The AMA has been a critic of the Federal Government’s so-called “10-year moratorium”, which helps plug workforce gaps with overseas trained doctors, for some time.
Yesterday the AMA issued this statement, raising concerns about the outrageous problems these doctors and their families face in accessing healthcare and other services, amongst other things. It garnered this nice big splash in the SMH today, under the headline, AMA ends support for bush doctor rule.
But Dr Ian Cameron, CEO of the NSW Rural Doctors Network, says the issues are far more complex than the AMA is allowing, and has some other suggestions for tackling rural doctor shortages. He writes (and please note the update at the bottom with some amendments):
“The AMA has joined RDAA in calling for an end to the 10 year moratorium. It is difficult from the press releases to see what they actually want.
Section 19AA is not discriminatory. It applies to all doctors, Australian trained or overseas trained who were registered after 1996, and denies them a provider number for ten years unless they achieve Fellowship of a College. This was strongly supported by the RACGP as enforcing training for General Practice as a specialty. This is the ten year moratorium – is this what AMA and RDAA wish to remove?
Or are they talking about the exemptions to the ten year moratorium that allow some doctors to work in rural areas, deputising services and as GP registrars. These exemptions were introduced in response to Democrat and AMA lobbying that young doctors would not be able to do rural locums, or get experience in General Practice before joining a training program. The RACGP has opposed the exemptions because they see what was an education issue being turned into a workforce issue.
Or is it only Section 19AB that the AMA and RDAA want rescinded? This is discriminatory, and applies only to temporary resident doctors and requires them to work in a district of workforce shortage. For more rural and remote places this ten years may be reduced to 3.5 to 5 years, as long as the doctor also achieves Fellowship.
For temporary resident doctors it has been a choice to come to Australia – instead of removing 19AB why do we not fund the provision of adequate assessment, orientation, clinical and education support that will change an overseas trained doctor into an Australian trained doctor?
The AMA and RDAA have focussed on the provider number issue, but there is also the issue of medical registration. Do the AMA and RDAA also want to remove conditional registration in an area of need? This also compels doctors to work in what are usually more rural or remote locations.
In NSW at least, the RACGP has been unable over two years to put in place processes for the Specialist Pathway (except FRACGP equivalence) and an end point to the Competent Authority Pathway. This means that there is no pathway for the more experienced or equivalent overseas doctors. While the NSW Medical Board has appropriate processes for assessment of doctors applying under area of need provisions, there needs again for there to be better orientation, professional, clinical and education support for these doctors
Both AMA and RDAA have called for better conditions to attract more rural doctors – more carrot and less stick.
However they have largely focussed on more money, a simplistic approach that on its own is unlikely to change things. Government policy has been built around increasing education places at undergraduate, prevocational and vocational levels.
This has been highly welcomed, but as with better remuneration, is unlikely to lead to change unless accompanied by measures leading to a large increase in the number of new doctors choosing General Practice, rural General Practice and rural procedural General Practice. This means looking beyond outmoded cottage industry model of General Practice and moving towards offering alternatives that give GPs professional and clinical independence but relieve them of administrative burden.
There are a few things we could do for international medical graduates (IMGs) as well as providing that professional and education support. If IMGs who had passed both parts of the AMC exam were able to do their year of supervised practice in General Practice, it would both free up more intern positions in the hospitals and recognise that IMGs have prior hospital experience, but often need Australian General Practice experience.
Maybe we could require all IMGs to work as Physicians Assistants until they achieve General Registration or Fellowship. If contracted to an existing doctor this would ensure they received serious support and assessment, allow them to work within a clinical setting in the health system, and let the existing doctor make some money.
The ability to value add would mean an end to “you can’t make a bob if you work with your hands” mentality, help with workforce shortages and with appropriate support I am sure would have the support of the AMA and RDAA in recognising Physician Assistants as being part of the medical, rather than nursing or some other, system.”
“Overseas-trained medical graduates are an essential way of addressing the doctor shortage in rural and remote Australia…The 10-year moratorium is vital for staffing remote and rural practices. Our workforce in the country would be decimated if you got rid of it and the AMA needs to be careful that it doesn’t throw the baby out with the bathwater on this issue..If that policy was unilaterally dropped, I don’t know how places like the Kimberley and Brewarrina would ever be staffed…”
Update on 21 Jan from Ian Cameron:
My Croakey bit needs some revision.
19AA does not include the moratorium. Basically you can’t get a provider number for General Practice unless you achieve FRACGP or FACCRM, or have one of the exemptions.
19AB applies to permanent resident OTDs (or Australian graduates who were not citizens or permanent residents when they were students) and they cannot get a provider number for ten years unless working in a District of Workforce Shortage (This may be reduced under the 5 year program for more remote places) For temporary residents the ten year moratorium only cuts in when they become permanent residents. It is discriminatory.
However I think my basic premise remains that there should be better support for all IMGs in orientation, clinical and professional support, and education. Having recruited temporary residents to Australia they should have access to Medicare and free schooling for their children in the public system. In this I agree totally with the AMA and RDAA. However we should separate the support issue from the moratorium issue and debate them separately.