Scapegoating internationally trained doctors misses the bigger picture.
One of the conundrums which comes with the rise of a party like One Nation is the decision about whether to cover its seemingly purposefully divisive policies.
One does not want to give these people oxygen, especially when political operators like Pauline Hanson have proven savvy at turning even negative press into a platform.
On the other hand, sunlight is very good at killing mould.
This week, Victorian One Nation candidate Colleen Harker published a blog post titled “Before we import another doctor, give Australians a chance to become one”.
She argued that Australia’s tough medical school entry requirements meant that “many young Australians with outstanding academic results miss out” on university places, while the international medical graduates on which Australia’s health system depends were “not require[d] … to have ranked in the top 0.35% of their school cohort”.
“Medical education depends on hospitals, clinical placements, doctors and other health professionals who supervise and teach students, as well as health infrastructure substantially funded by Australian taxpayers,” Ms Harker wrote.
“If Australian taxpayers help provide the infrastructure that makes medical education possible, it is reasonable to ask whether Australian students are being given sufficient opportunity to access it.
“An Australian higher education system receiving billions of dollars in public support should play a central role in developing Australia’s own human capital.
“Yet we have constructed a system in which highly capable young Australians are turned away from courses leading to occupations we classify as being in shortage, and then use migration to help fill those shortages.”
Now, there are multiple reasons why Ms Harker is perhaps barking up the wrong tree here. It’s been well established, for instance, that simply training more doctors – like adding extra lanes to a highway – is not the panacea we think it is.
And as for the insinuation that overseas-trained doctors, who make up more than one third of the medical workforce, are any less brilliant and capable than Australian graduates – a look at the sheer number of exams and hoops that overseas-trained doctors are forced to jump through in order to start working in Australia should be enough to disabuse anyone of that notion.
But what makes grievance politics like Ms Harker’s so attractive to some is the grain of truth which sits at the centre. In this case, it’s the thorny presence of the medical specialist training bottleneck.
Right now, there are not enough non-GP specialist training positions to go around. By 2033, there is expected to be an oversupply of around 8000 prevocational doctors hanging around the system, an increase from the oversupply of 1391 that we currently have.
Ms Harker is not the first to connect the idea of internationally trained doctors and the specialist training bottleneck.
Earlier this year, the NSW Medical Students’ Council released a paper claiming that, because internationally trained doctors are treated as equivalent to Australian graduates at entry into training, they are competing with Australian trained doctors for the same pool of registrar positions.
By 2048, internationally trained doctors are set to account for 64% of the growth in registrar numbers.
In light of this, the council argued, graduates of Australian medical schools should be prioritised for selection into specialty training, ahead of internationally trained doctors.
Related
A recent post to the r/AusJDocs subreddit featured a screenshot from the AMA Facebook page, with an image of president Dr Danielle McMullen alongside a quote from her appearance at a senate hearing on immigration.
“International medical graduates are not a temporary fix,” the quote read.
“They are respected colleagues and essential contributors, and they should be supported to contribute fully.”
Reddit commenters took the quote as the AMA “dunking on locally trained docs and appealing to the IMG crowd”. Others called for Dr McMullen to be removed from her position, despite her term being up in a matter of weeks.
The frustration experienced by Australian medical students is clearly real – but internationally trained doctors aren’t the villains.
A Grattan Institute paper released last year split the blame for the bottleneck between the specialist colleges and public hospitals.
“For too long, specialist training numbers have been determined by the priorities of specialist colleges and the immediate service needs of public hospitals,” the paper read.
“This has left Australia without enough specialists in some disciplines, and in many rural areas. Specialist training places should be tied to community needs.”
Reforming the system will take time, and we still need doctors during that time. The Grattan paper recommended making migration for overseas trained doctors easier, not harder.
Australian Medical Students Association president Seniru Mudannayake had his own take on the situation when he spoke to The Medical Republicearlier this year.
“Australia graduates medical students at one of the highest rates in the OECD, yet our public is not receiving the access it deserves because we keep doing the simple thing of increasing [medical school places] instead of aligning them with training positions and eventual public specialist jobs,” he said.
That is to say, Australian graduates, as it stands, tend to wait to get on their desired training pathway rather than take up all the existing training spots for all specialties. The situation is not the same for internationally trained doctors.
“No international doctor migrates to Australia because they are passionate about solving our rural workforce crisis,” Associate Professor Alam Yoosuff, a rural generalist based in western NSW, wrote in a recent opinion piece.
“That is not a criticism, it is reality. IMGs come for economic opportunity, safety, professional development, or a better future for their families.
“Australia benefits enormously from those choices. For most IMGs, general practice is not their preferred training pathway; but they choose it because it is the most viable route to achieving their goals.”
Ms Harker’s proposal to limit immigration and broaden medical school entry requirements would likely land the country in an even bigger pickle, workforce-wise, than it is currently.
There’s no one group to blame for the rural health workforce shortage and there is no one solution – but it’s probably a good idea to stop adding all those lanes to the highway.
