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Thursday, September 23, 2010

An Immigrant's Perspective of AMC and Practice in Australia

 The original article can be found here.

Hi Everyone:

There are a lot of questions and opinions posted on this site. Time for a new forum and leave this one just for the MCQ?

I am just going to give my perspective here. Maybe it will help someone decide whether to come to Australia.

1. Why Australia for you?

Oz is not a bad place to live. It's pretty safe and clean. But it can also be quite boring. If you come here, you are uprooting yourself, saying goodbye to your family and friends, to a strange country where people speak a different language and have no appreciation of who you are, and, unfortunately, the undercurrent of racism is still quite strong here. However, you can strike it lucky and make some good friends here. Most Aussies are simple people, but they are generally stand-offish.

The pay for doctors is not bad compared with most of the world, but there are many other western countries that pay doctors better. Even some developing countries pay doctors better than here. So forget about making a giant fortune. You will be very comfortable as a doctor in Australia financially, but life will not be extravagant. If you want to be a gazillionaire working as a doctor, then you'll need to fight to get into a surgical specialty (see later).

The working environment here is quite different from many parts of the world. In many places, the doctor is god, and patients shut up and listen. Here, it's the other way around. The patient expectation is very high here (not as high as the USA thank goodness). A lot of it depends on your interpersonal abilities. If you speak English very well without much accent, can build relationships very easily with patients, and have strong medical knowledge, it's not bad. However, many overseas-trained doctors fail miserably because they have no interpersonal skills. Aussies are very intolerant of other English accents - even Kiwi accents! Ask yourself if you are the kind of person who can put up with spending two hours with an anxious patient to consent for a minor operation. If you are not, think again about coming here.

Career-wise, I can guarantee right here and then, that your career will suffer a setback for years. (Unless you are invited here as a postgraduate fellow or specialist, which is a totally different story). See later regarding training.

So coming to Australia? I suggest you talk to as many people as you can before jumping on the boat. There are more than 3,000 overseas-trained doctors working in Australia. Obviously there will be some success stories and some disasters. It's not for everyone. So always find out more before you go.

2. Demand for Overseas-Trained Doctors in Australia

If you are a recent medical graduate, you have until NEXT YEAR to come to Australia, pass some parts of the AMC and get general registration. The reason for this is the federal government has set up a huge number of new medical schools in every little town that has a service station and a pub, basically due to a political demand. The result is that in 2009, DOUBLE the number of medcal graduate will come out of Australian medical schools, and by 2012 the number will more than TRIPLE. What this means is the Australian system can't even absorb the new "tsunami" of graduates and offer them qualit internships, and we will probably be an exporter of medical graduates rather than importer. So if you are a recent graduate with little experience and you desperately want to come to Australia, NOW is the time to come. The gate will be forever shut afterwards. They are already talking about cancelling contracts of OTDs who don't have the AMC exams and general registration.

If you are a registrar or specialist level doctor overseas, then you have more time until the tsunami of Australian graduates becomes more senior.

Of course, if you are a GP and want to go out to wop wop (Australian word for middle of nowhere out in the country) to fill an "Area-of-Need" job, they will always take you with both hands. Every state medical board will give you registration on the spot. The problem is, why would you want to go out there when Australians themselves would rather die or fly overseas? These are isolated little towns somewhere in the dust bowl, with little clinical support, no educational opportunities, no chance for specialist training, nothing. Imaging yourself sitting there, having to deal with multi-trauma, obstetric emergencies, paedatric emergencies, and everything else that comes through the door. You make one mistake and one patient complains, you lose your registration from the medical board. You are on call 24 hours a day, 365 days a year, with no break, no holidays, little sleep. Not many people last long in this sort of job. But there are plenty of this kind of jobs going around if you are interested. Just ask anyone.

An additional complication is the UK's Foundation Program and "Modernising Medical Career". It's such a big disaster there that there could be a huge exodus of UK junior doctors to Australia. Of course, they will be taken preferrentially over someone whose English is a second language and has not got white skin. We will still have to wait to see if the flood eventuates.

3. Exams

An oddity, but true. The AMC exam is TOTALLY UNNECESSARY to get a job as a doctor in Australia. I find this very odd as how can you guarantee the quality of doctors coming in, even though the AMC exam is by no means perfect? But desperation for doctors in the "Area of Need" positions means you can go for years without even thinking about it. In the hospitals, it depends on how desperate they are. My feeling is they will become a lot less deperate because of the tsunami of Australian medical graduates.

So if you get into the system and plan to spend more than 2-3 years here, it's worth thinking about passing the AMC. If you want to migrate, the AMC is a must.

The AMC exams are tough but not impossible. If you are smart and willing to spend time studying lots and lots, you will pass. A note of caution - it's great to have lots of old MCQ questions from the website. However, they only indicate the KIND of questions you will be asked. They hardly ever repeat a question, and when they do, they change one or two words in the question so the correct answer it totally different. Therefore, use the questions on the website as a guide only. There is no substitute for solid knowledge.

The clinical exam is very cultural. You need to have very broad medical knowledge, but the interpersonal aspect of interacting with the patient, as well as the exam techniques to pass a viva, are more important. But with practice, all can be overcome. It's just a show.

4. Specialty training

In Australia, specialty training is generally competitive. With the new tsunami of medical graduates coming, the specialist colleges have done very little to open new training positions. So getting into specialty training (including GP) will be harder and harder.

The difficulty of getting into specialty training is directly related to income. In Australia, procedurist are the multi-millionaires, so anything to do with procedure earns lots of money. That's why in specialties such as surgery and ophthalmology, you can forget about it as overseas-trained doctors. Racism is deeply entrenched in the medical hierarchy. In fact, even a white Australian graduate has little hope of getting into ophthalmology if his father is not an ophthalmologist. Just look at the surnames of ophthalmolgists. Nepotism is the word. The same goes for popular internal medicine subspecialties such as gastroenterology and cardiology. If you don't have the right surname, it's tough. Forget about these popular specialties if you dream of specialising in them. Better off doing it at home.

In some less popular specialties, anyone half-decent can still get in without much trouble. These include pathology, psychiatry, medical administration, public health, sexual health, etc. So if you are interested in one of these, you still have a future, although I don't know what will happen when the "tsunami" of medical graduates hits us. My feeling is they will probably all be swallowed up in 3-4 years' time.

So do you think you can come here to get into a good specialty for training and career advancement? Think again. Think again. Australia uses OTDs for labour and pays little regards to their development, welfare, training, etc. But there are exceptions. Sometimes people do get through. They are the rarity rather than the norm.

5. Where to work?

This is a very difficult question, and there is no right answer.

I have been in hospitals where the majority of doctors are OTDs. Some places treat them well, give them lots of help in passing exams and mentorship for furuture development. Some places treat them absolutely miserably. They are chucked into jobs no one else wants with no support or supervision, basically set up to fail. I have seen a young Pakistani doc, the day after arriving in Australia, thrown into a rehab ward with 40 80+-year-olds, each with five pages of medications, with NO CONSULTANT AND NO REGISTRAR. He killed a couple of them. Lucky they were old anyways. A Phillipino girl was thrown into two months of night ward-call the day after she arrived in Australia, of course again without any type of orientation and supervision. It's just appalling.

Don't think the major tertiary hospitals are heavens. They can have grossly excessive workload. And their super subspecialisation and impersonal nature may not be so good for passing exams. Because they are staffed mostly by Australian-trained doctors, they are normally unsympathetic to the needs of OTDs.

The suburban and regional hospitals vary a lot in quality and support for OTDs.

In the Area-of-Need positions, the support is extremely variable again. You maybe ver lucky in a town with 3-4 others who work really well as a team, share the on-call and do not hesitate in supporting you. Or you can end up in a one-doctor town where you are it, good luck.

The gist of the story is: ASK before you jump. Check out the place that give you an offer. Ask for statistics. Ask for rosters. Ask them what support they have for you. And most importantly, ASK to talk to the OTDs on the ground there.

So does Australia still appeal to you? Is it the right thing to do? There is no exact right answers, and everyone is different. There are more than 3,000 OTDs working here. Some love it, some hate it. Some find it enjoyable and have no problem fitting into the system and society, and some struggle a great deal. Occassionally there are big disasters.

I hope this information/opinion help people a bit.

An immigrant, and proud of it.

I think you have given a fair perspective of the picture.

My background is Asian, non white, non Indian. I qualified in medicine from a prestigious UK university, am a Fellow of a British College and hold GMC Specialist Registration and came to Oz in 2003 from a UK locum consultant post under a 422 Visa in an AON programme as a specialist in a Regional hospital. My speciality is a non procedural one.

When a local Ozzie qualified, she "eased me out" using a political move by getting the DMS to express concerns about me. This misinformation led the College to postpone my recognition and required a transfer to a Metropolitan hospital for another 6 months.

This is near impossible as no metropolitan hospital will employ a specialist without a provider number or an Australian fellowship: I was given 5 years to achieve this after which "the College will have the right to impose new conditions"

I obtained good support from the AMA for this injustice but the pay off midway through the contract was only 3 months instead of the full contract.

I put up my hand and volunteered for a part time paid post but did full time and following some haggling with DIMIA, obtained a 457 visa and completed the 6 months. The Medical Board then immediately cancelled my registration - as I had completed my requirements - and, this was in a state desperate for doctors.

The College still imposed caveats on my specialist recognition and caused me numerous problems with registration in another state....I obtained conditional specialist registration in NSW without conditions but the College continued to disturb me and disclosed my difficulties with them to my employer. I appealed and after 3 months a new committee completely threw out the caveats imposed by the Censor.

By that time, the damage was already done.

My employer, a regional hospital, gave me a one year contract with a variable part time/full time involvement as a Level 1 Staff Specialist (few OTDs would know exactly what this meant) and seconded me to a privatised clinic without my knowledge or consent.

Within several weeks, Medicare Australia rang me to caution me regarding 'defrauding the system' When I brought this up with my employer, the manager ordered 'disciplinary action' against me.

I received no warning letter about 'concerns' expressed about me and after 8 weeks from the start, I was suddenly suspended and an investigation launched against me.

My case was reported to the Medical Board as a 'high risk' concern not unlike that of Dr J Patel's case.

I was left high and dry to defend my case as the AMA/ASMOF policy was not to assist with cases which are reported to the Medical Board. My legal bill has exceed AUD 50K and I am still repaying it.

To cut a long story short, there were 30 odd published allegations against me, with 28 by the CNC. All but 3 allegations were substantiated. Those substantiated were related to

1. A post anaesthetic case where I was accused of having poor communication with a pt !

2. Two other consultation cases also related to poor communication and poor judgment

The report also described gross dysfunction in the privatised unit. It also raised a possibility that I was paranoid and mentally impaired!!!

Meanwhile, Medicare Australia bulk billing reconciliation statements revealed irregularities of fraudulent claims.

Also, because of the inconsistent work hours given to me, I had complained to DIMIA and my 457 Visa was cancelled. I did not renew my medical Registration.

After I filed the response to the investigative report, my contract was terminated as I did not possess registration (in response to no right of work)

My Solicitor who initially did a good job in drafting my response, took the case to Industrial Court and despite reconciliation attempts, did not work. A hearing led to a determination that I was not dismissed and that I had myself ended the contract by not maintaining my registration.

If I had done so, I would be the subject of a Performance Inquiry which would most certainly have led to further conditions being imposed on my registration.

Meanwhile, I rang 3 patients whose "complaints" had been "substantiated" to genuinely apologise BUT to my surprised realised from them that they had NOT complained about me but that the allegations had been falsified.

Two gave me Statutory Declarations and I made a report to state Police. They have asked the Complaints Commission to completely review the matter (This is a statutory body which is above the Medical Board) and to refer it back to the Police if they found it appropriate.

The case is ongoing with my having been nearly bankrupt with no employment, no certificate of good standing to move on and a huge legal bill. Medicare and the Director General of Health's office continue to inquire into the matter.

I had to leave the country to seek employment elsewhere where I had maintained my registration. I am just recovering but as my family had settled down to study, I left them there - under International Student Visas.

The Shadow Minister of Health recently expressed grave concerns this has happened to an OTD who was vulnerable. It was promised that the Health Minister will be asked to look into it. I am not sure whether this interest is related to opportunities in gaining some political mileage in the forthcoming elections.

The other side is trying hard to divert attention from its alleged malpractice of alleged fraud using an OTD's Specialist Provider number to cost shift from the State to the Commonwealth (Federal) Govt.

This short stay of 4 years in Australia has been the most traumatic in my professional and personal life. Unlike our friend the Immigrant, I did not succeed in staying in Australia although I did succeed in getting recognised as a specialist.

Be warned. There are many ingrained racists. I came with an open mind that Australia is not racist. I have found that racism is prevalent and tolerated. There are also some very nice non racist people. But, you would not find out till you are stung. And, when you come in, they make it a point to make you vulnerable to all sorts of issues.

Dr Haneef's case was the worst but at least he had publicity and some public support: mine has been covered up all along the way.

I also know of another non white doctor from South Africa in my same place of work who suffered a similar fate: his case was publicised in the National Press and his name was removed from the Medical Register: when they found out that they had acted on misinformation, there was no apology but just a simple invitation for him to reregister to work under supervision in an approved hospital.

He did not, registered as a teacher (he was a trained teacher) and earned his keep that way. He has since made plans to return to South Africa.