IMGs still treated “unfairly”

INTERNATIONAL medical graduates continue to be burdened by “unfair hindrances” say experts who have called on the federal government and medical authorities to implement the recommendations of a 2-year-old inquiry into registration and assessment processes.
    
In a Perspectives article in this week’s MJA, Professor Carlos Zubaran, conjoint professor of psychiatry at the University of Western Sydney, and Dr Susan Douglas, chair of the Australian IMG Support, Advice and Advocacy Network, wrote that the failure to implement meaningful reforms in line with the 45 recommendations contained in the inquiry meant that a two-tier system for international medical graduates (IMGs) and Australian-trained doctors persisted. (1)

The Lost in the labyrinth report was tabled in the House of Representatives in March 2012 by the Standing Committee on Health and Ageing. (2)

The MJA authors wrote that “unfair hindrances faced by IMGs are irreconcilable with principles of equity and mateship that are at the core of Australian society”.

They highlighted several areas where inequities remained, such as restrictions associated with 457 visas, including a lack of access to Medicare benefits; and the so-called 10-year moratorium, requiring IMGs to work in underserviced areas for up to 10 years. “This restriction is unparalleled in the developed world”, the authors wrote.

Australian Medical Council (AMC) CEO Ian Frank told MJA InSight the council had been “busy” streamlining processes to address many of the registration issues highlighted in the Lost in the labyrinth report.

“Most of the major recommendations that involve AMC have either been implemented or are well on the way to being implemented, but there is still work to be done in fine-tuning some of those processes”, Mr Frank said.

The development of a purpose-built National Test Centre in Melbourne, which opened in July 2013, has enabled the AMC to increase its examination capacity to assess around 2500 IMGs a year, and reduce the waiting time for candidates from 24 months to 12 months.

“This was a major breakthrough,” Mr Frank said.

Since July this year, overseas-trained specialist candidates have been able to apply directly to specialist colleges for registration once they had received their primary source verification from the AMC, which was also being streamlined.

In further responses to the Lost in the labyrinth report, Mr Frank said the AMC was working on improving feedback to candidates and redesigning websites to ensure information was readily accessible to IMGs.

The MJA authors also drew attention to the limited availability of workplace-based assessment (WBA) for IMGs. “It has been shown that WBA is a cost-effective form of assessment that facilitates a straightforward integration of doctors into the local health care system”, they wrote. (3)

Professor Kichu Nair, director of Centre for Medical Professional Development, Hunter New England Local Health District, said the 6-month WBA program was also proving to be effective in retaining IMGs in areas of need.

“What we have found is that when they do the [WBA] program, the candidates get exposure to other doctors and other specialists. They get to know each other and become part of the local medical community — then they tend to stay there too”, said Professor Nair, who developed the program in conjunction with the University of Newcastle and the Local Health District.

He said the program was slowly being expanded to other centres around Australia.

Mr Frank told MJA InSight that while it had recently launched WBA Online to help standardise the delivery of WBA, it was a labour-intensive form of assessment.

“It’s going to take a little while for WBA to get going, but we’re still confident it’s a very powerful way of assessing IMGs and integrating them into the workforce.”

Late last week Assistant Minister for Health Fiona Nash announced a revision of the District of Workforce Shortage system, which would have “a beneficial impact” on IMGs who were required to practise in these areas to access Medicare billing arrangements.

The Minister’s office released a statement saying the revised system would be updated to use the latest Australian Bureau of Statistics population data and geographic boundaries, which would be reviewed annually.

“This is likely to provide more certainty around opportunities for IMGs to gain employment in private practice, and addresses some of the issues raised in the Lost in the labyrinth report”, the statement said.

1. MJA 2014; 201: 509-510
2. House of Representatives Committees: Lost in the labyrinth 2012
3. MJA 2014; 200: 41-44

(Photo: Stuart Jenner / Shutterstock)