‘We are going to miss out’: Stark warning on IMG recruitment

Many countries need international medical graduates (IMGs) to shore up their healthcare workforce but Australia is falling behind in its efforts to attract them, a Federal Parliament committee heard this week.
 
In a series of public hearings, the Standing Committee on Migration was told how red tape is delaying qualified doctors from practising in this country – and in some cases deterring from them from coming altogether.
 
One example compared the process for recruiting an IMG into the workforce in New Zealand. The Primary Care Business Council described how across the Tasman, the task takes an average of three months, and costs $5000. That compares to an average of 14 months in Australia with a cost of $23,000.
 
It is a situation that RACGP Rural Chair Associate Professor Michael Clements, who represented the college at a hearing for the committee’s Migration, Pathway to Nation Building Inquiry on Thursday, recognises very well.
 
He told the committee about the challenges his own practice has faced in recruiting overseas GPs, giving the example of an 18-month wait between offering a contract to a Scottish GP and her being able to see her first patient in Australia.
 
Citing a declining interest in general practice among medical graduates, Associate Professor Clements also told the committee members that more than half of doctors working in rural areas gained their degrees overseas – and that the situation is unlikely to change soon.
 
‘We are going to be heavily reliant on overseas trained doctors for the foreseeable future, and it’s our quickest opportunity to fill some of the gaps where we need the most,’ he said.
 
He noted that the situation is not unique to Australia, with countries including New Zealand, Canada, and many European nations ‘all extremely reliant’ on overseas trained doctors, with up to half of their rural workforces having gained their medical degree abroad.
 
‘At the moment, we are in absolute competition with places like Canada and New Zealand and Ireland in looking for these overseas trained doctors,’ he said.
 
‘If we don’t do better, we’re actually going to miss out.’
 
One person who is also all too familiar with the pressures on recruitment is Anjali Palmer, a practice owner in the Northern Territory town of Katherine.
 
Ms Palmer said Katherine had been without a practice for six months when she and her husband opened the Bauhinia Health practice in March 2021.
 
‘People were travelling [more than 270 km] to Darwin,’ she told newsGP.
 
‘The reason we started this was it was … obvious that no one was going to do anything. We have been advertising from the day we started.’
 
She describes myriad frustrations with the bureaucracy involved in recruiting GPs, including a stalled bid to introduce a single employer model with the Northern Territory Government that she believes would help to alleviate some of the strain.
 
‘From our point of view, as practice owners, given that there’s such a shortage, surely someone, somewhere should be thinking, “how can we make this really easy, particularly in rural remote areas where there is a dearth of doctors, for private practices in particular?”’ she said.  
 
‘It’s really difficult because here in Katherine we’re competing against the hospital, and against three Aboriginal community-controlled organisations who pay their doctors really well.
 
‘There’s been practices I know of that have come to the verge of closing and then survive because a registrar has signed up.
 
‘That’s no way to provide services to remote communities. Everyone deserves the basics of life, and healthcare is one of the most important of them.’

RACGP Rural Chair Dr Michael Clements in Katherine with Bauhinia Health owner and practice manager, Anjali Palmer. (Image: Supplied)
 
One frustration for Ms Palmer is the supervision requirements for IMGs, with too few supervisors to go around, and little incentive for supervision.
 
‘Why would any general practitioner want to give up their income to supervise an IMG?’ she said.
 
Associate Professor Clements agrees that that the question of supervision is ‘a real problem’.
 
‘It’s a real capacity barrier to some of the rural and remote towns in expanding the numbers of doctors,’ he told the committee.
 
‘It’s a difficult one to answer though because as a college, we don’t support watering down supervision.’
 
He says a solution proposed by one corporate general practice is to employ a supervisor.
 
‘I’ve been involved in areas where we are looking at promoting the idea of a GP being funded just to supervise because at the moment there’s no funding to supervise the IMG, there’s no program that pays for the GP’s time,’ he said.
 
‘So we do think that if we can crack that supervision nut open by finding dedicated funding … we can increase the capacity of the good practices.’
 
He also reiterated that the 10-year moratorium approach, which obliges IMGs to go to areas of greatest need, is not supported by the college.
 
‘In some cases they stay, but in most cases at the end of the moratorium, doctors do migrate to where they want to go,’ Associate Professor Clements said.
 
‘We’d actually like to see incentives that attract both Australian trained graduates and internationally trained graduates.
 
‘We’re not talking about carrots just for the international graduates, we actually need a whole rethink of our overall health system … that actually does drive both the Australian and the international graduates out there.’
 
He also suggests scrapping requirements for Labour Market Testing and Health Workforce Certificates.
 
‘It just seems silly that we still do that,’ he said. ‘We just need to cut away some of these steps.’
 
Those are also among the recommendations put forward in the Independent review of overseas health practitioner regulatory settings, which was published last month.
 
Conducted by former senior public administrator Robyn Kruk, the review proposes a series of ‘practical reform’ measures that would narrow the gap that currently exists between Australia and countries like New Zealand.
 
‘Implementing the package of reforms will enable overseas trained GPs from countries with similar regulatory systems to complete the journey in less than three months,’ the review states.
 
For Ms Palmer, change cannot come quickly enough.
 
‘The essential messaging that is not being heard is that something radical – that works – needs to be done about the GP shortage in Australia as soon as possible,’ she said.
 
‘People need this essential service, and the only way we can get personnel out in the sticks is by using IMGs. 
 
‘Treat them respectfully – register them as level 1 or 2 registrars as appropriate – and cut the damn red tape.’
 
The full college submission to the Migration, Pathway to Nation Building Inquiry can be read on the RACGP website.
 
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