Proposed changes to the regular, non-expedited specialist registration pathway will see the medical board have final say on how much supervision each internationally trained doctor receives.
AHPRA and the Medical Board of Australia are pushing for major changes to the way specialist doctors who trained overseas gain their Australian registration – changes which will sideline the medical colleges.
Technically, the regulator has three separate international medical graduate-related consultations on the go.
Two of these look at relatively minor changes to the pathways through which overseas trained doctors can gain general registration in Australia.
Namely, these are the “competent authority” pathway and the “standard” pathway. Both are designed for doctors who want general registration, not specialist registration.
Some of the changes include mandatory Aboriginal and Torres Strait Islander health modules detailing culturally safe care.
The third consultation is where things get interesting.
It looks at “streamlining” the specialist pathway (not to be confused with the already-streamlined expedited specialist pathway).
Currently, doctors who fellowed with their relevant specialist college overseas have two pathways to get their specialist status recognised in Australia. The one that they pick is determined by their country of origin and their specialty.
GPs who completed fellowship in the UK, Ireland or New Zealand between certain years, for instance, have the option to go down the expedited specialist pathway.
AHPRA’s data indicates that 96% of doctors who have gone through the expedited pathway so far have achieved Australian specialist registration within one year of submitting a complete application.
This number is closer to 8% for doctors on the regular specialist pathway, which is the option that specialist doctors who fellowed in countries other than the UK, Ireland or New Zealand must take.
It’s this second option which the third AHPRA consultation focusses on.
“The Board considers that redesigning the Specialist pathway is needed to streamline processes, reduce duplication and support more timely decision making and consistent outcomes,” the report reads.
“The proposed changes enable closer alignment between Specialist pathway assessments, the requirements of the Registration standard: Specialist registration and the National Law.
Under the current process, overseas-trained specialists first apply to the relevant Australian medical college for a comparability assessment, and the medical college conducts that assessment.
The college then makes a call on whether the training that specialist doctor received in their country of origin was “substantially”, “partially” or “not” comparable to Australian training requirements. This decision in turn determines how long the doctor must spend under supervision.
It’s only after this process that the doctor applies to the medical board for provisional registration.
Once the doctor has served out their period of supervision, the college submits a report confirming that the specialist doctor is safe and competent to practise.
The board decides whether to give that doctor specialist registration, and the college decides whether it will award fellowship to that doctor.
Under the new proposed process, much of the work on the college’s end would be transferred to AHPRA and the medical board.
Instead of approaching the college for a comparability assessment, overseas-trained specialists will apply to AHPRA using a common application form. Once ensuring each application is complete, AHPRA will forward the forms to the relevant specialist college.
The colleges would still conduct an assessment of each internationally trained doctor. But instead of being developed by each individual college, the assessment will be a standardised, medical board-approved framework.
The colleges still submit a report to the board, but the board makes the decision on supervision requirements.
Instead of just “substantially” and “partially” comparable, the board has three supervised practice streams to choose from.
Under the first, the internationally trained doctor need only do six months of supervised practice as well as some upskilling and workplace-based competency assessments.
The second stream is the same, but the supervised practice period is 12 to 24 months.
Doctors put in the third stream have to undergo 12 to 24 months supervised practice, upskill and complete examinations alongside workplace-based competency assessments.
The final few steps remain unchanged: colleges still sign off on the doctor as being safe and competent and decide whether to award fellowship, while the medical board decides whether the doctor gets awarded specialist recognition.
Related
AHPRA’s consultation documents say the medical colleges will “retain a central role” in assessing overseas-trained specialists and that “their continued involvement is a fundamental feature of the proposed pathway”.
In fact, AHPRA contends that these changes will benefit the colleges.
“The proposed option is expected to reduce administrative burden associated with managing applications, reconsiderations and data reporting, allowing colleges to focus on their core expertise in assessing [specialist international medical graduates’] qualifications, training, experience and specialist competence,” the consultation reads.
“Colleges may experience initial impacts associated with implementing revised assessment frameworks, reporting templates and advice requirements.
“However, these changes are intended to improve clarity of pathway requirements, increase consistency across specialties, and make assessment outcomes more transparent.”
Despite these assurances around the continued power of medical colleges, AHPRA did acknowledge that its own role in the process would increase.
“The proposed option strengthens the Board’s role as decision‑maker under the National Law and is expected to improve alignment between assessment outcomes, registration decisions and regulatory accountability,” the regulator wrote.
The consultation documents also claim that supervisors will benefit from clearer expectations about the specific competencies and scope of practice they need to assess for.
Consultation on streamlining the specialist pathway closes on 27 July.
