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STANDING COMMITTEE ON HEALTH AND AGEING
Registration processes and support for overseas trained doctors
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STANDING COMMITTEE ON HEALTH AND AGEING
Registration processes and support for overseas trained doctors
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STANDING COMMITTEE ON HEALTH AND AGEING
(House of Representatives-Thursday, 31 March 2011)
CHAIR (Mr Georganas)
BURLEY, Ms Robyn Margaret
CAMERON, Dr Ian
BAIG, Mr Nasir Mehmood
BUTT, Dr Christopher Edward
JIN, Dr Bo
TIPPETT, Dr Christine
NAIR, Professor Kichu Balakrishnan
HOLLANDS, Dr Michael
TEGEN, Ms Susanne (Susi)
McKENZIE, Associate Professor Paul
SWINBOURNE, Mr Donald William
GARG, Dr Vikas
GRAVES, Dr Debra Jane
CAINS, Dr Stephen Elsworth
ALLAN, Associate Professor John
- ACTING CHAIR
Content WindowSTANDING COMMITTEE ON HEALTH AND AGEING - 31/03/2011 - Registration processes and support for overseas trained doctors
CHAIR —I welcome participants in the doctors’ forum. Although the committee does not require you to speak under oath, you should understand that these hearings are a formal proceeding of the Commonwealth parliament. Giving false or misleading evidence is a serious matter and may be regarded as a contempt of parliament. I will first ask each of you to introduce yourself and make a short introductory statement. Following the introductory statements the committee will ask questions. It will be informal, like an open forum. The discussion will be recorded by Hansard and will form part of the public record for this inquiry.
Dr Jin —I am retired now and I appear in a private capacity.
Mr Baig —I am an international medical graduate from Pakistan and I have an issue with registration because of English. I have passed the Australian Medical Council exams, which are required for registration in Australia. I have passed all the examinations, such as the English. That was the first, basic and mandatory requirement of the Australian Medical Council—English proficiency: the OET exams—with B grades in all four English skills.
I passed it in 2004 and then, after that, the AMC allowed me to sit in the medicine exam, to proceed the exams. So I passed my medicine first part exams in 2005 and, finally, I passed my clinical exams in May 2007. And finally I got the pass certificate from the AMC and it is clear-cut mentioned, ‘The registration is available’—I will read this statement here. They said in the certificate that ‘Nasir Mehmood Baig has satisfied the requirement of the council and passed all its examination’. In the other letter which I received by the Board of Examiner AMC, he has written that ‘registration is available for those doctors who have obtained the AMC exams, passed the AMC exams and obtained the AMC certificate’. This is the state and territory law.
Following this pathway, after I had completed all these steps, including my English exam, in May 2007 the New South Wales Medical Board raised the issue that my English exam was more than two years old. Of course, obviously I accept it was more than two years. But after doing this English and all these medicine exams I remained all the time in Australia, and they encouraged me to do the English. I convinced those people. Look, I did this medicine exam; I passed the English exam, and the expert AMC doctors and professors, they have already tested, they have already examined my medical knowledge and medical skills and, especially the communication skill, which I did, and I got this certificate. This is the certificate. So what is the point to pushed me to do the English again and again and again? Believe me, since that that time, I passed the same with four B grade in all four skills. I am doing this English over the last four years, almost, and I have written this exam 19 times—one nine. I passed three skills several time with A or B grade and I missed the fourth one. I got the C grade. C grade is pass but it is not acceptable to the Medical Board. So I am very concerned about how long I have to write this exam. Believe me, I financed thousands of dollars to complete all these steps. It is a very sad story. When I was in the Westmead library and I was preparing this medicine exam we had no money to buy a milk bottle for my children. I passed all these steps and, finally, at the end of the day, they say, ‘Mr Baig, you have to do the English again,’ which I did at the first. Why?
CHAIR —Mr Baig, have you done that second English exam at this point?
Mr Baig —I did it 19 times after that—one nine—at the cost of $15,000, and I have done a number of preparation courses from the University of New South Wales, online courses, and, believe me, I am very hard worker. Now I am not getting the four B at the same time. But I have passed these all B, B, B—
Ms HALL —It is the last component you are having trouble with, isn’t it?
Mr Baig —Yes.
CHAIR —We will open up for questions at the end of the statements.
Mr Baig —Sure.
CHAIR —Dr Butt, do you have a statement?
Dr Butt —Thank you for allowing me to come here today. I am here today mainly to speak about the occupational English test and the effectiveness of that test, not to criticise it as such. I think in principle it is good that you test English within the professional situation that people are placed. But the fact remains, as you have just heard, there is a lot of disquiet about the process of assessing English, as I am sure you will hear more of this morning.
My background is that I am a retired GP. I was working as a GP for 20 years in Sydney and then I did some English teaching. I have been teaching English communication skills for overseas health professionals for nine years at TAFE and other places, but mainly TAFE—although today I am appearing for myself; I am not appearing on behalf of TAFE.
In the last nine years since I have been teaching, the level of English required to satisfy the Australian Medical Council has significantly increased, as you have probably just understood. In fact many doctors now think that passing the English test is harder than passing the medical tests. I am not saying whether that is a good or a bad thing; I am just saying that is a fact of life.
I would like to make some suggestions about how we could improve that particular test. With regard to the speaking component of the test, there has been a lot of controversy because of the way it has been run with inexperienced and poorly trained interviewers. Perhaps, as we have some discussion, I can go into that in more detail.
One of the main problems that you have just heard again is the need to pass all four components of the test—reading, writing, speaking and listening—at one administration of the test. The pass rate in that test is about 60 to 65 per cent. For each component, if you think of the statistics of it to get pass rates in all four, means that you have quite a difficult task to do that, and many students will get three Bs and one C. They have to resit the exam; three months later, $600 later, they go back and do the exam again. Sometimes they will again get 3 Bs and a C; even sometimes a C in a different modality.
My suggestion is that, if people get 3 Bs and a C—that is, just a close fail, as it were—that they be given a supplementary examination in the area that they failed. If they pass that supplementary examination then that could be counted as a pass at the one administration. This is not such a rare idea. The Australian Medical Council do this with their clinical exams. If someone does a clinical exam and has 16 stations at the exam, if they pass, they pass; if they get 10 or 11, they get a supplementary exam. Of course, if they get lower than that then they have to redo the exam. This is not a strange thing.
The other thing is that there needs to be greater transparency in the exam process and some way of entering into conflict resolution. The examining body that runs the occupational English test has the power to fail people and they collect a substantial fee for the next test. I am not claiming that anything is being done dishonestly, but you need transparency in this area. The government needs transparency in this area as well, and you have the Ombudsman and such like that will give some transparency to process. I think that perhaps the testing boards need that as well.
Finally, the other area we might address if we have time is the problem when overseas medical graduates from non-English-speaking backgrounds come to Australia. When they first come here, they flounder for months, if not even longer, not knowing what to do. Many of my students who have come to my classes have said they wished they had known such a course existed and they had wasted months not knowing that. I think a system of mentoring new arrivals would be helpful. I know that has been done to some extent through the medical education system in the past but I am not aware of it—and certainly none of my students are—of a process whereby both medical and English standards are assessed so that people are given very specific mentoring advice about what is the best path for them. Should they do general English? Should they do English preparation course in advanced communications? Should they go straight to the exam if their English is very solid et cetera? I think that would be very useful. That would have to be organised through the department of immigration, I would presume: someone who knows who the people are coming into Australia.
Finally, I think that public education has a role to play here. At the same time as the English requirements are getting harder, the federal government has just withdrawn its funding from public training programs at least in Sydney. They were trained under the language, literacy and numeracy program. That has been given to a private—
CHAIR —That is specifically for overseas trained doctors.
Dr Butt —No, for engineers and all sorts of people. It is a vocational training program but of course doctors and other health professionals are part of that. The contract has recently been given to a private provider. I am not aware that they are doing anything like we were doing but maybe they will. Unfortunately, it means that public education is missing out on this opportunity to get these people on the road quickly and it leaves the doctors floundering even longer, which wastes your time, our time and the whole community’s time.
CHAIR —Thank you very much. Dr Jin.
Dr Jin —Many thanks for giving me the chance to be here. I appreciate it very much. I believe my report has been already put on your desk. I am an overseas trained physician from China and I am also an Australian citizen. I have been living in Australia for more than 20 years—since 1990. I have been struggling with getting the qualifications for an overseas trained physician assessment for more than 15 years—since 1994-95. I am still unsuccessful.
Recently I received two letters from the college after submitting this report. One is the copy of a result regarding my 2007 clinical examination. To be honest, this is the first time for me to see this result. My total score was less 32. I failed this examination but I was told—and it is well known—that 4-plus is the minimum requirement for each of the six cases for an Australian training physician to pass this examination. I believe that the college has never allowed me to pass this examination because the clinical examination is the final barrier left for me to cross. The position I am looking for is an Australian training physician.
A few days ago, in another letter, the current CEO of the college again refused to tell me who my patient was for the 2007 clinical examination. She stated that it was a misinterpretation of the handwritten note. As you know, I examined a female patient for this examination but she was replaced by a male patient in the feedback letter. This is unbelievable. Until now, nobody can tell me exactly who my patient was.
In summary, I have been living in Australia as an OTP, overseas trained physician, and an Australian citizen. The Medical Board refused to grant me with medical registration. I am not allowed to practise in Australia but I am asked to pass all the FRACP examinations, including the clinical examination. I am 56 years old this year. Sixteen years is a long enough for the college to play the game with me. In fact, an Australian medical student will become a physician in less than 15 years. As a medical doctor, I do hope that I will have a chance to serve our Australian people. It is well known that there is a significant shortage of endocrinologists in the Australian nation, especially in remote and country areas. Thank you.
CHAIR —Thank you very much. Also, thank you to all of you for your statements. Mr Baig, Dr Jin and Dr Butt, thank you for sharing your personal stories with us. My question is directed to Dr Butt. You speak about the three Bs and one C and how that would be a fail in the English test. Could you elaborate a bit more on that. Our concept is that an A, B or C would be a pass.
Dr Butt —‘A’ basically means native speaker level; ‘B’ means high professional standard, and ‘C’ means acceptable English—but, in their eyes, not high enough to be professional standard; and ‘D’ is a fail.
CHAIR —In the example you gave of the three Bs and one C, you would have to go back and sit all four components again—
Dr Butt —All four—
CHAIR —You are suggesting that they go back and just sit the one component, which was a ‘C’.
Dr Butt —Yes. And if they passed that, it would be counted as a pass at the one administration of the test.
CHAIR —My other question is to Dr Jin and Mr Baig. You both spoke about frustration and lack of information et cetera. At our hearings in Melbourne and Brisbane, we heard very similar stories to yours from other overseas trained doctors. So there is a common thread here.
We have been hearing that one of the frustrations is that if you want to challenge a particular examination result there is no independent process of appeal. If someone fails an exam, they need the information to know where they have gone wrong. Did you find that there was nowhere to go to have your case heard or your complaint heard or to have an assessment of what went wrong? This is what we have been hearing from other overseas trained doctors who have gone through similar situations. Do you want to tell us a bit about how you think an independent appeals process would work? Would that have been helpful in your cases?
Mr Baig —Basically, we do not have a right for any appeal. If you pay the money—$65 or $75 or something like that—they will give you the feedback. If you argue with those people, you will be in trouble. I had an argument, a few months ago, last year, with the OET department because I passed three skills already, so I wanted to know where the problem was with the fourth one.
CHAIR —So you passed three components?
Mr Baig —Yes.
CHAIR —And there is one left?
Mr Baig —And I never missed a speaking test. I always passed—eighteen times—the speaking test. When I argued, they failed me in the speaking test. I did not fail eighteen times. This speaking is a problem. My wife advised me, she said: ‘Just sit down. Wait patiently. Drive a taxi.’ I had just started to drive a taxi. I have a big family; four children. I have to do something. There are no complaints from customers. No-one from the company ever had to say, ‘Mr Baig, you are doing the wrong thing.’ I do not want to drive, but I have to. I have four children to support. My wife does not go to work. What is going on?
CHAIR —It must be very difficult.
Mr Baig —My suggestion is that we need more professional people in the OET department to assess the level of English of the candidates. I go again and again; every second month I have to go for this OET exam and I have seen 20-year-old boys—and not Aussies; they are of Chinese origin—conducting this exam. If you are not Aussie, how will you be able to make the assessment? This is a big problem. They are 20-years-old, 18-years-old.
CHAIR —You are saying there are people whose English skills are not at the same level as—
Mr Baig —I have noticed on several occasions, not only one time, that many of the people conducting the speaking tests are not Aussie, not native speakers. If they are not native speakers, how will they make the assessment? That is my point. We need more professional people.
Mr IRONS —Can you give us a brief description of what the English speaking test is?
Mr Baig —In the English speaking test they assess your communication skills, your fluency, a number of things. They give you a scenario, like: suppose a 35-year-old patient comes in with chest pain. You need to take a history and explain to them: ‘It’s a normal thing. You don’t need to worry. It is not a heart attack’, something like that. You are examined on your fluency, your communication skills, and your understanding of this type of thing. They mark you on that.
Dr Butt —They run two role plays—each are five to seven minutes—where the interviewer is the patient and the professional is the professional. They run a scenario—it might be, as he said, someone with chest pain—and you have to ask appropriate questions and then give some outline of treatment or reassurance or whatever you have to give. So they assess your communication. The problem is that that interview is recorded and sent down to Melbourne to where the people who administer the test are based, as that—
Mr IRONS —It is a university based assessment is it?
Dr Butt —It is the CAE. It is related to the university but it is an independent organisation. So the person who sets up the interview—in other words, the interviewer—is anybody. I was doing it from time to time until two years ago when they banned teachers from doing it. They stopped anyone who was involved in OET preparation from doing the test, which I thought was a bit strange. I, and I am sure all other teachers, would act professionally. If we had some of our own students, we could never examine them; we would make sure that we did that correctly. Perhaps they were worried about overseas situations.
Anyway, the last time I went there some of the other interviewers—one man was a bartender and one lady was between jobs—said, ‘What do we do?’ I said, ‘Don’t you know?’ They said they did not know what to do, so I taught them how to run a role-play in the half-hour lunchbreak before we started. They do not mark the thing; they just do the interview to get it onto the recording. The actual marking is done by the trained people in Melbourne, so it is not as bad as it sounds. Nonetheless, I have had students who have had to coach the interviewer and tell them what to do, because they had no idea.
CHAIR —Is it because out in the real world you will get people who will come in—
Dr Butt —That is right. That was the argument that the OET people put. They said that this is a real situation. But they are turning up and saying. ‘Do you have any idea what I do?’ That is what has happened. They should have some training.
Ms HALL —Is there any standardisation of the answers? When the tape is sent back, is there a standardised answer for the questions that removes the subjectivity from it?
Dr Butt —There may not be a standardised answer in the sense that you can answer any question 100 different ways. The interviewer will have a set of questions or directions in which to take the interview.
Ms HALL —I am interested in the answer when it is being evaluated.
Dr Butt —I do not know the answer to that. As I said, you could ask me a question and I could answer it 100 different ways. Probably some are more valid than others. I think they make the assessment on that. There are guidelines. Is their overall communication clear, is their grammar clear, is their tone of voice correct and is their professional language correct? There are guidelines for all of those sorts of things. With any one role-play there is not a set answer, but there are guidelines they have of communicative skills.
Ms HALL —So there can be a degree of subjectivity when the answers are evaluated in Melbourne?
Dr Butt —There could be. I think that is why they normally have two people listen to it, not one—in order to cut that out.
CHAIR —I want to go back to the original question I was asking about the appeals process. I had Mr Baig’s response and I would now like Dr Jin’s response. Dr Jin actually spoke about not being able to find out where he went wrong and to actually challenge the process if he wanted to.
Dr Jin —My story is complicated. It has been not only for a long time but it is for the very strong organisation such as the college of physicians. About 15 years ago when I came to Australia I applied for a GP position. Dr Carmen Lawrence, the former health minister, wrote a letter to me saying that there were no GP positions available in Australia because there were too many GPs. She said I would have to go back to the AMC to apply for the overseas trained physician assessments through the college of physicians.
I started this process in 1994, but the college of physicians asked me to first finish my PhD or master’s degree study because there was a new policy. With things like the OET English test there is always a change of policy, a change in the law. They say you have to do something else. I completed my PhD in 1999 and went back to the AMC. The AMC said everything was okay and I should go back to the college of physicians. This is the key issue. The college has known that I am not allowed to practise in Australia as an Australian citizen. A visiting doctor can practise in Australia but I am not allowed to do that because I am an Australian citizen. It is very difficult and frustrating.
I have passed across all barriers except for the college of physicians test. I passed the English test in 1999 and also I got my PhD degree in my area of endocrinology. Also I passed the FRACP written examination in 2006. This was the last one in 2007. The first thing was why they refused to provide me with the result until a few weeks ago. Also, they write me a letter a few days ago to say, ‘The gender is not have any problem.’ I saw a female patient who had a hysterectomy and a mastectomy, so she was definitely genetically female, but they said she was male.
CHAIR —So the model was a—
Dr Jin —Yes, I believe so. I got confused. This is the last barrier for me. If I had passed the clinical examination I can be a doctor here, I can serve our people. But this is so difficult for me. The solicitor on behalf of the college of physicians told me, ‘Don’t try to think about any legal action against the college of physicians. It will cost you money with your time.’
CHAIR —You have not taken it.
Dr Jin —Yes. To be honest, I have almost given up. I say that that is okay, that is my life here, I do not want to do anything. But this is my last chance. I thank everybody for giving me the chance to just let the public know this story and make a judgment.
CHAIR —That is what we are here for.
Ms O’NEILL —Could I clarify what you have just told us there. There are two elements. One is that you recently received a letter from the college—
Dr Jin —Two letters.
Ms O’NEILL —Two letters providing you with feedback on your tests from 2007?
Dr Jin —Yes, 3½ years ago.
Ms O’NEILL —Do we have copies?
Dr Jin —Yes, I have a copy here.
Ms O’NEILL —We might take those. You also just made a statement about legal advice that you were given. Could you just repeat what happened in terms of the legal advice from the college? And you had a conversation with the college recently and you were given some legal advice. Could you just explain that again—I do not know if I heard you correctly.
Dr Jin —After the 2007 clinical examination I have not got any result. The college just gave me that feedback later, so that I found out the huge mistake there, that the second patient of mine was a male. It was not my patient—the history of the patient was different.
Ms O’NEILL —So you thought about taking legal action?
Dr Jin —I just contacted them and said, ‘There is something wrong there; I am not sure,’ and they said, ‘Everything is okay,’ but I still got confused. I found another solicitor who helped me to write a letter to the college of physicians in 2008. The CEO, Dr Miller—not the current one—wrote a letter back to my solicitor and she checked with the examiner, and the examiner confirmed that he saw the patient who was a male, not female. The current CEO also wrote me a letter saying that the problem was not from the gender but from the handwriting. I believe that as the doctor if you are seeing the patient, you are going to write down the note on the patient—you must know the patient is a male or female.
Ms O’NEILL —Yes, exactly.
Dr Jin —If you were the patient and you got a letter to say that you are male, it would be terribly frustrating. But my key issue is that until now the college of physicians never ever give me explanation. They never said, ‘This is wrong; I am so sorry.’ If the college say sorry to me, maybe I say okay—maybe something is wrong with me, but definitely I am not sure who was my patient.
Ms O’NEILL —Thank you very much for that. Regarding the testing that you spoke about, Mr Baig, you undertook tests in those four areas—reading, writing, speaking and listening—and the test that goes to Melbourne to be assessed is a tape, a sound file, of your interview with the ‘patient’ in the role play? Is that correct?
Mr Baig —Yes.
Ms O’NEILL —Is a video provided? We know that a fair degree of communication through people is visual, but we are relying totally on a sound file of an interview that happens with somebody who may or may not be prepared for the capacity to do a role play.
Mr Baig —That is correct.
Ms O’NEILL —Would you consider that a very high-quality test?
Dr Butt —Of itself it should be but it is not.
Ms O’NEILL —So there are significant problems with the test?
Dr Butt —From the feedback I get from students.
CHAIR —Before we go to the next question, I need a committee member to move that we accept the two letters from Mr Jin as evidence: one being the letter from the Royal Australasian College of Physicians and the other being a letter from the Royal Australian College of Physicians.
Mr IRONS —I move that.
Mr COULTON —I second it.
Mr LYONS —You have done the test 19 times.
Mr Baig —Yes.
Mr LYONS —Is it always that particular section that—
Mr Baig —It is just the same: the same reading; the same writing; the same, ‘I have to practice a lot’.
Mr LYONS —So you passed the other three?
Mr Baig —Yes. I am passing three and missing one C grading 19 times. I said to these people: ‘Do this same test again and again 19 times and then I will ask, “How do you feel?”‘ It is so terrible.
Ms HALL —For listening?
Mr Baig —No, missing the reading test.
Ms HALL —Reading is the one you fail?
Mr Baig —Yes. But I passed all four in the past with a B grade in 2004 prior to my medicine: B, B, B, B.
Mr LYONS —So why do you have to do it again?
Mr Baig —They said it was more than two years. This two years policy was introduced from 1 July 2007. Before that, the medical board never asked to English-test AMC graduates. There are four pathways to registration with the medical board. If a candidate who lives overseas is looking for work in Australia, he/she can apply for one of these pathways here. Obviously, you need English. But I have passed the English and I have supplied that result to the AMC and asked, ‘Why are they asking again?’ I have come to sadly regret it. They have written in the AMC certificate, ‘Mr Baig has satisfied the requirements of the council and has successfully passed his examination.’ So what else are they looking for?
Ms O’NEILL —Dr Butt, you explained that the standard of English in the nine years that you have been teaching this course has continued to rise and rise.
Dr Butt —Yes, I think the test—
Ms O’NEILL —Could you give us a little bit more detail about that? Are there any copies of these exams that we could see?
Dr Butt —I am sure there are copies. In my experience, the writing and speaking levels have been approximately the same over those nine years. I do not think there has been a big change. There may have been a change in the marking standard—that is another question—but not in the actual doing of the test. The reading is much harder. They have added a second component to reading, where you have to skim and scan some texts and complete a cloze—
CHAIR —Skim and scan?
Dr Butt —Skim and scan means to read very quickly and then scan through to find particular pieces of information. They then complete a cloze, which is like a summary with missing bits, and you have to fill in the missing bits. There are about 35 missing bits and you have to do that in 15 minutes. I think it is actually quite a good test, but it is probably set a little bit too high; it is a little bit too hard. But the actual idea of having a test like that is okay. If members of this committee were to do it, you would succeed, but you would want all 15 minutes, I think, and you would want to have had a good night’s sleep the night before.
Mr COULTON —Or you would not pass that well.
CHAIR —In other words, I would fail it today because I was up until 2 am.
Dr Butt —Then they have a multiple choice section. That is a little more challenging than before. The other thing that is more challenging is the listening test. There are two components. One is taking notes from a health professional and patient interview. The other is a lecture of perhaps 20 minutes on a health subject that you have to write specific answers to. There are a lot of questions and if you compare sample tests that they had 10 years ago with sample tests now, it is a much more vigorous test. I am not saying that is a wrong thing; I am just saying it is a fact of life.
Mr COULTON —Even though the test is an English test, it does assume you have medical knowledge.
Dr Butt —General medical knowledge—no specific medical knowledge. We are talking about doctors; but I also have lots of nurses, dentists and others as well. For example, nursing students—until the nursing board changes its mind, which it may do shortly—also have to do that test. They often have names of drugs and diseases that you would not expect them to know, yet they still have to pass at the same level, which I think is wrong.
Mr COULTON —The LLNP has now been tendered out to private providers. I presume there is a private training organisation that would be doing that. Is that a set curriculum? I have issues in a couple of my towns. But the people who are doing the LLNP out there are quite often people who have an insufficient education. There are a lot of Indigenous people doing LLNP to get the basic literacy to pass a drivers licence, for example. That course has the flexibility to handle highly educated people, but coming in as a second language.
Dr Butt —I presume it does. We obviously have a very high level of literacy in this particular area. When we were using that program we did have a lot of feedback. We had to get lots of samples of materials and things we had to give to someone—I am not sure who because the administration people did it—to check that we were working at the sort of level they were expecting us to work at. There was quite a lot of oversight of that program to check that we were actually teaching what we were meant to be teaching and not just down having a good time at the pub.
Ms O’NEILL —Is there oversight of the tests in that their candidates can receive a copy of their test? Do they receive a copy of the sound file?
Dr Butt —No, they do not. They get a feedback page. Somebody mentioned that. I have brought a sample of one if you want to see it. One of the students has given me permission to give that to you. It is a feedback on their writing. They give specific examples of where they made errors in their writing. Looking at that, the number of errors is so small that I cannot believe that they did not pass. If they do not like that feedback it doesn’t matter—do an IELTS test instead.
Ms O’NEILL —How much does it cost to get the feedback?
Dr Butt —I think it is $70 or $80.
Ms O’NEILL —How much does it cost to sit the test on each occasion?
Dr Butt —It is just under $600.
CHAIR —I just note that the committee accepts the ‘Occupational English Test’ document as evidence for the inquiry. Moved by Mr Lyons and seconded by Mr Irons.
Mr COULTON —Mr Baig, you are driving a taxi now. Since you came to Australia, have you been working anywhere in the medical system as a doctor?
Mr Baig —I had over eight years experience as a general practitioner in Pakistan.
Mr COULTON —Have you worked as a doctor in Australia?
Mr Baig —No, I did not. Because when I came here in 2004-05, I had a few options at that time. I could apply for direct registration to the medical board in an area of need. But I thought that the AMC pathway would be more secure, if you passed the exams. But that was wrong thinking. I understood that once I pass all these steps—the English, the MCQ exam, and the clinical exam—I would get the full registration. First I would get temporary registration for one year; then it would be converted to full registration.
Mr COULTON —You have been in Australia for about six years. Is that going to present a difficulty, not having practised medicine for six years? Obviously, with medicine being a fluid, moving type of occupation, is that going to be a problem for you when you eventually do get through this pathway?
Mr Baig —I do not think so. I have just been in Pakistan for five weeks and I practised for about 10 days with a friend. I did very well. I recently passed the post-graduate diploma in child health from the Westmead Childrens Hospital. I passed it with very good marks. I have a certificate and have very good marks. My point is that I am looking at the one-year supervised training program. In that program you do not even prescribe paracetamol to the patient. You have to work under supervision for one year. I am looking at that job because I have done all these steps successfully and just because of this English I am out of the system, driving a taxi.
Ms HALL —We have heard similar stories throughout Australia. The thing that really interests me, and I think it is an important point for the committee to take a note of, is the fact that because you are an Australian citizen, Dr Jin, you are in a different position to somebody on a 457 visa. The simple fact that you are an Australian citizen means that you cannot practise in the way you could if you were on a 457 visa. Would you like to explain that to the committee?
Dr Jin —It is a good question—unbelievable. An overseas trained doctor on a visitors visa can practise in Australia.
Ms HALL —A 457 visa.
Dr Jin —Especially if they are from a European country or a Commonwealth country. They can practise here but if you are an Australian citizen you are not allowed to do that. You have to apply for the position through AMC or the medical board to apply for medical registration. Otherwise it is illegal to practise in Australia.
Ms HALL —So there is actually a disincentive for overseas trained doctors to take out citizenship.
Dr Jin —This is a long story. They changed lots of the policy. When I came to Australia 20 years ago—there were another five countries. The doctors did not need any assessment; they could practise here. But for me, especially from an Asian country where English is not your first language, you have to pass all the examinations required by the AMC or the College of Physicians. Also, if you have your permanent visa, or citizenship, you are not allowed to do that.
Ms HALL —Dr Jin, since you have been an Australian citizen, you have travelled overseas—was it Canada—and practised medicine.
Dr Jin —Not it was not me.
Ms HALL —So the whole time you have been here you have not practised medicine.
Dr Jin —Since 1994 I have been studying or working in RPA hospital—for more than 10 years. I completed my PhD whilst training there.
Ms O’NEILL —What sort of work do you do at RPA.
Dr Jin —In 1994 I applied for the temporary position, for one year, as a research assistant with Professor Handelsman. In 1994 I started my PhD study and completed it in 1999 while working in the endocrinology department at RPA Hospital. In 2003, I applied for the unpaid position—just as a volunteer—of endo registrar for 12 months. But the College of Physicians had decided that I had to stop that position and focus on the FRACP written and clinical examination again. That is why I stopped there and focused on the examinations.
Ms HALL —My next question goes to all of you, Dr Butt included. What impact does the simple fact that the rules keep changing have upon everybody involved? Also, do you have any suggestions as to how that can be dealt with to ensure fairness for people that enter the system at a particular time and still encompass the changes?
Dr Butt —I agree that that is always going to be a problem. As I mentioned a short time ago, nurses doing their training find that halfway through their university course they suddenly change the English requirement rules, even though they have already started. What they should have done was say ‘in 2013’, or whatever, ‘these are going to be the rules’. Then people who had not started yet could know those rules. It is the same with doctors. The rules change every two years and one of the things that councils should do is give notice of that. The rules should not change as of tomorrow but as at a certain time in the future so that people who are in the process do not get disadvantaged.
Ms HALL —Would you be supportive of a system that assessed people under rules whereby they agreed to come and practice in Australia, as opposed to assessing them under a changed rule? Or do you think they should all be assessed under the changed rule?
Dr Butt —I think that is natural justice really.
Ms HALL —It is, isn’t it.
Dr Jin —I passed the OET test in 1999. If you got a ‘C’ for each of the four components of the OET test you passed the whole examination. If you failed one of the components you just had to repeat that one, you did not need to repeat all four of them. I think that was fair. English is very important for professionals such as doctors; it is necessary. I think that a ‘B’ pass for each component is too high. Maybe even Australian trained doctors could not pass if they had to get a ‘B’ for each component.
Ms HALL —Going back to the English exam, I like the idea of a supplementary exam following quickly if a person misses one particular component of the four. I think that is a new and different suggestion. How long does the whole exam take and what level of concentration and application does a person have to put in?
Dr Butt —The exam takes most of the day. The three components of writing, reading and listening are done over a half day—perhaps from 10 in the morning until two or something in the afternoon—with interviews in the afternoon.
Ms HALL —By just coming back and doing a supplementary in one area it could link in to the—
Dr Butt —It would have to be done after the marking was done, so it would have to be several weeks later. It is a question not so much of the timing but of the fact that they count it as if it were at the one administration.
Ms HALL —Yes, I agree. I think that is really a positive suggestion.
Dr Butt —One of the problems probably will be that the people who run the English test will say, ‘We are just running an English test. It is none of our business.’ And the people running the Medical Council will say, ‘We are just getting the results. It is none of our business.’ The fact is that the students have somehow got to coordinate that.
Ms HALL —I have noted your comments about public education. What can be done to increase the transparency around English language testing and the whole of the system? Anyone can come in on that but I know, Dr Butt, that your particular area of expertise is English.
Dr Butt —I have been preparing people who have been in this situation for some years. It is mainly—and the gentlemen today have mentioned this; they have all had issues—the 19 sets of issues. At some of the times that you get feedback, you get feedback from the people who are paid to pass you or fail you. I have given you an example of what I think is a feedback that really does not help very much and probably convinces me that the person should have passed. There has to be some system whereby an independent person or group can look at that and say, ‘Well, you were hard done by,’ or ‘No, actually the result was quite fair and you need to redo the test.’ Mind you, that could be quite expensive.
Ms HALL —I have a final question. Do you think there is a need for an independent review process—that is, one removed from the current processes that take place—which is, say, similar to that of an ombudsman whereby process is looked at?
Dr Butt —Yes, I do.
Mr Baig —From my point of view, we need more professional people in the department. They have to consider my number of attempts. I am talking about my case in which I appeared 19 times. They have to consider my case where I have passed this 4B in the past. They have to consider that. Apart from that, they can organise some special course for the overseas trained doctors, the international medical graduates, so that they can work in the health system. It might be the less cost-effective, but it would be a good idea.
Ms HALL —Dr Jin, the independent appeal process?
Dr Jin —I think the OTE test is necessary. I have done it before. Maybe I am going to resit that again as required by the Medical Board. But I think a B pass is also necessarily—
Ms HALL —I am not just talking about English.
Dr Jin —I have no comments at the moment for myself. For the OET, I can say something. But for me the frustration is the clinical examination result. The Australian paperwork has four-plus. I saw six patients and each patient got four-plus. Four-plus is enough to pass the examination for an Australian training physician. But my result was 32. I do not know why the number was 32. It means that 32 is much higher than 24, because four times six is 24, and that is enough. But my score was 32. That is unacceptable.
CHAIR —Mr Irons has been waiting extremely patiently throughout this session to ask you some questions.
Mr IRONS —Mr Baig and Dr Jin , I admire your resilience and determination to achieve your goals; but, if you are not going to achieve your goals in Australia, at what point do you make the decision to leave the country and maybe pursue your chosen vocation somewhere else? Is there a tipping point? Is there a level where you say: ‘Hang on. I’ve done 28 tests. I’m not ever going to get through this system. I’m going to give up and head back overseas.’ And we in Australia may lose the opportunity to have some more doctors practising in Australia.
Mr Baig —From my understanding, there are dozens of doctors who have the problem of English issues. They have not been working. So all these doctors need to have their cases reviewed by the Medical Board to get to work in the health system. We need to change some of the rules by which we can come into the system to start our work because we have already lost our precious time—four years. Mr Coulton asked me. You are out of touch for a long time. It is a very serious issue because we are not working and we are driving taxis. Some other people are working in factories after doing all this study. It is a very serious issue and we are very concerned about the uncertainty of our future.
Dr Jin —I am Australian. I have been here for many years. I cannot go anywhere. I am just looking for the chance to use my knowledge. I do not want to waste the time. My parents are quite old. They are retired doctors in China. My dad is 87 this year and still consults with patients. He always said: ‘Use your knowledge to serve people, so don’t waste your time retiring at home. You are wasting your time.’ Now I am definitely having trouble here in trying to look for a job. I prepared for the examination for quite a long time. I cannot leave here. This is my country. That is my answer.
Mr IRONS —On that basis, if you deservedly got your registration do you see any problems with the supervisory 12 months? Do you understand the full process of what you would be engaged in over those 12 months, plus the pitfalls, and the areas that the supervisory role would look over during those 12 months? Are you fully aware of that? Have you been given that pathway and shown what it will be?
Dr Jin —From my position, I know the qualification. At the beginning, the college of physicians are unwilling to know me as a doctor because they cannot trust me. So they said to me that I had to pass everything, including what you say in the peer review. They asked me to work in a hospital and have the peer review. I do not mind. I like that because I have been Australian for many years. I have not practised here. This is my problem, I know that. I need the time in a hospital to practise, but I am not allowed to do that without the medical registration. That is why I applied for unpaid positions, which mean that I have no responsibility to see patients. That is another problem for me. I definitely need the time to look after patients in a hospital. That would be a good chance to practise and improve my medical knowledge and skills. That is necessary, but I did it in 2003.
Ms O’NEILL —Dr Jin, I am very pleased to hear that your father is 87 and I hope, if this is resolved, that we might have 30 years of you practising in Australia. I noticed in the evidence that you gave you spoke about working in America. I also note in your evidence today, Mr Baig, that you have returned to Pakistan to practise and refresh your skills there. That is the first I have heard about seeking opportunities outside the country to maintain your skills. Is that common and could you tell me a little bit more about that?
Mr Baig —I have over eight years experience. Where I live in Karachi there are heaps of patients. Normally we check about 150 to 200 patients. I have gathered these skills over a long time. I do not think that during this time when I have not been in the field that I have forgotten these skills. I am planning on looking at the situation in the next few months to the end of this year; otherwise, maybe I will go back to my country or to some other country to start my practice again.
Dr Jin —Last year, I prepared the FRACP clinical examination again, in 2010. Because I am not allowed to practise in Australia, I have to go back to Beijing. The American hospital is there. This looks like similar compared with Australia. My friend who was still working there said, ‘You can come here to practise.’ It may help me to practise there and pass the clinical examination. I was in China for a couple of months.
Ms O’NEILL —That was in your evidence. So it was the American hospital in Beijing that you went to.
Dr Jin —Yes. It looks like an American hospital. I checked from the website. These American people opened the hospital in China because now Chinese changed laws. I do not know why. But the American people are allowed to open the hospital in China. They see all the foreign people in China. The patients are all from different countries, foreign people.
CHAIR —The time allocated for this session has come to a close, so I would like to thank Mr Baig, Dr Butt and Dr Jin. Thank you very much for your evidence both written and the statements you have given here today. If there is anything further that you wish to inform us about in the near future, please feel free to contact the secretariat, and vice versa. If we need to clarify anything or to speak with you again, we will contact you as well. Once again, thank you for giving your time today for us to hear what you have been through, your views and everything that we have collated from you here today will be part of forming our recommendations for the inquiry once it is completed. Thank you very much.