Are international medical graduates well supported by the emergency medicine community in Australasia? Yes.

Abstract

In putting together my thoughts for this discussion, I am drawing on both personal and professional experience. As one of the directors of emergency medicine training at my hospital, I have had the opportunity to support many trainees through their training, both graduates from Australia and those who have obtained their initial medical qualification overseas, the International Medical Graduates (IMGs). As an IMG myself, who obtained my undergraduate medical degree in Ireland and then came to Australia in 2004, seeking fame, fortune and sun (ultimately achieving only one of these goals), I have also had the firsthand experience of navigating my way through the Australian health system and undertaking emergency medicine (EM) training. This process was reasonably complex, but I can certainly say that I felt supported through it and in no way disadvantaged as an IMG, certainly not in terms of employment opportunities and access to training. I appreciate, of course, that my own personal journey may have been different to that of others. IMGs form a substantial proportion of the Australian health workforce. Figures from the National Health Workforce Data Set from 2014 suggest that nearly 28% of employed medical practitioners are IMGs, with graduates from India and England forming the largest proportion of this group.1 Interestingly, and tellingly, IMGs are represented even more strongly in the Australasian EM workforce. In that same year, 54.4% of all ACEM trainees and 45.9% of new Fellows were IMGs.2 These numbers alone imply that, at the very least, the EM community is providing a lot of employment opportunities for IMGs. I would venture to suggest that EM provides more than that, and that this large proportion of IMG trainees within EM training is due to a number of factors. A report from Health Workforce Australia in 2014 states that ‘IMGs are disproportionately represented in rural and regional areas as well as in the less “popular” specialties’, but this same report notes that EM has the third highest number of vocational training positions.3 That EM has established itself as such an attractive and vital specialty and that it is populated with such a large number of IMGs is in itself evidence that the EM community supports IMG trainees; however, I believe that this support is not just quantitative but qualitative. One case for the large numbers of IMGs within EM training is that of sheer exposure. Many non-specialist IMGs will gain employment in Australia through the standard pathway, which usually requires a period of supervised practice.4 Frequently, this period of supervised practice involves a 10 or 12 week term in an ED. During this term, the IMG is exposed to the challenging and varied caseload that comprises core business for most EDs, while at the same time benefitting from close supervision by more senior staff. This immediate access to more senior clinical input is certainly one of the things that first attracted me to the specialty. Anecdotally, it is often in the ED that junior doctors who are struggling tend to become more exposed – their clinical abilities and communication skills are very much in the spotlight. This allows for senior staff to supervise and support those doctors through this difficult period. Although in no way implying that IMGs tend to struggle more so than Australian graduates in the ED, I feel that this supportive environment tends to inculcate a fondness for the specialty in those who are as yet undecided in their career choice, or who may be relatively new to the Australian healthcare system. The same community that provides support for those who are yet to start their specialist training has a similarly robust degree of support for those who are enrolled in EM training itself. In recognition of the high proportion of IMGs in its number, including those who work in areas of need, ACEM has a number of projects to help those who are coming from overseas adjust to the Australian healthcare system. The first shift in the ED orientation programme contains useful resources that explain some of the nuances of Australian life and how to navigate the system (the Aussie slang section here alone justifies membership of ACEM – ‘Get a wriggle on, you galah’, and that is just from the ‘G’ section).5 There are many other resources here that explain the morass of paperwork that awaits anyone making the transition from overseas to Australia. The ACEM assessment process has also recently broadened its approach to incorporate workplace-based assessments. These have made non-technical skills such as communication and leadership a lot more explicit and allow trainees to get some more focussed assessments on these areas during their training. For IMGs who may not have English as their first language and who may struggle more in these areas, this focus should help to hone these skills and prepare them for fellowship exam success. For those who are already recognised as EM specialists in other countries, ACEM provides guidelines and regulations regarding obtaining recognition in Australia; thus completing the suite of support for IMGs, from junior doctors through to specialists. I write this piece at the end of a busy shift in my ED. I was struck this morning by the number of IMGs at handover. The overnight registrar is from India. She came here 3 years ago with her family and signed up to EM training after her first year. The senior house officer on with her overnight is from the UK. He is in Australia for 6 months but has already approached me about EM training and asked if he can extend his contract. They handed over to me, who came here more than 10 years ago as an IMG and was struck by the inclusivity of emergency medicine and the supportive nature of its training programme. I believe that IMGs form a vital part of the EM workforce, reflecting the ever-diversifying nature of Australian society and that the EM community gratefully supports them. None declared.