Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008