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Many of us have found ourselves in a full waiting room to see the GP, looking at a laminated sign about a fee increase taped to the reception desk.
Australia is facing a shortage of doctors, especially GPs. The impacts are felt hardest in rural and regional areas, where patients wait up to 12 weeks for a consultation. These long waits compound rural health inequalities.
Meanwhile, medical students are turning away from general practice. One survey of GPs found 58% reported experiencing burnout since the pandemic. Estimates project by 2031 there will be a shortage of more than 10,000 GPs.
To address this shortage, the government recently announced plans to cut “red tape” to make it easier to recruit doctors from overseas. The number of doctors from overseas working in Australia has doubled since the COVID pandemic hit.
But when a high-income country like Australia recruits doctors from overseas, we risk causing a “brain drain” elsewhere.
Australia isn’t the only country short of doctors
Australia is increasingly recruiting doctors from low- to middle-income countries. But we aren’t the only place facing a doctor shortage. This recruitment risks worsening global health inequities and raises concerns around justice.
A recent estimate suggests Nigeria has 80 oncologists (cancer doctors) for more than 213 million people. Australia has more than 600 oncologists, and we are a much smaller country, with 26 million people. Recruiting even one of these oncologists could benefit Australia, but have a disproportionately negative impact on the Nigerian health system.
If we recruit a doctor from a low- or middle-income country such as India, not only does the Indian health care system lose a doctor, it also loses the money invested in training these doctors. It’s a double blow.
However, higher salaries in Australia can serve as a big draw. It can also be unfair and discriminatory to restrict opportunities for individual doctors who might want to emigrate to Australia, just because they are from a lower-income country.
Ensuring quality of care and fair treatment
If we recruit doctors from overseas, it’s important to ensure they can provide care to Australian standards.
That doesn’t just mean knowing how to diagnose a melanoma or do an ultrasound – it’s also about being familiar with different legislation and guidelines, such as requirements for doctors to refer patients elsewhere if they don’t want to provide an abortion.
Language proficiency is also important – clear communication is critical for patient safety. However, having doctors who speak a language other than English is also a big positive, especially for refugee and migrant communities seeking health care.
We also need to ensure new recruits are treated well. A global review of international medical graduates found doctors from overseas reported being given fewer professional opportunities, as well as experiencing racism and discrimination. We have an ethical obligation to make sure doctors we recruit are treated equally and get the support they need.
How else can we boost doctor numbers?
We need to train more doctors to meet Australia’s future demand for health care. This has already begun, with efforts to open more medical schools in rural and regional areas, including at Charles Darwin University in the Northern Territory.
But it goes beyond just medical school – we need to ensure there isn’t a “bottleneck” of medical graduates who can’t get further training.
GPs in Australia earn less than doctors working in other specialties, and Medicare rebates being outpaced by inflation makes it increasingly difficult to bulk-bill.
We can make general practice and working in rural and regional areas more attractive, such as with higher pay or scholarships.
There are also other ways we can increase access to health care. These include telehealth, as well as nurse practitioners, who can play an important role in improving access to health care and addressing health inequities.
However, it’s important not to end up with different levels of care for different communities: people in rural communities should be able to access a doctor when they need one.
Importing doctors from overseas is one way of resolving our urgent shortage of doctors, but has significant ethical implications.
If we do import doctors, especially from other countries with doctor shortages, we should give back to those countries and their health-care systems. This could be by increasing foreign aid, or providing further training for health-care professionals who can then take those skills back to their country of origin.
Australia needs more doctors, and that isn’t going to change any time soon. Although importing doctors from overseas is one solution, it’s not a straightforward fix.
Hilary Bowman-Smart is a Research Fellow at the Australian Centre for Precision Health, University of South Australia.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
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Another way of asking the question might be “is it ethical to expect doctors living in dangerous, chaotic or war-torn countries to remain there and not make a better life for their children? It is part of being a parent to want to provide a safe and secure life for your children.
Part of this discussion should include the effect of AHPRA’s activities that are causing many doctors to become disenchanted and retiring early.
The flowing points should be considered
1. Global Workforce Mobility:
In an interconnected world, restricting the movement of professionals like doctors can be seen as counterproductive. International experience and exposure can benefit healthcare systems globally, promoting the exchange of knowledge and skills for BOTH developed and developing countries
2. Economic and Professional Development: Doctors from developing countries often seek opportunities abroad to advance their careers, gain specialized training, and earn better salaries. This can lead to personal and professional growth.
3. Return Migration: Many doctors who work abroad send remittances back home, contributing to their home countries’ economies. 8.9% og the gross domestic product of the Philippines comes from OFW (overseas Filipino Worker) l. The Philippines is the largest exporter of nurses worldwide. Additionally, many return with new skills and experiences that can improve local healthcare systems.
4. Structural Issues in Healthcare: The root causes of doctor shortages in developing countries often include inadequate funding, poor working conditions, and lack of infrastructure. Addressing these structural issues might be a more effective and ethical approach than restricting international recruitment.
5. Lastly- Ethical Consistency: If the argument is based on ethical concerns, it should be applied consistently across all countries facing shortages. Singling out developing countries while ignoring shortages in developed nations suggests an incomplete ethical stance. There is a shortage of almost 300 000 nurses in Germany, in April 2023 there were nearly 48 000 nursing vacancies in the UK.
I believe we could make ‘importing’ overseas doctors more ethical if we reimbursed their country of origin the cost of their medical education.
Peter Moore
An excellent review of the pros and cons of importing overseas trained doctors with the social cultural and moral implications.
Australia and Britain are two countries that have relied very and perhaps far too much on overseas doctors for service requirements.
A health workforce that has both local and international training has the benefit of “cross fertilisation”.
The net exchange of such highly trained workers, medical and allied, should approximate zero for the sake of fairness for all countries.
Our education systems need to be considerably strengthened to allow the training of enough health care workers to satisfy the projected long-term needs.
A part of this would include better education and support for our multicultural community. While English has to remain the lingua franca, too many Australians are denied the opportunity to learn second languages. It is possible to learn at least two or three second languages. Such education should commence very early in life and should be consistent over a long period of time rather than being a short term “taster” to be forgotten after some months or years.
Having been fortunate to have acquired some second languages, being able to at least great many of my patients in their own language brings a lot of satisfaction.
Lastly, Australia is struggling with the massive positive net migration. Rapid growth has created immense growing pains in providing sufficient infrastructure. The current cost of housing is obvious. Long waiting times for health services is another. The lead time for construction can vary from two to ten years or more depending on whether we are considering private homes to new hospitals, clinics, and fire, police and ambulance stations.
Indeed the problem is not simple. As a migrant from Zimbabwe my reasons for moving were the collapse of the government (public) health system, fears for personal safety and separation from family that had already left or were intending to leave. In addition I had to have a private practice as the government pay, if it came at all, was totally inadequate to live on. Everyone comes here for a different reason but there is no way that migration of medical professionals can be limited. There doesn’t need to be any active recruiting program for foreign trained doctors, we come here of our own volition as conditions are good, the country is stable and our children get a good education and opportunities which they would not be getting in their country of origin.
Australia’s doctor shortage, particularly among GPs, is a complex issue requiring multiple solutions. Doctors in Australia face several significant challenges that impact their ability to practice effectively and maintain a satisfying career. These issues span education costs, reimbursement, insurance, litigation, and regulatory bodies. Medical education in Australia is expensive, leading to substantial student debt, and the extensive training required adds to the financial and time investment, making the profession less appealing. General practitioners earn less than other specialists, and Medicare rebates have not kept pace with inflation, making bulk billing increasingly tricky. Additionally, there is a lack of sufficient financial incentives for doctors to work in rural and regional areas. High medical indemnity insurance premiums add to the financial burden, and the increasing threat of litigation discourages doctors from practicing, particularly in high-risk specialties. Regulatory bodies like the Office of the Health Ombudsman (OHO) and the Australian Health Practitioner Regulation Agency (AHPRA) impose significant bureaucratic challenges, adding to doctors’ workloads and stress levels. The demanding nature of the profession often leads to long working hours, contributing to burnout and reducing the career’s attractiveness. The government’s plan to recruit overseas doctors while addressing immediate needs raises ethical issues, including brain drain from low- and middle-income countries and maintaining quality of care. These ethical concerns need to be addressed in a balanced approach to ensure the best outcomes for all stakeholders.
I am a fully qualified surgeon from Australia looking to return from overseas and the barriers are telling even for me! For example I will treat adult patients but have to get a working with children check which may delay my commencement several weeks…