International medical migration: what is the future for Australia?

Perspective ustralia has developed extraordinary reliance on international medical graduates (IMGs) compared with other OECD (Organization for Economic Cooperation and Development) countries. Based on analysis of an unprecedented range of secondary data, I aim to define the recent scale and sources of medical migration, IMGs' immigration categories, their distribution, their performance in the Australian Medical Council examinations, and the impact of the Competent Authority Pathway. IMGs were sponsored to Australia on a temporary basis, with a further 2790 selected as permanent skilled migrants. 1,2 Thousands of additional IMGs arrived unfiltered in advance for human capital attributes, admitted as spouses and through Australia's family or humanitarian categories. Recent IMGs have trained in highly diverse countries, associated with very variable English language testing results and medical registration and employment outcomes. Despite such challenges, I argue that Australia's reliance on IMGs is likely to be maintained in the future, owing to a combination of factors. First, medical migration remains Australia's key strategy for addressing medical workforce maldistribution, with competition to recruit and retain medical migrants recently intensifying rather than diminishing. Second, the Competent Authority Pathway for registration has improved IMGs' outcomes, enhancing their immediate value as a source of supply. Third, Australia has become increasingly reliant on internationally trained specialists to serve in select undersupplied fields. Fourth, there is growing Australian demand for international medical students, who achieve exceptional early outcomes relative to IMGs. Despite greatly enhanced investment in domestic student training, Australia's dependence on international migration thus appears likely to persist rather than reduce in the foreseeable future. By 2006, 45% of medically qualified residents were overseas-born, including an estimated 25% who were overseas-qualified. other southern and central Asian countries, North Africa/ the Middle East, South Africa, sub-Saharan Africa (excluding South Africa), and the Philippines were the primary source countries at this time (Box 1). 4 Medical workforce diversification has proven challenging, however. Just 53% of IMGs who arrived in Australia during 2001–2006 secured medical employment by 2006 (across all immigration categories). Doctors from English-speaking countries made the transition seamlessly, while Asian-Commonwealth doctors from countries such as Singapore and Malaysia, India, Sri Lanka and Bangladesh fared reasonably well. Outcomes were poor for many other birthplace groups (Box 1). Just 6% from China had found medical employment within 5 years, 23% from Vietnam and 31% from Eastern Europe. Many had arrived through the family and humanitarian categories — untested in advance for employment …