To the Editor: McGrath’s article on integrating overseas-trained doctors (OTDs) into the Australian medical workforce noted that the areas of difficulty in this area have been well defined.1 McGrath challenged us to “get on with it”. We interpret this challenge to mean that there has been enough regurgitating and redefining of the problem, and it is time for some action.

In South Australia, the difficulties of integrating overseas doctors into the workforce mirror those experienced by other states. The Department of Health Overseas Trained Doctor 2004 database listed 93 OTDs as eligible to work in SA. Seventy were employed. All of these doctors had only completed the Australian Medical Council (AMC) Multiple Choice Question (MCQ) examination. Since its inception in April 2003, the Postgraduate Medical Council of South Australia (PMCSA) AMC doctors subcommittee has worked to put in place a number of educational initiatives to support and assist OTDs to complete the Australian Medical Council Exams, and to advocate for their ongoing needs for better orientation to the workplace and protected education time at work.

The programs initiated by the PMCSA are both Government-funded and self-funded. They are: culture and medical communication for doctors, MCQ tutorial program, ready for work program, hospital tutorials, objective structured clinical examination practice exam, clinical bridging program, and study groups.

Examination results in 2004 for candidates undertaking the PMCSA programs bettered the national average. Of the 16 enrolled participants in the MCQ tutorial program, which ran from January to April 2004, nine sat the May AMC MCQ exam and seven deferred. Eight of the nine passed, giving a pass rate of 89% (AMC pass rate 56%; Australian Medical Council, personal communication).

In the AMC clinical examinations, our candidates achieved an overall pass rate of 67%; 30 sat the exam, 20 passed and 10 were given a re-sit or a fail result. (AMC pass rate 59%; Examinations Officer Clinical, Australian Medical Council, personal communication). Twenty chose to defer after using the various programs and tutorials on offer to gauge their level of preparedness. These doctors are planning to undertake the exam in 2005.

These programs constitute the South Australian Action Plan for OTD inclusion in the workforce. 2 All of these programs are available and appropriate for any OTD (permanent resident or temporary resident). To the best of our knowledge, no temporary resident wishing to work in “areas of need” has enrolled in our programs yet.

In reply: Hart and Vernon-Roberts outline the South Australian Action Plan by the Postgraduate Medical Council of South Australia Australian Medical Council (AMC) doctors subcommittee to support and assist overseas trained doctors (OTDs). Their worthy efforts are directed predominantly towards the many OTDs preparing for their AMC examinations, with associated bridging and “ready-for-work” programs to facilitate entry into the hospital medical workforce.

However, the question that needs to be addressed, and which was the main thrust of my article,1 is why we don’t have a national coordinated approach to all elements of the pathway to integrating OTDs into the Australian health care system. This cannot be a largely political approach, as is the Australian Government’s Strengthening Medicare initiative, which is particularly weak in the areas of assessment for safe practice and support in training.

A recent article has highlighted the need for a national approach to coordinated governance for postgraduate medical education in Australia and the unsatisfactory complexity of medical education and training systems in this country.2 This excellent article includes only very brief reference to OTDs, using the term “international medical graduates”, 2 which is becoming the more acceptable term and the one recognised by other countries. It does not address the many gaps and problems in the pathways for this group.

The number of international medical graduates seeking employment and/or being actively recruited into the medical workforce in Australia each year is far greater than the number graduating from our own medical schools. Thus, there is a degree of urgency about the debate on postgraduate medical education in Australia. We need a national authoritative body, like the new United Kingdom Postgraduate Medical Education and Training Board.