Australia plans to hire more overseas doctors. Is it ethical to recruit from countries with doctor shortages?

Many of us have found ourselves in a full waiting room to see the GP, looking at a laminated sign about a fee increase taped to the reception desk.

Australia is facing a shortage of doctors, especially GPs. The impacts are felt hardest in rural and regional areas, where patients wait up to 12 weeks^[1] for a consultation. These long waits compound^[2] rural health inequalities.

Meanwhile, medical students are turning away^[3] from general practice. One survey^[4] of GPs found 58% reported experiencing burnout since the pandemic. Estimates^[5] project by 2031 there will be a shortage of more than 10,000 GPs.

To address this shortage, the government recently announced^[6] plans to cut “red tape” to make it easier to recruit doctors from overseas. The number of doctors from overseas working in Australia has doubled^[7] since the COVID pandemic hit.

But when a high-income country like Australia recruits doctors from overseas, we risk^[8] causing a “brain drain” elsewhere.

Australia isn’t the only country short of doctors

Australia is increasingly recruiting^[9] doctors from low- to middle-income countries. But we aren’t the only place facing a doctor shortage. This recruitment risks worsening global health inequities and raises concerns around justice.

A recent estimate^[10] suggests Nigeria has 80 oncologists (cancer doctors) for more than 213 million people. Australia has^[11] more than 600 oncologists, and we are a much smaller country, with 26 million people^[12]. Recruiting even one of these oncologists could benefit Australia, but have a disproportionately negative impact on the Nigerian health system.

If we recruit a doctor from a low- or middle-income country such as India, not only does the Indian health care system lose a doctor, it also loses the money invested in training these doctors. It’s a double blow.

However, higher salaries in Australia can serve as a big draw^[13]. It can also be unfair and discriminatory to restrict opportunities for individual doctors who might want to emigrate to Australia, just because they are from a lower-income country.

Ensuring quality of care and fair treatment

If we recruit doctors from overseas, it’s important to ensure they can provide care to Australian standards.

That doesn’t just mean knowing how to diagnose a melanoma or do an ultrasound – it’s also about being familiar with different legislation and guidelines, such as requirements^[14] for doctors to refer patients elsewhere if they don’t want to provide an abortion.

Language proficiency is also important – clear communication is critical for patient safety. However, having doctors who speak a language other than English is also a big positive^[16], especially for refugee and migrant communities seeking health care.

We also need to ensure new recruits are treated well. A global review of international medical graduates found^[17] doctors from overseas reported being given fewer professional opportunities, as well as experiencing racism and discrimination. We have an ethical obligation to make sure doctors we recruit are treated equally and get the support they need.

How else can we boost doctor numbers?

We need to train more doctors to meet Australia’s future demand for health care. This has already begun, with efforts^[18] to open more medical schools in rural and regional areas, including at Charles Darwin University in the Northern Territory.

But it goes beyond just medical school – we need to ensure there isn’t a “bottleneck^[19]” of medical graduates who can’t get further training.

GPs in Australia earn less^[20] than doctors working in other specialties, and Medicare rebates being outpaced by inflation^[21] makes it increasingly difficult to bulk-bill.

We can make general practice and working in rural and regional areas more attractive, such as with higher pay or scholarships.

There are also other ways we can increase access to health care. These include telehealth, as well as nurse practitioners, who can play an important role^[22] in improving access to health care and addressing health inequities.

However, it’s important not to end up with different levels of care for different communities: people in rural communities should be able to access a doctor when they need one.

Importing doctors from overseas is one way of resolving our urgent shortage of doctors, but has significant ethical implications.

If we do import doctors, especially from other countries with doctor shortages, we should give back to those countries and their health-care systems. This could be by increasing foreign aid, or providing further training for health-care professionals who can then take those skills back to their country of origin.

Australia needs more doctors, and that isn’t going to change any time soon. Although importing doctors from overseas is one solution, it’s not a straightforward fix.

References

1. ^{^} wait up to 12 weeks (www.ama.com.au)
2. ^{^} compound (search.informit.org)
3. ^{^} turning away (www1.racgp.org.au)
4. ^{^} survey (www.publish.csiro.au)
5. ^{^} Estimates (www.ama.com.au)
6. ^{^} recently announced (minister.homeaffairs.gov.au)
7. ^{^} doubled (www.health.gov.au)
8. ^{^} risk (www.thelancet.com)
9. ^{^} increasingly recruiting (www.sciencedirect.com)
10. ^{^} recent estimate (ascopubs.org)
11. ^{^} has (www.sciencedirect.com)
12. ^{^} 26 million people (www.abs.gov.au)
13. ^{^} big draw (www.ncbi.nlm.nih.gov)
14. ^{^} requirements (bmcmedethics.biomedcentral.com)
15. ^{^} Laddawan punna/Shutterstock (www.shutterstock.com)
16. ^{^} big positive (onlinelibrary.wiley.com)
17. ^{^} global review of international medical graduates found (www.ncbi.nlm.nih.gov)
18. ^{^} efforts (ministers.education.gov.au)
19. ^{^} bottleneck (www.aph.gov.au)
20. ^{^} earn less (www.ausdoc.com.au)
21. ^{^} outpaced by inflation (www1.racgp.org.au)
22. ^{^} play an important role (onlinelibrary.wiley.com)