Just 10% of the GPs who have come through AHPRA’s fast-track specialist scheme are working outside of an MM1 location.
Overseas-trained specialist GPs who use the new expedited registration pathway are overwhelmingly flocking to the cities, in what prominent rural doctors say is an indictment of the distribution priority area policy.
Earlier this week, the Medical Board of Australia published data from the first full calendar year of the expedited specialist international medical graduate (SIMG) registration pathway.
Combined with the SIMG doctors who registered through the regular, college-led pathways, the number of new overseas-trained specialist GPs registering in Australia increased by 30% in 2025 compared to 2024.
The new program allows doctors who fellowed as a GP in the UK, Ireland or New Zealand between certain years to register (albeit conditionally) as a specialist GP in Australia without having to undergo expensive and time-consuming appraisal from either ACRRM or the RACGP.
According to AHPRA’s numbers, 368 specialist GPs applied for the program and began completing supervised practice during the 2025 calendar year.
Just 39 of these doctors did so outside of an MM1 location; 89% of the overseas-trained specialist GPs who came in via the expedited pathway are working in Australia’s most urban areas.
Technically, these doctors are subject to the same Medicare rules as all doctors who were not an Australian citizen or permanent resident when they first enrolled in their medical degree.
The upshot of that is they’re required to work in an area of workforce need – aka a designated distribution priority area (DPA) – for at least 10 years from their initial registration date.
All MM2-7 regions are automatically classified as DPA, as are MM1 regions which have applied for review citing exceptional circumstances.
Successive reforms have greatly expanded the number of DPA-eligible locations over the past few years.
Most of the expedited pathway doctors – about 88% – were working in a DPA location, and 12% were given an exemption.
It is difficult to judge whether the distribution pattern among the expedited SIMGs is anomalous, because AHPRA did not provide a breakdown showing where doctors who came in on the regular, non-expedited specialist pathway were working.
A number of experienced rural doctors took the skew to be more indicative of the DPA failing.
“It’s almost meaningless now, really,” rural generalist and immediate past RDAA president Dr RT Lewandowski told The Medical Republic.
“Really, I think you’d have to look long and hard to find a place that wasn’t DPA under the new guidelines.”
The fact that nine in 10 overseas-trained GPs were working in a metro location was likely more to do with the broken DPA program than the expedited pathway itself, Dr Lewandowski said.
“It’s failure of the systems, period,” he said.
“DPA is one of the systems, and it’s probably the most direct distribution tool. But the fact is … rural medicine is very fulfilling and satisfying, but also very hard and challenging. It’s not as well supported, oftentimes, as practising in an MM1.
“I think the best distribution tool is to change that – to make it not only rewarding as a career but also having supports that make it available as a career and comparable as a career as far as your remuneration and even your time.”
Dr Lewandowski himself is an SIMG, having trained and worked in the USA before emigrating to North Queensland. The process of transferring his registration to Australia, he said, was “frustrating to the point where I really almost gave up”.
“[Specialist IMGs are] people who are determined – I hope I fall into that category – and people who can’t go anywhere else,” Dr Lewandowski said.
“I think you’ve got to be in one of those two categories, which is really unfortunate. What ought to happen is we identify people who honestly are going to come to the country [and work where] the services are needed, so either they’re going to come for a reason that makes sense, or we need them to be here, or both. And then we make it fair to them.
“Once every practitioner is in this country, we ought to have tools that distribute them to the needs of our population, and ideally those tools would be based on carrots more than on sticks.”
RACGP rural chair Professor Michael Clements also called out the dysfunction of the DPA system.
“It’s a bit farcical to call it a distribution priority tool when this is the outcome, when we see most of these doctors that are coming into so-called areas of need are going to the Gold Coast and Sunshine Coast or other the urban areas,” he told TMR.
“We have been calling for a long time on the government to enact the recommendations back in the Medicare review, which is two years old now. We haven’t been calling for a scrapping of the DPA system, we’re just calling for it to do what it’s supposed to do and actually focus on priority areas.”
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Professor Clements said the skewed distribution of doctors coming through the expedited program could also be explained by the specific demographics of the cohort using the new pathway.
“MM1 DPA is technically almost exclusively only for those that are under the specialist recognition pathway, including the expedited pathway,” he said.
“So that’s why we don’t see as many of the non-UK IMGs in those MM1 DPA locations.
“Not only did we see the current government grant a lot of MM1 locations DPA exemption status, they also [granted] a lot of DPA exemptions [for individual doctors] on academic grounds, where universities would say that the doctor was needed for lecturing or for tutoring or for contributing to the university curriculum.”
ACRRM president Dr Rod Martin told TMR that urban practice was likely easier for doctors coming from the UK to adjust to.
“Most of these people have come from the UK, most of them are used to the UK system, so the easiest way to transition to that is to go to larger hospital settings and certainly larger metropolitan general practice settings where it’s all familiar,” he said.
“The orientation challenge, as most colleges and certainly the [council of presidents of medical colleges have] argued, is one of the big issues.
“You can’t just send people out to remote locations and expect that they’ll orient themselves, and so they’re voting with their feet and going to places where it’s comfortable and safe and familiar.”
