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

Jolyon Attwooll

19/05/2023 4:33:46 PM

While New Zealand can process IMGs within three months, Australia’s bureaucracy is proving a major barrier to addressing workforce shortages.

Man frustrated with paperwork
It take on average 14 months and $23,000 to emigrate to Australia as a GP.

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.’

IMG-hearing-article.jpgRACGP 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.
Log in below to join the conversation.  

IMGs International Medical Graduates overseas trained doctors

newsGP weekly poll Should after-hours Medicare rebates extend to all-day Saturday?

newsGP weekly poll Should after-hours Medicare rebates extend to all-day Saturday?



Login to comment

Dr Patrick Fergal McSharry   19/05/2023 5:19:11 PM

I'm one of the Docs affected. 3 years application to enter Australia
Then 3-5 years after entry before PR.( and discrimination for being over 45 and having too.many qualifications) 😢

anon   20/05/2023 5:24:12 AM

I worked as a GP in katherine previously and return there from time to time because the people are fantastic. But there is no way any doctor would move with their family there given how much crime is going on. Making the town actually safe and livable would be a good start.

Dr Christos Papachristos   20/05/2023 9:50:19 AM

All this is great but has anyone thought of training more Australian doctors rather than plundering the third world of theirs? I know it will be a slow process but it is really the only long term, sustainable solution. Please stop this short term thinkong.

Dr Bradley Arthur Olsen   20/05/2023 12:49:27 PM

I think it may be the federal govts secret selection process .Only those that will tolerate a top heavy ,non medical admin telling us what to do will be permitted to enter Australia . Here they will be rewarded with....... a top heavy non medical admin telling us what to do . But on a more serious note rural/ remote medicine is in dire straits without them

Dr Bilal Ali Khan   21/05/2023 10:32:40 AM

currently the system is favoured towards the sticks rather than carrots. I.e restrict IMGs to rural by way of moritorium with little other incentives. Who in the right mind would like their children to grow in a far away rural place where there is not enough schooling etc. We are taking about doctors , who are carrier oriented and like their children to succeed in life with good educational opportunities. Only way Rural areas be reasonably staffed is to introduce more carrots i.e incentivise financially very well so doctors think of working there in early or late carriers rather than midlife where family is more important. That way Australian trained as well as IMGs will think about working in rural when they have no children , primary school aged children or Uni going . Other barriers like RACGP equivalence , AHPRA , and immigration take extremely long time and requirements like HWC etc make things more difficult even immigrating to or near major cities.

Dr Bilal Ali Khan   21/05/2023 10:43:57 AM

I say scrap moratorium and Health workforce certificates. Let doctors immigrate to cities and have supervision there which is easily available. Heavily incentivise rural work and let the market forces play. RACGP to cut the crap and keep only the relevant requirements for IMG applications and streamline processes to fast track applications. Reform and staff AHPRA to process application within 1 month ( currently you can't even talk to a human in AHPRA without trying multiple days and hours of holding on phone and still get very generic responses if you did mange to talk). Process doctor visa applications on priority seperate from other pools, like in NZ ( currently processing in 21 days) .

Dr Abdul Ahad Khan   21/05/2023 11:06:17 AM

Dr. Papachristos, we do produce our own Medical Graduates, but majority want to take up other Specialties - only a small proportion want to become GPs because it is NOT FINANCIAKKY ATTRACTIVE !
Dr. Ahad Khan

Dr Simon Holliday   21/05/2023 10:23:07 PM

From verbal agreement to seeing his first patient it took us 22 months for one South African doctor with a Masters and a Fellowship . Due to this delay his family did not come over as well. This was also because his Permanent Residency was dependent on getting the Fellowship. Family factors made him return to South Africa. He tells me all his South African colleagues who want to leave are going to UK or Canada, In Canada, if you secure a job, you are automatically provided Permanent Residency. Our system is not a system at all. With numerous State, Federal and Professional players, none of whom co-ordinate, recruiters of IMGs are left to run around in circles as if in a macabre Benny Hill skit bumping into walls and falling over.
Our regulators need to ensure equitable access to doctors so that more Australian trained doctors go rural.

Dr Abdullah Fadil Abdullah Alsharik   22/05/2023 2:16:34 PM

How NZ is easier than Australia ?? I dont think its totally true as I know someone there , aGP from overseas who has full experence and qualification in GP and Obsteric /gyn (MRCOG1,2,AND NOW DONE WTH 3) and struggle to get the assessment ,passing AMC1 then the Clinical (OSCE) Had a longwait list ,they kept waiting with no hope ,had to work as doctor assisstant in family planning ,told me the regitrar working there one day could not get the morphololgy /head of baby ,where she was consulted and managed well ,told that why she is not working??
the doctor was actualy trying to do AMC 2 ,manged to do online one due to covid last year then got job overseas and left NZ and I dont think will get the qualification and all complex assessment even here in Austrlaia .the will get the specialist in 2 year In gult region and the salaries and all incentive more better than here.

Dr Emma Jane Slyderink   23/05/2023 10:50:34 AM

Its not just IMGs but anyone wanting to come back. My husband is Australian and graduated in QLD but completed GP training in the UK. We are both GPs with many years of experience. I have PR. We have been going through this process for 9-10 months already and come across various barriers because we don't "fit" into the correct boxes. The amount of duplication with document checks is ridiculous. We have been in Australia for 8 weeks already because you have to be here to complete the AHPRA registration ID check, which in this age of technology is surely something that can be overcome? We still do not have provider numbers, mine hasn't even been sent for due to delays from the college. Meanwhile we are sitting at home doing nothing (and spent all our savings) whilst everyone we meet tells us how short of GP's the country is. The agency we used in the UK told us that many people give up before getting this far.