VICTORIA, AUSTRALIA
OVERSEAS TRAINED DOCTORS
Media Attention
In September 2002 media attention focused on the employment of overseas trained doctors (OTDs) in Victoria’s public hospital system, highlighting concerns about the supervision and safety of these doctors.
The board issued a media release outlining the vital role overseas trained doctors play in Victoria’s medical workforce and describing the board’s role in providing limited registration, enabling the OTDs to train in Victoria’s hospital system under supervision.
Victorian hospitals are responsible for ensuring these doctors are appropriately supervised and supported so they can provide safe medical care to the Victorian public. The board grants specific registration (Medical Practice Act 1994 s8(1)(b)) to enable these doctors to undertake training as part of their preparation for the Australian Medical Council examination.
Experiencing the hospital system — while supported and supervised — and gaining an understanding of patient expectations in Australia is an important part of training for overseas trained doctors. The same is true for junior Australian-trained doctors who also work under supervision in the State’s public hospital system.
In registering these doctors — with limitations on their practice — the board aims to strike a balance between protecting the community, ensuring the availability of a qualified medical workforce and providing overseas trained doctors with supervised and supported experience in the Victorian hospital system.
OTD Briefings
The board began regular briefing sessions in September this year for all newly registered overseas trained doctors, to welcome them to the Victorian medical community. The board recognizes that these doctors face many challenges when they first begin practice in Victoria. Not only do they have to deal with a new place of employment, but they must also navigate an unfamiliar medical regulatory system and, in many cases, become familiar with a different culture.
The briefing sessions aim to support specific registrants in their transition to practice in Australia and complement orientation programs run by individual hospitals and other medical organizations.
All medical practitioners granted initial specific registration are required to attend a briefing session within two months of registering. The sessions are led by board members and cover issues including:
Trust and the medical practitioner
Boundaries
Communication
Culture
Good medical practice
Personal health
Professional development
Registration matters
The briefings are scheduled for the first Friday of each month and all doctors currently holding specific registration are welcome to attend the sessions. To register for a briefing session please telephone the Registration Department on (03) 9655 0555. Specific session times are published on the board’s Web site at www.medicalboardvic.org.au
Update From the Department of Human Services
In October 2002 the State Government announced that overseas trained doctors working in Victorian public hospitals will receive communication and cultural training as well as a pre-registration assessment.
The Department of Human Services (DHS) says the additional pre-registration requirements aim to ensure the interests of both the community and overseas trained doctors are protected. The Department has worked with a range of stakeholders, including the board, and commissioned a study into the training and education needs of overseas trained doctors. The resulting strategies are to be introduced from 2003 and include:
New standardized pre-registration assessment of medical skills, clinical knowledge and communication skills
The introduction of a communication and cross-cultural training program
Comprehensive pre-employment orientation to the Australian and Victorian health system
More rigorous and monitored supervision and ongoing assessment of overseas trained doctors employed in the public hospital system.
Victorian Overseas Trained Doctors Rural Recruitment Scheme
In late 1999 the DHS introduced the Victorian Overseas Trained Doctors Rural Recruitment Scheme in an effort to attract appropriately qualified and experienced general practitioners to communities in rural and remote locations that find it difficult to recruit and retain doctors. These doctors are registered under section 8(1)(c) or section 8(1)(e) of the Medical Practice Act 1994.
Section 8(1)(c) of the Act enables an applicant to practice within a medical specialty when that applicant has qualifications in a specialty obtained outside Australia, but recognized by the relevant Australian specialist college. Section 8(1)(e) of the Act enables the board to grant registration when an applicant holds qualifications in medicine that do not qualify the applicant for general registration, but the board believes that, to meet an identified need in the community for a medical practitioner, it is necessary for that applicant to provide medical services.
Doctors registered under section 8(1)(e) must obtain fellowship of the Royal Australian College of General Practitioners (RACGP) within two years of selection and commencement in a scheme position. The registrant must remain within a scheme position for five years to become eligible for an unrestricted Medicare provider number.
After obtaining fellowship of RACGP, the registrant may then apply for permanent residency through the Department of Immigration and Multicultural and Indigenous Affairs. After obtaining the fellowship of RACGP, these doctors are registered under section 8(1)(c), which provides for a more permanent form of medical registration. OTDs applying for this registration are subject to the same conditions as all other doctors applying for renewal of registration, although when registration is granted their practice is restricted to the field of general practice.
The board, through its Clinical Practices Advisory Committee, has a role in the assessment of medical practitioners who apply for the Scheme. Eligibility is based on past general practice experience, as assessed by the RACGP, structured interviews, objective structured clinical examinations and independent referee checks. The assessment aims to ensure that the medical practitioner is safe to practice independently. More than 80 doctors have been placed in rural Victoria through the Scheme since its introduction in late 1999.
Doctors and Self-Prescribing
Many medical practitioners continue to be unaware or do not understand that it is not legal to self-prescribe. When the board has published this advice before, some of the most frequent statements made by doctors included:
“I am only prescribing repeat prescriptions for a chronic condition, such as hypertension”
“I don’t have a general practitioner”
“I don’t have time to visit a general practitioner”
“I’ve been writing my own prescriptions for years and the pharmacist has always dispensed the medication”
“I thought I could prescribe medications as long as they are not drugs of addiction”
None of these responses are acceptable. Regardless of the circumstances, self-prescribing remains a breach of Regulation 47 of the Drugs, Poisons and Controlled Substances Regulations 1995.
Regulation 47 states that:
‘A person must not use, prescribe, sell or supply, a drug of dependence or a Schedule 4 poison, Schedule 8 poison or Schedule 9 poison for the purpose of self-administration unless that person — a) is a patient for whom a medical practitioner or dentist has prescribed that drug, poison or controlled substance…’
Regulation 47 was drafted with the intention of precluding people, including medical practitioners, from self-administering Schedule 4, 8 or 9 drugs except when they are prescribed by another medical practitioner or dentist.
Advice from the Drugs and Poisons Unit of the Department of Human Services confirms that a medical practitioner cannot self-prescribe a Schedule 4, 8 or 9 drug. The advice of the department is that a person cannot be both a medical practitioner and his or her own patient at the same time. The department has also confirmed that it has successfully prosecuted several medical practitioners for failing to comply with Regulation 47.
Reprinted from the Medical Practitioners Board of Victoria Bulletin, Vol. 4, December 2002
ALBERTA, CANADA
PIN PILOT SUCCESFUL
The Final Report of the Pharmaceutical Information Network (PIN) Steering Committee was presented to the Information Management/Information Technology (IM/IT) Governance Council on December 2, 2002. The IM/IT Governance Council will in turn be making recommendations regarding PIN and the Electronic Health Record (EHR) project to the Deputy Minister of Health and Wellness.
The Steering Committee reported that the pilot project running in Westlock and Leduc was successful, and recommended implementing PIN province wide, as a component of the provincial EHR initiative.
Also recommended was the creation of an EHR data stewardship body, which would be responsible for health information placed into a provincial EHR system. The recommended multi-stakeholder group would ensure that EHR data is gathered, stored and shared in a secure system, with appropriate security and confidentiality provisions in place.
A total of 154 physicians, pharmacists and hospital health care providers in Westlock and Leduc piloted the PIN application from March through to October 31, 2002. Over 12,000 prescriptions for 3,100 patients were entered into PIN during that time.
Users stated that PIN provided value, through the provision of:
a more complete patient medication profile,
legible prescriptions,
more complete prescription information (i.e., pharmacist instructions, SIG instructions, management of drug to drug interactions)
a reduction in prescription or medication errors,
the detection of patient medication compliance or misuse, and
assistance in care delivery decision making (e.g., clinical practice guidelines, drug monographs).
Reprinted from the College of Physicians & Surgeons of Alberta January 2003 issue of The Messenger
ONTARIO, CANADA
REMOVING BARRIERS TO PHYSICIAN SUPPLY: NEW INITIATIVES WILL BRING MORE DOCTORS INTO THE SYSTEM
In collaborating with key players in the Ontario medical community, the College of Physicians and Surgeons of Ontario has developed a practical plan to address the province’s urgent need for more doctors.
The Physician Resources Task Force was set up last spring to find timely and effective ways to increase Ontario’s physician supply without compromising registration standards. It included representatives of the Ministry of Health and Long-Term Care, the Council of the Ontario Faculties of Medicine, and the Ontario Medical Association.
Ernie Eves, Ontario’s Premier and Tony Clement, Minister of Health and Long-Term Care, estimate that the new plan will add more than 650 new physicians — mainly International Medical Graduates (IMGs) — to the health-care system over the next five years. It is expected that the plan will enable up to 150 new IMGs to provide medical service in Ontario in 2003.
“By removing barriers and providing more training opportunities, we will more than double the number of foreign-trained doctors practicing in Ontario and significantly improve access to front-line health care,” said Premier Eves.
Dr. Jeffrey Turnbull, a CPSO council member and chair of the task force, says that each element of the plan removes an impediment that keeps doctors from practicing in Ontario. “We all had to give up something. The college, for example, has agreed to broaden what it was willing to consider as qualifications for registration in Ontario,” he said, referring to the new fast-track assessment program (see table on the next page).
“We will move beyond simply looking at credentials that may have been established a long time ago and instead assess the physician’s practice. It is innovative. It is philosophically challenging. And I think it took a lot of faith for the College to say ‘yes, we can set up structures to do this.’”
Under the new assessment system, doctors currently practicing in other jurisdictions can access a streamlined assessment and registration system. This system will allow the college to expedite registration by customizing the assessment process, said Dr. Turnbull. Highly qualified candidates could be registered soon after making their applications.
It is expected that the assessment system will get underway shortly.
The new system will complement other elements of the plan, such as the repatriation program for Ontario-trained doctors now working abroad. “The genius of this plan lies in its multi-faceted approach,” said Dr. Dody Bienenstock, the college’s past president.
In making its announcement about physician resources, the government outlined the following eight initiatives:
Creating 60 new advanced level postgraduate positions in 2003/2004 and up to 85 the following year. The positions will accommodate both IMGs and Canadian medical graduates in need of additional training to become licensed.
Creating 25 entry-level training positions beginning in 2003/2004 with positions dedicated to IMGs through the Canadian Residency Matching System (CARMS) in 2004/05.
Creating a resource office and single integrated assessment that targets IMGs seeking registration in Ontario.
Establishing a fast-track process to assess and license physicians practicing in jurisdictions outside the province to practice in Ontario, especially those willing to practice immediately in underserviced communities. This program will also assess osteopaths who are qualified to provide medical services.
Providing stipends to IMG participants while they are undergoing the six-month assessment.
Providing funding for a physician-extender pilot project in anesthesia to support physicians and nurses.
Amending the Schedule of Benefits to allow specific categories of specialists who do not have national certification to bill as specialists.
Establishing a health human resources planning body, composed of three to four health professionals who would provide advice and research on the supply, mix, and distribution of health human resources.
How the New Assessment System Works
Screening: Candidates will be screened to determine if they have minimum qualifications, such as a medical degree and a clear record with their licensing bodies.
Assessment Route: A candidate’s training and current practice will be reviewed to determine if a full practice assessment is necessary or if the process can be modified and expedited. (For example, an internationally trained doctor practicing in another Canadian province would rarely require a full assessment.)
Practice Assessment: If a full practice assessment were required, a trained assessor would visit the candidate for a day’s evaluation. The evaluation would include a full review of patient charts, interviews with patients, and colleagues. A College committee would review the data collected from the evaluation and determine if the candidate was immediately eligible for a certificate authorizing independent practice or if practice validation were required.
Practice Validation: If the candidate required skills upgrading to qualify for registration, he or she would be given a restricted certificate of registration and would be required to practice under supervision, and participate in on-going assessments and continuing education. On satisfactory completion of this program, which could last up to one year, the candidate would be certified for independent practice.
Dr. Turnbull says the new initiatives are a solid way of addressing the supply of physicians. However, he added that attention has to be paid on the other side of the equation. “To use a surgeon’s analogy,” he said, “you don’t want to just keep putting in red blood cells; you have to also stop the bleeding. So we have to start addressing the reward and recognition side of the equation, so that physicians don’t continue to leave the province.”
Reprinted from the College of Physicians & Surgeons of Ontario Web site
