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What keeps IMGs in rural areas after their 10-year moratorium?

18 Nov 12:00 by Doug Hendrie of NewsGP, RACGP

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Some overseas-trained GPs move to major cities after their mandatory rural work, but others stay on and put down roots. What makes people stay?

For international medical graduates (IMGs) settling in Australia, there is a major hurdle to jump: the Federal Government’s moratorium, which requires living and working in rural or remote areas for up to 10 years. 
 
As Australia wrestles with persistent doctor shortages outside major cities, newsGP talks to three overseas-trained GPs who stayed on.

Practice principal

For Dr Mirza Baig, movement is normal. After training in Hyderabad, India, Dr Baig and his anaesthetist wife decided to see the world.

They lived and worked in a small town in Saudi Arabia for seven years, where Dr Baig worked as an ophthalmologist. After they had a child, the couple wondered about moving home.  But when they saw a position open on Tasmania’s north-west coast, the young family took the plunge.

Dr Baig began as a registrar at a local hospital emergency department, where his wife also worked, before training as a GP.

‘For us, it doesn’t matter where we are. It’s whether we are comfortable,’ he told newsGP.

The two doctors had to work to overcome a range of initial challenges, from isolation to discrimination.

Fifteen years later, they have put down roots. Though Dr Baig’s rural moratorium period is over, he has stayed put and become a principal at his practice in the small town of Latrobe.

In Peter Barns’ experience, owning or co-owning a practice is a key factor in deciding to stay in rural areas.

Mr Barns, the CEO of Tasmania’s rural workforce agency, HR+, told newsGP that the opportunity to buy in is crucial.

‘When GPs first come from overseas, everything is dictated by 19AB [the moratorium legislation],’ he said.

‘But when they become owners, they’re in charge – and people want to be in charge of their own destinies.’

By contrast, IMGs working in corporate practices tend to head to the city once their moratorium is over, according to Mr Barns.

Of the 900 GPs in Tasmania, around 40% first trained overseas, with the proportion rising the further you go from Hobart. Some areas are almost totally reliant on overseas-trained GPs.

Mr Barns said another key factor for people staying rural after their moratorium period is whether there were other people from their home country living in the area.

‘Whether from Africa, the Middle East or New Zealand, if you have a cohort of people, or are able to build up a community of people, you stay,’ he explained.

‘It used to be every practice was owned by Australian-born or British expatriates. Now practices on the north-west coast are 85% owned by people who were subject to the moratorium at some stage.

‘People do stay if they put down roots, professionally and personally.

‘It can be bewildering, but probably more for the country town than for the doctor. Most doctors have worked internationally before coming here – say, Nigeria to Barbados to the US to Tasmania – and may have lots more multicultural experience than their 96-year-old patients.’

Finding employment for partners and good schools for children, Mr Barns said, is also a key factor.

‘The kids of many IMGs are now doing medicine at the University of Tasmania, so that will be an interesting factor – seeing what the next generation will do,’ he said.

The only GP for miles

Dr Michael Livingston likes to tell people he is the only permanent doctor between Esperance and Albany, on the south coast of Western Australia.

The Glasgow-born GP told newsGP he decided to try Australia after a ‘bad day at work’ in England.

‘I thought it was time for a life change,’ he said.

‘What’s the worst that can happen? So I came with my wife in 2013 with two suitcases.’

Dr Livingston began in Mandurah, on the south-west WA coast, and worked in Gunnedah in New South Wales before spotting an opportunity in Ravensthorpe, 500 km south-east of Perth, where he has been for five years.

After taking over the practice, Dr Livingston has settled into rural life. In fact, he loves it.

While his area may seem remote, it has three large mines nearby, as well as traffic between Perth and Esperance.

That means a constant stream of challenging and interesting cases, ranging from occupational medicine to road trauma to snakebite to farming injuries.

‘Diabetes, auto-immune disease, iron infusions, appendicitis, gall bladder, bowel cancers on ultrasound, a skin cancer list twice a week, GP services, ultrasounds, obstetrics, amputated fingers – bloody well everything,’ Dr Livingston said.

‘The scope and the expectations are massive. The next shire along hasn’t had a permanent doctor in years.

‘GPs can be devalued and negatively viewed by the public as a referral machine, but the patients I’ve picked up, with a plethora of diagnoses from mental health to autoimmune disease, they haven’t had to go see the super-specialists [immediately]. They can be investigated here and have the initial management here.

‘There are a thousand ways I could leave and get paid more, with more time off. But if you can make a difference, that makes you feel good as well.

‘You think you’re not going to last two minutes, but if you don’t let the job destroy you and start getting good outcomes, it becomes quite enjoyable. You can go from saying, I don’t like the bush to, actually, I can do something.’

Dr Livingston, like other IMGs, believes having his own practice makes a big difference. That work, too, has been rewarded, with his practice recently taking out a local community service award.

‘You own your own space and can change it,’ he said.

That helicopter job

Living overseas was normal for Dr Sara Fergusson, with stints of her early life in Scotland, Fiji and Canada.

‘The world wasn’t so foreign,’ she told newsGP.

Dr Fergusson’s first taste of Australia came during medical school, when she did an elective in the Willowra community north-west of Alice Springs.

But what hooked her on rural life, funnily enough, was when she moved to Australia and found herself doing paediatric retrievals from Westmead Hospital in Sydney.

‘I was a girl from Scotland who came to Australia and found myself in this job flying across the countryside of New South Wales,’ she said. ‘We did amazing retrievals with lots of neonatals, so I decided I wanted to have a career in rural medicine.

‘Right from the beginning, that helicopter job, the rural hospital, picking up sick children, that’s when I realised I wanted to work as a rural GP, and I didn’t need the moratorium to do that.’

After Sydney came the Northern Territory, where she worked in the emergency department in Tennant Creek, and later the Blue Mountains.

Then came general practice training, followed by work in Mudgee and Broken Hill.

‘I love hospital work, but I wanted to know my patients and know the community,’ she said.

Dr Fergusson can still remember the first time a patient brought her a dozen eggs from his chooks.

‘That was beautiful,’ she said. ‘And I remember my first home visit – an incredible experience.

‘The life of a country GP made me really content.’

Local friends invited her to a picnic, where she met her future husband, a Mudgee boy who had moved to the city and was back on a visit. They eventually took over her husband’s family farm near Mudgee, north-west of Sydney, where they raised two children. 

Rural life has given Dr Fergusson the opportunity to pursue many different professional interests, such as rural locum work in the Northern Territory, work as a psychiatry registrar, a growing interest in occupational medicine, opioid prescribing for a corrections centre, an academic post in Broken Hill, and work as a Remote Vocational Training Scheme (RVTS) supervisor and Practice Experience Program (PEP) mentor.

‘You get these opportunities, lots of them, to continue training and to take on more skills,’ she said.

‘The main message I have is that I love rural and remote medical practice in Australia.’

 

The article was originally published by newsGP and is reproduced with its permission.

 

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