IMGs are forced through a cruel game in order to practise — will AHPRA fix it?
I have previously written about the appalling way we treat IMGs and how distressing it can be for them while trying to qualify to practise in Australia.
The real question is, why do the authorities make it so hard? It is far more than issues of professional standards.
Snakes and ladders
At last year’s annual workshop for the Doctors’ Health NSW on-call panel, our medical director, Dr Kathryn Hutt, arranged a game of snakes and ladders to demonstrate the difficulties IMGs face.
We all stood around a table with a bundle of Monopoly money in one hand and dice in the other.
Before us was a tortuous map featuring the six citadels of bureaucracy — the Australian Medical Council, the Department of Home Affairs, the Medical Board of Australia, AHPRA, Medicare and the specialist colleges — all interconnected by a network of ladders and slippery snakes.
In turn, each participant had to throw a particular number in order to draw a card that provided advice from the citadel being approached.
The card might say ‘Pass’ or ‘Fail’, provide information as to why the player had failed, or say what they had to do to reapply and how much it would cost.
If you failed, you were sent back to your last successful post and were obliged to throw the appropriate number again to re-enter the contest.
The game was extremely frustrating to play, dragged on for an inordinate length of time, and produced few successful players.
The exercise was based on the reality of the situation and demonstrated clearly what all IMGs have to put up with.
Since that workshop, AusDoc has published the personal experience of an IMG who was mentored by one of our panel doctors.
This IMG was a specialist medical practitioner in their homeland and came to Australia with their immediate family to seek a better life.
They kept meticulous notes of their endeavours and, at my colleague’s suggestion, produced a detailed report of their own game of snakes and ladders, offering some sensible suggestions as to how the system might be improved to help all parties involved.
This IMG was ‘lucky’. They only spent two years playing this game, although the application fees alone cost them more than $22,000.
During this time, they were unable to work as a medical practitioner and had to finance their living expenses and personal healthcare.
This is not a unique case. I recently spoke to an IMG who took four years to negotiate the process, and at the end was granted a limited qualification to work as a registrar under supervision to re-skill into the specialty they had previously worked in back in their home country.
Changes are afoot — really?
AHPRA and the medical board have said they want to take greater control of specialist registration, shifting power away from individual medical colleges to streamline processes and address workforce shortages.
As outlined in a consultation paper released in June, AHPRA would become the “front door” for all specialist IMG applications to make the process a “more consistent, transparent and predictable assessment experience” for IMGs.
The relevant college would assess each applicant’s qualifications and make recommendations around supervision requirements, necessary upskilling and suitable employment positions.
But the medical board would ultimately determine whether the IMG was eligible for specialist registration or if limited or provisional registration was more appropriate.
This, it would seem, is an endeavour to break the specialties’ control over professional standards.
It’s all very well for AHPRA to get involved in assessing IMGs’ professional standards, but this is just one small ladder in the overall game.
If, as it appears, the Federal Government, like those in many other Western countries, prefers to import healthcare workers from developing countries — because it is cheaper than graduating some of our own — you would think it would want to have a say in how to get them here and up to speed.
Why not lock up the leaders of the six bureaucracies in a room and not let them out until each has agreed to simplify their processes and work together to achieve the government’s needs?
As for costs, I’m not sure whether each of the citadels is trying to keep the applicants out or shore up their budgets. The costs are horrendous and are imposed on our medical colleagues who can least afford them.
AHPRA is the only authority that has shown any desire to change things, and we can but wonder why.
I may be a cynic, but I can’t see AHPRA’s small step improving the plight of the IMGs, and there is no sign of any other significant changes afoot.
IMGs will have to keep playing the frustrating game of snakes and ladders.
Australia needs — nay, depends on — IMGs.
Currently, 56% of GPs working in Australia are IMGs, as are 30% of non-GP specialists. So why are we making it so difficult for them to negotiate the qualification process?
Are the citadels hiding in their own silos, complacent with their overly cumbersome processes, and oblivious to the stressors faced by IMGs seeking to come and practise in Australia?
Has the game been made deliberately complex, or has it simply mushroomed unchecked over time because no-one cares?
Dr Craig Lilienthal is a later-career GP in Sydney.
