland Public Hospitals Commission of Inquiry was set to up to look into the assessment, registration and monitoring of overseas-trained medical practitioners, following a series of deaths at Bundaberg Base Hospital linked to US-trained surgeon Dr Jayant Patel.
 
Nicknamed ‘Dr Death’ by both co-workers and patients after being linked to a number of botched operations, Dr Patel was eventually jailed in 2010 for three manslaughters.
 
While Dr Patel successfully appealed his conviction in 2012, when a High Court judge ruled some evidence used in the prosecution case as inadmissible, he was ultimately found guilty of obtaining his position by fraud and permanently banned from medical practice in Australia.
 
Before moving to Bundaberg, Dr Patel had also been restricted from performing certain types of surgery in Oregon and had also been required to surrender his licence in New York. The failure of his Australian employers to pick up those limitations was sharply criticised in the Queensland commission’s report.
 
Dr Higgins says many of the concerns raised remain relevant today. 
 
‘I am a Queenslander and this report still casts a huge shadow here,’ she told newsGP.
 
‘It’s a stark warning to everyone involved about what can happen when the specialist colleges are put to one side in the accreditation process – and it’s something we can never allow to happen again.’
 
The inquiry heard that during the time of Dr Patel’s employment, processes had ‘mostly avoided’ pathways for ensuring the competence of overseas medical practitioners such as fellowship or registration as a deemed specialist.
 
‘In my view, the [Queensland Medical] Board has registered many area of need applicants on terms that would deem them to be specialists, but without invoking the safeguards set out in the national guidelines, namely consultation with the relevant college,’ the report author, former Supreme Court judge Geoffrey Davies, wrote.
 
He concluded that ‘the process of obtaining deemed specialist registration was largely circumvented’.
 
The then President of AMA Queensland, Dr David Molloy, told the inquiry this was because it was ‘not always easy' to obtain a college’s approval for a candidate, and that the college would ‘almost always impose a condition that supervision be provided and this could be awkward for Queensland Health’. 
 
He also said the college’s requirement for continuing medical education ‘might be inconvenient for Queensland Health’. 
 
To avoid any risks in limiting the role of specialist colleges, Dr Higgins believes it would be better to simplify requirements rather than transfer responsibility to the AMC.
 
‘If the system for comparing the experience of IMGs was more streamlined for the colleges, we’d still get to the place we all want to get to, which is a swift, safe and efficient way of getting IMGs working in Australia, but protecting the standards we are rightly proud of,’ she said.
 
Dr Higgins reiterated her commitment to working with the Department of Health and Aged Care and AHPRA to address the concerns around the future of the general practice workforce.
 
‘Almost half of our GPs are international medical graduates; they are part of the lifeblood of general practice and make a massive contribution to communities all around Australia,’ she said.
 
‘We have been advocating loudly to reduce red tape for our IMGs, and we recognise the Government’s efforts to do something about it.’
 
A final version of the Kruk Report is due later this year.
 
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