Tough call for doctors trained overseas

Since the Jayant Patel case surfaced years ago, I have exaggerated my Australian accent for fear of being seen as an overseas doctor. This fear is worst when I work in rural areas, to the point where I considered carrying my Sydney University degree.

Even before the ubiquitous Indian computer worker, there was the Indian or south Asian doctor. A Department of Health report into overseas-trained doctors in 2007 noted in the past 30 years, doctors from south Asia supplied the largest proportion of imported medicos across Western countries. Moreover, they worked in areas where locally trained doctors would not.

They represent a large proportion of an estimated 40 per cent of overseas-trained doctors serving our rural and remote communities. They have treated thousands of patients, delivered babies at small local hospitals and stayed on call seven days a week. This trend has been repeated across the West, from small towns in the American south, to icy cold outposts in Canada to forming the backbone of the National Health Service in Britain.

Their children went into the most demanding professions, many following in their parents' footsteps. They are forming the most successful immigrant group in the world, as measured by education status and income. In the US, figures such as the director of Sixth Sense, M. Night Shyamalan, and the Governor of Louisiana, Bobby Jindal, are children of Indian doctors working in isolated areas.

The influx of overseas-trained doctors has represented a form of indentured labour, a term not normally used in highly skilled professions.

The government report found that along with filling a need in remote communities, a growing proportion fill the junior positions in our public hospitals, jobs associated with grunt work and relatively low wages. Their lower pass rates in the required training examinations often mean they remain in such positions for long periods, trapped in a kind of occupational prison public hospitals can become.

The recent sentencing of Patel has placed them under the spotlight once more. While authorities have called for all overseas doctors not to be tarred with the same brush, this discrimination often works unconsciously. The images of Patel, who resembles the average south Asian doctor to many Australians, automatically creates a fear not easily overturned.

Even before his conviction and sentencing, the case had done its damage. Overseas doctors are now known as international medical graduates, a term believed to be less stigmatised. They are now subjected to a screening test, given a limited time to obtain Australian qualifications and continue to receive little in the way of training resources to complete arduous exams.

Many rural areas wait up to a year to have overseas doctors scrutinised by the relevant registration authorities. Much of this is appropriate. Medical qualifications around the world are becoming difficult to assess. The growing deregulation of education has led to a proliferation of medical colleges. An international body overseeing the sector recorded about 2,000 medical schools in 170 countries in 2008.

Sue Douglas, a representative for the Australian Doctors Trained Overseas Organisation, says her members, many of whom have worked in other Western countries, rate Australia as the most parochial nation with regard to its medical fraternity, often dismissing legitimate qualifications from prestigious centres. This is likely to get a whole lot worse given the imminent influx of thousands of graduates, a load the system is not yet equipped to train. This will transform the profession, overturning the long-held status of the job being secure and well paid.

As the weakest point in the system, overseas-trained doctors will be the most vulnerable. Douglas believes those who have not yet received permanent residency, or are still trying to gain Australian qualifications, will miss out once local graduates become available. This is in spite of their huge personal and financial sacrifices to help serve needy areas.

She argues the Australian Medical Association does not stand up for her members. Despite representing almost a quarter of the country's medical workforce, the profession's peak body does not give the group any formal representation within its organisation. The contribution to the health and welfare of our nation by overseas-trained doctors has been profound, but their future may be bleak.