Dialogue: Lowering the barriers risks safety of patients

PIPPA MacKAY responds to criticism that a closed shop which discriminates against overseas-trained
doctors operates in the New Zealand medical profession.

It's not uncommon to hear politicians and others say the medical profession is a closed shop. But when pressed to explain their comment, they can often express only a vague feeling that unreasonable barriers are imposed on overseas-trained doctors who want to work here.

After all, we've all heard the stories about overseas doctors working as taxi drivers and pizza deliverers, rather than being able to work here as a medical practitioner.

It's also widely known that during the early 1990s, there was an influx of doctors to New Zealand who were incorrectly told by immigration authorities that they would be able to work here.

Unfortunately for many of them, their qualifications were not accepted for registration. (The Government has now stepped in to help these doctors by providing extra training for some).

So what are the facts? According to the Medical Council's annual report for 1999-2000:

Thirty-eight per cent of doctors working in New Zealand trained elsewhere in the world.

A total of 473 doctors from 38 countries were granted temporary registration, up from 434 the previous year.

General registration was granted to 226 New Zealand and Australian graduates, and 174 overseas-trained doctors during 1999-2000.

The six countries providing the most overseas-trained doctors to New Zealand are (in order of doctor numbers): Britain, South Africa, India, Australia, Sri Lanka and Iraq.

When the facts are known, the claim that medicine is a closed shop becomes increasingly difficult to substantiate.

As well, the Medical Council is constantly reviewing its registration processes. Just before Christmas, it announced that doctors from Britain, Ireland, Canada, South Africa and the United States (countries with similar standards of medical training and practice to New Zealand) would no longer have to sit an examination after their temporary registration to proceed to permanent registration. This will be particularly useful to recruit and retain doctors for areas which have been hard hit by the doctor shortage (such as rural areas).

The Medical Association welcomes overseas-trained doctors. In fact, many of our members were not educated in New Zealand. We also acknowledge that many young New Zealand doctors want to travel and get overseas experience. With the expanding global economy, such opportunities are even more accessible.

In recent months, the association has lobbied strongly against the Medical Practitioners (Foreign Qualified Medical Practitioners) Amendment Bill, a private member's bill introduced by Act MP Ken Shirley.

This bill would require the Medical Council to register overseas-trained doctors whose qualifications have been accepted by the Qualifications Authority. In effect, it would create a two-tier system of medical registration, and has the potential for lowering safety standards.

Our concerns are twofold. First, we have yet to be convinced that a serious problem exists with the current registration system.

Far from being a closed shop, many overseas-trained doctors have gained registration in New Zealand and work here. If there are perceived problems with the Medical Council or the specialist medical colleges, it would be better for the council to be reviewed and improvements made to the registration system.

In fact, the Medical Association has proposed that an independent review should take place.

Secondly, we question if the Qualifications Authority should be involved in the registration of doctors.

Among other roles, the authority coordinates qualifications in secondary schools and in post-school education and training, and administers national secondary and tertiary examinations. The registration of doctors is a complex business, and the Medical Council already carries out this function. Why duplicate it?

The only possible reason for involving the authority is because the council requirements are seen as too onerous. Presumably the authority requirements would be easier.

This would inevitably introduce a two-tier system, and all overseas-trained doctors would be likely to end up being seen as having a second-rate qualification.

The Medical Council administers NZREX examinations for overseas-trained doctors, which are designed to ensure that doctors are safe to practise, at the minimum level of a sixth-year New Zealand medical student. There is also a requirement for a competent level of English.

With pressure on the medical profession following such events as the Gisborne cervical smear inquiry, and questions about safety in hospitals, it seems contradictory to be advocating lowered standards for overseas-trained doctors.

All parties have voted to send the Medical Practitioners (Foreign Qualified Medical Practitioners) Amendment Bill to a select committee. The Medical Association understands that Labour and National oppose it becoming law, so it should not proceed further.

However, the MMP environment sometimes means support for legislation is based on political expediency rather than common sense, so the association will continue to advocate strongly on this issue. It makes no apology for insisting on high standards for all doctors working here.

The Overseas Doctors Association has also been quoted as being opposed to the Shirley bill. No doubt their members don't want to be seen as getting in under a second-rate system.

New Zealand-trained doctors continue to leave the country in large numbers, driven by huge debt levels and attracted by much higher pay in many overseas countries which have made a commitment to funding more doctors.

The Government is setting up a health workforce advisory committee which aims to find solutions to workforce problems here and improve the health environment, so more doctors decide to stay.

In the meantime, overseas-trained doctors are welcome, as they always have been, but only if they meet the same high standards that New Zealanders expect from doctors who train here.

* Dr Pippa MacKay chairs the Medical Association.