Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia

To the Editor: In the article by Elkin and colleagues,1 the conclusions drawn from the data analysed do not appear to be adequately supported. It should be noted that only 30% of complaints against doctors had a final hearing, and the risk of adverse findings (ie, where the doctor was found to be guilty) was not analysed by country of origin. Although doctors from certain countries attracted higher rates of complaints, it is inappropriate to label them as “high risk” in the absence of data on adverse findings. It is conceivable that the complaints against the so-called low-risk groups (typically, from English-speaking countries other than Australia, such as the United Kingdom, New Zealand and similar countries) were less likely to be simply driven by cultural misunderstanding or racism and might therefore have been based on actual deficiencies in practice. This, in reality, could possibly be driving the significantly higher risk associated with international medical graduates (IMGs) as a whole in terms of the rate of adverse findings. In addition, a larger proportion of complaints attracted by the so-called high-risk groups may eventually be proven to be unsubstantiated. Therefore, this study is unable to prove whether the professional practice of the group labelled as high-risk was concerning at all.

We agree with the authors that more research is needed on underlying causes for complaints against IMGs and Australian medical graduates. Ideally, such a study would use data on complaints adjudicated by board members blinded to the doctor’s country of training. Equally important would be creating more opportunities for acculturation and supervised training for IMGs, especially in the initial period of their practice in Australia.