Dr Mikaela Seymour reflects on PNG Government efforts to recruit international doctors - which she says has disappointed and confused newly-trained PNG medical practitioners who are struggling to find training positions in government-funded health care. She considers Australia's experience with international doctors and identifies training barriers facing pre-vocational doctors in both countries.
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The PNG Government’s efforts to recruit Cuban Doctors to the PNG health workforce have disappointed and confused pre-vocational PNG medical practitioners as they struggle to find suitable training positions in government funded health care. PNG’s approach reflects the longstanding Australian policy to recruit professionals in areas of deficit to provide speciality health care to rural and remote populations. This article aims to explore the success (or otherwise) of this initiative and highlight the training barriers facing pre-vocational doctors in both countries.
Australia has long welcomed International Medical Graduates (IMGs). Since 2004 there has been an active effort to recruit overseas trained doctors to fill a medical skills shortage, especially in rural and remote areas. In 2015, 25% of all doctors working in Australia graduated overseas and were classified as IMGs. The hope was this injection of health expertise would buoy our own medical workforce until an increase in our own domestic medical graduate numbers could fulfil Australia’s health requirements.
However, the Australian Medical Students Association (AMSA) have identified that the huge increase in domestic medical student numbers (>200% nationally), intended to address this national medical skills shortage, has strained the public health system’s ability to provide quality internships and speciality training positions for our own domestic medical graduates. Australian Medical Association Council of Doctors in Training agrees and attributes this to a lack of workforce planning, and the direction of resources towards increasing medical student numbers and recruiting international specialists, without consideration for the specialist training pathway between these two careers points.
PNG has a similar issue. Dr Ludwig Nanawar, Director of Medical Services at Laloki Psychiatric Hospital, Port Moresby, describes “hundreds of PNG doctors out there in the wilderness who cannot get a job in the public health system because of [a lack of] positions”. Freezing public service recruitment from within PNG while intending to hire overseas doctors is contradictory at best and hypocrisy at worst. Dr Leslie Kawa of Port Moresby General Hospital agrees, telling me (via e-mail) that the government moratorium on public service hiring has most disadvantaged junior doctors attempting to enter speciality training. He believes the solution lies with stronger connections between Australia and PNG, with the Royal Speciality Colleges of Australia and New Zealand embracing our closest neighbour as part of our training programs. However, no move to improve the training relationship can be made without appropriate workforce planning.
Community Health Worker Students from Rumginae Health School working with Griffith University Medical Students 2015 (Photo supplied: Mikaela Seymour).
In PNG medical training only occurs at the School of Medical and Health Sciences at the University of Papua New Guinea (UPNG), located in the capital of Port Moresby. Similar to the majority of medical programs in Australia, UPNG students complete a basic sciences undergraduate degree before being accepted into the Bachelor of Medicine/ Bachelor of Surgery Program. Approximately 50 students are accepted yearly. On graduating, students must complete a two year residency, usually at Port Moresby General Hospital, before being eligible to apply for specialist training.
In order to specialise in a specific medical area, you must undertake vigorous post graduate training. In Australia this is run through the Speciality Medical Colleges, in PNG through the Masters of Medicine Training Programs, facilitated by UPNG and the Department of Health.
Comparing numbers, PNG’s 50 graduates and Australia’s 3648 domestic graduates, you would think Papua New Guinean pre-vocational doctors would find positions on speciality training programs more easily, without the fierce competition now emerging in Australia. Unfortunately this is not the case, and both countries are dealing with a growing number of junior doctors with no clear speciality training pathway available to them – potentially wasting the enormous personal and state resources poured into their training thus far. These doctors are not registered on a particular training program, have no clear career path and no standards enforced for supervision, continued training and professional development.
It is frustrating that the PNG Department of Health is looking overseas to recruit specialist doctors rather than focussing on training its own pre-vocational doctors. This could be understandable if there was strong evidence IMGs successfully provided health care to currently neglected communities. The World Health Organisation estimates PNG needs to produce 300 further medical graduates annually to meet the minimum acceptable health demands of the population. It is obvious why recruiting overseas doctors would be attractive to try and meet this number, however the PNG government must be careful to avoid the situation Australia is now facing.
Despite a decade of vigorous overseas recruitment, Ewen McPhee, President of the Rural Doctors Association of Australia states the critical skills shortage for rural Australia continues unresolved. He believes that despite having excellent skills and good intentions, overseas doctors are unsupported, ‘forced’ to work in rural areas where they are isolated and dealing with cultural barriers which make it difficult to practice quality medicine, and as a result are not meeting the specialist shortfalls that they were recruited for in the first place. In response, the Australian Health Department has successfully campaigned for the removal of 41 health roles from the skilled occupation list (used by the Department of Home Affairs to favour visa applications from professionals with specialist skills which Australia lacks) to allow domestic graduates to fill these positions.
In both PNG and Australia, the government has failed to provide appropriate health workforce planning from medical school to specialist accreditation. Simply recruiting IMGs without consideration for pre-vocational doctors training numbers will leave further communities underserviced, unless appropriate planning is undertaken to increase specialty training positions.
In analysing this crisis facing junior doctors in both countries, it is my hope that PNG will learn from Australia’s mistakes and not divert funding and resources towards recruiting IMGs without first addressing the lack of speciality training positions available to its existing resident doctors. This is an opportunity for the PNG National Department of Health - in association with the Department of Personnel Management and Department of Labour - to lead in the Pacific in producing a sensible, collaborative National Health Workforce Plan which will both provide appropriate career paths for medical professionals in PNG and ensure the country’s health needs can be met.
 Pre-Vocational Doctors are those which have recently graduated and have not yet trained in a particular speciality area.