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A program that aims to fast-track international medical graduates into rural Australian placements is facing criticism for lacking detail and safeguards.
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!!”
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I am skeptical the ESP will do the job it was created to do – counter workforce shortages. As a seasoned international medical recruiter of psychiatrists, anaesthetists and Obs/Gyn, I don’t think an absence of paperwork will increase numbers in the proponents of the new system hope. People who decide to move to Australia tend to accept paperwork is a necessary feature. I’ve rarely spoken to someone who has declined the opportunity to work in Australia because they had to fill out more forms. If you really want to get specialists to work in more rural areas, permanent residency and professional development are the necessary inducements. There are some other colleges whose SIMG policies, pathways and assessments really, really need reform…such as radiology …
On another note, I wonder how New Zealand will react to this , given the ESP is similar to their process?
In response to Anonymous comment October 28, 2024 at 8:16 pm
I don’t think that Dave Story ANZCA President or many of the commentators here are saying that only the ANZCA
(or any of Australian medical colleges) are capable of producing competent specialist in Australia.
There are plenty of IMGs working in Australia. For example more than 50% of GPs in Australia are IMGs.
However until now, all of the IMGs working with unconditional registration and no restriction, have gone through the assessment and accreditation of the local medical colleges, both to guide the introduction and embedment into practicing of their craft in Australian context, as well as ensuring they are practicing at the level of their peers. For their achievement they are awarded the fellowship of the local medical colleges.
The heads of departments of anaesthesia of all hospitals in Australia may have many other qualifications, but I would expect all of them would hold a FAZNCA.
The IMG specialists (GP and non-GP) under the new pathways, does not and will not get such a fellowship, as far as I can tell, since they did not get an assessment and accreditation by the local medical colleges.
These IMGs will be assessed by AHPRA and their appointed supervisors, not the colleges. Hence the responsibility is solely with AHPRA, how they assess and who do they get to assess the IMGs.
There is some irony on this, since one of the main reason the formation of AHPRA gained support as part of legislation, was due to the fallouts from the various IMGs assessed and appointed by certain hospitals but not by medical colleges. Now AHPRA is going to do this assessment without the explicit involvement of medical colleges, and within 6 months (knowing that this is unlikely to be Level 1 or 2 supervision.
As an aside, those who work in the hospitals long would know that how heads of department are appointed vary from hospital to hospital. Some based on seniority, some on department support, some based on willingness to attend hospital meeting and run a department, some as a condition to be employed in a public hospital. Hence while head of department title do carry some clout, it’s not all the same. Whether or not someone is good or experienced because they are the head of department is not a certainty.
In response to Dave Story (ANZCA President).. if it were true that it is only the ANZCA that produces competent Anaesthetist Specialists in Australia – Would you like to explain why the heads of Department of most of the large Public hospitals in Australia are not local graduates but in fact trained and obtained their Fellowships overseas?
Feel free to check my claim.
International experience is an advantage and of benefit to our institutions and patients.
Your assertions are nothing but xenophobia and self-interest.
There is a few issues to consider:
1. Let’s face it, there is no GP shortage in the capital cities (it’s really about the out of pocket costs, and bulk billing – for the relative “shortage” in metro areas), the real mismatch is in certain regional and remote areas. The govenment had shot themselves in the foot by changing the 19 AA and AB moratorium, which make the indirect/informal conscription of IMG GP to rural areas by medicare provider numbers restriction, and made it alot harder for certain regional areas to recruit IMGs when some other regional areas are just 45 mins or less away from capital cities
2. The approved GP colleges are in countries where there is some form of capitation, which changes how medicine is practiced
3. There is some assumption that those GPs working in those “approved” countries are of comparable standard to Australia; but the fact is how the GP practices are quite different to Australia’s fee for service model. For example in the NHS, until 2022, there is signficant restriction in GP access to ordering various imaging for non-cancer conditions, including CT and MRI, and even those patients whose symptoms attract 2-week-wait review in the hospital for cancer have to have certain tests done (BTW that 2WW is now changed to 2 month wait). I understand NZ GPs have far more restriction on what imaging can be ordered for cancer and musculoskeletal condition, whereas there is very little restriction for CT and some restriction for MRI in Australia. If there is just 6 months supervision, certain practice differences may not be obvious
4. In the 3 approved countries of origin for the GP fellowship, “rural” location generally about 2-3 hours from the big cities. In Australia, we talk about 4-6 hours drive in the country side at 100km/hr and country people don’t blink an eye. Getting IMGs to practice in these rural areas will be a drastic change in services and lifestyle as well as getting support from their peers and non-GP specialists
I suspect the Kruk review would be considered our biggest mistake when we look back in 20 years time; the question is how many people will have to die and be maimed for this?
The colleges failed to advocate against increasing the scope of pharmacists and nurse practitioners.
Now, they are again making ineffective noise.
The problem is service provision, workforce supply, and access to primary health care. This is an issue that needs to be addressed immediately, not within a decade.
As an alternative to recruiting doctors from overseas, what real solutions are the colleges proposing?
Imagine how those of us living remotely react to these discriminatory schemes. Why is government so keen to introduce untested strategies for importing medical workforce for populations at greatest risk and already with the worst health outcomes? How can Colleges as ethical institutions setting professional standards be bypassed?
I can only speak in support of UK trained GPs, they have rigorous training and face a hostile government and working conditions/expectations. They will find working in Australia a dream, my only thought is that an arbitrary 5 years’ experience as a GP or consultant specialist would be a great benefit to all. As it will show who can prevail and weed out any grossly inadequate/incompetent this would reassure the public and Australian colleagues.
Silly and uneducated comment. Foreign doctors are not untrained or untried. In many if not most cases they are equally or better trained than local doctors, and international experience should be mandatory for every doctor to avoid parochial insular and biased attitudes like this
There are widespread concerns and the proposal is another example of AHPRA going beyond where it should be going.
Flooding the market with inadequately trained and vetted medical practitioners may alleviate access issues and improve bulk billing rates temporarily, however does nothing to address why we have shortages and why general practice is on its knees.
Unfortunately when this legislation was passed about 14 years ago, there was little to no resistance from the professional organisations and this was always going to be the outcome, as the legislations always allowed for this. Most got enticed by the fact that registration became nationwide and they ignored the other traps in the regulations.
The Australian Doctors Federation was one of the few, if not only, group to consistently state that the AHPRA legislation was flawed.
The colleges and the AMA need to be strong to resist what is going on for the sake of public safety.
As always, this is about getting bodies into towns, to appear to be doing something. But it will be wasted until the conditions of service are improved enough to improve retention of those who are already in place, and those arriving. Those conditions must include adequate pay for the “overtime” work, including taking extra time checking about conditions they have rarely seen, the on-call support from colleagues and specialists, and support for continuing education to ensure maintaining competence.
It is assumed that established Australian remote. GPs will have the capacity to supervise other doctors. This decree is clearly written by people who have never worked remote. I have worked remote on and off for 20 years and it is a tough but rewarding gig. There is little time to supervise other doctors as our main job is actually working and supervising nurse lead activities in the clinic.
I agree with the first responder. The proposal to create a pathway for foreign doctors to practice in Australia raises significant concerns that warrant careful consideration. Although the initiative aims to address healthcare shortages, it seems more like a government strategy to saturate the medical market and control costs rather than a genuine effort to meet healthcare needs effectively. The ACRRM and the RACGP have expressed serious worries about the rapid implementation of this pathway, highlighting risks to patient safety and quality of care. Patient safety could be compromised without robust processes to ensure that incoming doctors meet rigorous standards. There are also concerns that many foreign doctors may lack the specific training necessary to navigate the complexities of the Australian healthcare system, particularly in rural areas, where one in five may require additional education despite having comparable qualifications. The proposed six-month supervision for foreign doctors raises questions about its adequacy, given past incidents of misdiagnosis linked to underprepared practitioners. Furthermore, there is scepticism regarding whether this pathway will effectively address workforce shortages in vulnerable communities, as it might attract more doctors to urban centres. Instead of establishing a new path, the government could enhance existing systems designed for integrating international medical graduates. Ultimately, while the intention behind the proposal is commendable, its rushed and poorly planned nature raises critical concerns that must be reevaluated to prioritize the safety and quality of care for all Australians.
The patient safety is of significant concern, also the checks prior to accepting applicants for (un)professional conduct. In a step before this, I am at a loss at to how Aust came to this situation. I have not read anything to indicate the cause or the lack to attending paid to this growing problem of a lack of qualitied workforce.
As one of the next in line, the College of Anaesthetists (ANZCA) shares the concerns of our colleagues in general practice about this rushed implementation that is short on important details. It remains unclear why rather than expediting current College processes the first approach has been to create a parallel system. AHPRA data suggests ANZCA already meets the desired timelines. Further it is clear that those developing this pathway are struggling with the “nuance” of assessing specialist anaesthetists.
We all agree that the regional, rural, and remote workforce is in crisis, but this rushed opaque process marginalising the Colleges may, at times, undermine quality of care, quality of training for Australian junior doctors and trainees for Australian conditions; and the wellbeing, both professional and personal, of the international specialists.
Like other colleges we call for a pause in the rollout of this parallel “expedited ” pathway. ANZCA remains fully prepared to work with AHPRA to enhance our current processes.
This is a serious issue and creates risks and also fails to address root causes of GP shortage.
https://youtu.be/R7DsUrEp_-8?si=9REQltDWL7tDjJCr
We discussed this in a podcast above.
I am not working as a GP but as an Australian Specialist, so there is no bias or self-interest.
Income of GPs lags significantly behind the income of other specialists when they work in private practice.
Especially in rural locations it is much harder to run a viable GP practice based on Medicare rebates, and the number of patients able and willing to pay $ 70-100 for a longer consults much smaller in these communities.
If Medicare item numbers in a MMM4+ location would be indexed, so 200% MMM4, 250% MMM5 … this would relevant to attract more doctors.
Of course also working conditions need to be appropriate and flexible, and living conditions not just for the doctor, but also for their families appropriate which will need support by the communities and beyond.
I have always considered that GP’s have the hardest job in the whole medical hierarchy, particularly rural GP’s. When one is the only doctor for miles around, you are it. If you miss something there is no safety net – that patient may die. Is this really where Australia wants to put untried and untrained overseas doctors? I know Government is just interested in “bums on seats”, but this is ridiculous.