International medical graduates (IMGs) feel shut out of the national health system during a COVID-19 pandemic where medical staff are already stretched to breaking point.
Hundreds of experienced doctors trained overseas and now living in Australia are caught in a mess of bureaucratic tape, when they're most needed in regional areas.
IMGs are able to pass their clinical and written (AM1 and AM2) exams, however they are unable to meet a 'recency of practice' rule introduced in 2013 and required by the Australian Health Practitioner Regulation Agency (AHPRA).
The rule means IMGs must have experience as a medical doctor within three years, regardless of previous years of employment.
Former Italian general practitioner Dr Cristina Villani is one of the IMGs caught in the system. The 37-year-old worked for two years in private hospitals and clinics in Italy before moving to Sydney in 2015.
Dr Villani passed the relevant exams over an extended period from June 2016 until 2018, however she was then told she needed her recency of practice to gain APHRA registration.
"I came here when the situation was different and Australia seemed to be open to doctors from overseas. It has been such a terrible experience," she said.
"After I passed my tests I thought that I could apply for jobs, however recency of practice had become a problem because I had not worked while studying and would now need to go back to Italy to get experience.
"To apply for a job you must have AHPRA registration, but to have that registration you need a job offer. It's a paradox.
"I've done everything I've been asked to do and now I'm stuck," she said. "I had even been offered a job as a GP in Armidale but that has ended because they couldn't wait for me to be registered.
"The process has totally demoralised me, I now have doubts in my skills and knowledge because I've gone through hell.
"It boils my blood because I know I've thrown away years of work."
Dr Villani has been working as a social worker with Mission Australia for four years, helping people with mental health, drug addition and homeless issues.
If IMGs pass their exams, apply and get a job offer, they still must meet the recency of practice requirement. Even a successful registration can mean months of waiting and an elapsed job offer, she said.
The situation has become so common that an 'IMGs with practice gap in Australia' group has been established on social media with almost 1000 members.
An 'Allow International Medical Graduates to support Australia during the pandemic' petition has also been created with more than 900 signatures.
Dr Sohail, an IMG who worked as a doctor in a military hospital in Pakistan, moved to Port Macquarie in May 2017.
"If I am not able to work within three or four months, I will be out of recency, but I also cannot travel to Pakistan to update my skills (because of the pandemic)," Dr Sohail said.
"It's very depressing and brings me to tears because I moved here to secure my future.
"I live here with my family but I am unable to carry on with my career. I think it's humiliating the way we are being treated."
Many international medical graduates attend bridging courses and study extensively for the Australian Medical Council exams. The exams are only held in certain times of the year and can involve months of waiting.
Previously most IMGs would return to their home countries after passing their clinical exam, to work for at least six months in order to complete the 'recency of practice' requirement.
Many IMGs are suggesting a clearer and more accessible return-to-practice pathway be made for doctors and that the 'recency of practice within three years' requirement be relaxed or waived.
International Medical Graduate (IMG) Mr Balraj, who works as a GP clinical assistant near Taree, permanently moved from India to Australia in 2017.
The 41-year-old has studied at St Petersburg State Medical Academy in Russia, acted as a first responder during the devastating India tsunami in 2004 and was a practising GP in India since 2010.
Mr Balraj also worked as a two-year contracted GP at the oil and gas industry's interior and remote location clinics in Oman.
"I understand that the Australian Medical Council (AMC) maintains highest standards with its exams because they care about the quality of medical practice in this country," he said.
"Hence when IMGs come to this country, they know that the AMC exams are not easy. Most of us quit our jobs just to prepare for the clinical and theoretical exams to be eligible to practice as doctors in Australia.
"Once we pass the AMC exams, our next challenge is to address the Recency of Practice requirements.
The current situation with COVID crisis, travel bans, and clinical exams being postponed has made it even more difficult to meet these requirements."
"We are told that we need to go back to our respective countries, practice for at least one month and come back. But given the current situation that is extremely difficult."
"I just want the authorities and the health care system to look at the current situation with an eagle eye view. It is our future and employing us is a win-win situation.
Mr Balraj said there are thousands of IMGs on ground, awaiting an opportunity and are being overlooked by a system with a shortage of medical professionals.
"We're already here on our own visa, many of us even have citizenship and the system can save on millions of dollars bringing in external resources," he said.
"The public needs enough medical professionals, the system needs enough medical staff to address the shortage and there are IMGs who can be deployed effectively into the workforce at different levels based on experience. It's time to make it official."
An Australian Health Practitioner Regulation Agency spokesperson said AHPRA appreciates IMGs' willingness to help during the pandemic.
"Since the start of the COVID-19 pandemic, AHPRA and national boards have made a series of pragmatic decisions (to boost the number of available practitioners in key professions to respond to the emergency) and to temporarily modify some of our regulatory requirements, while maintaining patient safety.
"One example of this is the Medical Board of Australia's decision, that for the duration of the pandemic, it will streamline processes to enable IMGs within hospitals with limited and provisional registration to be deployed more easily without a formal application to the board.
"In regards to IMGs in Australia returning to practice, there is flexibility in the board's recency of practice registration standard and medical practitioners can return to practice after an absence, under conditions where it is safe to do so.
"The board must balance flexibilities to support medical practitioners while maintaining the high standards that the community expects."
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