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Overcoming systemic barriers are the key to preventing international medical graduates from exploitation.
The Australian Medical Association (AMA) is calling for immediate reforms to better support international medical graduates (IMG’s) and the crucial role they play in Australia’s health care system.
This follows a survey of its members, which resulted in a new report “The experiences of Australia’s international medical graduates” outlining their lived experiences, the systemic barriers they face and opportunities for reform.
AMA President Dr Danielle McMullen says the IMG’s are a critical part of Australia’s medical services, but red tape, discrimination and anti-competitive practices are undermining their work.
“Their pathway to being able to practice in Australia remains unnecessarily convoluted, costly and opaque,” Dr McMullen said.
“Many report feeling trapped in a complex and confusing registration process, often having to work outside of medicine while awaiting registration.
“Qualified doctors are left feeling stuck navigating a maze of duplicate documentation, inconsistent requirements, and vague job descriptions at a time when Australia faces widespread medical workforce shortages that are only expected to worsen.”
IMGs now make up more than half of Australia’s medical workforce at 53%, and more than 50% of all general practitioners nationwide.
This trend extends to specialist roles as well, with more than 30% of Australia’s specialists having received their medical training overseas.
The report found IMG’s faced four main challenges: cultural and communication barriers, system and workflow adaptation difficulties, lack of professional integration and support, and personal and social challenges.
It also identified barriers such as social and cultural isolation, limited professional and career development, family and personal considerations such as employment for spouses and education for children, and systemic barriers.
The AMA is now urging governments, regulators and stakeholders across the health system to:
- streamline and simplify the IMG application and registration process;
- eliminate duplication and outdated administrative procedures;
- provide transparent, upfront information regarding job placements and support structures; and
- align Australia’s approach with best-practice international standards.
IMGs facing racism and exploitation
Dr Mahalekshmi Selvanathan is the chair of the AMA’s IMG working group. She was born in Malaysia and went on to attain her medical degree in Russia, and is now based in general practice. She said while she’s pleased to see this progress, these proposed reforms are well overdue.
“The first thing is the bullying — it comes in all kind of forms. There’s very subtle bullying, some of them are quite direct, some of them are quite subtle,” Dr Selvanathan said.
“I’ve seen contracts for IMG’s which are quite scary. And there’s no one to look at these contracts. So they blindly take it because they want a job so badly. So they just sign up without looking and then they’re stuck in that.
“The level of supervision is not adequate. A lot of people become supervisors, but they don’t really supervise. They’re not in town, it’s all on paper. And then these candidates, they fail their exams. We always said that there’s somebody who needs to supervise the supervisors.”
She said she had experienced racism first hand.
“Three months ago, I called a tertiary hospital to speak to a specialist. He answered my call. And he said, when you can speak English, call me back. And he hung up the phone,” she said.
“That’s quite common. So things like that, this is just a key, a little part of it.
“The exploitation, I think that’s what they’re looking into quite a bit now. And then with the visas, the tying down on the visas, it’s like modern slavery. You come up there, you sign up and then you just sell your life.”
She’s pleased that the IMG Working Group has made such great progress highlighting the issues, and that hopefully more changes can now be made and successful support programs can be rolled out further.
“Armidale has come up with this thing called The Welcoming Experience for health care workers and they’ve concentrated on doctors and specialists coming to town,” she said. “They’ve helped them with housing, they’ve helped them with fixing them into the community. That seems to be working quite well.”
The backbone of the health care system
Dr Usha Parvathy is a member of the AMA’s IMG working group and the director of the Newcastle Local Health District IMG program.
“It’s been an ongoing battle. As you know, around 2012, the Ministry of Health decided that they will not be needing international medical graduates since they increased their medical school intakes,” Dr Parvathy said.
“But we continue to need the support of international medical graduates for running our health care system. Since then it has been a struggle to get some sort of national approach to supporting international medical graduates. And AMA has now taken up this issue and has some advocacy roles in place.”
Dr Parvathy is hopeful that the Australian health services are now recognising the fact that international medical graduates are not just a stop gap measure, but rather the backbone of the health care system.
“We are trying to see whether we can have a national approach to supporting these doctors,” she said.
“Their needs are very varied. So you’ve got to individualise the support that we provide for them as well. And accept that every international medical graduate that comes to our country will need some sort of support and a local targeted orientation and induction to support them to get acclimatised to the Australian health care system. We need to accept that without support, these doctors are going to struggle.”
Nance Haxton was a journalist at the ABC for nearly 20 years. She’s also worked as an Advocate at the Disability Royal Commission helping people with disabilities tell their stories and as a senior reporter for the National Indigenous Radio Service.
In that time she’s won a range of Australian and international honours, including two Walkley Awards, and three New York Festivals Radio Awards trophies.
Now freelancing as The Wandering Journo, Nance is independently producing podcasts including her personal audio slice of Australia “Streets of Your Town”.
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I think we all agree that IMG’s need assistance to “get settled” into medical practice in Australia . Even for Australian graduates moving can be daunting. We can help, as individuals, when a new doctor starts in our town or hospital, regardless of where they come from. The problem is getting them to that point. Skilled health care workers driving taxis while waiting for visa processing, or College assessment, is ridiculous.
I think this is a very good move. I think as a country we should be upfront as to what is being offered so that people can make informed decisions. Exploitation of anybody is not acceptable.
What I’m however, very concerned about is the fast tracking of specialists. We have a very good system of examination and training, which brings out a very basic standard as a minimum. Fast tracking of foreign train medical specialists without the appropriate oversight or going through the program is only going to lead to a change in the basic standards. I’m not suggesting that people from overseas are less competent but The focus overseas can be different because of differing needs. I believe as a minimum they should go through the program of the various colleges anything less should not be acceptable. We don’t want half baked specialists.
The items of support wanted by IMG’s and apparently offered in Armidale are applicable to ALL medical graduates locating to regional areas.
The fact that 53% of all medical practitioners are now IMG’s might indicate we need MORE undergraduate training positions for local school leavers or we could go with the flow and close our medical schools and import all our required medical graduates from overseas. (return to our historic cultural cringe while demonstrating our “tolerance” acceptance and inclusivity)