Media release: Concerns mount over expedited pathway

A new national fast track system that allows overseas trained medical specialists to work and live in rural and regional Australia is seriously flawed because of a lack of transparency surrounding hospital supervision and clinical oversight, according to one of Australia’s leading medical colleges.

The Australian and New Zealand College of Anaesthetists (ANZCA) is particularly concerned about the potential risks associated with the lack of clear guidelines for hospital supervision of the overseas trained specialists – also known as specialist international medical graduates (SIMGs) − approved under the expedited pathway process and the broader implications for patient safety.

The expedited pathway, introduced late last year, allows anaesthetists from the UK and Ireland to bypass standard medical college processes as a way of addressing specialist workforce shortages in regional and rural areas.

However, ANZCA President Professor Dave Story says the new system has been introduced without any requirement for those approved through the expedited pathway to serve mandatory rural and regional service periods.

“It is ironic that the Medical Board who often reprimand doctors in disciplinary hearings for poor communication are themselves so poor at communicating with the broader profession in areas of concern for both patient safety and workforce well-being. To be blunt, it is unprofessional.

“It is simply astounding that the pathway was sold as a way of plugging specialist workforce gaps outside metropolitan areas yet there is no requirement or clear mechanism for those who are approved under the new pathway to work in rural or regional areas for a set amount of time.”

With reports that at least eight anaesthetists from the UK and Ireland have already been approved to start the expedited pathway, Professor Story says the college has still been unable to get answers to key questions from the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (Ahpra), the regulatory bodies that manage the program.

Professor Story says ANZCA is concerned about the clinical oversight of supervision for this group of anaesthetists and the legal implications for anaesthetists who will be supervising the overseas trained specialists approved through the expedited pathway system.

“Patient safety and high-quality care must always be our top priority,” he says. 

“We must ensure that any new pathways for international doctors are thoroughly evaluated and that appropriate safeguards are in place.”

The pathway system bypasses existing medical college assessment processes, with the Medical Board of Australia conducting paper-based assessment of overseas trained specialists and then approving them for specialist registration (with conditions) in Australia. 

Once approved the anaesthetists need to successfully complete six months of supervised practice in Australia along with workplace-based assessments, cultural safety education and an anaesthetic crisis course.

But Professor Story says there is still a significant amount of confusion and uncertainty around how the expedited pathway will operate.

“We are in the dark about the process and are seeking answers from Australian health regulatory bodies to the following questions:”

• Who is supervising these anaesthetists, and what are the qualifications of those responsible for their oversight?
• Is it true that only one year of anaesthesia practice in Australia is needed to supervise others new to Australia?
• What are the legal implications for anaesthetists who are supervisors of expedited anaesthetists if any issues arise during clinical practice?
• Can someone refuse to supervise anaesthetists on this pathway?
• Will the Medical Board pay supervisors for their time? 

“We need to understand how these processes will protect patient safety and ensure that supervisors are appropriately trained and supported in their role,” Professor Story says. 

ANZCA has been contacted by current SIMGs wo are confused and concerned by statements from the Medical Board suggesting the expedited path was mandatory. 

Professor Story says ANZCA has been “bemused to find that the clearest guidance comes from a recruiting company rather than the Medical Board.” 

ANZCA has written to every state and territory health minister and is planning to raise its concerns in a meeting with Ahpra in April.

“Our priority now is to minimise risks and ensure that the safety and quality of care provided by specialist international medical graduates is upheld,” Professor Story says.

“We are committed to working with the government to resolve these issues and ensure that appropriate measures are put in place.”

ANZCA is also calling for increased involvement in the assessment process, ensuring that supervisors are fully qualified fellows of the college (FANZCAs), and reinforcing the importance of ANZCA fellowship and continuing professional development for all anaesthetists.

“The college stands ready to assist the Medical Board with our 20 years of experience in assessing and supervising international anaesthetists, but so far we have been largely ignored,” Professor Story says.