Australia relies on overseas-trained medical experts yet consigns them to professional purgatory | Ranjana Srivastava

“I was a cancer surgeon. That was before I did this.”

On my way to a conference, the taxi driver has taken an inordinate interest in my work until I am forced to reveal that I am an oncologist. I am impressed by his insightful comments, but it never crosses my mind that he might be a doctor himself. The disclosure makes me sink deeper into my seat to render myself invisible.

He fled his country during war. When he turned his mind to medicine, the hurdles were onerous and the rules opaque. The thought of going back 20 years to the beginning of residency was unpalatable. There was little guidance and a perceived hostility towards skills accumulated in a “no-name” hospital, never mind that some of the most astute doctors are those who have mastered their skills in resource-strained settings.

He jokes that his new job is a lot like medicine – you get to meet lots of interesting people, but I can’t help thinking of the sheer waste of talent when a surgeon becomes a taxi driver.

An overseas-trained surgeon was once appointed as my intern. He had long forgotten how to interpret ECGs or adjust the insulin dose, but put him in front of a complex MRI or a terrified pre-op patient and he shone.

Sadly, day after day I watched his niche skills atrophy while he figured out mundane tasks. I tried to “tutor” him, but turning an accomplished surgeon into a medical intern felt demeaning. Eventually, he gave up on his dream of reprising his former role, thus providing a loss to his country of birth and his adopted one.

The pandemic-fuelled exhaustion of doctors and nurses has forced many rich countries to improvise.

Australia relies very heavily on foreign-trained doctors and nurses to sustain its healthcare system. Around half of the healthcare workforce was born overseas and a quarter trained overseas, typically in India, China, the Philippines and the UK.

Recently, the Victorian government proposed a plan to lure foreign professionals by paying them $2,000 to relocate. When there were few takers, the amount was multiplied fivefold but there was still no stampede.

The idea of ​​paying experts to leave their own country to fulfil a local need creates an ethical dilemma. Last month when I was in India, I did not meet a single person unaffected by the pandemic. While the official figure was almost 500,000 dead, the World Health Organization estimates the true number to be closer to 4 million, including droves of frontline healthcare workers.

But amid the rickety infrastructure, I saw clear evidence of progress and ambitious goals to achieve better population health.

My childhood friend is a doctor serving the slum-dwellers of Mumbai. Her team screens people for preventable diseases, including cancer and diabetes, and treats common illnesses before they become a problem. Each community worker has a footprint we could scarcely comprehend in the rich world.

If we lured just one of these professionals to Australia for the negligible cost of $10,000, who would bear the largest cost of all? The patients without a voice and the country that spent money training them.

In 2013, researchers estimated that Australia saved US$1.7bn in medical education costs through the arrival of foreign-born medical practitioners over just the previous five years.

Still, one might argue that in a free world, workers should be free to take their skills wherever they want.

So, it’s the second issue about importing workers that should give us pause for thought. The workforce shortage in rural and remote regions is so dire that without international workers, there would often be no one to see the patients. Nearly all doctors are sent to rural and remote areas to provide years of service, with conditional registration and limited rights of practice that local graduates often refuse.

Many struggle with social adjustment and cultural dissonance. There may also be an unemployed spouse and dislocated children in tow. Add to this the dilution of prestige and career uncertainty and the average international graduate has a lot to contend with in a new country.

But what rankles most is the professional purgatory. In far-flung places, there can be a lack of mentoring and guidance because of an emphasis on patient turnover rather than supporting professional aspirations. Zoom meetings, sold as the solution to isolation, are no match for the incidental corridor consult, a chat on the way home, or the hand of a caring colleague on the shoulder.

To add insult to injury, certain overseas trained doctors tend to attract a higher rate of complaints.

Indeed, some patients unabashedly tell me that their “foreign” doctor or nurse is “no good”. I bristle at this broad accusation because the situation might be different if they received a proper orientation, a cultural education, and ongoing professional and pastoral care. In the absence of these things, career progression can become an afterthought.

Australia weekend
Australia weekend

I once worked with an overseas doctor who held aloft the emergency department. Every day, he plastered fractures, removed splinters, drained wounds, reversed overdoses and resuscitated hearts. His range of skills was unparalleled and the community admired him.

But year after year, he remained the workhorse while others became his boss. He was never considered good enough to lead a department or even head a small team. Most galling was the presumption that coming to Australia marked the peak of his ambitions. He left as soon as he could.

Qualified medical specialists can have a particularly difficult time satisfying standards of equivalence. While scrutiny is essential for patient safety, there is concern that doctors from non-western countries often face a higher bar for acceptance by specialist colleges, eliciting calls for fairness, transparency and respect in assessing qualifications.

There has been recent progress in this sphere, but much more is needed to inform prospective arrivals of the hurdles they will encounter. Smoothing their way and respecting their needs is not the same as giving them a “free pass”.

There have always been calls for local graduates to serve the local population – this will take time, and frankly, a lot of convincing. In the meantime, if overseas trained professionals are attracted to the excellent Australian healthcare system, we should be proud.

But it behoves us to realise that those who come here make many sacrifices and are doing us a favor by supporting the healthcare system to be the best that it can be. It is our duty to judge them fairly and treat them well.

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