The RACGP says anything but a ‘cautious rollout’ would be indicative of a ‘recklessness’ not seen before from AHPRA and the board.
The lack of clarity around the upcoming specialist IMG fast track – namely supervision requirements, what countries will be considered equivalent and more – is “extraordinary”, says RAGCP president Dr Nicole Higgins.
But ultimately its workforce maldistribution that remains a pressing problem, adds the chair of the Council of Presidents of Medical Colleges of Australia, Dr Sanjay Jeganathan.
Last December, the Kruk report – which reviewed the registration process for overseas trained doctors – recommended a new or expanded fast-track pathway for specialists in shortage.
In April, the Medical Board proposed a pathway – which took the colleges by surprise – that would see medical graduates with “substantially equivalent” overseas qualifications fast-tracked for specialist registration through the Australian Medical Council, rather than through a specialist college.
The plan is for the pathway to be available to specialists in four areas identified as most in need: general practice, anesthesia, obstetrics and gynecology and psychiatry.
Implementation is set to start with GPs on 21 October, subject to ministerial approval.
Speaking to Dermatology Republic, Dr Jeganathan said that the underlying workforce issue remained maldistribution, as opposed to simply short supply, of specialists.
“The problem is not uniform across Australia so our response cannot be one size fits all,” he told DR.
“The proposed expedited Specialist International Medical Graduate pathways must address not just overall doctor shortages, but the critical imbalance in the availability of specialists and GPs between rural and urban areas.
“The CPMC is committed to working with AHPRA to refine these pathways, maintaining high standards while improving our medical workforce distribution.”
The RACGP – which potentially stands to lose a chunk of examination and membership fees as a result of the new pathway – says it remains in the dark about major details, including what will constitute “substantially equivalent” qualifications and plans for supervision.
“The fact we still don’t know the answers to these questions makes us question if [the board] is ready for a process that’s supposed to start in weeks,” said Dr Higgins.
“If this is going to start so soon, it needs to be with a cautious rollout.
“Anything more would reflect a recklessness we do not expect and have not experienced from the Board and AHPRA.”
The college has raised concerns with the board about the readiness of the pathway and possible clashes with the current expedited pathways.
Dr Higgins called on the board to heed the college’s concerns.
“We work with the board continuously, and for there to be so many known unknowns is extraordinary,” she said.
“As things stand, this process relies on a paper-based suitability assessment, whereas we and other colleges have fast-tracked our processes for overseas-trained specialists while keeping the rigour and standards our patients expect.
“The deeper concerns though are about what we don’t know.
“The board must have appropriate systems, processes, and resources available to ensure the new pathway truly ‘expedites’ the process.
“We have yet to see evidence of this.”
Dr Higgins said the college had not been told what qualifications would be eligible for the pathway.
“We have been clear that if this is to happen so soon, only GPs with training in contexts most similar to Australia should qualify – the UK, New Zealand, and Ireland,” she said.
“This isn’t about which countries are ‘best’, it’s about which practitioners will be able to practice safely in an Australian context from day one.
“Australia is a different context with different systems to the US and Canada, for example.”
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The plan for supervision also remained unclear, said Dr Higgins.
“We have been told there will be a six-month supervision process under an expert Australian GP, but we have yet to hear what that supervisor will be monitoring, and what will be measured and how,” she said.
“We don’t even know what is supposed to happen when a practitioner is approved to come and start practicing in Australia under supervision, but is found to be unsuitable for the program.
“That’s deeply concerning.”
Dr Higgins called on the government to instead support the college’s fast-tracked specialist pathway.
“The government must also support the training of more GPs here,” she said.
“Ensuring Australian doctors training as GPs have the same remuneration as other specialists in training would make a big difference in incentivising them to train as GPs.”
The AMA previously told the Department of Health and Aged Care the “rapid” timeframe for implementation was “unrealistic” and insufficient given the “very significant changes” involved.
