Report on the Audit of Health Workforce in Rural and Regional Australia

3.2.2 Overseas trained health professionals

Page last updated: April 2008

Immigration of overseas trained health professionals to Australia is governed through the different visa requirements, all of which are administered by the Australian Government Department of Immigration and Citizenship.

Most overseas trained health professionals enter through the temporary skilled visa categories, for initial periods of up to four years. During that period some will seek additional assessment and will apply to migrate to Australia permanently following a positive assessment by the relevant professional body and/or registration board.

Overseas trained professionals are generally recruited by employers directly, often through specific health professional recruitment agencies or directly by state and territory governments. The movement of overseas trained health professionals throughout the world is significant and subject to considerable study and discussion in international forums such as the World Health Organisation and the Organisation for Economic Cooperation. Concerns about movement of health professionals from third world countries to first world countries has led to protocols, such as the Commonwealth Code of Practice for the International Recruitment of Health Workers, of which Australia is a signatory.

There are a number of factors that encourage overseas trained professionals to seek to work in Australia, which are categorised as 'push and pull' factors. In particular, overseas trained professionals often value the Australian lifestyle, strong economic growth, and opportunity to work in a technologically advanced health sector. In addition, health professionals may be experiencing 'push' factors in their own countries, such as limited economic opportunities, conflict and warfare. It is also known that some countries have a policy of training an oversupply of some professions (for example, nursing in the Philippines) with a view to encouraging emigration of some of those professionals following graduation.

International medical graduates

Recruitment of international medical graduates to practice in Australia occurs in a variety of ways. Many medical position vacancies are advertised in international medical journals and are open to overseas based applicants. Commercial recruiters may engage a medical practitioner to fill a vacancy listed with their agency. Alternatively, some medical practitioners may seek to move to Australia first and then apply. Others come to Australia for a working holiday. State and territory health authorities are significant direct recruiters of overseas trained graduates to work as salaried medical officers in public hospital services.

Currently, those countries in which most international medical graduates have trained prior to entering general practice in rural and regional Australia include South Africa, Nigeria, India, Pakistan and Sri Lanka.

Salaried medical practitioners, such as those working in the public hospital sector, are not in private practice and do not require a Medicare provider number. They may elect to stay in the public sector indefinitely with no further requirements. Medical practitioners working in salaried positions for private companies are similarly not required to hold a Medicare provider number. Consequently, these doctors are not identified in Medicare data. Top of page

Restrictions on practice

For overseas trained doctors (OTDs) working in private practice, either wholly or in part, the Health Insurance Act 1973 (the Act) places restrictions on the areas in which they may practice through Section 19AB. This section of the Act requires the medical practitioner to work in an area of workforce shortage (AOWS) for a period of up to ten years and applies to both GPs and specialists. This requirement came into effect in 1996-97.

The Department uses a range of factors to determine whether an area is an AOWS. The first factor is the GP (or specialist) to population ratio. This allows comparison of a region to the national average of the medical professional to population ratio and an initial determination to be made as to whether the area under comparison has more or fewer medical practitioners than the national average. Areas that have medical professional numbers below the national average are considered to be an AOWS. Inner metropolitan areas are excluded from the provisions and cannot be considered an AOWS.

Should an area not be deemed to be an AOWS through this initial comparison, other factors can be considered when granting overseas trained doctors a Section 19AB exemption. These factors include local issues, such as whether the practice will be providing services to local aged care facilities, whether there is a higher proportion of young families and/or older persons in the area and whether a substantial portion of its patient base will be drawn from a nearby AOWS.

For specialists a similar process occurs, with all areas outside capital cities automatically being considered an AOWS. In capital cities, inner metropolitan placement may be agreed based on the specialty, as some specialist services require the infrastructure provided by a major teaching hospital.

Overseas trained doctors

As at February 2008, there were 4,669 overseas trained doctors, including GPs and specialists, with current Section 19AB exemption status14. There are 3,028 overseas trained GPs and 1,641 overseas trained specialists in private practice nationally. Of the 3,028 GPs, 1,068 work in capital cities (including the outer metropolitan areas) and 1,437 work in rural and remote areas. Of the 1,641 overseas trained specialists, 181 work in rural and remote areas and 1,027 work in capital cities. Top of page

Overseas trained nurses

The Department of Immigration collects data in relation to the number of nurses entering Australia to work on a temporary basis under an approved employer sponsorship agreement, 'subclass 457'. In 2006-07, there were 3,090 visas granted to nurses under subclass 457. However, the exact number of overseas trained nurses working in Australia is unquantified, as information is not collated on nurses visiting Australia on Occupational Trainee Visas, working holidays or as dependents on visas. Also, nurses granted visas in subclass 457 in previous years may still be working in Australia.

Other health professions

Data is not available on the number of overseas trained professionals in the other professions covered in this audit.

14 Overseas Trained Doctors administrative data, February 2008.