Working in AustraliaBMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7175.2a (Published 02 January 1999) Cite this as: BMJ 1999;318:S2a-7175
The number of potential pitfalls for overseas doctors seeking employment in Australia is increasing. Steve Kisely and Judy Jones update the scene
Recent publicity in the Australian press would suggest that there is a severe shortage of doctors, especially in states such as Western Australia.(1) The Australian Medical Association has highlighted how consequent overwork was leading doctors to misuse prescription drugs and alcohol. In the case of general practice the 47 doctors who trained in Western Australia in 1997 were not sufficient for the 62 vacancies that occurred in the state last year.(1) There are also shortages of radiation oncologists, dermatologists, and general surgeons across Australia. In response, the Australian Medical Workforce Advisory Committee (AMWAC) has recommended increasing the numbers of training positions for all three specialties.(2)
At first sight, this would suggest that there are tempting opportunities in Australia for doctors wishing to enjoy a sunny climate and experience the practice of medicine overseas. In this article we set out a number of pitfalls to be avoided when considering coming to Australia. In addition, we highlight how regulations have been tightened and include details on general practice not covered by our previous article.(3)
The perceived shortage of doctors is, in fact, very localised and largely restricted to areas of work where Australian doctors would not consider practising. Those coming to Australia therefore face a variety of registration and immigration rules designed to ensure that overseas doctors work in places or specialties the local doctors do not want to work in.
If you are coming to take up a permanent position make sure that you are sponsored by your prospective employer for permanent residence. People on a temporary work permit can be ejected from the country as soon as their services are no longer required. In addition, they cannot even buy a house.
Most of the Australian medical royal colleges will recognise all or part of training undertaken in Britain. Doctors with specialist qualifications can therefore apply to the Australian Medical Council (AMC) to have their qualifications assessed.(2) The AMC sends these applications to the relevant Australasian college for its view, in much the same way as the Specialist Training Authority relies on the advice of UK colleges in assessing application for entry on to the specialist register. This process is quite separate from any reciprocity in the recognition of training between UK and Australasian colleges for entry into the Australasian college, although increasingly some are insisting that those with overseas qualifications complete some of the examination process. Entry as an overseas medical specialist means that you can work anywhere in Australia within that specialty without the need to pass the AMC examination.
There are two exceptions to this section - general practice and public health medicine - which are outlined later. When applying for recognition of overseas specialist qualifications, make sure that the Australasian college understands the meaning of UK membership or fellowship, the certificate of completion of specialist training, and entry on the UK specialist register, as many of the Australasian colleges seem unfamiliar with recent developments in British postgraduate education. Misunderstandings have meant that some doctors have been given only conditional registration subject to passing the relevant Australasian exam when they should have gained access to the overseas specialist register. In spite of the involvement of the AMC, registration remains the prerogative of the relevant state medical board, and some have become quite strict in conditional registration granted to applicants trained overseas.
Avoid the exam if you can
The examination set by the AMC and consists of a multiple choice paper and clinical examination. The rules concerning this examination change continuously. Currently, you must be a permanent resident before you can apply to sit it. Initially, places were restricted by quota, but now rationing is done by waiting list, the current period being two years. The clinical exam can be taken only when the multiple choice paper has been passed, with an overall pass mark of 50%, and not less than 45% in any of the five component subjects. After passing the AMC examination, doctors then have to work for a year in the equivalent of a preregistration house officer post before gaining full registration. At the end of this long process you may think your troubles are over, but in fact they are just beginning.
A provider number is all
The Australian health system is basically a private health system with national health service provision, known as Medicare, grafted on. Outside public hospitals, general practitioners and specialists providing treatment under Medicare must have a provider number, which is used to process all claims for payment. From January 1997, all doctors trained overseas, irrespective of registration status, have been barred from access to provider numbers for 10 years. The only exemptions are those with specialist qualifications recognised by the requisite Australasian college or for work in an “unmet area of need.” Furthermore, areas of unmet need are subject to review, so you could find yourself suddenly unable to practise if the area in which you are working is re-indexed as no longer being of unmet need.
Even locally trained junior doctors have been blocked from obtaining provider numbers. If they wish to work outside the public hospital system, they have been obliged to compete for places on the general practitioner training programme. Only 400 places have been allocated, less than a third of the number of new medical graduates each year.
Assess the area
Areas of unmet need vary quite considerably. In Western Australia they range from Mandurah, a pleasant seaside resort within an hour's drive of the cosmopolitan city of Perth, to Port Hedland, a grim mining town in the middle of nowhere. Locum agencies will not necessarily tell you of the more attractive alternatives, as they are more likely to find an Australian to fill the post. So check with the local medical board to find out which are the unmet areas of need in the state where you wish to work.(3)
Some forms of registration are linked to specific immigration categories, and once you have embarked on a particular course of action it is difficult to change tack. If you are coming to Australia for temporary experience or for postgraduate training, teaching, or research, a temporary work permit linked to conditional registration will be all you require. However, if you are entering the country to join a partner or spouse who has Australian citizenship or residence you will be barred from conditional registration and will have to go to the AMC to gain registration, either by passing its examination or through recognition of overseas specialist qualifications. In this case entry on a temporary work permit and gaining experience and contacts through conditional registration may be an alternative, although at some stage you will have to leave the country to apply for permanent residence.
General practice in Australia is not considered a medical specialty, and so entry via the recognition of overseas qualifications such as the MRCGP is not an option. General practitioners have to pass the AMC exam, work as interns, and practise in an unmet area of need for 10 years before they can practise without restrictions in Australia. In addition, there is increasing recognition of general practitioner vocational training, and a requirement for specialty training, such as the FRACGP examination, could be introduced during this period.
Similarly, the Australasian Faculty of Public Health Medicine has imposed a blanket ban on assessing doctors' overseas qualifications without their having passed the AMC exam. This means that, although the mechanism for recognising overseas qualifications in public health medicine exists theoretically, the attitude of the faculty prevents any doctor trained abroad from working in Australia. Some medical boards offer lists of agencies of locums, so do not rely solely on those that advertise prominently in the classified section of the BMJ. Check the fringe benefits, such as the provision of a car or accommodation, and whether a prospective employer can offer longer term placements. If you are prepared to go to isolated places remember that you are in a seller's market and so bargain accordingly.
Equal Opportunities in Medicine (EqOpsMed) is a support group of BMA members that helps individual doctors negotiate their way through the maze.
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