The 10‐year anniversary of the Lost in the labyrinth inquiry into registration processes and support for overseas trained doctors: the good, the bad, and the ugly

A decade after reporting obstacles in the registration process, are international medical graduates still “lost in the labyrinth”?

Obstacles to registration and accreditation for international medical graduates (IMGs) are not new. On 16 March 2012, the standing committee on Health and Ageing released the Lost in the labyrinth report into the registration processes and support for IMGs. The scope of the inquiry was extensive, involving over 200 submissions and 22 public hearings, which were held in 12 cities.1

Chair Steve Georganas wrote:

The report included 45 recommendations which, if adopted, would significantly improve the efficiency, effectiveness and, most importantly, the fairness of the system.

What has happened in the interim decade since the report was tabled? Are IMGs still “lost in the labyrinth”, or at least stuck in cul‐de‐sacs, as suggested by Yeomans and colleagues2 in the accompanying article? What still needs to change to improve the system?

The good

In the past, the system for the collation and verification of documentation required for registration and accreditation of IMGs was fragmented, convoluted and lengthy. The Australian Medical Council (AMC) has developed a central portal for the repository of primary documentation (the Electronic Portfolio of International Credentials [EPIC]), which can be shared by the Medical Board of Australia (MBA) and specialist colleges, thus streamlining the process and greatly improving efficiency.3 Other significant improvements implemented by the AMC include expansion of the number of places for Part 2 of the AMC exam and the workplace based assessment pathway.4,5

The MBA has also taken several steps to improve the transparency and accountability of the registration and accreditation processes for IMGs. The MBA website provides clear and comprehensive information on the requirements and processes involved in the Standard, Competent Authority and Specialist Pathways.6 It has also developed a clear and comprehensive set of standards for the specialist colleges for the assessment of specialist IMGs. These standards include a set of guiding principles which stipulate that assessment processes must be fair, transparent, efficient, effective and accountable, and that IMGs must be afforded procedural fairness. It also clearly defines the comparability standards against which IMGs are to be assessed and the steps that the colleges must follow to assess a specialist IMG’s qualifications and training.7

The bad

A lack of transparency in the criteria and processes used by the colleges to assess the comparability of specialist IMGs qualifications and training has been a long‐standing problem.8

This issue was recognised by the committee who wrote:

I did a search of the specialist colleges’ websites and associated links from the perspective of a specialist IMG who wanted to know if they were likely to be assessed as substantially comparable. Most of the websites did provide a comprehensive overview of the steps and rationale for comparability, but only two provided enough detailed information on their websites for me to be able to self‐assess whether I was likely to be evaluated as substantially comparable or not.9,10 One of the websites included a self‐assessment tool for IMGs. One of the questions was whether the IMG trained in a comparable system.11 This is the crux of the issue: how do they know if they trained in a comparable system, and what information does the college use to make this determination? For example, does the college look at specific qualifications and/or the country they trained in, or do they consider this on an individual basis? Specialist IMGs need to spend thousands of dollars to apply to the AMC and the colleges for a comparability assessment. It is only fair that the colleges provide this type of information in the public arena to enable specialist IMGs to make an informed decision about whether to pursue a career as a specialist in Australia.

The ugly

The Lost in the labyrinth report was tabled in Parliament on 19 March 2012. According to legislation, the government must issue a response to an inquiry report within 3 months. However, the 19 June deadline came and went without any official response from the government.12 Ten years have passed and there is still no official response from the Labor or Coalition governments, despite calls from the IMG community for them to endorse the inquiry recommendations.13 To add insult to injury, the federal government publishes a list of parliamentary inquiries related to health and their responses. The Lost in the labyrinth report is not even on the list.14 Personally, I know that many IMGs were left feeling shocked, betrayed and defeated by the government’s protracted silence.

Final thoughts

I do believe that significant improvements have been made to the registration and accreditation systems for IMGs in the past 10years, particularly with respect to improved efficiency, transparency and accountability. It also needs to be acknowledged that the AMC, the MBA, and the specialist colleges adopted many of the report’s recommendations in the absence of an official government response. Nonetheless, Yeomans and colleagues2 suggest that IMGs still struggle with barriers to registration, with no obvious avenues for addressing these problems. This leaves them stuck in cul‐de‐sacs, which, although not as convoluted as being “lost in the labyrinth”, still leads to a dead end.

The Chair, Steve Georganas, wrote:

The federal government has a responsibility to IMGs and the Australian public to keep this promise and finally formally respond to the Lost in the labyrinth inquiry.