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Monday, 21 May 2012
Page: 4918


Mr WYATT (Hasluck) (17:03): It is good to have the opportunity of rising to speak on the House of Representatives Standing Committee on Health and Ageing Lost in the labyrinth report, which was an inquiry into the registration processes and the support for overseas trained doctors. This report is interesting because it reflects the complex nature of the accreditation and registration processes and the breadth of issues faced by international medical graduates in their personal and professional lives. Each individual who gave evidence brought a different perspective to some of the challenges that they experienced in this total process—from the time of leaving their country of origin to their arrival in Australia and their appointment to a region somewhere within Australia.

I found the evidence provided by the committee both interesting and vexing. The ongoing challenges were not being considered problematic, and the patterns of access and reasons for failure to me seemed evident, but did not appear to be when we questioned those responsible for the processes when they appeared before us. Whilst things have improved, I hope that this report streamlines the way in which IMGs are recognised for their qualifications, their capabilities and their capacities, and the way in which they meet the registration requirements. I think the Commonwealth government agencies need to better coordinate the service they provide and not assume that all is fine in respect of IMGs, who provide an invaluable service to regional and rural Australia.

The other element that I found interesting was the complexity of the issues facing individuals and the way in which they had to fundamentally go it alone at times in challenging some of the considerations by the professional colleges, and certainly by government agencies, in chasing paperwork and the problematic issues of acquiring additional paperwork from their country and university of origin.

Australia has one of the best health systems in the world, delivering high quality health care to the community. The work of the committee reflects the need to ensure that the status quo is maintained. At no stage did we ever want a reduction in the standard that is provided. In fact, at a hearing in Cairns, three witnesses left the hearing. They made a comment about the committee's inquiry and the details that we were seeking. One of them suggested that we were trying to lower the bar. But at no stage did we ever contemplate that. We have an obligation to ensure that the highest quality of care is provided across this country.

The committee does not support any reduction in the high clinical standards expected of our medical practitioners. Australia is reliant on IMGs to address medical practitioner workforce shortages, particularly in the regional, rural and remote communities, where they make up over 40 per cent of the medical workforce. In some jurisdictions it is slightly higher, but on average it is around that level. IMGs indicated, in both the 22 public hearings and the 216 submissions received by the committee, that in their view they do not always receive the same level of support from the institutions and agencies that they interact with.

The aim of the committee's work was to reduce red tape, duplication and the administrative hurdles faced by IMGs, whilst ensuring that Australian standards continued to be rigorously applied. We heard from those who had difficulties meeting the new mandatory registration standards, particularly the standards pertaining to English language proficiency. One IMG shared a story of how they failed because they were not able to express what an Australian colloquial saying was—which I found very interesting to have included. Another told us about when he was asked 'When an Aboriginal grandma brings a child in for medical treatment what is the first question you should ask the patient?' and he had responded by saying you should ask about the condition of the child. He was chastised for not asking, 'Where is the mother?' On that basis, he did not pass that test. The transcripts, if you get the opportunity of reading them, are well worth looking at. They document some of the challenges experienced by highly credentialed people who through a 10-year period served time in rural and remote Australia.

Let me also say that the response from the Medical Board of Australia, the Australian Health Practitioners Registration Agency and the Australian Medical Council was constructive and positive. In fact, when I met with some of them after we released the report, they were very complimentary about the way the committee had looked at the issues but gave recommended actions that were pragmatic, that they could take responsibility for and implement. We were also ensuring that the supporting documentation, which is often a challenge in terms of presenting it to multiple points of registration and multiple points of examination, became easier with one central depository they could go back to.

We also covered in the report the issue of developing a cohesive and comprehensive system of ongoing support for IMGs and their families, with a particular emphasis on the educational needs of their children along with support and employment prospects for the spouses. The committee recommended that Health Workforce Australia in consultation with key stakeholders develop a nationally consistent and streamlined system of education and training support for international medical placements and for the graduates.

The thing that puzzled me in all of this—it still does to some extent and I hope that we do address it—is that it demonstrated that our workforce planning for our population is not our strength as a nation. If the population projection for the next decade takes us from, say, 22.5 million to 27 million, then why are we not forward planning the number of doctors and allied health professionals that we will need, and making available those places within a university? It makes logical sense. I also do not want to see us plunder other nations for their medical practitioners, because that leaves a deficit in their healthcare systems, and I would rather see us have that as a strength.

The number of medical schools needs to be seriously considered, given the time required for doctors to be trained before they can become general practitioners. We assume that a six-year training degree automatically puts a doctor in situ, where they will practice, but in fact it takes 13 years before they are able to practise on their own. So our time lag is significant. I am aware that Curtin University is seeking to establish a school of medicine to increase the number of doctors for Western Australia and, ultimately, Australia. I hope that in the future they are supported in that endeavour.

The other thing that really struck me was our absolute neglect of rural, remote and regional Australia. Time and time again we heard of the IMG's ageing workforce and some of the challenges in getting people out into regional, rural and remote Australia. We have a requirement for those on 457 visas to spend a period of 10 years in regional Australia; but under some circumstances they can return to a capital city—but they have to be mitigating. It is time that all persuasions of governments at all levels give serious consideration to health services in rural Australia and the models of care that are provided. When we consider what is in this report, I think it should be read by every member of this parliament, because it contains a good synopsis of the challenges we face for the workforce of our health system and, in that sense, will help us to position ourselves to be much more strategic in the training and skilling of people. I would hate to see in 10 years time that we have a lack of numbers to fulfil the needs of Australians.

The other thing that is important in the report is those who contribute to the skilling, to the professionalism and to the quality healthcare system that we enjoy and take for granted. On that basis, I commend the report for broader reading and certainly for support in respect of the recommendations. If they are adopted and taken up, then we will see incredible growth in the number of professionals that service this country. We will see the maintenance of a standard and quality of health care that we take for granted.