International Medical Graduates (IMGs) bring diverse skills, knowledge, and experiences from their home countries to the advantage of Australians.
Australia has relied upon and benefited from IMGs to meet the healthcare needs of its population. In 2021, more than 52 per cent of Australia’s General Practitioners (GPs) were IMGs. It is well known that as we head toward 2030, we shall be facing a significant deficit of specialist GPs to care for Australians. GPRA is absolutely committed to securing and stabilising the future General Practice workforce training continuum.
Migration of overseas qualified doctors is absolutely essential to address the shortfall in specialist GP labour. As we move forward, it’s critical we address the roadblocks and challenges they face. We recently spoke to Dr Muhammad Raza, GPRA Registrar Liaison Officer for IMGs, and he expressed how disheartening it is to see the lack of support for IMGs and the financial burden they often endure during their training and supervision. He believes that by enhancing training pathways, reducing financial barriers, and implementing strong support mechanisms, we can create a healthcare system that embraces the skills and diversity of IMGs – which will benefit the health of all Australians.
GPRA has read with interest the promise that the recent interim ‘Independent review on overseas health practitioner regulatory settings’ by Robyn Kruk (Kruk report) offers IMGs and Australia. Released in April 2023, the Kruk report recommends immediate actions, such as ‘fast track more cohorts from countries with similar regulatory systems’ to reduce red tape, cost, and uncertainty for IMGs wanting to come to work and live in Australia. You can access the full report here. Specifically, the ‘journey map’ of IMGs (page 32 of the Kruk report) shows the level of complexity that Dr Raza refers to. It maps current pain points, barriers, costs, and articulates feedback from individual IMGs at different stages of their recruitment process.
GPRA welcomes the immediate implementation of these recommendations in the Kruk report, which addresses the current operational system to essentially ‘get the house in order’.
Whilst GPRA welcomes these recommendations, we ask how are we, as medical leaders, going to be able to bring IMGs to Australia ethically? And how do we support them when they are here? Healthcare is a scarce resource and everywhere needs more doctors. We must contemplate how we can ensure ethical recruitment practices in conformity with the provisions of the WHO Global Code of Practice on the International Recruitment of Health Personnel (the WHO Code) and how do we care for them when they are here.
The ethics of ‘medical brain drain’ have been written about in a multitude of papers, and refers to the self-determined departure of medical and healthcare professionals to other countries. Autonomy in decision making and the ability to independently assess information that draws an individual from their source country is key. The WHO Code, a voluntary code of conduct for Member States of which Australia is one, attempts to address this tricky problem of ethical medical immigration citing autonomy within the limits of the source country’s laws for ‘pull’ and ‘push’ factors:
“(Clause 3.4) Member States should take into account … individual rights of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negative effects and maximize the positive effects of migration on the health systems of the source countries. However, nothing in this Code should be interpreted as limiting the freedom of health personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them.”
Ethical recruitment strategies must be embedded early to build a culture of trust with IMG candidates. Clause 4.4 in the WHO Code states, amongst other things, that ‘Member States…. must observe fair and just recruitment and contractual practice in the employment of migrant health personnel….(that they) are not subject to illegal or fraudulent conduct.’ Matters such as registering of employment contracts for transparency are essential, and the question of who could or should do this, fall outside the current Kruk report recommendations, but we hope they could be considered holistically.
In considering the ethical recruitment, retention, and quality training for IMGs, it is our opportunity to consider the existing inequity in Australian Medical Graduates’ (AMGs) different training programs and take the opportunity to uplift the entire system. For example, GPRA would call for a supplement to support base rate parity between GP registrars and non-GP registrars to ensure that GP registrars – both AMG and IMGs – attain the equity desired within the medical workforce landscape. Both this and portability of benefits are essential to create a sustainable GP specialty training continuum (Clause 3.6 of the WHO Code).
The ongoing conversation around developing a sustainable Australian healthcare workforce is of great interest to GPRA. We continue to advocate for quality training and fair working conditions, as well as provision of resources, educational support, and pastoral care for medical students, junior doctors, GP registrars (regardless of their training pathway), and new Fellows.
We welcome, with open arms and hearty support, our IMG colleagues.