Introduction by Croakey: Reform of the regulations governing the registration of overseas health practitioners has been a work in progress for many years, if not decades.
However, the urgency of this work has been heightened by the impact of COVID-19 on health workforces globally, nationally and locally.
Croakey editor Jennifer Doggett reports on the interim findings of a national review that aims to streamline these regulations, led by Robyn Kruk, a former Secretary of New South Wales Health.
Jennifer Doggett writes:
Despite registering record numbers of health practitioners last financial year, Australia currently still needs 860 more GPs, and this shortage is likely to grow to 10,600 by 2031-32, according to the interim report of the Independent Review of Overseas Health Practitioner Regulatory Settings.
As well, we are likely to need more than 40,000 additional registered nurses by 2026, including in aged care.
The report also discusses the growing need for allied health professionals, stating that employers across public, private health, aged and social care sectors are struggling to recruit health professionals in all categories.
The report highlights the impact of workforce shortages on access to timely and appropriate healthcare and states that half of patients in Australia are currently waiting at least 40 days for elective surgery.
It also highlights key areas of shortage, including waits of up to six years for people to see neurosurgeons and ear, nose and throat surgeons and up to six months for National Disability Insurance Scheme (NDIS) clients to see allied health professionals.
The review’s interim report was endorsed by First Ministers at the 28 April meeting of National Cabinet.
Announced by National Cabinet last September, the review is investigating options to help ease health workforce shortages while maintaining high standards in healthcare quality and patient safety.
It complements work being done by the Australian Health Practitioner Regulation Agency (AHPRA) and links to outcomes from the Jobs and Skills Summit in September, including the comprehensive review of Australia’s migration system.
It follows a number of previous similar reviews about recruitment, regulation and retention of overseas-trained health professionals in Australia. These include a report conducted as part of the Aged Care Royal Commission, a Productivity Commission inquiry and an independent workforce review.
The Kruk Review’s interim report covers many of the same issues addressed by these reviews, within the current context of global workforce shortages.
It focuses on streamlining regulatory settings to make it simpler, quicker and cheaper for international health practitioners to work in Australia and discusses how this will drive productivity dividends for migrants, health sector employers and communities, while maintaining quality and safety standards.
In setting the scene for the review’s recommendations, Kruk makes the following key points:
- The most important resource in any health system is the skills and competencies of health professionals.
- Pre-existing workforce shortages in Australia have been heightened by the COVID-19 pandemic and are expected to continue as Australia’s population ages.
- The health workforce is increasingly a globally sought after resource.
- The Australian health system relies heavily on overseas trained doctors and nurses. In 2020, around 18 percent of Australia’s registered nurses and around 32 percent of medical practitioners were internationally trained.
- The National Registration and Accreditation Scheme (NRAS) is vital in order to promote consistent, high-quality, national professional standards for Australia’s health workforce.
- The NRAS needs to evolve in order to remain current to be effective, including to reflect changes in technology, good practice and evidence.
Key barriers
Consultations with employers and health practitioners that informed the report revealed that Australia’s current registration and related immigration processes are slower, more complex and expensive in many instances than in other comparable countries.
The consultations found that Australia’s registration and immigration processes are duplicative and inconsistent, often requiring the same or similar information to be provided to multiple agencies. Applicants report they receive little or no support navigating the process.
While cohorts from a small number of countries undergo a simple process, other cohorts, even from countries with similar regulatory systems, must sit exams or undertake further training to qualify, adding costs and delays. Many are subject to long periods of supervision despite having extensive clinical experience.
Mid-career senior clinicians are choosing not to come to Australia due to perceived barriers, costs and uncertainties in the process. As a result, Australia is missing out on their knowledge and skills.
Applicants report that the current process makes them feel undervalued, disrespected and even demeaned.
The report also says that English language requirements are more onerous than necessary to support effective communication and patient safety. Australia’s requirements to demonstrate the written standards are higher than in the United Kingdom (UK) and New Zealand (NZ).
The visa process increases costs on employers and means it takes longer to fill vacancies. Age restrictions on permanent skilled visas limit Australia’s ability to attract experienced and senior health practitioners who specialise over their career.
- Image source: The interim report
Recommendations
The report provides a broad set of recommendations with the overall aims of reducing duplication and inefficiency in the current system and permitting applicants to commence delivering health services sooner while maintaining the focus on public safety.
It states that together these recommendations should increase the attractiveness of Australia as a destination for highly skilled and experienced health practitioners and enable the recruitment of more practitioners at lower cost to employers and the applicants themselves, within faster timeframes.
The recommendations are grouped into immediate and longer term actions that governments and regulators can take to boost the health workforce in the short term and ensure Australia is a competitive destination for the global health workforce into the future.
Immediate actions
The immediate recommended actions involve accelerating key immigration and related checks for skilled practitioners to alleviate urgent shortages in medical, nursing, midwifery and allied health professions.
This requires both individual and coordinated actions from the Department of Health, AHPRA, the National Boards and state/territory governments.
The review says AHPRA should remove duplication and align evidentiary requirements so applicants only need to provide information once, and enable more cohorts from trusted countries to be ‘fast-tracked’. It also should improve recognition of overseas health practitioners’ experience and skills.
The National Boards should provide applicants with greater flexibility in demonstrating their English language competency, including by aligning Australia’s requirements with the UK and NZ.
The review also recommends the Department of Health and Aged Care, state and territory governments, AHPRA and NRAS entities should take joint action to continue workforce supply and demand modelling for medicine (generally and by specialty) and nursing, and commence work with states and territories and relevant stakeholders to address gaps in allied health workforce data to facilitate supply and demand modelling in the future.
Longer term recommendations focus on the need for health ministers, AHPRA and others to work together over time, to reduce regulatory costs for employers and overseas health practitioners coming to Australia.
This includes developing integrated and regularly updated workforce data and national cross-sectoral strategies to inform workforce planning and policy.
The report suggests that governments should provide additional funding for these systemic improvements to Australia’s regulatory process, warning that without this investment regulatory agencies would have to significantly increase fees on health practitioners, making it harder for Australia to attract sufficient practitioners to meet the community’s growing need for care.
It notes that Australia’s “international peers have made their own regulatory process simpler and cheaper, without lowering standards”.
At a press conference following the meeting, First Ministers said they would work together to progress the recommendations that can be implemented immediately. They also committed to reporting back to National Cabinet with a fully-costed implementation plan for the remaining recommendations.
See here for Croakey’s archive of stories on the health workforce
