Working in AustraliaBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7103.2 (Published 02 August 1997) Cite this as: BMJ 1997;315:S2-7103
A congenial climate and the absence of language barriers makes Australia a popular choice for British graduates who wish to work abroad, but tighter immigration rules could prove frustrating. Steven Kisley reports
Australia and its Commonwealth counterparts New Zealand and Canada have long been popular destinations for medical graduates from the United Kingdom who wish to work on either a temporary or a permanent basis. Changes to immigration procedures, medical registration, and the recognition of specialist qualifications have made working in all three countries more difficult for British doctors. This article, which covers Australia, is the first in a series explaining these changes and their effect on British doctors considering either temporary work experience or permanent settlement in any of these countries.
Australian health service
Australia has a federal constitution and consists of six states and two territories. The health system is a hybrid of publicly and privately funded provision.(1) Although the whole population is covered for treatment in the public system by Medicare, the independent sector is larger than that in the United Kingdom, with significantly more people having private health insurance.
Publicly funded health care is, in turn, a joint responsibility of the federal (termed commonwealth) health department and the separate departments of health in each state.(1) The commonwealth is responsible for Medicare, pharmaceutical benefits, and nursing home funding, while the state governments act as both the purchaser and provider of publicly funded hospital and community services.(1)
There is an oversupply of doctors in many parts of Australia, and, although employment vacancies exist in the more remote areas, fewer opportunities are available in the main Australian cities or regional centres.
Medical training in Australia is very similar to that in the United Kingdom. The award of a primary medical degree is followed by a year as an intern (equivalent to the preregistration house officer year). Junior doctors then undergo a period of basic specialist training of two to three years as a resident within a teaching hospital, usually completed by part 1 or some other primary examination of the relevant medical royal college. Afterwards, trainees spend a further two to four years in advanced specialist training (analogous to training as a specialist registrar), at the end of which they attempt part 2 of the membership or fellowship examination.
As the part 2 examinations are an exit qualification rather than an entry to higher specialist training, there is often a greater emphasis on the acquisition of skills required for practice. Otherwise, the content of specialist training in Australia follows closely that in the United Kingdom.
Working in Australia
Doctors wishing to work in Australia encounter three obstacles, which will vary in difficulty according to whether temporary work experience or permanent settlement is contemplated. These are medical registration, specialist recognition, and immigration requirements. Progress in one is often contingent on success in the other two.
Registration for medical practice in Australia is regulated by separate laws in each state and territory, and the laws are administered by the relevant medical board. Twenty years ago the Australian Medical Council was established as the first step towards uniform medical registration. It acts as a standards and examination body for the assessment of suitability for practice in Australia for overseas trained medical practitioners.
In 1993 the commonwealth and state governments introduced automatic recognition of certain categories of registration across state boundaries. Doctors who have full or unconditional registration in one state or territory are automatically registered and able to practice in another (this is termed portability). Unfortunately, this also provided the opportunity to remove the rights to full registration previously granted to British and Irish trained graduates in some states.
There are now two standard registration categories across Australia. The first is registration without conditions, which is available only to graduates of Australian and New Zealand medical schools or, in the case of doctors holding overseas medical qualifications, to those who are successful in the examinations of the Australian Medical Council. Eligibility to sit the examination is, however, limited to Australian citizens, permanent residents, and doctors who have completed preliminary application procedures for migrant entry to Australia. The examination consists of multiple choice and clinical examinations. The annual quota of candidates who can sit the multiple choice examination and proceed to the clinical examination is 200 on the basis of performance in the multiple choice examination.
Because of the complexity of gaining unconditional registration, most graduates from medical schools outside Australasia opt for the alternative of registration with conditions. This can take several forms.
Temporary or restricted registration without examination is available for doctors visiting Australia to teach, receive approved postgraduate training, serve in shortage specialties, or serve in places of special need such as remote rural locations.
Registration as an overseas trained specialist is available after assessment and recognition of training by the relevant Australasian college. Specialist recognition is important if a permanent move to Australia is contemplated. The assessment procedure varies from college to college but may include a formal interview, parts 1 and 2 of the membership or fellowship examination, or further specialist training. If a doctor is sufficiently senior a final viva may be all that is required. Some royal colleges, such as the College of Psychiatry, have clear mechanisms for the mutual recognition of Australasian and British specialist qualifications.(2)(3) At the other extreme, the Faculty of Public Health Medicine insists on success in the Australian Medical Council's examination before assessing any overseas qualification in the specialty. It is advisable to contact the relevant college for further details. Unfortunately, eligibility for specialist assessment is restricted to the same groups as those that are able to sit the Australian Medical Council's examination: Australian citizens or permanent residents and those who have applied for migrant entry.
The Australian High Commission in London can advise on temporary work permits and migrant entry (see box). Because of the oversupply of doctors in Australia, it is unlikely that someone would be allowed to work in the country on a temporary or permanent basis without sponsorship from a prospective employer.
Getting a job
Finding out about available posts is best done through senior colleagues with contacts abroad. Apart from jobs in the overseas section of the BMJ's classified supplement, posts are also advertised in the relevant specialty journals. The Medical Journal of Australia is available on the internet (http://www.library.usyd.edu.au/MJA/), and its web site contains links to useful addresses in Australia. Unfortunately, it does not contain the journal's classified section, but it is possible to have the advertisement pages of the journal sent by air mail each week at $10 a copy (see box). Jobs are also advertised in ordinary newspapers such as the Australian, the Age, and the Sydney Morning Herald. If time spent in Australia is to be counted as part of training, it is important to clarify with the relevant Australasian royal college that experience will be recognised. With the introduction of the specialist registrar grade in the United Kingdom, a post that is not recognised for training by the Australasian College is unlikely to be recognised as counting towards the certificate of completion of specialist training, so it is important to check beforehand whether such experience is recognised.
Australian medical training is similar to that in the United Kingdom, and British trained doctors will find that drug names and treatment regimens are similar. Pay is comparable to that in the United Kingdom, but the cost of living is lower. The only exception is in the academic sector, where pay can be lower, and it is important to establish the exact details of clinical loading in these cases. Working conditions are generally superior to those in Britain. Hours of work for junior doctors are lower, and there is greater acceptance of shift and part shift working, partly because they are paid at a higher rate than they are in Britain. For senior doctors and general practitioners the main difference is the greater importance of fee for service practice paid for by Medicare, health insurance companies, or the patients themselves. Fee for service as a specialist under Medicare or private health insurance is highly lucrative, especially in the major cities, although the government is now restricting the ability of overseas trained specialists to work for Medicare.(4) The Australasian colleges are currently in negotiation with the government on relaxing restrictions on overseas trained specialists who have membership or fellowship of an Australasian college.
Australia offers comparable (if not better) medical experience to that in the United Kingdom in a sunny climate with better conditions of service. For most doctors temporary registration for postgraduate training, or work outside the major cities, offers the easiest route into the country. Permanent settlers should prepare for a long haul and enlist the help of a prospective employer.