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Thursday, 26 November 2009
Page: 13153


Mr DREYFUS (1:29 PM) —Since coming to office in November 2007, the Rudd government has paid close attention to reform of the health system and that close attention has taken the form of innovations in relation to primary health care and preventative health care, and a great deal of consultation and listening to the community. Since the release of the national health report by the Minister for Health and Ageing in the middle of the year, we have seen the Prime Minister at very many hospitals throughout the country, sometimes in the company of the health minister and sometimes with other ministers. It is an indication that the Rudd government, from the Prime Minister down, is listening hard to what Australians have to say about the need for reform of the health system.

The emphasis that has been placed on preventative health care and primary health care is very important. Certainly what I hear constantly from people in my electorate is the need to attend to and to make sure that the system works in favour of the interaction that most people have with the health system, which of course is not in large hospitals or in relation to very acute conditions but rather in day-to-day medical care and, in particular, the care that is provided to the community by general practitioners. Certainly I have heard in the course of a men’s health forum that I conducted earlier this year at the Central Bayside Community Health Services centre in my electorate, which was attended by the health minister, about the importance of ensuring that the primary healthcare system is delivering services in the way that it should. And at a women’s health forum that I conducted in my electorate later in the year we very much got the same message—that is, it is important that the primary healthcare system deliver services.

The particular legislation that is before the House, which is the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 has, as its focus, changes to the way in which New Zealand doctors are able to work in Australia. It proceeds by treating New Zealand doctors—and it is entirely appropriate that this occur—differently to the way in which the system treats doctors who have obtained their qualifications in places other than New Zealand or Australia. It is perhaps not well understood by the wider community, but it is a fact and has been for many years, that the Australian Medical Council, which is the body that accredits training institutions and, in particular, accredits undergraduate training for doctors, administers a system that looks, together, at Australian medical schools and New Zealand medical schools. Although it is called the Australian Medical Council, it is one which delivers accreditation to New Zealand undergraduate medical training in exactly the same way as it delivers accreditation to Australian undergraduate medical training. It has produced the outcome over many years that New Zealand undergraduate medical training is undertaken to exactly the same high standard as is reached in undergraduate medical training at Australian institutions.

It has also been the case for many years not only that New Zealand citizens and New Zealand permanent residents undertake their undergraduate medical training at Australian medical schools but that numbers of Australian students—that is, Australia’s citizens or Australian permanent residents—go to New Zealand to undertake their medical training. It is quite appropriate that there be an adjustment to the system which recognises that closeness of association between Australia and New Zealand and recognises the high standard that is achieved in New Zealand undergraduate medical training.

Since 1997 the Health Insurance Act has adopted a mechanism which creates a 10-year moratorium for overseas trained doctors and former overseas medical students. The 10-year moratorium is a bar on those medical practitioners providing professional medical services that attract Medicare benefits for a period of 10 years. That is why it is called the 10-year moratorium. It is used as a tool of workforce management. It is possible for an overseas trained doctor or a former overseas medical student to be granted an exemption from that 10-year moratorium, and a primary consideration—and the legislation sets this up—in granting an exemption from section 19AB of the Health Insurance Act is that an applicant is working in an officially designated district of workforce shortage.

What that produces is that section 19AB, which sets up this 10-year moratorium, is able to be used as a key mechanism in directing doctors to areas of our country which are experiencing a shortage of doctors. Generally speaking, those communities tend to be rural and remote. It has produced the result over time that a very significant proportion of doctors in rural and remote areas are overseas trained doctors. I think it is probably obvious to all that, were it not for the adoption of this mechanism sometime back, there would be very many areas of our country, particularly rural and remote areas, where there would be no doctors at all. It is the case that there are very many communities in Australia that are reliant on overseas trained doctors.

As the Minister for Health and Ageing commented in her second reading speech, Australia is certainly not alone in facing that phenomenon. Other OECD countries, notably Canada, the United Kingdom, New Zealand and the United States, have experienced a very significant increase in the number of foreign trained doctors working in their countries. Recognising, however, the closeness of training and the high standards that are reached in undergraduate medical training in New Zealand as well as in Australia, this legislation seeks to remove the restrictions which are imposed by effectively a combination of the Australian Citizenship Act and the Migration Act on New Zealand citizens who have trained and obtained their medical qualifications either in New Zealand or in Australia.

The way in which the provisions currently interact is that the Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with many benefits and citizenship rights. One of those provisions accords to New Zealand citizens permanent residency rights without the requirement of obtaining a permanent residency visa. A number of other speakers in this debate have commented on the hundreds of thousands of New Zealanders who are living in our country and making a tremendous contribution to Australia. They are very often very well educated and very enterprising people and fit very closely in the Australian community, not just for the reason that English is their native language but for many reasons of cultural similarity. I have noted that many of the other speakers in this debate have commented on the closeness of association in relation to various sporting events. Indeed, we have shared competitions with New Zealand in a range of sports.

While that is the situation created by the Australian Citizenship Act, the Migration Act, by various provisions in the Health Insurance Act which interact with it, is the authority for determining residency status. Under the Migration Act, New Zealand citizens who are living in Australia, even though they are able to come to Australia without obtaining a permanent residency visa, are considered for the purposes of the Migration Act to be temporary residents of Australia. The consequence of the interaction of these provisions is that New Zealand citizens who are doctors are considered for the purposes of the current regulatory regime to be overseas trained doctors if they were first recognised as medical practitioners after 1 January 1997.

As I indicated earlier, it is the case that many New Zealanders elect to receive their undergraduate medical training at Australian universities and some Australian citizens or permanent residents elect to receive their training at New Zealand universities. It is wholly appropriate that the health insurance regime recognises the high standards of undergraduate medical training that are provided in both Australia and New Zealand and recognises that, where we have someone who happens to be a New Zealand citizen but who has received undergraduate medical training that is for all intents and purposes identical to that of an Australian citizen, and sometimes there will be Australian citizens obviously educated at exactly the same medical school at exactly the same time, it is appropriate that there be a recognition of the standard of undergraduate medical training that New Zealand citizens or New Zealand permanent residents wishing to work in Australia have and to treat them differently to medical practitioners who have obtained their undergraduate medical training and their medical qualification in a place other than New Zealand or Australia.

The technical result of the amendments that are contained in this bill will be that New Zealand residents or citizens who have obtained their primary medical degree from an Australian or New Zealand medical school who would under the current provision of section 19AB have been subject to the 10-year moratorium will no longer be subject to that moratorium. Any person who has already commenced working in Australia and being subject to the moratorium will also no longer be subject to that moratorium. Equally and obviously, in relation to a New Zealand citizen with training from an Australian or New Zealand university who has obtained a section 19AB(3) exemption, for a person in that category the exemption will cease to have effect.

It is to be noted that the Department of Health and Ageing is very well aware that there will be some New Zealand citizens and some New Zealand residents who have come to Australia wishing to work as medical practitioners whose undergraduate medical training was not at an Australian or New Zealand medical school. The legislation draws that distinction and it will be the case that any New Zealand citizen or New Zealand permanent resident whose undergraduate medical training was not from a New Zealand or Australian university will continue to be subject to the regime that presently applies to them.

Although the moratorium provision and the exemption which goes with it are directed at ensuring that the workforce shortages that are experienced in rural and remote parts of Australia are able to be managed, it is also the case, and I hear it constantly in my electorate, that there are in fact shortages of doctors in the outer suburbs of our large capital cities. My electorate takes in a range of middle and outer suburbs, including in particular growth areas like Carrum Downs, Keysborough, Springvale and Dandenong South, which are in part established but also are experiencing great expansions in new housing. It is also the case that suburbs like that which are at a distance of 20 to 40 kilometres from the centre of Melbourne—and there is a similar phenomenon in Sydney and Brisbane—are finding that the traditional model of provision of general practitioner services, which was a solo practitioner operating a family practice in possibly a fairly residential setting in the suburbs, is disappearing. Practices that have been conducted for decades are not able to be sold, not able to be transferred to a younger practitioner because younger doctors, it seems, wish to work more in group settings. What is being found is that the spread of provision of general practitioner services is in decline. Certainly that is something that is constantly mentioned to me by the GP networks in my electorate—that is, the Dandenong-Casey GP network and the Bayside GP network.

The Dandenong-Casey network covers the eastern part of my electorate, across into Casey and into the federal electorate of Holt. The Bayside GP network covers, as the name suggests, the suburbs along Port Phillip Bay. The phenomenon of shutting down solo general practices is one that has now been going on for several years and is continuing. I contacted the hardworking CEOs of those two GP networks: Kath Ferry, who is the CEO of the Bayside GP network; and Anne Peek, who is the CEO of the Dandenong-Casey GP network. I meet with them as often as I am able. They are able to keep me informed about issues of concern in the health system. They had some very favourable observations to make about this amending legislation, both of them saying, in effect, that it was desirable for the simple and obvious reason that it will make it easier for New Zealand doctors to come and work in Australia. It is likely that that will benefit electorates like mine and communities such as those I represent because it is likely to increase the availability of doctors and will deal with workforce shortages that are occurring in the middle and outer suburbs of our cities, even though those areas are not designated areas of workforce shortage. Kath Ferry, the CEO of the Bayside GP network, said, ‘The measures are desirable to make it easier for New Zealand doctors to work in Australia and will help to address workforce issues in areas like ours which are other than officially designated districts with workforce shortages.’

Anne Peek, whom I mentioned earlier, the CEO of the Dandenong-Casey GP network, said, ‘Not only are New Zealand doctors excellent but the proposed measure in this legislation will help our area enormously in addressing the supply of doctors.’ It is to be sincerely hoped that her expectation of the worth of this legislation is in fact realised.

The legislation has some other, minor changes in it, but the major measure that is contained in it is of course the appropriate recognition of the different status of New Zealand doctors who have received their training in Australian or New Zealand medical institutions. The second change is to amend the classification, which is presently used in the legislation, that places restrictions on a category of individuals known as—and this is the defined term—‘former overseas medical students’. That is to be amended to ‘foreign graduate of an accredited medical school’. It is an appropriate amendment to make because the term ‘former overseas medical student’ has been commonly misunderstood and has resulted in significant confusion among doctors. The term is very much intended to refer to foreign persons who graduate from an Australian medical school, and renaming the term as ‘foreign graduate of an accredited medical school’ aims to remove this confusion.

The third matter that is dealt with by this legislation is the removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. (Time expired)