Specialist boom through expedited pathway a 'missed opportunity'

This was one of the findings in an evaluation of the first 18 months of the pathway, however only a small percentage were heading to regional and remote areas - something the pathway was intended for.

The report shows WA had the highest percentage of specialists registered through the pathway than any state or territory, during the period up to April. More than a quarter (26%) of the 476 specialists who were registered to practice in Australia via the pathway came to work in WA.

That was higher than New South Wales, Victoria and Queensland, despite the much lower population bases in those states.

Interest is also continuing to grow. Since the evaluation period for the report, monthly summary reports show at any one time there have been more than 100 registrants indicating interest in relocating to WA through the program.

Australia is facing a shortage of specialists and a whole of medical workforce report released by the federal Department of Health earlier this year showed shortfalls were expected to grow.

There is expected to be in undersupply of almost 7000 specialists by 2033 across the country, with this deficit increasing to 12,812 by 2048.

Ahpra said the evaluation shows the pathway is achieving its intended objective of providing a more streamlined registration process for eligible internationally qualified specialists while maintaining the standards expected by the Australian community.

The evaluation found a 29% increase in applications from SIMGs for the tranche one specialties (anaesthesia, general practice, obstetrics and gynaecology and psychiatry), across all paths to registration for internationally qualified specialists since the pathway became operational.

However, Rural Health West’s deputy chief executive Kelli Porter said while the pathway had removed some of the barriers faced by SIMGs like costs and uncertainty around recruitment, increasing the overall supply of doctors was only part of the workforce challenge.

"We also need to consider where that workforce is going. The national data suggests that while the pathway is improving workforce supply, it is not addressing workforce distribution," she said.

The evaluation showed just 6% of all SIMGs that came through the pathway nominated an MM3-MM7 region to practice in - that is areas considered regional, rural and remote and often areas where doctors are needed most.

Ms Porter said the pathway was not designed as a workforce distribution mechanism.

"This is a missed opportunity for rural and remote locations where medical workforce shortage is most acute," she said. 

"We would like to see further consideration given to how the pathway or other mechanisms such as Distribution Priority Area (DPA) can support workforce distribution as well as workforce supply." 

Ms Porter said more work needed to go into making rural opportunities more attractive and viable for doctors and their families, it was not as simple as directing doctors to rural areas.

She said support with relocation, housing, professional development, supervision where required and employment opportunities for partners and connections into local communities needed greater consideration. 

Given doctors entering Australia via the ESP were not required to obtain Fellowship of their specialist college, this could result in a disconnect with their college and may impact on future supervision capacity, she added.

"This is a concern for rural and remote locations where access to supervision is often already limited, so it is important for workforce growth and sustainability that those doctors are able to supervise in the future."

Rural Health West has supported two doctors to arrive in regional WA through the pathway and a further 11 had secured positions and were progressing through registration, visa and relocation processes.  

The report showed about 80% of applicants were going on to be registered to practice in Australia, with most completing the process within six weeks.

Ms Porter said it was also important to remember that the ESP only applies to doctors who meet specific eligibility requirements, and represented only a small number of doctors across the entire workforce.

"International medical graduates who continue to navigate traditional specialist pathways can still face significant costs, delays and administrative complexity," she said,

A senior medical clinician within WA Health’s tertiary system told Medical Forum it could be difficult to locate SIMGs in rural or remote areas without them having experience in such environments.

“I think it’s hard to send people to rural or remote areas because they need exposure in Australia before going rural,” he said.

He said rather than one perfect solution, the WA health system required a variety of different solutions to address the current workforce shortages.

“I don’t see the expedited SIMG pathway as a quick fix solution.”