The struggle for justice for overseas-trained doctors

Contact Robyn Iredale at

See also Submission to the Australian Competition and Consumer Commission

This document is located on the

Suppression of dissent website

in the section on Documents

In late 1997, a 19-day hunger strike by overseas-trained doctors was suspended after the NSW Health Department brokered an agreement to facilitate negotiations between the doctors' association and the Federal Health Minister, Dr Michael Wooldridge, the Australian Medical Council (AMC), the NSW Department of Health and the Australian Medical Association (AMA).

Associate professor Robyn Iredale was invited by the Australian Overseas Trained Doctors' Association (ADTOA) to participate in these negotiations due to her long association with this issue.

The negotiations during 1998 focussed on a wide range of issues encompassing assessment, training, registration and employment. One of the major gains has been the development of number of models for an accredited bridging program (to partially replace the AMC exams). The models are now being considered by the Commonwealth and State Health Ministers Advisory Committee.

Another significant achievement was the provision of 100 places in Medical Schools in 1999, funded by the Commonwealth Minister, for retraining of overseas doctors (especially refugees). These people will complete an Australian medical degree and then undertake their internship training and five years of practice in rural areas of Australia.

Potentially the most important outcome from the hunger strike and the Agreement is the Review of Employment of Doctors in NSW. Unfortunately the report has been withheld by the NSW Government and only the recommendations have been sent to the ADTOA.

According to Michael Reid, Director-General of NSW Health, it could be 'defamatory' of some organisations and 'it is in the best interests of the doctors not to release the report as it may make stakeholders unwilling to cooperate with the Government in the reform of processes'.

The Australian Trained Doctors Overseas Association President, Dr Chen Ding, does not accept this explanation. The following Press Release was issued by Robyn Iredale on 3 February, 1999 and this led to a number of radio, TV and newspaper interviews. The ADTOA is now being supported by the National Farmers' Federation and by other mainstream groups, especially from rural areas.

The recommendations of the report are also included on this site, following the Press Release. Interested individuals are urged to press the Government to implement these recommendations as they represent a 'blueprint'for reform.


UNIVERSITY OF WOLLONGONG NSW 2522 TEL 02 4221 3926 FAX 02 4221 3128
3 February 1999

What do they have to hide?

A migration analyst has condemned the State Government's suppression of parts of a report into employment of overseas-trained doctors.

The report 'Race to Qualify' was released under the Freedom of Information Act with large sections of text blacked out.

However it indicated the treatment of some overseas-trained doctors could be considered 'unlawful discrimination'.

Associate Professor Robyn Iredale, of the University of Wollongong, believes the suppressed sections contain further damning conclusions.

The Department of Health this week refused an internal appeal to release the full report.

Associate Professor Robyn Iredale is a researcher with an international reputation on global migration issues and is an adviser to the Australian Doctors Trained Overseas Association (ADTOA).

She said the State Government's secrecy had lost the trust of the ADTOA and many others involved in ethnic affairs and health.

'Health Minister Andrew Refshauge and Premier Bob Carr are stalling, as the next stage of appeal would successfully delay the release of the report till after the coming election', Professor Iredale said.

She said this contravened a recent High Court decision that information should not be suppressed by government, except in extreme circumstances.

Repeated calls for the full report's release from Professor Iredale, ADTOA, the NSW Ethnic Communities Council and Shadow Health Minister Jillian Skinner have failed.

Professor Iredale published a book in 1997, 'Skills Transfer', which argued indirect discrimination was an inherent part of the accreditation system for overseas-trained doctors.

'Race to Qualify' highlights many instances of direct discrimination by the

NSW Medical Registration Board and the NSW Health Department, she said.

'Some of the statements in the report received so far are:

(1) no documentation was available on the criteria used to assess the suitability of applicants for specialist area-of-need positions;

(2) the NSW Medical Board's criteria for conditional registration placed permanent residents in double jeopardy;

(3) the differential treatment [of permanent and temporary resident doctors] may constitute unlawful discrimination'.

'Race to Qualify' was prepared as a condition of an agreement signed on 5 December 1997 by the ADTOA and the NSW Health Department to end a hunger strike of overseas-trained doctors. It was prepared by a Committee of Inquiry set up in February 1998.

The Committee included the Heads of the Ethnic Affairs Commission, the Anti-Discrimination Board and the Office of the Director of Equal Opportunity in Public Employment.

Professor Iredale said the Health Department refused to have any non-Government members on the Committee, in spite of the ADTOA's concerns about possible future suppression of information.

The suppressed parts are apparently so damaging that they will cause 'heads to roll' if the full report is released, Professor Iredale said.

'Skills Transfer' was published by the International Business Research Institute (IBRI) at the University of Wollongong. Professor Iredale analyses migration, multicultural studies, equality and human rights in the new Key Centre for Asia Pacific Social Transformation Studies (CAPSTRANS), an initiative of UOW and the University of Newcastle.

She can be contacted on 02 42214903 or 02 42213448 or mobile 0417 215783.

Issued by Kerrie O'Connor, Media Services Unit Tel (02) 4221 3926



October 1998

part of the Executive Summary

'Fundamental to the Committee's approach is the principle of the separation of standards of assessment from workforce-management questions or membership of particular organisations. The Committee is confident that the recommendations are designed to maintain the highest medical standards in NSW and in Australia generally' (page 13).

The NSW Medical Board and NSW Health Department

Recommendation 1:

That the NSW Medical Board ensure that identical processes for assessment and registration for area-of-need positions are applied to permanently resident overseas-trained doctors and temporary resident doctors (see page 87).

Recommendation 2:

That NSW Health, centrally and in conjunction with stakeholders standard protocol for Statewide labour market assessment. The protocol should stipulate minimum advertising requirements, including a requirement that copies of advertisements be provided to relevant overseas-trained doctors associations. There should be a standard advertisement format, with particular mention that area-of-need positions may be available to permanently resident overseas-trained doctors, who may require conditional registration. before nay action is taken to recruit doctors from overseas, NSW Health should be satisfied that the protocol has been duly followed (see page 89).

Recommendation 3:

That NSW Health develop a comprehensive policy on, and minimum standards for, the recruitment and selection of medical practitioners. The documentation should support the principles and values of merit selection, including a non-discriminatory approach and minimum standards that must be followed for the employment of any medical practitioner in the NSW health system. The documentation should be developed in consultation with the NSW Anti-Discrimination Board, the Ethnic Affairs Commission of NSW, and the Office of the Director of Equal Opportunity in Public Employment (page 90).

Recommendation 4:

That NSW Health negotiate with all bodies that assess medical practitioners' suitability for filling area-of-need positions, and any other positions that cannot be filled by medical practitioners with general registration in Australia, with a view to documenting and publishing the criteria that are used to assess overseas-trained doctors for suitability for such positions (page 91).

Recommendation 5:

That for area-of-need positions that are not in hospitals accredited by the Postgraduate Medical Council, the NSW Medical Board grant conditional registration to permanently resident overseas-trained doctors.

This conditional registration should continue to operate following successful completion of the clinical examination and successful candidates should be given priority for supervised accredited placements.

Should a conditionally registered permanently resident overseas-trained doctor working in an area-of-need position fail the clinical examination, they should be given priority for an area-of-need position, with training to help them prepare for another attempt at the examination (page 97).

Recommendation 6:

That NSW Health establish and maintain a database of all categories of overseas-trained doctors with conditional registration working in the NSW health system. Resident status and country of primary medical qualification should form part of the database (page 101).

Recommendation 7 :

The Committee recommends that NSW Health review all positions in NSW filled by occupational trainees, to

* determine whether the placement of occupational trainees in all of these positions is appropriate:

* develop criteria for occupational traineeships against which the appropriateness of the classification of the position can be assessed;

* review current occupational traineeships against these criteria.

Australian Medical Council (AMC) examinations

Recommendation 8:

That the Board publish its criteria for determining the period of supervised training fort AMC graduates. Further, given that the NSW Medical Board requires a period of supervised training for AMC graduates, the Committee recommends that NSW Health monitor the demand for supervised training places for AMC graduates and assess the adequacy of the number of available training positions (see page 117).

Recommendation 9.1:

That NSW Health explore with the private health sector the availability of facilities for the conduct of the AMC clinical examinations, to increase the number of facilities currently available (page 124).

Recommendation 9.2:

That NSW Health recommend to the AMC that a minimum of four weeks' notice of available places in a clinical examination be given to AMC candidates (page 124).

Recommendation 10:

That NSW Health approach the Commonwealth DETYA to seek recognition of the Pre-employment Orientation Program as a formal training course that attracts the relevant benefits (see page 133).

Recommendation 11:

The Committee commends NSW Health for developing the Pre-employment Orientation Program for AMC graduates and recommends that this Program be instituted on a permanent basis (page 133).

Recommendation 12:

That access to a nationally accredited bridging program is fundamental to the training needs of permanently resident overseas-trained doctors. In the interim, the Committee acknowledges the value of the existing Clinical Bridging Program in NSW and recommends that it be maintained as a viable and accessible course (page 134).

Recommendation 13:

That NSW Health formally propose through the Australian Health Ministers Advisory Conference that the AMC permit candidates who fail a single subject to take a supplementary examination in that subject (page 155).

Recommendation 14:

That NSW Health formally propose to the Australian Health Ministers Advisory Council that, to ensure procedural fairness and to avoid complaints of discrimination. the AMC examinations be based on a clearly articulated curriculum (page 158).

Taking Account of Cultural Diversity

Recommendation 15:

That the NSW Medical Board and the NSW health system ensure that medical practitioners are aware of the medical, ethical and legal reasons for using professional interpreters (page 172).

Recommendation 16:

That NSW Health review the need for bilingual medical practitioners and specialists and develop a strategic approach in its recruitment of medical practitioners, including

* encouraging applications for relevant employment and training positions from suitably qualified medical practitioners with cultural and linguistic skills;

* the establishment of scholarships for permanently resident overseas-trained doctors with cultural and linguistic skills that are identified by NSW health as being in short supply. to prepare for initial registration or to undertake further training, or both (page 173).


Recommendation 17:

That NSW Health propose to the Australian Health Ministers Advisory Conference, that where the availability of training places for specialist training is limited in number that some of those places should be identified and made available specifically for the assessment of overseas-trained specialists who are permanent residents of Australia who qualify for training (page 186).

Recommendation 18:

That s.7(1)F of the NSW Medical Practice Act be amended to require the NSW Medical Board to provide conditional registration to overseas-trained specialists for preparation for examinations and nay further training for the period prescribed by the specialist colleges as necessary for recognition of the applicants' overseas qualifications (page 191).

Recommendation 19:

That legislative changes be made to allow individual medical practitioners refused registration, other than on the grounds of medical standards, competency and professional conduct, the right of appeal in the judicial system (page 191).

Recommendation 20:

That the NSW Medical Board be required to inform any person refused registration of the grounds on which registration has been refused, their right to appeal, and the process of appeal (page 191).

Recommendation 21:

That, to ensure equity of access to employment opportunities for overseas-trained specialists, NSW Health pursue an amendment to the definition of specialist in clause 2(d) of the Salaried Senior Medical Practitioners (State) Award, to require employers to recognise the specialist qualifications of overseas-trained specialists

* whose qualifications are on the list of qualifications recognised by the National Specialist Qualifications Advisory Committee or

* who have proof of recognition as a specialist by the Specialist Recognition Advisory Committee or

* who have conditional registration with the NSW Medical Board as an overseas-trained specialist (page 201).

Recommendation 22:

That, in the recruitment and selection of medical practitioners for specialist positions in the NSW health system, the policy and minimum standards described in relation to area-of-need positions apply (page 201).

Review of the Medical Practice Act 1992

Recommendation 23:

That the Director-General of NSW Health advise the NSW Minister for Health to pursue the following amendments to the Medical Practice Act 1992.

Recommendation 23.1:

Section 1.30 of the NSW Medical Practice Act should be amended

* at subsection (2)(d) to replace 'a registered medical practitioner nominated by the Ethnic Affairs Commission' with 'the Chairperson of the Ethnic Affairs Commission of NSW or his or her nominee'.

Recommendation 23.2:

* to include the following members

- an independent chairperson, to ensure consistency of approach and total independence. Ideally, the person should not be a member of any decision-making body in the medical profession associated with education, registration, assessment and the medical workforce. Consideration should be given to a member of the judiciary being the chairperson,

- the President of the NSW Anti-Discrimination Board or his/her nominee,

- one representative of overseas-trained doctors, nominated by the NSW Minister of Health (pages 202-203).

Recommendation 24:

The NSW Minister for Health should be given legislative power to direct the Board on matters of policy, but this power should not include issuing directions on matters pertaining to the registration or individual medical practitioners or the setting of medical standards (page 203).

Recommendation 25:

The Medical Practice Act should be amended to clearly identify the powers of the NSW Medical Board, including that it not take into account matters other than medical standards, competency and professional conduct in the registration of individual practitioners and the setting of medical standards (page 203).

Recommendation 26:

To acknowledge the social and cultural diversity of NSW, the State's Medical Practice Act should be amended to require the NSW Medical Board, and any other bodies operating under the Act, to conform in their policies and processes with the requirements of the NSW Anti-Discrimination Act 1977 (page 203).

Recommendation 27:

Subsection 7(1)E of the Medical Practice Act should be amended to require the NSW Medical Board to provide conditional registration to overseas-trained specialists for the purpose of their competence being assessed by the AMC or any other prescribed body (page 203).

Validation of the AMC Examinations

Recommendation 28.1:

That, to ensure public accountability, transparency and independence, NSW propose to the Australian Health Ministers Conference that there be periodic independent monitoring and validation of the AMC examinations. The validation should relate directly to medical standards and be concordant with the requirements of Commonwealth and State legislation as it applies to anti-discrimination. It should also recognise cultural diversity, and it should ensure that AMC examiners are trained in cultural awareness and anti-bias techniques (page 205).

Recommendation 28.2:

The validation should have the following representation:

* an independent chairperson from the judiciary

* the current representatives of the Australian Medical Council

* a representative of the Human Rights and Equal Opportunity Commission

* a representative of the Standing Committee on immigration and Multicultural Affairs

* an expert in English as a second language

* representative of overseas-trained doctors associations, as nominated by the Australian Health Minister Conference.

Recommendation 29:

That NSW Health ask the AMC to develop and publish the standards and processes for the conduct of the written and clinical examinations and develop uniform and comprehensive documentation of the process and outcome of individual clinical examinations and make them available to candidates who wish to appeal against the outcome (page 206).

Other Recommendations relating to Specialists

Recommendation 30:

That NSW Health propose to the Commonwealth Department of Health and Family Services that further work be done to identify and remove any barriers to assessment of overseas qualifications and access to training places for overseas-trained specialists. This work should build on the work already done by the Medical Colleges Selection and Appeals Steering Committee of the Medical Training review Panel. Representatives of the Human Rights and Equal Opportunity Commission and a representative of overseas-trained doctors associations, as nominated by the Australia Health Ministers Conference, should be involved (page 207).

Recommendation 31:

Further, s.7(1)E of the Medical Practice Act should be amended to require the NSW Medical Board to provide conditional registration to overseas-trained specialists for the purpose of their competence being assessed by the AMC or any other prescribed body (page 207).

Restrictive Practices

Recommendation 32:

The Committee invites the NSW Government to consider whether the Competition Code is meeting its stated objectives in providing legal redress to individuals and groups with concerns about restrictive practices of professional bodies (page 210).