twrama 1990_final oc.. - AMA WA

HIGHER RISK OF COMPLAINTS AGAINST SOME
INTERNATIONAL MEDICAL GRADUATES
I
nternational medical graduates are more likely than their Australian-trained counterparts to have complaints made against
them to medical boards and receive adverse disciplinary findings, according to a study published in the Medical Journal of
Australia.
However, the results differed markedly by overseas country of training, according to the lead author Katie Elkin and leader
of the research group Professor David Studdert, from the School of Population Health and Law School at the University of
Melbourne, and their co-author.
The researchers found that doctors who qualified in Nigeria, Egypt, Poland, Russia, Pakistan, the Philippines and India
had higher odds of complaints than Australian-trained doctors.
The numbers of international medical graduates (IMGs) in Australian clinical practice have grown and now account for
nearly 25 per cent of doctors in this country. According to the authors, some high-profile cases featuring incompetent IMGs
have ignited public concerns, but there is very little hard evidence about whether the quality of care delivered by this large
section of our national medical workforce is better or worse.
The researchers analysed over 5000 complaints resolved by the medical boards in Victoria and Western Australia between
2001 and 2010 and found that overall, IMGs had 24 per cent higher odds of attracting complaints than Australian-trained
doctors, and 41 per cent higher odds of having adverse disciplinary findings made against them.
The big differences were among IMGs themselves. For example, complaint rates against doctors trained in some countries
were more than five times greater than complaint rates against doctors trained in other countries.
Despite having relatively high complaint rates, the contribution of IMGs from some countries to total complaints in
Victoria and Western Australia was small, the authors wrote. The authors added more research was needed to uncover the
reasons for the inter-country differences.
The data used in the study preceded the move to a national practitioner registration system.
“The recent move to a national registration framework should expand opportunities for research in this area,” they wrote.
“Findings from this study should provoke and inform discussion about more sophisticated approaches to regulating
IMGs”, the researchers concluded.
In an accompanying editorial published in the same issue of the MJA, Professor Balakrishnan Nair and his co-author,
from the Centre for Continuing Medical Professional Development at John Hunter Hospital, Newcastle, wrote that the report
highlighted “the need for a proactive and tailored approach in assessing, mentoring and supporting IMGs, which, in turn, will
improve patient care”.
According to the authors, an unpublished survey conducted by their centre showed that, of 243 IMGs, one-quarter
reported receiving no formal orientation and fewer than half received orientation lasting less than one day.
“Instead of setting IMGs up to fail, we should be doing everything to set them up to succeed. If IMGs fail, both the
Australian community and the medical profession will suffer,” they wrote.
SNIPPET
AUSTRALIA’S FIRST LIVER–INTESTINAL TRANSPLANT
HAILED A SUCCESS
Australia’s first intestinal transplant recipient remains well two years after his operation who described the breakthrough
procedure in detail in the Medical Journal of Australia. Dr Mayur Garg and Dr Adam Testro, gastroenterologists with
the Liver Transplant Unit at Austin Hospital, and their co-authors described how a team of 20 surgeons, anaesthetists and
theatre staff performed the operation.
Austin Hospital and Royal Children’s Hospital in Victoria recently joined the ranks of 35 centres worldwide that are
equipped to perform this procedure, which can save the lives of patients with irreversible intestinal failure.
The 32-year-old recipient had experienced bowel dysfunction since birth and had had multiple operations by the age of 18
years. Since the operation, his psychological well-being and quality of life had improved markedly. He is now able to eat and
has returned to full-time work for the first time in 14 years.
According to the authors, there have been enormous advances in immunosuppression protocols, surgical technique and
post-operative care since the first human intestinal transplant was performed three decades ago. Figures now show five-year
survival rates of more than 50 per cent for intestinal transplants performed between 2006 and 2011.
Prior to the establishment of this service, Australians who needed this operation either succumbed to their condition or
had to travel overseas at great financial and psychosocial expense, said Associate Professor Simone Strasser, a senior staff
specialist at AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, in an editorial in the same issue
of the MJA.
However, medical advances such as intestinal transplant would be stymied unless organ donation rates improved, she
wrote.
“We must have an effective and sustained improvement in organ donation rates to bring Australia in line with countries in
North America and Europe that are able to provide transplantation to two to three times as many patients as we do.”
October MEDICUS 43