Article on the plight of IMGs / OTDs in Australia

In response to the article for national shortage of doctors by Monash University demographer Bob Birrel (Click here for article http://theconversation.edu.au/is-the-national-doctor-shortage-a-myth-12568), the failure seems to be omnipresent in the governing bureaucracy itself rather than the actual shortage. This ‘myth’ is actually a morph of ‘mismanagement and failure’ of government healthcare policy and should be treated as such rather than being woefully and indifferently dismissed as a myth. One only has to ask people in rural Australia a very simple question as to why it takes them to 14 days to get an appointment, or why are there no immediate emergency services or question the 3 hour drive it takes for an average rural citizen to reach the nearest doctor, the so called ‘myth’ can be easily dispelled.

I’d like to write this short article in light of the difficulties and in support of the sacrifices International Medical Graduates have given in order to practice in Australia. The article is written from my personal perspective alone and is intended as free speech. I am not a medical practitioner but I am married to one and having experienced what they go through, I wish to clear up some doubts and hopefully provide the IMGs with a voice. Most are intimated by the system itself and cannot voice their opinion in fear of damaging their career or getting sued by organisations. I believe that fairness must be fought for.

There does exist a general feeling among the IMGs that while they are needed in Australia, they are not wanted here. Most of the International Medical Graduates answered the call to help Australia in the hour of need, some before the pump was started to produce local graduates and by the time I have penned these words, their careers were severely affected and in some cases over. There is also a sense of xenophobia in the closed profession of medical practice and a general perception that all foreign medical graduates are less trained than their Australian counterparts by the community which is an unfortunate prejudice considering what Australia stands for - giving everyone a fair go. Some IMGs are way more qualified and experienced than the average fresh local graduate as was demonstrated in a case where an overseas trained specialist was required to sit for basic exams only to find that he was the author of the prescribed text book (http://ahha.asn.au/news/lost-labyrinth-overseas-trained-doctors-report-tabled-parliament). No dodgy certificate holders can sit and get the AMC examination as the process has been corrected over the years and the AMC's vetting process fine tuned ensuring that the qualifications are awarded from acceptable universities. This list of acceptable universities with acceptable standards and medical proficiency is maintained by the ECFMG, USA and the Australian Medical Council also use their services plus their own vetting process, as do the USA, UK, Canada, etc. Not all overseas doctors from non-english speaking nations are incompetent. There are an equal number of incompetent local graduates too. It is just unfair and in my opinion, un-Australian to to have that preset prejudiced mentality that if they are brown / black then they are no good. Doctors are humans too and not demi-Gods who are taken for granted to diagnose correctly in the first instance. A lot depends on outcome of investigation and diagnosis can dynamically change based on outcomes of investigation, patient prognosis and research. As with any of us, they too can make mistakes, in spite of their best effort and intentions. The secret of developing great doctors lies in encouraging and allowing them to learn more to minimize such errors, coupled with appropriate checks and balances in place. Australia is a harmonious nation of immigrants and in certain communities, doctors with additional language fluency can prove to be more effective.

If the issue is so prevalent, the government should just state the obvious that foreign doctors are not welcome here rather than inviting them here, giving them absolutely no opportunity to practice while accepting all their money in endless series of examination is just an undeniable shame for the government. Some communities cry for more doctors but don’t want competent foreign doctors while other communities in rural Australia appreciate them and fight for the rights of them. It is unfortunately confusing… are the IMG’s wanted here or are they not? More must be done to clear the community’s perception of IMGs and foreign graduates. It is to be noted that while some IMG’s are not allowed to practice even if they are specialists or have years of proven experience, they are however allowed to teach medicine to local graduates in becoming future doctors in prestigious Australian universities. Ludicrous!

As with every country, the government must do more in opening positions to address new medical graduates and international doctors already here to gain a foothold to establish a career. If the flow of doctors exceeds the capacity to provide practicing opportunities, the government should immediately suspend AMC examination until the need for more IMGs is demonstrated for new applicants. The current government has no excuse to have redundant doctors lying around, their careers in tatters, their toil of 15 years wasted while the rural Australians could have benefited enormously from them. This is a simple case of greedy bureaucracy at work ensuring that millions of $$$ continue to flow to the coffers of some organisation. (Simple maths, 200 examination candidates at a single seating multiply by nearly $5000 approx for two examination then multiply by at least 14 venues and then multiply that by approximately 4 times a  year = ? $$$ and then multiply the total by 60% as they will re-attempt over and over again not to mention the amount of $$$ saved on training OTDs in the rare eventuality if they actually do pass the examination and registration process excluding additional assets they bring to the economy). Unfortunately, the fact that hundreds of millions of dollars is at stake will disable any effort to correct the system.

Let’s not kid ourselves here, while most of the rural Australians need to wait 2 weeks to see a GP, there are hundreds of qualified doctors, having passed Australian Medical Exams flipping burgers at a joint simply because the AMC and the AHPRA have a system in place that makes it extremely difficult for International Medical Graduates to navigate, even if they pass the AMC examination. One of the most prominent and undeniable catch 22 element on the road to General Practice for IMGs is  “1) Pass the AMC”, “2) Find a job” and “3) Apply for registration” where the condition for eligibility to “2) Find a job” is to “Possess a registration, have recency of practice and have x years of  local experience” where the condition for local experience lies in finding a job where the job depends on having a registration where the condition for registration lies in getting a job!!! Ludicrous! Anyhow, you get the idea.

It is also a general perception that overseas trained doctors are less trained. That is just pure stereo-typing in my opinion. While the conditions of medical practice may be inherently different when compared to practice settings in Australia, this does not mean that they are inadequately trained. If they are provided with an opportunity to work in an Australian setting, they can quickly evolve into an expected medical practitioner in Australia. Medical science is universal. Accredited good universities across the world have the same basis for medical training and practice. The process of getting Australian recognized registration is extremely rigorous and well-vetted. The only notable difference in actual practice would in process, techniques or language. Language is not a priority. Yes, it is important for doctors to have acceptable communicable standards in English but they do not need to write works of literature in them. If they can communicate enough to pass the medical exams in English, pass the English test once, I am sure they can communicate well enough to save lives and make a difference without having to sit for English exams every 2 years even if they are working and living in Australia. I frankly cannot understand how can one’s English can possibly decline when they have been living in Australia. Most OTDs have been educated in the best schools in their country and some far exceed the level of competence of even Australian private schools. They need not be William Shakespeare to work in medical practice either. Further, their accreditations are vetted by the ECFMG, USA (Educational Commission for Foreign Medical Graduates) at the source of their primary qualification and after having passed AMC 1 & 2 exams, they are more skilled, experienced and qualified than local Australian graduates. The AMC already establishes that their knowledge meets or exceeds local graduates when they pass the AMC tests and if their work experience is taken into account, they result in being more skilled. Some OTDs are experienced in rural medicine, having past experience working in remote areas in other countries where facilities are much less than in rural Australia. This means that they can be deployed in the most remote areas with little facilities and yet be counted upon to save lives. Why cannot the present government encourage that and ensure the registration process is open to candidates that want to work and address the needs of such communities?

There is also a general attitude that most doctors are here purely for money. While this may hold true for some, majority of IMG doctors are not here for money. Some of these overseas doctors have made a conscious decision to serve the rural Australian community in answering the call by Australia years ago. Some are here to advance their knowledge to serve humanity because the means and machines to do so don’t exist in their home country. Some are here for personal reasons such as persecution because a female has earned a medical degree, or social discrimination in their country because they married their childhood friend of a different social class or caste, or the fact they are married to someone practicing a different religion, some purely due to their choice and  various other factors have to be considered before stereotyping them unfairly. Most doctors stand to make significant good income in their own country, not to mention the honour and prestige. They unfortunately cannot further their career, or serve in areas of benevolence as their own country lack in infrastructure. I have a feeling that doctors that are in for money generally get filtered out eventually because of their passionless work and most end up discontinuing their profession or venturing on other profitable interests. The myth that soon as you are doctors, you become a instant millionaire must be dispelled. Doctors in general are not paid too well when compared to other qualified highly scientific fields when the two factors, length of study and experience are matched into a level playing field. It is only when they have 20 or 25 years of education and experience and possess a specialist degree can they expect to make above average income. In other scientific careers, you can expect to retire by the time a doctor really starts to live and earn significantly. Having studied for 10 years sometimes putting 14 hours a day of effort for months and years on end and then working at junior positions and low income for the next 3 to 5 years, in most cases at the most desolate places on earth serving the most rural communities while paying off huge loans both here and your home country, you tell me if they don’t deserve every bit of their income when they are 50.  My word, they sure do deserve every cent of it… and it doesn’t have to thanked with extra $$$. Just a sincere thank you will suffice and to the credit of many rural Australians, they have thanked the overseas doctors that worked in their community in ways that will never be forgotten.

Further, whatever happened to the parliamentary inquiry into Registration Processes and Support for Overseas Trained Doctors? Lost in the labyrinth of bureaucracy? For articles relating to the parliamentary inquiry, please google "parliamentary inquiry of overseas trained doctors" or view the following links:

• http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/overseasdoctors/report.htm
• http://ahha.asn.au/news/lost-labyrinth-overseas-trained-doctors-report-tabled-parliament 
• http://www.smh.com.au/national/foreign-doctors-obstacle-course-a-disgrace-20111119-1nonl.html
• http://www.aph.gov.au/About_Parliament/House_of_Representatives/About_the_House_Magazine/Previous/ATH_41/Cover_story_-_Medico_limbo
• http://www.abc.net.au/news/2011-03-10/inquiry-warned-of-tsunami-of-mediocre-doctors/2662936
• http://www.medicalobserver.com.au/tags/IMGS

In my opinion, some of the steps the government should take to address the issue at hand are :

1. Legislate mandatory rotational internship in rural Australia for local Australian graduates as pre-requisite for obtaining any type of registration.
2. Prevent waste of valuable skills such as IMGs and offer them along with local Australian Graduate to work in teams in unmanned positions across rural Australia. They are too valuable and should not be flippin’ burgers period.
3. Grant immediate observership positions for IMGs to observe the Australian method of medical practice in both General Practice and hospitals. This does not involve additional cost and will only serve to enhance the ability of the practising doctor in future. All they need to do is sit and watch, and in occasion ask the doctor to clear any doubts they may have.
4. Immediately re-examine AHPRA and registration policy and remove all unfair, un-navigable, ambiguous and pathetic catch 22 rules for IMGs to work in their respective fields.
5. Grant incentives and bonuses for local graduates serving rural Australia such as tax breaks, relocation of families and ensuring their children are cared for if they are in areas where there are no schools, preferential acceptance in specialist colleges, etc. Let’s face it, most local city graduates will not work in rural areas and most rural graduates will emigrate to the big smoke! It is unfortunate, but it is the truth. They stand to gain a lot working in the big smoke.
6. Scrap the need for reapplying for English language test every x years if they are continually living in Australia. If they are in Australia, is studying or working in English, shopping in English, writing in English, talking in English and living in English, I don’t see the need for them to give endless exams every x years unless they have departed Australia for more than 6 months. It is quite frankly ridiculous! The article here is clear enough: http://www.medicalobserver.com.au/news/legality-of-english-test-is-in-doubt
7. Level the playing field and require all local graduates to pass the same examination as the IMGs. Mind you, they are designed to ensure that few succeed. In some cases, it is akin to a near retiring physicist having to go through HSC again and expect to pass! It is insulting to senior practitioners unless the system is universal to include all graduates as in USA and other developed countries!
8. Provide opportunities IMGs/OTDs to work with local Australian graduates in team supervised positions. In most cases, experienced IMGs are able to mentor local graduates due to their skills and experience and work as a team so everyone can serve in the best interest of communities that are currently doctorless.
9. Provide for local graduates and IMG’s to immediately serve in unmanned positions in rural Australia to provide basic and emergency healthcare. It is better to have an IMG to provide emergency health care rather flip burgers. Basic life saving services and non-invasive practice must be allowed with meaningful registration process to prevent rural Australians having to drive 3 hours to safe their loved ones. Of course, detailed conditions of practice must be provided and a remote supervision available should they need assistance and supervision.
10. Provide IMGs to obtain temporary visas allowing them to gain work experience rather than a catch 22 situation where registration and job must be held prior to applying for a temp visa.
11. Provide opportunities for IMG’s that have passed their AMC Part 1 examination and local graduates to live and work in Australia without the need for acrimonious unfair bureaucratic process in terms of jobs, registration and visa process. This is extremely important as the AMC pass certificate is valueless anywhere outside of Australia and they must have a legal means stay temporarily to pursue their career should they pass their first part AMC examination. They are usually relegated to no-mans-land having to start a yet third career or depend on their spouses for visa requirements. They are, in my opinion, independent and qualified enough to have a chance to succeed in their own careers rather than depending on needless third career options such as again studying nursing, or even accounting, or cookery just to keep their career options alive only to gain nothing as they would may damage the prospects of a career in medicine, in some cases permanently due to their large gap pursuing a needless visa option.
12. Provide guidance and career counselling to target areas where the need for doctors are most pronounced, such as rural Aboriginal communities, or other areas not currently serviced.
13. Ensure that the career of IMGs are not permanent damaged by preventing them from accessing medical practice environment. A gap of 3 years in medical practice is enough to permanently kill ones career. This must be immediately addressed as in my perspective, this is tantamount to a serious misconduct by the government - knowingly and purposefully preventing them with any means to continue in career development.
14. Retain IMGs already in Australia that have passed AMC examination and provide them with guidance and placement along with local graduates and rural trainees to stop them from returning or serving elsewhere. Few of my own specialist friends have departed after realizing that while they were needed here, they are not actually wanted here.

If you think they deserve, thank them for their services and encourage them because, believe it or not… they have sacrificed a hell of lot more than you and I can ever imagine. They need it!

Someday, I hope that the Australian people that need them the most will actually benefit from those that they should have benefited from a long time ago, especially the real rural Australia.

Pro Genere Human Concords… Primum Non Nocere