Bridging the Gap: Australian Medical Practices and International Medical Graduate Doctors

The Australian healthcare system is known for being robust with very high standards and often faces challenges in meeting the high demand for the medical practitioners needed. The skills shortage following the pandemic has made this issue more pronounced and led to an increasing trend in Australian medical practices hiring international medical graduate doctors (IMGs). This article explores the process of hiring IMGs, the motivations behind this trend, and the legal implications for your medical practice.

The Rising Demand for IMGs in Australia

Australia's healthcare industry has been experiencing a shortfall in the number of medical practitioners needed, particularly in rural and remote areas. This gap has been partially filled by IMGs, who bring diverse skills and knowledge to the Australian medical landscape. These doctors, often from varied cultural and medical backgrounds, not only address the shortage but also contribute to the multicultural fabric of Australian healthcare.

The Process of Hiring IMGs

Hiring an IMG in Australia is a multifaceted process governed by strict regulations to maintain the quality of healthcare services. The process includes:

Verification of Qualifications

IMGs must have their qualifications verified by the Australian Medical Council (AMC). This ensures that their training and education are equivalent to Australian standards.

English Language Proficiency

Since effective communication is crucial in healthcare, IMGs are required to prove their proficiency in English through tests like IELTS or OET.

Visa and Work Permits

IMGs must obtain a visa to work in Australia that is appropriate for them. The most common categories of visa for IMG doctors are the Temporary Skill Shortage visa and the Employer Nomination Scheme visa. Let’s explain them in more detail.

Understanding the Visa Options for IMGs

Before embarking on hiring an IMG, it’s a great idea to be familiar with the visa options available and understand how the process works at a high level. The two primary visa options available for IMGs coming to Australia are the Temporary Skill Shortage (TSS) visa and the Employer Nomination Scheme (ENS) visa.

Temporary Skill Shortage (TSS) Visa

A TSS visa is also known as a subclass 482. This is the most common pathway for migrating to Australia as a doctor, which requires individuals to be sponsored by an Australian medical practice or hospital. This visa allows medical practices to sponsor skilled workers to fill positions that Australian workers cannot fill. It has two streams, Short-Term and Medium-Term, with varying eligibility criteria.

Employer Nomination Scheme (ENS) Visa

An ENS visa is also known as a subclass 186. The ENS visa is a permanent residency visa that allows medical practices to nominate skilled workers for permanent residence in Australia. It requires a more extended commitment from both the medical practice employer and the IMG.

Understanding the Specific Requirements

Understanding the specific requirements and nuances of these visas is crucial for medical practices seeking to engage IMGs. In order to obtain work in Australia, there must be recognition that there is an undersupply of the work sector you are in. While there may be an assumption that IMGs are required to work rurally, in most cases, IMGs are not necessarily restricted to working in a certain location. However, different visas and practice areas may have different restrictions. For example, anaesthetics, dentistry and exercise physiology are all currently listed as needing to be in a regional area under the TSS visa. Nonetheless, consultation with migration agents or legal professionals experienced in healthcare immigration is recommended to assist in streamlining the visa application process.

Medical Registration

IMGs must be registered with the Medical Board of Australia. They may be required to complete the AMC exams or be assessed through a workplace-based assessment program, depending on the circumstances. Additionally, depending on the profession of the IMG, they may be subject to specific requirements by their assessing authority for skills assessments, such as completing a certain number of supervised hours or showing evidence of ongoing learning and professional development relevant to the field.

Orientation and Training

To familiarise IMGs with the Australian healthcare system, they will need to undergo orientation and training programs, which cover legal, ethical, and professional practice standards in Australia. This can include a period of training at your practice, which of course, includes an investment of doctor time to get them up to speed.

Engagement Options

Once an IMG successfully navigates the rigorous process of qualification verification, English language proficiency testing, visa acquisition, and medical registration, medical practices in Australia can consider various contracting options when hiring IMGs, depending on the conditions of their visa. The most common arrangements include:

Locums

An IMG may choose to work as a locum, providing temporary coverage for absent or busy doctors. This arrangement allows medical practices to address immediate and urgent, more short-term staffing needs. Care should be taken by practices to consider if there is a supervision requirement and how this is worked into the legal engagement terms with the doctor.

Fixed-Term Contract

Medical practices can offer IMGs fixed-term employment contracts, providing a defined period of employment. This option allows both parties to assess compatibility and performance before either party is required to commit to a longer-term arrangement.

Permanent Employment

Some practices may want an IMG to work with them as a permanent employee. In this case, the medical practice can offer an open-ended, longer-term contract, providing stability and career growth opportunities for the IMG. As the practice will likely be investing time for supervision, this will be included in the contract, and some medical practice owners include incentives for the IMG to stay longer term, especially if they are located outside major centres and have found the attraction of doctors to be difficult in the past.

Telehealth and Remote Work

With advancements in technology, telehealth has become an option for medical professionals, including IMGs. This arrangement allows doctors to provide healthcare services remotely, addressing workforce shortages in rural and remote areas, usually as an independent contractor.

You should consider if this arrangement is right for you based on the visa, AHPRA, or College requirements; in particular, any requirements to supervise doctors can be more challenging when doctors are working remotely from the medical practice. If a practitioner is consulting with patients who are in Australia, regardless of the practitioner’s location, the Medical Board of Australia expects the practitioner to be registered with the Board and meet all relevant registration standards. If you are in Australia and consulting with patients outside of Australia, the practitioner should be registered in Australia and confirm whether they are required to be registered by the medical regulator in the country where the patient is located.

Service Agreement

While there may be more barriers to contracted work under a TSS visa in comparison to an ENS, IMGs may be engaged through well-structured Service Agreements, given they meet the requirements and hold the necessary certifications to practice in Australia. This way, doctors are engaged as independent contractors or independent business owners, with this approach, providing a collaborative and mutually beneficial environment for both medical practices and IMGs.

Tenant Doctor Arrangement

A Tenant Doctor Arrangement may also be considered whereby the IMG leases space within a medical facility to conduct their practice. This arrangement provides flexibility for medical practitioners to begin to establish their practice in Australia and allows for cost-sharing and collaborative use of resources. Tailoring a Tenant Doctor Arrangement to IMGs assists in providing an avenue to navigate the complexities of starting a medical career in a new country while benefiting from shared facilities and support within an established medical setting.

Make sure that the visa requirements are carefully checked before engaging an IMG. While a TSS visa requires applicants to work full time and for the same employer for the duration of their stay in Australia, IMGs may seek approval of an exemption to work part-time or irregular hours on the basis they may be considered a ‘highly skilled overseas worker,’ and wish to work in this type of role. Conversely, an ENS visa does not hold these same restrictions and allows individuals to work for different practices without having to obtain a new visa.

Care and Compassion

In our legal practice, we have seen arrangements with IMG doctors that are not legal or ethical. When engaging with IMGs it is imperative to maintain ethical standards, aligning business needs with fair labour practices. Despite medical centres not requiring formal reporting under the Modern Slavery Act (2018) there is a moral and ethical obligation to ensure your organisation does not engage in modern slavery. Upholding these principles establishes responsible business practices and enhances the ethical standing and reputation of your medical practice.

Hiring IMG doctors is a vital feature of Australia’s healthcare system, addressing critical workforce shortages and adding to the sector's diversity. The process involves rigorous checks and balances, which is essential for maintaining the high standard of healthcare in Australia. Care must be taken when engaging IMGs to ensure that you both make the most of the opportunity, and attention to the visa, AHPRA and college requirements, as well as the legal requirements in the engagement to ensure that it’s fair and equitable for both parties.

Our team has extensive experience in providing advice and preparing documents to engage with international medical graduate doctors. To discuss the assistance you need, contact our team here, and we will put you in touch with the best professional for your needs.

Related Articles: Medical Practices & Foreign Workers: Necessary legal considerations for your practice.