Transcript The Impact of Maldistribution and Undersupply on the Accreditation of International Medical Graduates in Australia ARC Health Governance Conference (Brisbane) Professor Lesleyanne Hawthorne Associate Dean.

The Impact of Maldistribution and Undersupply on
the Accreditation of International Medical Graduates
in Australia
ARC Health Governance Conference (Brisbane)
Professor Lesleyanne Hawthorne
Associate Dean (International)
OECD and Faculty of Medicine, Dentistry and Health Sciences
University of Melbourne
10 December 2007
Australia’s Evolving Medical Workforce
Who?
1. Australia-born
2. First generation migrants:
a. Permanent medical migrants
b. Temporary medical migrants
c. The children of migrants/refugees in medicine
3. International medical students
The latest Australian migration developments
Case Study 1: Migrant/Refugee Youth in Australian
Medical and Dentistry Course Enrolments (2004)
Country of Birth
Australia
UK
Malaysia
China
HK
India
Sri Lanka
Taiwan
New Zealand
South Africa
Singapore
USA
South Korea
Vietnam
Iran
Canada
Other countries
Total
Medical
No.
5,298
227
190
170
170
169
163
146
119
100
76
71
63
56
43
34
493
7,588
%
69.8%
3.0%
2.5%
2.2%
2.2%
2.2%
2.1%
1.9%
1.6%
1.3%
1.0%
0.9%
0.8%
0.7%
0.6%
0.4%
6.5%
100.0%
Source: I Dobson & B Birrell, People and Place Vol 13 No 4 2005
Dentistry
No.
504
25
48
47
41
31
29
72
12
4
9
4
42
28
17
7
121
1,041
%
48.4%
2.4%
4.6%
4.5%
3.9%
3.0%
2.8%
6.9%
1.2%
0.4%
0.9%
0.4%
4.0%
2.7%
1.6%
0.7%
11.6%
100.0%
Case Study 2: International Medical
Students in Australia

Numbers: Around 1500 per year

Internship outcomes (late 1990s versus 2006)
Student goals (privately funded versus scholarship students)
Changing Australian policy (shortage-driven)
Victoria, South Australia, NSW

Potential internship  ‘area of need’  permanent
resident pathway

New skilled migration policy: Medicine = ‘migration
occupation in demand’ (20 bonus points)

Variations by state
Source: J Hamilton & L Hawthorne forthcoming (2008)
The Demographic Context of International
Medical Graduates (IMGs) in Australia
The Registration and Training Status of Overseas Trained Doctors in
Australia: L Hawthorne, G Hawthorne & B Crotty (Department of
Health and Ageing 2007)

Growing global competition for doctors (West, Gulf States, Africa)

Temporary flows ↑
–
–
–
–

Permanent flows ↑
–

Migration Occupations in Demand List
Differential patterns and strategies by state:
–

Attraction to government/ employers
Multiple players (eg ‘Recruit-a-Doc)
Comparison: Canada, UK (NHS and Skilled Temporary Migration Program)
Different accreditation requirements
Eg WA ‘adventure medicine’
Net gains versus losses in OTD retention:
–
Highest retention for Middle East, South Asia, SE Asia, NE Asia
Degree of Australian Reliance on IMGs
Compared to the US, UK and Canada (2005)
No.
1.
2.
3.
4.
5.
6.
7.
Sending Countries
to
United States
India:
40,838 (4.9%)
USA-trained IMGs:
25,380 (3.0%)
Philippines:
17,873 (2.1%)
Pakistan:
9,667 (1.2%)
Canada:
8,990 (1.1%)
China:
6,687 (0.8%)
USSR:
5,060 (0.6%)
Sending Countries
to
United Kingdom
India:
15,093 (10.9%)
Ireland:
2,845 (2.1%)
Pakistan:
2,693 (1.9%)
South Africa:
1,980 (1.4%)
Egypt:
1,592 (1.1%)
Nigeria:
1,529 (1.1%)
Germany:
1,525 (1.1%)
Sending Countries
to
Australia
UK:
2,735 (4.0%)
South Africa:
1,754 (2.6%)
India:
1,449 (2.1%)
Ireland:
1,164 (1.7%)
Saudi Arabia (a):
658 (1.0%)
Egypt:
558 (0.8%)
USA:
519 (0.8%)
Sending Countries
to
Canada
UK:
4,664 (8.6%)
India:
2,143 (4.0%)
New Zealand:
1,742 (3.2%)
South Africa:
1,253 (2.3%)
Sri Lanka:
627 (1.2%)
Egypt:
545 (1.0%)
Singapore:
438 (0.8%)
Source: Adapted from data provided in ‘IMGs at Home and Abroad: A Challenge to USA Medical Educators’, F Mullan, 2005
Supply-Demand Issues in Medicine in
Australia
1.
Growing medical shortages:



2.
3.
Reduction in 1996 of local university places
Doctors barred from skilled migration to 2004 (25 point negative weighting)
Demographic changes
Medical workforce maldistribution and under-supply:

Rural and regional locations

Public sector medicine (eg hospital junior registrar positions)
Speciality workforce:

Insufficient in select fields, eg Psychiatry, Surgery, Emergency Medicine
Current strategies to address medical shortages

New medical schools (Notre Dame x2, Deakin, Western Sydney, Wollongong, Bond)

Growing reliance on foreign medical graduates and former international medical
students for at least the next 10 years

Increased temporary and permanent migration
Case Study: Impact of Demographic Transition:
Surgeon Age (42% aged 55 or older)
Number of Surgeons by Specialty and Age Group, Australia (2003)
Main Specialty
General Surgery
Cardiothoracic
Neurosurgery
Orthopaedic
Otolaryngology
Paediatric
Plastic &
Reconstructive
Urology
Vascular
Other
Australia Total
Number
1,119
110
126
756
279
84
32-34
4
1
3
2
5
1
239
218
72
13
3,016
2
3
0
0
3
% by age group
35-44 45-54 55-64
23
26
32
28
37
25
35
29
23
34
30
22
28
24
33
24
26
36
33
33
21
0
28
25
28
18
8
27
31
27
54
62
29
65+
15
8
10
13
10
13
Total
100
100
100
100
100
100
10
9
7
31
13
100
100
100
100
100
Source: Review of the Australasian Surgical Workforce, Royal Australasian College of
Surgeons, B Birrell& L Hawthorne 2003
Impact of Demographic Transition: Number of
Surgical Operations by Patient Age (2001 versus
1991)
Rate of Surgical Procedures Per Thousand Persons by Age Group,
Victoria, 1993-94 Compared to 2000-01
Age Group
00-04
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Total
1993-94
2000-01
51
36
27
43
54
63
70
72
75
80
87
94
114
137
149
178
175
157
75
54
35
26
41
48
57
70
79
80
86
99
113
133
166
208
254
263
222
87
Source: ‘The Outlook for Surgical Services in Australasia’, B Birrell, L Hawthorne and V
Rapson, Royal Australasian College of Surgeons, May 2003
Case Study: Australia’s Dependence on Migrant
Nurses to Overcome Net Gains/Losses (1983-2000)
(Source: L Hawthorne 2001, 2002)
8000
7000
6000
5000
4000
Numbers
3000
2000
1000
0
-1000
-2000
-3000
-4000
-5000
-6000
-7000
1983/6
1986/9
1989/2
1992/5
1995/8
Year
Overseas qualified nurse arrivals
All nurse departures
Net nurse gain/loss
1998/2000
The Impact of Migration on Australia’s
Medical Workforce: 1991-2006

By 2001 46% of Australia’s medical workforce was overseas-born
(cf 40% in 1991 and 44% in 1996)

Permanent migration: By 2001 22,191 overseas-born doctors,
with medical migration continuing unabated (1,263 new permanent
resident arrivals in 2001-02)

‘Area of need’ arrivals: By June 2005 c5,500 temporary entrant
overseas-trained doctors per year (including specialists), cf c500
mid-90s

Occupational Trainees: Eg in surgery, 457 arrivals in 18 months
(January 2002-June 2003); 1200 in NSW alone by June 2005

Within select specialties: Growing dependence on overseas
trained doctors (eg psychiatry, emergency medicine, surgery)
Sources:
Birrell & Hawthorne 1997, 1999, 2004; Hawthorne & Birrell 2002; Barton, Hawthorne,
Singh & Little 2003.
Proportion of Overseas-Born Doctors in Australia
2001 (Compared to 36% in Canada)
Occupation
Engineering
Computing
Medicine
Science
Commerce/ business
Architecture
Accountancy
Dentistry
Arts/ humanities
Nursing
Teaching
Australia-Born
52%
51%
54%
63%
64%
64%
64%
65%
69%
76%
80%
Source: L Hawthorne, Australian 2001 Census data.
Overseas-Born
48%
48%
46%
37%
36%
36%
36%
35%
31%
24%
20%
Sources of Medical Migration to Australia (19962001) and Employment Outcomes by 2001
Employed
Arrival
Date
1996/2001
Birth
Country
Australia/NZ
Med
82.3
Other
Other
Prof/Man
8.4
UK/Ireland
83.3
USA/Canada
52.9
South Africa
80.7
South Eastern Europe
35.5
Eastern Europe
23.5
North West Europe
52.4
India
65.8
Other S/Central Asia
39.0
HK/Malaysia/Singapore
58.6
China (exc. Taiwan)
5.1
Taiwan
57.1
Philippines
33.3
Iraq
36.9
Other M East/N Africa
36.1
Central & South Americas
45.7
Other
36.1
TOTAL MIGRANTS (Exc.
NZ)
Source: L Hawthorne, from Australia Census data (2001)
8.7
11.6
5.8
5.8
5.3
20.9
6.5
2.3
4.3
20.4
0.0
7.4
3.8
11.6
8.6
7.4
Other
Work
3.6
SubTotal
94.3
Unemp
0.6
NLF
5.1
Number
26658
1.8
8.7
5.0
14.8
18.2
5.9
4.2
13.8
6.4
26.8
0.0
13.6
3.8
12.5
8.6
10.4
93.8
73.2
91.5
56.1
47.0
79.2
76.5
55.1
69.3
52.3
57.1
54.3
44.5
60.2
62.9
53.9
0.7
5.8
0.8
12.3
12.4
1.5
10.2
10.9
2.1
8.4
0.0
7.4
24.4
12.4
0.0
5.9
5.5
18.3
7.7
31.6
40.6
19.4
12.6
32.4
28.6
39.1
42.9
38.3
31.3
27.4
37.1
40.2
857
104
363
155
170
206
430
516
140
489
21
81
160
241
35
424
4392
Growth in Temporary Entry Medical Visas
Visa subclass 422 (‘Area of need’):
(Birrell & Schwartz 2005)

1,419 in 1999-2000

2,496 in 2003-03

2,428 in 2003-04

3,074 in June 2005 (up from 1,636 in June 2003 and 1,237 as of
June 2001)
Visa subclass 442 (‘Occupational Trainee’):

↑2,437 in June 2005 (cf 1,237 in June 2001), primarily to
Queensland, WA and Victoria

Recent increase in NSW: June 2004 = 1,202 (Most as HMOs)
Variations in State Reliance on Temporary Medical
Migration (Visa 422 ‘Area of Need’ Category)
Number of 422 Nominations by State
2000-2001 to 2002-2003
State
2000- 2001- 200201
02
03
WA
456
472
597
Victoria
406
508
581
NSW
58
89
176
Tasmania
94
82
89
SA
60
68
133
ACT
7
12
50
NT
84
98
97
Queensland
899
716 1,016
Total
2,062 2,045 2,739
Source: DIMIA 2004, prepared for
Hawthorne, Birrell & Young 2003
Major Source Countries of ‘Area of Need’
Temporary Doctors by 2001
Over 27 countries (growing diversity):
By-pass ‘mandatory’ credential examination requirements
UK/Ireland (1226)
India (423)
Malaysia (230)
Sri Lanka (191)
China (94)
Germany (83)
USA (56)
Philippines (55)
South Africa (45)
Canada (35)
Etc!
Issue 1: Differential Training Systems
Ranking of top 500 world universities (Shanghai Jiao Tong
2006:

206 in Europe (overwhelmingly located in North West Europe),
including 43 in the UK, and 40 in Germany

197 in the Americas (167 in the US, 22 in Canada, and just 7 in all
Central or South America [including 1 in the top 150])

92 in the Asia-Pacific (32 in Japan, 16 in Australia, 14 in China
(none ranked in the top 150, and with 2 of the top 4 ranked
institutions in Hong Kong), 9 in South Korea, 7 in Israel, 5 in New
Zealand, 4 in Taiwan, 2 in Singapore, and just 2 in India (neither
ranked in the top 300)

5 in the Africas (4 in South Africa, 1 in Egypt, with no other African
or Middle Eastern country listed) (Jiao Tong University 2006)
AMC Exam Results for Migrant Doctors by
Select Country of Origin (2002)
Australian Medical Council Examination Outcomes by Select Origin (2002)
Country of Candidate
Candidate
% Passing Candidate
% Passing
Numbers
MCQ
Numbers
Clinical
(1st or Repeat)
(1st or Repeat)
South Africa
17
88
23
Iraq
54
87
65
Sri Lanka
34
82
34
Bangladesh
81
80
63
Pakistan
36
75
19
Egypt
48
46
30
UK
38
74
34
51
China
69
35
47
India
133
49
50
Poland
4
3
47
Former Yugoslavia
17
17
33
Philippines
33
23
45
Other
307
164
56
Total candidates
871
559
Source: Derived from Australian Medical Council Incorporated. Annual Report, 2002,
Australian Medical Council Incorporated, Canberra, 2003
91
66
65
48
53
73
88
57
63
33
47
39
61
62
Methodology of Hawthorne, Hawthorne &
Crotty Study (2007)
Migration Flows: Analysis of all DIMA arrivals and
departures data, and Census data related to OTDs
AMC Exams: Analysis of all AMC examination outcomes by
key variables 1978-October 2005, plus analysis of
RACGP outcomes
New Data: Mailout survey of 3,000 fairly recently arrived
OTDs active in AMC (ie at least one MCQ attempt)
State Variations: Analysis of all categories of OTDs in State
Medical Registration Board databases (NSW, Victoria and
WA) to capture ‘invisible’ OTDs, plus 30 interviews
19
78
19 .
79
19 .
80
19 .
81
19 .
82
19 .
83
19 .
84
19 .
85
19 .
86
19 .
87
19 .
88
19 .
89
19 .
90
19 .
91
19 .
92
19 .
93
19 .
94
19 .
95
19 .
96
19 .
97
19 .
98
19 .
99
20 .
00
20 .
01
20 .
02
20 .
03
20 .
04
20 .
05
.
N. of candidates each year
Number of 1st Time MCQ and Clinical
Candidates by Year (1978-late 2005)
700
600
500
400
300
200
100
0
Year
MCQ
CE
Number of Candidates Passing the MCQ at
Each Attempt
7300
5000
Number passing
4000
3000
2000
1000
0
1
2
3
4
5
6
7
8
9
10
11
N. Attempts
12
13
14
15
16
17
18
19
AMC MCQ Outcomes 1978-2005
Candidates:

139 source countries
Top 10 sources:

India (14%), Sri Lanka (8%), Egypt (7%), Bangladesh (5%), China (5%), UK (5%),
Iraq (4%), South Africa (4%), Philippines (4%), Pakistan (3%)
Highest % of first time presenters:

S Asia, N Africa/M East, SE Asia and E Europe
Pass rates:

51% on 1st attempt, 47% on 2nd attempt, 81% overall
Highest pass rates:

UK/Ireland (95%), South Africa (86%), North America (86%)
Lowest pass rates:

Other Americas (67%), SE Asia non-Commonwealth (70%), East Europe (70%)
Age, English, gender and recency of training highly significant:

Harder to pass for older candidates
AMC Clinical Outcomes 1978-2005
Overall pass rate:

86% of attempters (but just 53% of all MCQ attempters go on to pass)
Highest pass rates:

South Africa (66%), UK/Ireland (64%)
Lowest pass rates:

Other Americas (41%), SE Asia non-Commonwealth (38%), South East
Europe (49%), Central Asia (49%)
Middle East/ North Africa:

Just as likely to pass as OTDs from English speaking backgrounds
(OTDs from Eastern Europe and non-Commonwealth countries the
most disadvantaged)
Age:

Highly significant (candidates requiring 3+ attempts older!)
tr
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N
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Percentage
Passing the Clinical Examination by Region,
Percentages (1978-2005)
100
75
50
25
0
Pass
Fail
OTDs, Age and AMC Pass Rates - MCQ
Table 3.6: CE pass rate by region and MCQ age tertile, percentages
Region
Australasia
Oceania
UK/Ireland
North West Europe
South East Europe
East Europe
North Africa/ & Middle East
South East Asia-Commonwealth
South East Asia-Other
North East Asia
South Asia
Central Asia
North America
Other Americas
South Africa
Other Africa
Age at 1st MCQ, tertiled
<32
32 to 36
37+
57%
63%
66%
66%
59%
60%
71%
61%
40%
63%
60%
54%
73%
45%
74%
65%
60%
59%
69%
56%
56%
60%
63%
52%
50%
57%
59%
46%
55%
47%
65%
67%
50%
51%
50%
34%
40%
44%
46%
39%
31%
41%
44%
50%
51%
34%
47%
18%
Accreditation Pathways and IMGs in the
Context of Maldistribution and Undersupply
Does full registration matter in Australia?

Just 26-33% of OTDs encounter the AMC

Growing use of RACGP and specialist pathways

Minimal impact on employment outcomes (high demand)

Future access to supervised training places?

Issues:
Variability of data!
Number and origin of OTDs conditionally registered by states
Characteristics (country of training, AMC status, actual credentials
etc)
Practice status
Which IMGs by Region of Origin are Working
With Conditional Registration? (IMG Survey)
N
English-speaking background
Europe
North Africa/Middle East
Asia-Commonwealth
All other
Total
Statistics: 2 = 60.14, df = 8, p < 0.01
171
153
154
386
255
1119
Type of medical registration
General
Conditional/
Not
registered
Specific
51%
36%
14%
33%
41%
25%
38%
39%
23%
28%
39%
33%
24%
35%
41%
33%
38%
29%
Major Findings: IMG Survey
Focused on OTDs deemed ‘active’ in the AMC pathway:

99% had attempted the MCQ exam (68% once, 21% twice, 11% 3+
times)

83% had passed it (doctors from ME/North Africa higher pass rates
than ESB doctors (UK/Ire, South Africa, US, Canada, NZ)

61% had attempted the CE (no difference by country of origin in the
number of attempts made)

41% of those attempting the CE had passed it

Gender matters: Males 63% less likely to have passed the CE
than females)

Region of origin matters: Compared with ESB doctors, OTDs
from Europe twice as likely to fail, those from Asia-Commonwealth
2.8 times as likely, those from ME/N Africa 2.9 times as likely, and
those from ‘other’ backgrounds 4 times as likely
Pathway to Medical Registration by Origin
(IMG Survey)
112
Intended pathway to medical registration
Other
Speciali
RACGP
AMC
st
College
13%
8%
16%
63%
102
106
243
143
52%
54%
65%
70%
N.
English-speaking
background
Europe
North Africa/Middle East
Asia-Commonwealth
All other
a = Excludes those who reported they were not registered.
2
Statistics:  = 22.11, df = 12, p
= 0.04
23%
26%
18%
20%
19%
14%
11%
8%
7%
7%
6%
2%
RACGP Pathway Examination Outcomes:
1999-2004
Year
1999
2000
2001
2002
2003
2004
Total
Alternative
Pathways
Program
0
0
0
4
33
36
73
Prac
Eligible
(Aus)
80
56
70
69
59
50
384
Prac
Eligible
(OTD)
86
145
226
279
386
334
1456
Training
(Aus)
Training
(OTD)
Overall
305
313
333
351
339
325
1966
77
64
90
92
114
150
587
548
578
719
795
931
895
4466
Source: The Registration and Training Status of Overseas Trained Doctors in Australia, L Hawthorne, G Hawthorne & B Crotty,
Department of Health and Ageing, released February 2007, pp 157
RACGP Examination Outcomes: 1999-2004
Year
1999
2000
2001
2002
2003
2004
Other
25%
73%
58%
Prac
Eligible
(Aus)
79%
86%
74%
87%
78%
78%
Prac
Eligible
(OTD)
61%
64%
39%
55%
47%
40%
Training
(Aus)
Training
(OTD)
Overall
96%
98%
95%
96%
96%
90%
72%
83%
71%
87%
80%
63%
85%
87%
72%
79%
72%
65%
Source: The Registration and Training Status of Overseas Trained Doctors in Australia, L Hawthorne, G Hawthorne & B
Crotty, Department of Health and Ageing, released February 2007, pp 157
Medical Employment Outcomes by Region
% of OTDs working in medicine in Australia:

78% (despite only 41% holding general registration)

ESB doctors (95%) compared to North Africa/ M East (82%), AsiaCommonwealth (74%), and Other doctors (68%)
When compared with ESB doctors, respondents from:

Europe and ME/ N Africa = 3 times less likely to have obtained
work in medicine

Asia-Commonwealth = 4.7 times less likely

Other backgrounds = 7.6 times less likely
Current key barrier to medical practice:

English language testing
Medical Employment Outcomes for 1996-2001
Arrivals in Canada Versus Australia (2001 Census)
South Africa: 81% employed in Canada (cf 81% in Australia)
UK/Ireland: 48% employed in Canada (cf 83% in Australia)
India: 19% employed in Canada (cf 66% in Australia)
HK, Malaysia, Singapore: 31% employed in Canada (cf 59% in
Australia)
Eastern Europe: 8% employed in Canada (cf 24% in Australia)
China: 4% employed in Canada (cf 5% in Australia)
Source: Labour Market Outcomes for Migrant Professionals – Canada and Australia Compared, L Hawthorne,
Citizenship and Immigration Canada (2007)
The Impact of OET Testing on Medical Candidates:
Pass Rates 1989-1995 (Hawthorne & Toth 1996)
Number of
Attempts
1
2
3
4
5 or more
Total
Pass
(% of all
candidates)
57.4
16.6
2.6
1.4
0.2
78.3
Fail
(% of all candidates)
Total Candidates
n
16.2
3.5
1.3
0.3
0.2
21.6
1532
419
82
36
10
2079
The Impact of OET Testing on Medical Candidates:
Location (1989-1996 Data: Hawthorne & Toth 1996)
Overseas candidates
Australian candidates
All candidates
Pass
%
Fail
%
No. of
Attempts
Total
No.
67
81
78
33
19
22
1.16
1.41
1.35
439
1640
2079
The Impact of Occupational English Testing on
Medical and Nursing Registration by Select Origin &
Location: 1989-1995 Data (Hawthorne & Toth 1996)
Candidates in Australia
(%)
Pass Rate
(All %)
Total
No.
79
99
96
82
66
91
59
77
84
78
200
191
133
126
93
32
38
57
96
40
41
50
55
35
70
413
96
51
51
37
Doctors
India
China
Former USSR
Egypt
Philippines
Nurses
Philippines
Hong Kong
India
Former Yugos.
Fiji
Predicting Those Not Employed in Medicine
in Australia (IMG Survey)
Age group
Region of origin
Base
20-29 years
English-speaking
background
Comparators
30-39 years
OR
0.40
40-49 years
0.33
50+ years
0.54
Europe
3.18
North Africa/Middle
East
Asia-Commonwealth
3.23
All other
7.61
4.68
95%CI
0.270.62
0.210.52
0.310.95
1.566.49
1.596.57
2.528.68
4.0014.48
Notes:
Statistics: Non-statistically significant variables excluded from the model: gender, pre-arrival medical experience, year of
arrival, number of attempts to pass the MCQ, number of attempts to pass the CE.
Model specifications: Logistic regression, -2LL: 1129.77, Hosmer & Lemeshow 2 = 2.15, df = 7, p = 0.95, 78% of cases
correctly classified.
Type of Medical Employment in Australia by
Origin (OTD Survey)
ESB Background
Europe
North Africa/Middle East
Asia-Commonwealth
All other
174
155
156
395
259
Hospital
resident
18%
34%
40%
32%
33%
Statistics:
 :
df:
p:
20.13
4
<0.01
a = Resident or registrar
b = Fisher Exact Test
2
Hospital
registrar
45%
21%
19%
20%
10%
Hospital
Other
9%
5%
3%
4%
4%
75.34
4
<0.01
8.72
4
0.07
Community Specialist
(a)
4%
2%
8%
1%
4%
1%
4%
3%
3%
2%
5.37
4
0.25
0.66 (b)
Other
GP
14%
19%
21%
14%
14%
88%
72%
70%
75%
70%
7.24
4
0.12
21.36
4
<0.01
The Link Between Accreditation Status and
Employment
State-specific differences:

Western Australia

New South Wales

Victoria
State Variations in Relation to OTDs: NSW,
Victoria, WA
Data consistency:

Minimal, just 10/27 variables in common (eg country of origin, AMC
status)
Screening and selection variability:

‘Recruit-a-doc’ versus RWAV (etc)

State competition for OTDs (sticks and carrots), $ incentives
Recruitment and bridging support:

WA (‘adventure medicine’, invisibility, retention)

NSW (65% of OTDs conditionally registered; focus x 12 OTDs per year)

Victoria (RWAV focus)
Future displacement of OTDs from supervised clinical training:

Rank order (domestic graduates, international students, OTDs)

Case study: WA
Financial Incentives to IMGs by State (2006)
State
Relocation
Orientation
Other Support
Total Package
Victoria
$0
Northern Territory
Queensland
$10,000 for
permanent
residents going to
higher area of
need
$20,000
$0
$2,000 contract of
immigration support
$3,000 for site visits
$1,500 Medical Board
costs
Up to $3,500
New South Wales
$550 course
$1,000 in practice
$2,000 to practice
$5,000
$3,000
South Australia
$10,000
$4,000-$7,000
$3,000 for site visits
$0 (though heavy
salary incentives to
attract IMGs into the
state)
$3,000 to spouse
$10,000 isolation
grant
$2/hr for childcare
Tasmania
$10,000
Western Australia
$20,000 single or
$30,000 couple
$2,000 and 1
week orientation
3 day orientation
Up to $16,500 fopr
PR IMGs moving to
higher areas of
need
Up to $28,000
$3,000+ salary
packaging
incentives
Up to $34,000 plus
childcare subsidy
Up to $12,000
Remote area for
some locations of
$20,000 or $40,000
plus 2 week bonus
after 6 months
Up to $70,000 plus
orientation and
bonuses
Source: ‘White Paper on the Viability of Rural and Regional Communities: Resolving Victoria’s Rural Medical
Workforce Crisis’, Rural Workforce Agency Victoria , 10 August 2006.
Conclusion: Individual Agency and Global
Health Workers
Motivations:

Rural → urban

Public → private

Poor → rich

Unsafe → secure (disease, law and order)

Employment conditions → remuneration, quality of practice, training, workload,
facilities, promotion, health service quality etc

Living conditions

Family choice → children’s education, spouse career (etc)
Medical Migration and Global Migration Trends (OECD 2007)
Source: Working Together for Health – The World Health Report 2006, WHO, Geneva; International Migration Outlook, OECD
2007, Paris
Impacts of Migration on Health Workforce
Shortages ( WHO 2006)
Risks: Exacerbating Undersupply in
Developing Nations (WHO 2006)
Future Medical Migration: Migration
Occupations in Demand List (2007)
Skill migration:

Raised from 33,000 97,500 per year and ↑

Regional migration schemes

International student flows
Which priority professions listed apart from health sciences?

Accountant, Engineers, IT
All other fields on the list = health sciences:
General Practitioner, Anaesthetist, Dermatologist, O&G,
Ophthalmologist, Emergency, Paediatrician, Pathologist, Psychiatrist,
Specialist Physician, Radiologist, Surgeon, Registered Nurse, Midwife,
Mental Health Nurse, Dentist, Dental Specialist, Hospital Pharmacist,
Retail Pharmacist, Occupational Therapist, Physiotherapist, Speech
Therapist, Podiatrist, Radiographer, radiation Therapist, Nuclear
Medicine Technologist, Sonographer
The Demographic Transformation:
Western and Select Asian Nations
Traditional population structure
Emerging population structure