Concerns over international doctor fast-track pathway

GP and rural health colleges have raised concerns over the readiness of the Australian Health Practitioner Regulation Agency’s (AHPRA) new fast-track pathway for rural doctors.

The expedited program launched on 21 October 2024 and aims to increase the number of GPs to address critical health shortages.

According to AHPRA, the fast-track process seeks to ensure that qualified specialist international medical graduates (SIMGs) see Australian patients sooner.

AHPRA announced the following accepted qualifications will be eligible to apply:

• Membership of the Irish College of General Practitioners from 2009 and a Certificate of Satisfactory Completion of Specialist Training;
• Fellowship of the Royal New Zealand College of General Practitioners from 2012; or
• Membership of the Royal College of General Practitioners (United Kingdom) from 2007 and a Certificate of Completion of Training.

From December 2024, specific specialist qualifications in anaesthetics, obstetrics and gynaecology, and psychiatry will be added to the accepted list after a rigorous qualifications assessment process.

Concerns that the pathway isn’t ready

However, both the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP) have highlighted that they’re worried the process has moved too quickly.

According to RACGP President Dr Nicole Higgins: “We’ve been clear about the problems with this rushed approach, including significant risks to patient safety and quality of care. The blame for anything that goes wrong must be on the decision makers behind it.

“Australia’s health ministers and AHPRA have pushed this through regardless of the major risks, unanswered questions, and lack of detail about how a GP’s suitability to practice will be assessed, just a week before it’s due to be implemented. We all hope it will work as planned, but you don’t guarantee the safety of patients and wellbeing of doctors with hope, you need appropriate processes,” Dr Higgins said.

ACRRM President Dr Dan Halliday agreed:

“I would safely say that there are concerns that the expedition of this has its origins outside of the college sector, and that appropriate engagement didn’t happen as we would have liked,” he told InSight+.

“It’s another layer in the bureaucratic machine which allows international medical graduates to come and practice in Australia. We already have systems set up, particularly in terms of the general practice specialty, between ACCRM and RACGP.

“The college believes that it would have been more beneficial to actually utilise the systems that are already in place and to boost those rather than setting up another pathway,” he said.

Potential training and supervision issues

The colleges are particularly concerned about doctors coming to Australia without the training and understanding of the complexities involved here.

“RACGP data shows one in five doctors require extra education and professional support despite their qualifications being substantially comparable on paper to those of Australian GPs. This is why qualifications should only be part of the assessment of a medical professional’s readiness to practice in Australia,” Dr Higgins said.

For doctors heading out of urban areas, Dr Halliday highlighted that rural and remote medicine is quite complex. He’s concerned that the implementation plan doesn’t consider some of these complexities.

“The context of medicine may not be necessarily consistent with a community general practice base which some of these international medical graduates might be coming from. It also incorporates elements of emergency medicine, emergency care pathways, internal medicine and inpatient care pathways and additional required elements of other subspecialty practice,” he said.

They’re particularly concerned that this workforce coming into Australia won’t have access to the right training and support.

According to AHPRA: “Each SIMG on the Expedited Specialist pathway will be supervised for six months by an Australian-registered specialist, have an orientation to Australia’s health system and do mandatory cultural safety education.”

However, Dr Higgins said they’ve yet to hear how that supervision will work.

“GPs shouldn’t be thrown into situations they are not ready to manage without the support of a colleague. We’ve seen failure to diagnose hypertension, inappropriate prescribing of opioids and unsafe management of critical hyperglycaemia, and inappropriate management of pain in a cancer patient.

“These are issues that appropriate supervision will pick up. We know because the RACGP provides this through tested processes. We are not confident this expedited pathway will provide the same quality of care for patients and support for doctors,” she said.

This is also ACCRM’s concern.

“ACCRM is concerned that the specialist IMG workforce coming into the country may not receive adequate peer support or have access to the contextual education and training networking requirements that colleges provide in this space,” Dr Halliday explained.

Will it lead to doctors going where they’re needed?

Dr Halliday’s biggest worry is that this program won’t address the vulnerabilities and workforce concerns of rural and remote Australia.

“We have concerns that they may actually not achieve those outcomes and potentially may exacerbate the maldistribution and contribute to an oversupply of doctors in the long term in urban and larger regional centres,” he said.

“It might be all well and good to recruit doctors into these vulnerable communities, but to actually retain them, that is another body of work together.

“Through the creation of those support networks, through the community and through the professional bodies, medical professionals are able to feel comfortable and confident and be content in their practice, to continue to stay in those vulnerable communities,” Dr Halliday said.

However, rural GPs like Dr Alex Draney from Armidale in the NSW New England region are hopeful.

She told InSight+ that they need more qualified GPs, especially in rural Australia where health outcomes lag behind metropolitan areas.

“If we want general practice to be valued, our communities need access to high quality general practice care. I believe that the UK, Ireland and New Zealand offer training of equal rigour to the Australian colleges. Please come to the New England!!”