NACCHO Aboriginal Health Workforce and #457visas : Overseas trained doctors still essential in the bush: assurances needed on 457

 ” While the Federal Government’s work to deliver more Australian-trained doctors to the bush is very positive and welcome, International Medical Graduates (IMGs) will continue to be essential in providing medical care in rural and remote communities for at least the next 5 years — and probably for the next 15 years “

RDAA President, Dr Ewen McPhee Rural Doctors Association of Australia has warned. (article 1 below )

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Many communities would not have doctors if it were not for the excellent work of IMGs,”

It is important that we strike the right balance between filling vacancies with locally trained graduates and ensuring that communities, especially in rural and remote Australia, have doctors in the right numbers and with the appropriate specialist skills and experience to meet patient needs.

The AMA welcomes the emphasis of the new arrangements to better target recruitment and the mandatory requirement for labour market testing, which the AMA has been calling for in light of the significant increases in locally-trained medical graduate numbers. ”

AMA President, Dr Michael Gannon (article 2 below)

Australian government to replace 457 temporary work visa  Source

Returning now to the Government’s announcement today that it’s scrapping the 457 visa program for foreign workers.

It is interesting to note that, of the 2618 people who arrived on Government sponsored 457 visas last year, 2268 were health professionals. It’s a huge proportion.

This graphic, which was published originally by The Guardian, shows the most common 457 visa jobs in different areas in Australia. You can see a lot of blue there, which represents café workers, but all the green that you can see on that graphic, mainly there in rural and regional areas, does represent doctors and nurses, health workers who have been brought in on 457 visas.

SkyNews interview Dr Michael Gannon (article 3 below )

Banning 457 visas will have an immediate and potentially significant impact on the recruitment of health professionals in rural and remote Australia.

Despite the increase in the number of health professionals graduating from Australian universities, recruiting professionals to work in rural and remote Australia is still difficult.

“I would love to be in the situation where we rely on locally trained health professionals to fill all vacancies in rural and remote communities“,

David Butt, Chief Executive Officer of the National Rural Health Alliance (article 4 below )

Article 1 RDAA continued

For this reason, RDAA has urged the Government to assure these much-needed doctors of their continued future support in Australia, under the 457 visa changes announced yesterday.

“Many rural medical practice employers, as well as IMGs, are highly concerned about the as yet unexplained requirements of the new visa arrangements, particularly around market testing and the changes to permanent residency applications” RDAA President, Dr Ewen McPhee, said.

“Market testing evidence has been a requirement for IMGs in applying for a Medicare provider number for many years, so we are hoping this is not going to duplicate a process that is already in place for these doctors.

“It is important that the Government works closely with all stakeholders — including rural medical practices and IMGs themselves — to educate them on the changes to the visa requirements, as this announcement has caused significant angst for many IMGs and practices with regards to what it means for them.

“RDAA understands that doctors listed in the revised visa arrangement’s ‘medium category’ will be eligible for a four year visa, with permanent residency applications eligible after three years — a change from the two year requirement under the current 457 visa.

“The recruitment of an IMG is a long process involving many steps. A number of the steps outlined in the Government’s new visa policy, such as market testing and criminal history checks, are already in place for IMG recruitment, therefore it is essential this change to the visa requirements does not duplicate but rather replaces the processes that are already in place.

“IMGs have been a backbone of medical care in rural and remote Australia for many years — and they will continue to be for at least the next 5 years, and probably even up to 15 years.

“If it weren’t for the many dedicated and highly trained IMGs who have delivered medical care in rural and remote Australia for many years, a large number of communities would not have had access to a local doctor for decades.

“Even with the very positive measures that the Federal Government has been taking to encourage more Australian-trained doctors to work in the bush, we are still a minimum of 4-5 years away from seeing the full benefits of these measures being realised.

“It will take time to deliver more of the next generation of Australian-trained doctors who are able to work unsupervised in rural and remote communities, and then it will be a slow, ongoing process of capacity building, with a gradual year-on-year increase in the number of Australian-trained doctors choosing to work in the bush.

“With IMGs still comprising approximately 40% of Australia’s rural and remote medical workforce, we will continue to need IMGs in country Australia in the short and medium-term at least, and probably well into the long-term for some locations.

“IMGs are highly appreciated and respected by the many rural and remote communities they serve, as well as by their Australian-trained colleagues.

“They deserve significant and increased support in their critical role, particularly at a time when they are highly concerned about what the 457 visa changes will mean for them and their families.”

Article 2 : AMA CAUTIOUSLY WELCOMES NEW VISA ARRANGEMENTS FOR OVERSEAS DOCTORS

The AMA has cautiously welcomed the Government’s new visa arrangements, but is seeking more detail and clarification of the possible impact of the changes on medical workforce shortages.

The current 457 visas will be abolished from March 2018, and replaced by a new Temporary Skills Shortage Visa, which will have tighter conditions and have a smaller number of eligible occupations. It will also be harder to progress to permanent residency from the new visa class.

The AMA has been advised that doctors will still be eligible for the new visa, but there is little detail about medical specialties or groups. Existing 457 visa holders will continue on the same conditions they have now. It is important that doctors with these visas who have been working hard towards permanent residency are not disadvantaged.

AMA President, Dr Michael Gannon, said that international medical graduates (IMGs) have made a huge contribution to the Australian medical workforce, especially in rural areas and during periods of chronic workforce shortages.

“Many communities would not have doctors if it were not for the excellent work of IMGs,” Dr Gannon said.

“Australia is presently in the fortunate position of producing sufficient locally-trained medical graduates to meet current and predicted need. It is time to focus our energies on training the hundreds of Australian medical graduates seeking specialist training.

“But we still need to have the flexibility to ensure that under-supplied specialties and geographic locations can access suitably-qualified IMGs when locally trained ones cannot be recruited.

“It is important that we strike the right balance between filling vacancies with locally trained graduates and ensuring that communities, especially in rural and remote Australia, have doctors in the right numbers and with the appropriate specialist skills and experience to meet patient needs.

“The AMA welcomes the emphasis of the new arrangements to better target recruitment and the mandatory requirement for labour market testing, which the AMA has been calling for in light of the significant increases in locally-trained medical graduate numbers.

“We also need to see the Government step up policy efforts to encourage local graduates to work in the areas and the specialties where they are needed.”

Today, the chief executive officer of the National Rural Health Alliance, David Butt, did warn that banning 457 visas will have an immediate, and potentially significant, impact on the recruitment of health professionals in rural and remote Australia.

Article 3 SkyNews interview

So what does the Australian Medical Association think of the change? Joining me now live from his office in Perth is Dr Michael Gannon. He’s the President of the Australian Medical Association. Dr Gannon, thank you for your time. Do you have any concerns about the changes announced today?

MICHAEL GANNON: Well, we cautiously welcome these changes, but what we want to see is flexibility in the new arrangements to make sure that areas that still do have genuine shortages, like the rural and regional areas you mentioned, do have the ability to recruit doctors, nurses, other health workers, if need be.

ASHLEIGH GILLON: I note, looking down the list of just over 200 job categories that are being removed from that list as to people who are eligible to apply for these visas to work here, doctors are obviously not on that list, but there are plenty in the medical field. Occupations being taken off the list include medical administrators, nurse researchers, operating theatre technicians, pathology collectors, dental therapists, mothercraft nurses, first aid trainer, Aboriginal and Torres Strait Islander health workers, also exercise physiologists. Are you confident those type of roles can actually be filled by Australians?

MICHAEL GANNON: Well, certainly what we’ve seen in Australia in recent years is tremendous investment in medical students, and we’ve seen similar investments in a lot of these other health professions. We need to see flexibility in the arrangements, so for those specialties or those areas of the workforce where genuine shortages remain, that we are able to get staff from overseas. But what we’ve seen too much of is this mechanism gamed. We need employers to be more honest about the needs for extra staff, and what we need to see is greater investment in training positions for those hundreds of locally trained doctors who are now lining up desperately trying to find specialist training, and then deploy them where they’re needed, making sure that Australians in rural and regional areas continue to be well serviced by health professionals.

ASHLEIGH GILLON: How far away are we from that point? From being in a position where we don’t actually need foreign doctors and nurses to bolster our health system, especially in those rural and regional areas?

MICHAEL GANNON: Well, certainly, in terms of numbers, we’ve got it about right. If anything, we’ve got an oversupply. But what we need to do, and this is going to require the input of government, it’s going to require the profession to change, we need to make sure that those potentially thousands of extra doctors that we’ve got are deployed in areas where we need them.

So we need to get smart in the future. The AMA’s calling for a third of all medical students to come from rural areas. We want to see more positive experiences for junior doctors and medical students when they go to the regions. We know from evidence that that means they’re more likely to go and work in the bush later.

There’s a moral dimension to these changes: every time Australia recruits a doctor from a Third World country, or from another country, they are taking those doctors away from populations that desperately need them. Australia’s definitely reached self-sufficiency in terms of total numbers of medical graduates. We’ve got to make sure that the public hospitals, the private hospitals, the general practices, have the training positions so that we can get Australian-trained doctors out there and working.

ASHLEIGH GILLON: Aside from the job numbers that are decreasing in terms of occupations that we’re looking for to fill some of the roles here in Australia, there still are some substantial changes involved in the announcement today, including mandatory police checks, labour market testing, but is it safe to assume that already happens in the medical field? Do you see any of the changes announced today impacting specifically people working in the health area?

MICHAEL GANNON: Look, I think that there’s going to be plenty of positives to this announcement, as long as we do maintain that flexibility. So if there is the opportunity for us to recruit a genuine superstar of academia, or someone who brings a new skill to Australia, we need the flexibility to be able to employ them. If we identify specialty by specialty, or region by region, genuine shortages, we must maintain that flexibility to employ them.

But too often it’s been easy in the public hospital system to say to Australian-trained doctors with genuine grievances, ‘look, take your problem and take it away with you. We’ll find another doctor from overseas’. It’s incumbent that the employers actually produce environments that are safe for doctors to work with and to work within. And it’s actually incumbent on them to listen to doctors if they identify shortages or shortcomings in the system.

This will make it harder for hospitals just to ignore problems. They might find it harder to just say to an Australian-trained doctor, ‘go away, we can find someone else from overseas to fill the shortage’.

ASHLEIGH GILLON: Just on another matter Dr Gannon, expectations are pretty high that the Government will be lifting the freeze on Medicare rebates for doctor visits in the Budget. You’ve been lobbying pretty hard for this change, for a long time now. How confident are you that we will see that change on Budget night?

MICHAEL GANNON: Look, I’m very confident that we’ll see some change. But one of the reasons that discussions continue between myself and the Health Minister is that he’s got a budgetary environment that is hard to give me everything that I’m asking for. We would like to see the freeze lifted across the entire Medicare Benefits Schedule. The freeze on patient rebates not only impacts on GPs, but it impacts on specialists who bulk bill their payments. And what it’s meant is that for many years now, procedural specialists have had the amount that they’re paid by the insurers frozen. That, in turn, has an impact on the public hospital system.

So you can see that the freeze is impacting across the board. To thaw out across the entire system costs over $3 billion. I’m sure there’s a situation where every other Minister is being asked to deliver substantial cuts in their budgets. And in the health sphere, we’re asking for increased spending. That’s difficult for the Minister to deliver on. Equally, he’ll be in no doubt that we want to see the freeze unravelled across the entire schedule.

ASHLEIGH GILLON: Only a few weeks to go and we’ll know all. And just finally, Dr Gannon, before you go, we saw these reports yesterday that doctors are fearing that the overuse of antibiotics could see common illnesses become life threatening. It follows the death of a woman in the US from an antibiotic resistant infection. Should we be worried about this? Should we be concerned that simple childhood illnesses could one day again become deadly?

MICHAEL GANNON: I think we’ve got a lot to worry about, and it’s not just children that need to worry, it’s adults as well. We potentially face returning to the pre-antibiotic era. This has numerous dimensions of concern. We might see what we regard now as very simple operations become too dangerous to perform. We might see people who are potentially able to be cured of auto-immune disease or cured of cancer denied these treatments because we can no longer deal with the infections that come from immune suppression.

This requires numerous elements of attention. It requires international cooperation through bodies like the G20 to recognise there is market failure in here and big pharmaceutical companies can’t afford to make the investment in looking for new antibiotics. At the individual hospital level, we need to see smarter antibiotic stewardship. At the individual patient level, we need to see patients understanding reasons why doctors don’t just want to dish out antibiotics for viral infections. These individual reports are going to become more common.

ASHLEIGH GILLON: So you think Australians at the moment are taking too many antibiotics when they don’t really need them?

MICHAEL GANNON: Well, certainly, individual doctors need to get smarter when they’re prescribing antibiotics. We need to de-escalate treatment in accordance with the results of microbiological testing, where it’s appropriate to use a narrower spectrum antibiotic. Individual patients need to get smarter in preventing the infections that can be prevented through vaccination, and they need to get smarter in understanding the difference between a virus and a bacterial infection, and if the doctor says you don’t need antibiotics for bronchitis or you don’t need antibiotics because this is a virus, they need to heed that advice and do their bit to prevent antibiotic resistance.

ASHLEIGH GILLON: Dr Michael Gannon, appreciate you joining us live there from Perth. Thank you.

MICHAEL GANNON: Pleasure, Ashleigh.

Article 4 : 457 visas vital for rural and remote health workforce

Banning 457 visas will have an immediate and potentially significant impact on the recruitment of health professionals in rural and remote Australia.

Despite the increase in the number of health professionals graduating from Australian universities, recruiting professionals to work in rural and remote Australia is still difficult.

“I would love to be in the situation where we rely on locally trained health professionals to fill all vacancies in rural and remote communities”, said David Butt, Chief Executive Officer of the National Rural Health Alliance, “but that is still many years away. Without overseas trained health professionals, many rural and remote communities would simply be without access to health care.”

“I note that a new class of visa will be available, and while I have not yet seen the requirements, I would urge the Government to be mindful of the need to ensure implementation does not impact negatively on the health needs of the seven million people living outside Australia’s major cities,” said Mr Butt.

“The people who live in rural and remote Australia have higher rates of diseases than their city cousins, and have poorer health outcomes, with death rates up to 60% higher for Coronary heart disease and 35% higher for lung cancer.

NACCHO TOP10+ #JobAlerts : This week in Aboriginal Health : Doctors, Aboriginal Health Workers etc. etc.

 

 

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