The recently released report from the House of Representatives' inquiry into the registration processes and support for overseas-trained doctors highlights some major shortfalls in how Australia’s health workforce is organised.
Poignantly titled Lost in the Labyrinth, the report explains how on the one hand, we rely on the skills of overseas-trained doctors, who account for 40% of the clinicians in regional Australia. On the other hand, we subject them to an enormous amount of red tape and administrative hurdles to have their overseas qualifications recognised.
Some groups, particularly specialist colleges, refuse to accept these highly qualified professionals and insist on them redoing basic examinations rather than assessing them on their job skills and providing on-the-job training.
Also in the report, the parliamentary committee rightly recommends a review of the ten-year moratorium on the requirement for overseas-trained doctors to work in an “area of need”. Currently, newly arrived doctors must service a geographically isolated are for ten years before being eligible to gain full Medicare access.
This rule should be modified to ensure overseas-trained doctors have access to services and support in the early years of their practice in Australia.
Worryingly, the committee noted that almost one third of the overseas-trained doctors who made a submission to the inquiry did so anonymously because of concerns their comments would adversely impact on their training and careers.
This alone shows the need for some fundamental changes in how we manage Australia’s health recruitment and workforce training. We must encourage openness among health professionals and allow challenges to authority.
Future role of overseas-trained doctors
Overseas-trained workers contribute significantly to our world-class health system and their skills will be required in future to help meet the challenges of Australia’s ageing and chronically diseased population. The Commonwealth government recently acknowledged this reality as one of four key factors in driving health workforce sustainability up until 2025.
But we can, and must, improve our health workforce recruitment and training processes. Small changes to reduce administrative duplication and streamline the registration processes could make a big difference to the lives of many overseas-trained doctors. This could include the use of on-the-job evaluation tools such as simulation, monitoring and mentoring programs.
We also need to tackle the important ethical issue of taking health workers from low-income countries, where they’re desperately needed, to staff our relatively human resource-rich system.
Rural health services
We will always find it challenging to attract doctors to work in rural and remote Australia. So we need to start considering other ways of delivering health services to these geographically isolated areas, without necessarily providing more doctors.
This includes restructuring the traditional health care team and creating “virtual” teams. If a rural health practitioner has good access to video conferencing and monitoring devices for chronic diseases such as diabetes, she can access the expertise of specialists working in larger regional centres or cities. That means her patients don’t have to take time of work or leave their support community, but still receive quality health care.
And there’s no reason why these health practitioners have to be doctors: they could be skilled nurse practitioners, allied health professionals or perhaps new types of health professionals, such as physician assistants. This role developed from the medics programs during the Vietnam war – to work as part of a team with a doctor – and has since grown to a workforce of 75,000.
A recent review of the contribution of physician assistants to primary care in Australia shows the model works well, particularly well in rural areas: physician assistants work successfully as part of a health care team, patient outcomes remain good and patients are well satisfied with the care they receive.
The way forward
Let’s imagine that small rural communities across Australia have a mix of so-called middle level providers: nurse practitioners, physician assistants, paramedics, pharmacists and allied health professionals who all have generalist skills.
These professionals could work with GPs and other specialists in distant centres as a virtual “community of health practitioners”, delivering high quality care across this vast land.
So what’s holding us back from making this dream a reality?
First, we need to encourage new models of care delivery by expanding the scope of practice of current health professionals. This includes the right to prescribe medicines and perform minor procedures.
We also need to develop training programs for these mid-level health practitioners (physician assistants, allied health practitioners, care assistants) and ensure they’re able to gain registration and employment.
We should support a limited number of overseas-trained doctors with good mentorships and appropriate recognition of qualifications. But at the same time, we need to reduce our dependence on graduates from low-income countries.
We are a rich and innovative nation – surely we can provide a sustaining health workforce while fulfilling our ethical obligations not to take doctors from countries that need them more that we do.
Are mid-level health providers to answer to Australia’s rural health workforce shortage? Share you comments below.