Issue 24 / 25 June 2012

WOULD you swap places with an international medical graduate hoping for registration in Australia? Certainly not!

And would you want to be a rural practice that needs an IMG to relieve workforce pressures? Unfortunately, that’s my practice.

I have been stuck in a horrible workforce crisis for the past 6 months. For the first time in 15 years, I have not had an assistant, associate or registrar to help at my practice.

There have been some benefits of flying solo, such as reconnecting with patients I have not treated for some time and not having to field numerous calls from registrars for advice. However, I do prefer the camaraderie and time flexibility that group practice brings.

For those of us in small towns, changes to the rural incentives program — the subject of many articles in the medical press in the past 2 years — have seen us shunned by doctors who now can enjoy all the benefits of holiday resort towns or large regional centres while pocketing large rural retention payments.

And since rural rotation is no longer compulsory for GP registrars — General Practice Registrars Australia persuaded government that an outer urban term is just as good — the workforce drought for small towns has never been as bad.

I am sure many GP registrars, regional training providers and government officers will say that all is fine and dandy, and will produce statistics to support their case. However, we need to dissect the figures and look at the situation town by town to see the real impact.

The solution for many rural GPs is to recruit an IMG. Unlike a registrar, an IMG under an “area of need” program can stay for a few years, particularly because almost all of them are on moratoria of 5–10 years in an area of need as part of their immigration conditions.

While the only contact most doctors will have with the Australian Health Practitioner Registration Agency (AHPRA) is paying a hefty registration fee once a year, the whole IMG experience brings you up close to this very impersonal organisation.

AHPRA was born in 2010 as part of the push for national registration and accreditation. Most of us swallowed the bait, as national registration sounded so appealing — one registration fee and form and you can work anywhere in Australia. It sounded good, so not many complained.

The sting is in the accreditation side, as the IMGs and their sponsors know.

I have had to fill in so many forms to get an IMG to work for me that I have lost track of how many pages my printer has spat out just for this in recent months … and I am still waiting for help.

Some of the questions I have been asked are not unreasonable — details about the IMG, the sponsor, the employer and the supervisor, a job description, the contract or job offer and hours of work.

Other questions do push the friendship, such as those about the town’s demographic mix and medical services. These questions make you wonder about relevance and why the government doesn’t already have most of this information.

And then the bit that really gets under your skin. These same questions and similar forms, with minor variations, have to be submitted to the following:

  • State government for an area of need application
  • Medical Board of Australia supervised practice plan and principal supervisor’s agreement
  • Medical Board of Australia application for limited registration for an area of need
  • Medical Board of Australia application for limited registration for postgraduate training or supervised practice

Virtually the same questions, virtually the same forms, FIVE times!

At least we now know where the money from registration fees goes.

Meanwhile, my patients and I are still waiting for some help …

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 25 June 2012

7 thoughts on “Aniello Iannuzzi: Take the IMG challenge

  1. docstrange says:

    Thanks for this insight, I can only confirm that in my case it took 4 years to get through the hoops of the already discriminatory AMC requirements plus the AHPRA registration rigmarole – in spite of supplying all paperwork immediately and having passed all tests at first go with top marks.

    As far as I can see the system at present stops most reasonable and highly skilled overseas trained doctors from working here, inviting instead the few who are stubborn or desperate enough to fight it out for whatever personal reason.

  2. Sue Ieraci says:

    Aniello – I emphathise with you. It seems that we have entered a phase of such risk-aversion in medical employment – apparently driven by a very small number of high-profile cases where something went wrong. Where I work (luckily for me, in a city hospital), I can’t sign up someone to work here without a criminal record check, even if they are concurrently working in another hospital a few kms away. The amount of crednetialling appears to be out-of-proportion to the risk. And here is the clincher: the risk created by leaving the position vacant (as in your case, Aniello) is likely to be much greater than the risk of employing the doctor. We need to see the pick-up rate of the current credentialling regime and decide rationally which steps actually do reduce risk.

  3. William says:

    As a foreign born, Australian Medical graduate who served in the Australian Army medical corp on deployed service, with each change of employment within NSW health, as a rotating registrar when I was one, even within the same city, I have had to provide Australian citizenship papers, and even details of my port of arrival in Australia on the P&O Oriana in 1969, to NSW Health bureaucracy prior to commencing the next registrar rotation on annual or 6 monthly basis. Bureaucracy gone mad for it’s own sake personified and perfected.

  4. C says:

    “very small number of high-profile cases where something went wrong”. Dr Ieraci, that is not correct. I have had to work with and supervise very many IMG’s working in emergency departments in Melbourne and country Victoria and Tasmania, and whilst there are some good ones, there are a large number that I have found totally incompetent to practise medicine without very close supervision and assistance with every single patient that they see. If they were to be granted employment liberally, the number of adverse events would become huge, the public would not accept it, and our medical defence premiums would all skyrocket.

  5. Mia says:

    “the risk created by leaving the position vacant (as in your case, Aniello) is likely to be much greater than the risk of employing the doctor.”

  6. Deborah says:

    Thank you for your balanced and sensible article – your point is that the current paperwork is inefficient and works as an effective deterrent towards employing a doctor in an area where he/she is genuinely needed. We need some rationalisation.
    And yes, I think most of us who are only involved in the annual re-registration with APHRA would agree that the system has become less efficient despite costing us more. One small example is the way they notified us by email that we could re-register via the internet, only to find that the system had been wrongly programmed so we had to telephone them (within office hours) to get access….the problem for me as a busy clinician was the time spent in useless attempts to do things electronically and also the lack of interest in early correction of this sort of error.

    Regarding the general attitude to international medical graduates: I find it amazing how much prejudice is openly displayed. As a senior physician who supervises many junior medical staff at all levels who are trained in Australia, the same comments about competency apply to them – a mixed bag, and often requiring assistance. To lump everyone in one group and believe that an IMG is different to others is to display the prejudice born of ignorance.
    I would recommend every Australian doctor who dislikes IMGs to try practising medicine in a different language and in a different country. I have done this (and I believe I am one of the lucky few who is multilingual), and it is no easy task! Let alone overcoming the cultural differences and the genuine differences in medical practice. Please, let’s have more balance and spend time helping rather than condemning.

  7. Sue Ieraci says:

    I support Deborah’s comments: learning to practice in both a new environment and a different language are enormous hurdles that consume one’s intellect until adaptation occurs. I have supervised more IMGs than most, as well as been involved in the regulatory process. What I have seen is that the vast majority eventually adapt and go on to be functional professionals who contribute care to our society. OF course they initially need very close supervision – that is why we structure their initial orientation that way. I would also ask commenters above to consider which of the checks and administrative processes associated with employing IMGs helps select those who will be most functional. Mia – I don’t know why you are so outraged by my comment – have you ever worked as a solo rural GP?

Leave a Reply

Your email address will not be published.