The Australian Society of Ophthalmologists (ASO) is “strongly opposed to the emerging indications” that the Federal Government may remove the power of RANZCO and other medical colleges when vetting and approving overseas-trained specialists to practise in Australia.
The call comes as the government considered 28 recommendations from the ‘Independent review of Australia’s regulatory settings relating to overseas health practitioners’ – conducted by Ms Robyn Kruk – aiming to remove “unnecessary regulatory barriers” faced by internationally qualified health professionals. It’s hoped cutting red tape will make Australia a more attractive destination for foreign health professionals and alleviate workforce pressures, leading to better healthcare for the population.
During the consultation phase, RANZCO said it could not endorse a proposed transition of equivalence assessments for specialist international medical graduates (SIMGs) from the medical colleges to the Australian Medical Council (AMC). A 2018 workforce report shows 12 ophthalmology SIMGs join the workforce annually.
The college said this represented a major move away from qualified assessors who are the recognised clinical experts in their field, and instead called for colleges to streamline their own assessments as a better, faster and cheaper method to ensure the community interests were served.
Kruk’s review found these medical college assessments were costly, with varying fees and processing time frames. It was noted some colleges only review applications for SIMG recognition at specific times throughout the year.
To address these issues, the interim report proposed transitioning the “determinative part” of comparability assessments from the specialist medical colleges to the AMC to drive greater consistency in performance and outcomes and reduce costs. Colleges would retain expertise and play a key role in the individual comparability assessment.
Since then, Kruk’s final report has emerged with slight wording changes. It stated the immediate focus should be on streamlining processes, removing duplication and providing greater support for specialist comparability assessments to ensure more timely decision making and consistent outcomes.
“However, should outcomes fall short of workforce needs within ministerially agreed timelines, the review recommends that centralising comparability assessment with the AMC, in full or in part, remains as an appropriate escalation strategy available to health ministers,” the report noted.
“A transition to the AMC would be a means of providing support to colleges that would retain responsibility for individual assessments of an SIMG’s comparability, while also providing an opportunity to drive greater consistency, and create a process and governance structure consistent with best practice regulatory outcomes.”
But the ASO said it still wasn’t clear how this would take shape. It was opposed to removing the “vital, longstanding, and proven role of medical colleges in maintaining high – and most importantly – safe standards of specialist education and training”.
In November 2023, the ASO wrote to Health Minister Mr Mark Butler to express its concerns and advocate against recommendations from the Kruk Review.
“This also included addressing concerns regarding other recent ministerial recommendations that aim to take greater control of medical colleges and their role assessing international graduates and training post accreditation,” the organisation told Insight.
“The ASO has received no response to this letter of grave concern.”
It is the understanding of the ASO that the Federal Government has since accepted recommendations from the Kruk Review, but the body said there has been little discussion or engagement around how it may look in practise.
The Medical Board of Australia will host the first meeting of the Specialist IMG Pathways Review Advisory Group on Monday 22 April 2024.
ASO president Dr Peter Sumich said he was eagerly awaiting this roundtable meeting “and the opportunity to learn more in detail about any changes being proposed to vetting and approving overseas-trained medical professionals”.
In its earlier submission, RANZCO said it had already simplified its application process for SIMGs and worked to assure quality through the same assessment methods used for RANZCO trainees, an established dual pathway for New Zealand applicants.
The college has also been trialling a pilot in Australia leading to full fellowship via work based and final on-site assessments. This was in response to the need for a more flexible and efficient approach to ‘area of need’ demands.
But transitioning equivalence assessments to the AMC would completely change the underlying framework that has formed the basis for SIMG clinical competency assessment, RANZCO stated, noting this was based upon the highest level of peer reviewed expertise and experience built up over decades.
Expedited pathways
Kruk said only applicants with qualifications, skills and experience from a small number of countries and professions were eligible for expedited pathways to practise in Australia. Applicants entering via these pathways experience a quicker journey, pay less and need to meet fewer requirements.
However, medical specialists do not have access to expedited registration pathways, meaning it can take years to be registered. GPs report spending two years navigating the system and incurring more than $33,000 in costs. Under the changes, international medical graduates who are eligible for expedited pathways would save $7,700, and would be expected to result in more health practitioners choosing Australia.
Overall, Kruk said feedback from overseas-trained practitioners was the end-to-end journey was complex, costly and slow. Applicants need to deal with several regulators, often supplying the same information multiple times.
Applicants also report the assessments and regulatory processes were often difficult, with requirements that are unclear, onerous and lack transparency, and result in inconsistent outcomes.
Despite being valuable to the Australian health system, the report noted that practitioners who specialise can face particularly high barriers.
“Unlike graduates with recent exam experience, many struggle to demonstrate they meet the required standard. Almost half feel their prior professional and clinical experience is insufficiently recognised. For those who come, many need to work in more junior roles and receive lower pay for an initial period. Too often, applicants report the process makes them feel undervalued, disrespected and even demeaned.”
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