Internationally trained doctors are facing a raft of tribulations in Australia, writes Habibur Rahman.
SABRINA* moved to Australia after marrying an Australian citizen who was born in another country, with the intention of settling down and putting her abilities to greater use.
Sabrina is a foreign-trained doctor, or international medical graduate (IMG), as the Australian Medical Council (AMC) refers to her. She landed in Australia in 2018 and completed her AMC MCQ in 2019, less than a year later. She began studying for her AMC clinical exam, which she was planned to take in early 2020, when the COVID-19 pandemic hit Australia.
All of a sudden, all the scheduled examinations were cancelled and she has been attempting to book one ever since, as this is the only way to get into the Australian employment market.
This isn't just her tale. It's about an entire community of highly skilled people who are being held back by a system.
The AMC clinical exam has a pass rate of less than 28% which makes it one of the toughest exams in the world.
For reference, PLAB in the UK has a pass rate of 66.7% in 2020, NAC in Canada has a pass rate of 68% in 2019 and New Zealand's NZREX has a pass rate of 60% for the last five years.
Now let's compare the cost involved in these exams. AMC MCQ exam costs $2,720 and clinical exam costs $3,530. PLAB takes 240 pounds ($446.20 AUD) for the MCQ part and 879 pounds ($1634.20 AUD) for the clinical part. The Medical Council of Canada costs $1,330 ($1424 AUD) for the MCQ and $2,945 ($3,152 AUD) for NAC exam. New Zealand clinical exam fee is $771.55 ($747.83 AUD).
Australia has the most difficult and expensive medical exam for international medical graduates. Any ordinary Australian can assume that AMC only hires the best doctors from across the world to practice in Australia so that Australians can receive excellent care.
But what happens after this severe quality control?
Can we expect that these few highly talented IMGs will join the Australian medical system and begin working for Australia after passing the rigours of quality control? We have a world-class healthcare system and a stringent quality control system that outperforms Canada, New Zealand and even the UK.
Can we expect that these few highly talented IMGs will join the Australian medical system and begin working for Australia after passing the rigours of quality control?
However, the facts are not always in line with our expectations. Between 2014 and 2016, there was a 17% increase of UK doctors moving to Australia, from 4,182 to 4,881, which isn’t appreciable if we look at the figures again. The UK has a pass rate of 66.7% compared to 28% in Australia and as a result of such stringent quality control, Australia is recruiting more doctors from the UK, whilst the UK wasn't until March 2021.
Based on personal experience, I estimate that it takes between one and three years to pass the exam and land a medical position.
And, interestingly, no poll has been undertaken on how many IMGs are finding jobs in Australia after passing the clinical exam, or how long the wait is between the two.
Of course, the ideal approach to acquire a job in Australia is to pass the PLAB examinations, which are considerably easier and less expensive, move to the UK and then get a job in Australia, as the number of doctors migrating from the UK is on the rise.
For someone like Sabrina, who is married to an Australian citizen, she cannot go to the UK to start her career because it's 9,443 miles away.
Australia has always had a competent pathway through which any IMG from the UK, the U.S. or Canada can apply for assessment and provisional registration with the Medical Board of Australia.
Even if an IMG passes all of the AMC exams, they do not qualify for registration with the Medical Board of Australia. The UK didn't have such an advantage over Australia until early 2021 when the General Medical Council (GMC) invited IMGs from Australia, the U.S. and Canada to apply for GMC registration.
The truth is that the GMC relies on its own pipeline for doctors, both domestically and internationally, whom they train and then integrate into their medical system, the National Health System (NHS).
In Australia, waits for someone to complete one to two years of training in the UK, Canada, the U.S. or New Zealand, and then waits for them to be integrated into the Australian health system, as Australia lacks a training system similar to NHS.
The Australian health system is ranked 18th out of 36 OECD countries, but it still relies on qualified doctors from the UK, the U.S., Canada and New Zealand. It also lacks the training structure that the UK and the U.S. have.
The UK recruit doctors from all around the world and integrates them into their training system, which can last up to ten years.
In Australia, an IMG must first obtain employment, then obtain provisional registration from the Medical Board of Australia, following which the doctor can apply for full registration after one year of work and then apply for a training post with the RACP or RACS.
A doctor's training post might take anywhere from three to five years.
Most hospitals prefer an IMG having at least three months of working experience within last one year whereas the average waiting time between MCQ and clinical exam is 18 months It gets worse for Doctor of Occupational Therapy (OTD) candidates who fail in their first attempt. they face a wait of about 22 months, in some cases even up to three years.
Most IMGs return to their home countries after passing their clinical exam to work for three to six months in order to complete this requirement. Doctors like Sabrina, however, are unable to return to their home countries at this time. Lockdown is to thank for this.
They have now wasted two years of their lives and are simply waiting for a date to sit for the clinical exam. Even if they pass the clinical exam, they will still have to wait for the ease of lockdown.
At the moment, the cost of flying to any place from Australia has doubled and the cost of returning to Australia has increased by roughly five times if and when Australian immigration permits it.
In many circumstances, there is no way to return because no flights are available. We can now either wish Sabrina luck or issue a warning.
*Sabrina is a pseudonym.
Habibur Rahman is a dual citizen of Bangladesh and Australia. He holds a bachelor's degree from Bangladesh and a master's degree from Australia. You can follow Habibur on Twitter @habibur_1997125.
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