North West Hospital and Health Service Acting Executive Director of Medical Services Dr Karen Murphy said health facilities throughout Australia relied heavily on IMGs to fill medical positions in rural and remote areas that were not attractive to many Australian-trained doctors.

"This is no criticism of Australian trained doctors, but it does show that there needs to be increased support for Australian-educated doctors to complete their training in the bush,'' she said.

"At the moment, as they move through their continuing education - and a junior intern straight from medical school, will need a further eight to 12 years of training - they actively seek to gain skills and education outside of Australia, or at least in the metro areas, which can leave a higher level of doctor shortage in areas across Australia, especially in rural and remote areas.

"In the bush, we therefore rely on IMGs to fill our positions.''

Dr Murphy said there needed to be a comprehensive and holistic approach to further training opportunities for Australian educated doctors as they complete their training, from junior intern through to their Medical College Fellowship exam to allow them to work as consultant specialists.

"Many of the Australian medical graduates will not apply for further positions outside of the Metro areas of Australia as they feel that the training opportunities to be able to enter in to a college fellowship programme are best served by remaining in the cities once they graduate," she said.

She said while there has been significant investment in training opportunities in Medical Schools across

Australia for medical students, this has not been met with opportunities for further training placements, managed by Medical Colleges across Australia.

"This means that the majority of Australian graduates believe that if they do not remain in Metro areas, they will be less competitive for the falling numbers of college fellowship training positions available within Australia.

"It's unfortunate that while the investments were being made to increase the number of medical students in Australia, none of the medical schools nor the medical colleges were directed to stipulate that as part of the first two to three postgraduate years of a junior doctor's training, they must work in rural and remote communities and regions.

"There needs to be a 'push' factor in the junior doctor's training that directs them into this country service as part of their training."

Alongside this compulsory rural training, there needed to be an investment in rural and remote support development, alongside the investment in medical schools.

"For many of these training placements, a junior doctor of any level, until they become a consultant, can only work with supervision directly from a consultant, therefore junior doctors who do choose to work in rural and remote areas often work in 'unaccredited' terms as the medical colleges review and 'permit' terms of working to be accredited for the training programmes.

"So, because of this, many of these unaccredited positions cannot be filled by Australian graduates, and while there is still a need to provide a doctor for the local population, it is often IMGs who will work there.

"Incidentally these international doctors are often already consultant level in their own countries, and are very experienced doctors, but because the Australian colleges make it very difficult for these doctors to get unsupervised registration in Australia without stepping down to more junior doctor positions, so you often get very experienced doctors this way for small communities," Dr Murphy said.

In addition, Dr Murphy said there is not enough consideration given to healthcare facilities which already have difficulty recruiting doctors, such as the North West HHS, for the reasons given above - colleges' inflexibility for unique situations, lack of junior doctors wanting to work outside of metro areas, and not enough consultant supervisors in rural and remote areas.

"My final comment is that there is no commonwealth plan to develop the very successful model of providing care closer to home, and getting away from the hospital model of healthcare.

"Colleges of medicine, governments, and public and private health services need to recognise that this is the best way to provide healthcare for patients, but because of these issues around inflexibility, there is no easy way for doctors to do this.

"We need to recognise that many of the "traditional" duties of a doctor can be done safely, effectively and cost-effectively by multi-disciplinary staff as well as doctors: nurses, pharmacists, allied health workers, so investment should be considered in those areas too," Dr Murphy said.

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