Senate inquiry into medical complaints process: Perceptions can be poison

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Dr Don Kane, who was interviewed this week at the Senate inquiry into medical complaints, warns that it's not the place of graduate eduation or training that should be scrutinised but the regulatory system.

THE FREQUENT use of the terms overseas trained doctor (OTD) and overseas medical graduate (OMG) in headlines and articles regarding misadventures in health services risks stigmatizing all OTDs and OMGs. This may give the perception that overseas training is something of which the community should be wary.

It is far from reality, as the vast majority of OTD and OMG have had training and developed skills equivalent to Australian trained medical officers. The OTD and OMG have the same spread of knowledge and skills as their Australian trained colleagues. At least, that is as it should be if the regulatory bodies are performing the work for which they are empowered and expected to do. Health misadventures are not the sole province of OTD and OMG practitioners, and happen for Australian trained graduates as well. Many Australian medical graduates and trained medical officers undertake training overseas. I was one of those. Thus, it is not the place of graduate education or training that should be scrutinised but the regulatory system.

Care should be exercised in informng the public about misadventures in health services so that unwarranted damage to reputations is avoided. This is particularly so when the regulation and administration of health services is far from perfect in Australia where there are numerous examples of incorrect decisions and actions taken by officers in both areas. 

The process for an OTD or OMG to gain registration to practice in Australia is onerous, time consuming and expensive for the candidate, potential employers and the health budget. The process is quite different to that of many decades ago and yet more misadventures seem to occur in these modern times. Regulation and administrations are a necessity, but the present systems are not functioning as they should and there is a dire need for major change if Australia is to maintain a quality health service. The systems are poorly structured, inappropriately staffed and open to abuse.

OTD and OMG medical officers frequently fill vacancies in Australia in the public and the private sectors often when these can not be filled by local graduates and trainees. The vast majority of recruits do commendable work. Difficult to fill positions in regional, rural and remote areas are often the placement for OTD and OMG recruits. It is regretable that, after extended periods of service in the areas having provided unblemished service without adverse events or on site supervision, a wish to relocate is in many cases blocked by misuse of the regulation system that claims the applicant is deficient in some aspect of practice. This is not Australian and is unacceptable.

The Senate inquiry into the medical complaints processin Australia that held a hearing in Sydney on 1 November 2016 is to report on 16 November and the problems created for OTD and OMG by inappropriate use of the notification process should be addressed by the inquiry. There are too many examples of OTDs and OMGs giving good service to the community with little supervision in regional and remote areas in “area of need” positions who are claimed to have poor communication skills or some other non-clinical problem when they wish to change the localality where they work. The colleges may contribute to the difficulty as well as AHPRA that this poses for OTDs and OMGs.

Current screening for OTD and OMG

There are several layers of scrutiny that new arrivals must negotiate before the regulation agency registration is granted.

They are:

  1. Department of Immigration;
  2. Australian Medical Council (AMC); and
  3. Professional bodies viz the Royal Colleges.

This is an uncoordinated, time-consuming and inefficient exercise that is not without its failures — for instance the Bundaberg Hospital fiasco. The screening procedure and subsequent administration of Dr Jayant Patel was flawed and it was these faults that generated the imbroglio that ensued. The system failed. Those responsible for the failure escaped any punitive action. The only person to have to defend himself was a surgeon who was a Queensland Health employee given the task of reviewing events. He was successful in defending himself, but this must have been at a cost of stress and a financial  burden.

Previous  screening for OTD and OMG

A system whereby reciprocal recognition of the qualifications of institutions in the international arena existed. The training programs from various international universities and professional bodies were accredited and accepted as sufficient for admission to work in Australian health services. This was an efficient, timely and secure system and far less costly than what is now in place. It begs serious consideration of reintroduction to replace the present system.

Don Kane MB BS (UQ), FRACP, FCCP is Chairman, Health Professionals Australia Reform Association (HPARA).

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