Overseas-Trained Doctors Cause More Complaints In Australia

Nearly 25 per cent of doctors practising in Australia were trained overseas. Complaint levels to medical boards are higher for doctors who studied outside Australia, but the odds of complaint vary widely depending on their country of origin.

Picture by Simon J Baker/Getty Images

A study published in the Medical Journal of Australia today analysed 5000 complaints against doctors in Victoria and Western Australia between 2001 and 2010. The study found that overseas-trained doctors were 24 per cent more likely to attract complaints, and 41 per cent more likely to have adverse disciplinary findings.

Given that only two states were covered, more research would be needed to confirm if this pattern was widespread and to identify potential causes. It's worth noting that the pattern wasn't universal: doctors from seven countries (Nigeria, Egypt, Poland, Russia, Pakistan, the Philippines and India) were more likely to cause complaints than their Australian-trained counterparts, but for 13 other countries represented in the study, there was no difference. (There were no obvious correlations with English-language skills, by the way.)

The paper's authors point out that orientation programs for newly-arrived doctors are often minimal, with a quarter receiving no orientation training at all. It seems unlikely Australia will be able to supply all its medical needs from its own population in the medium term, especially in rural areas, so it's clear we need to do a better job of integrating overseas doctors into our system.


Comments

    Lifehacker aims to provide tips on how to improve our lives yeah? So when you choose to share this information with us I can't help smelling the implication (inadvertent I hope) that we ought to stay away from eg. Indian doctors. This inconclusive data is not newsworthy in my opinion and it has the potential to be used as ammunition by bigots.

      Hey , if you guys weren't so crap at what you do i.e ,it was about the people you serve rather than big noting yourselves about the fact that you are doctors,then maybe you'd be more effective and therefore more appreciated as professionals. I have the experience of seeing what hese guys do to the lives of people because they can't get past their own egos, yes I work in the industry by the way.

      Well played. Get in early and hide behind the "bigot" card.

      Reporting on a paper published by someone else and then claims we need to help adopt them into our system (which would in turn help all of us). Cool bro, ~so~ bigoted.

    A Sri Lankan doctor friend of mine talked of having several computers to share amongst ALL med students at his school in that country. He's now very into technology, having the money and access to gadgets he didn't have there. But he said that an equal number of doctors trained there, in his experience, have the hands on patient skills but not, for example, the Internet research skills to keep most up to date, or the skills to investigate new kinds of electronic equipment that might help them in their practice. And don't have the interest in developing those skills. Looking at some of the countries' names, could it simply be a matter of economics not allowing for the same type of training that doctors in Australia and other more prosperous countries enjoy?

    As a medical student who is almost done, the single biggest reason as to why DRs get reported is a break down in communication. People expect so much and sorry to say it but the health system isn't infallible. International doctors are at higher risk of complaints because they often lack the tact to be able to softly explain that something has happened without overly implicating themselves or angering patients. The system is so litigious now it is disgusting

      Absolutely. Working in the public hospital system, I've seen many, many situations where people become unhappy with their doctor not because of inadequate skills, but because communication breaks down due to several reasons. Language skills are one, where the overseas trained doctor speaks english well, but not well enough to cope with subtle concepts.
      Cultural differences can also cause this, as the doctor's response is seen in the wrong light due to the cultural expectations of the patient.

      This might also explain why doctors from some countries (eg Bangladesh) do not show the same increase in rates of complaints. If those particular doctors tend to be GPs who have carved out a niche market in their own ethnic communities, they might not run into the same communication/cultural problems as say an Indian doctor treating anglo Australians.

      It would be useful to have more data - what type of doctors are they (GPs, surgeons, paediatricians, gynaecologists?); the broad nature of the complaints and the ethnic background of the complainants.

    The problem in the first place stems from a lack of students wanting to be doctors in the first place. The Australian Gov has to put more money into medical training and pay doctors more for the incredible hours they put in, both during training and in practice. It's no wonder rural areas can't keep doctors and I have to say if becoming a doctor meant working double and even triple shifts during training I most certainly wouldn't want to do it. Add to this the fact that the majority (not all) of todays generation of young adults are spoilt rotten and don't want to work and you have the perfect storm. Pay them what they are worth and they will come!

    Last edited 15/10/12 10:58 am

      At UWS there are approximately 13x as many applicants for medicine than there are places. All of the applicants meet the UMAT and ATAR requirements. It is not a pay or desirability issue - we just don't train nearly enough doctors because its expensive.

        Fairnuff but the Gov still needs to do something about the problem and that includes the hours worked! :)

          There's not much the Government can do. The hours worked is actually an AMA issue that various people in my industry (human factors) have been trying to resolve for some time. Until senior doctors commit to sharing the case load, junior doctors are going to have to continue working insane hours in emergency.

      Agreed. Many, many problems could be solved by making education and health much higher priorities. The flow-on effect would improve almost everything else. But noone's interested in doing it, it seems. Instead, let's concentrate on those damn boat people and the evil gays!

      The issue is not that there is a lack of willing/able medical students, nor is there a shortage of medical student places at universities. In fact there are far too many students (both domestic and international) for internship places. This is a known issue that thanks to the constant raising of awareness by student societies as well as the medical schools themselves is now recognised by the Federal government. Unfortunately, the states are refusing to provide these extra internship places so you have a large investment of tax payer money injected into the training of medical students who are then unable to return that service to the community as there are no internships available.

      If you care about your own health, where your tax money is going then I suggest that you help by annoying your own state health minister until this changes. Until then, we have to rely on importing already-trained doctors from other countries as we don't have the places to train our own junior doctors.

      https://sydneymedsoc.org.au/internships

    I'm not sure if this is true or not, but I know that if you have a wealthy family in poorer countries, you can pretty much buy a degree in anything you want.

    I know for a fact that a friend of my family in HK "made a substantial donation" for their son place in a prestige University so he supposedly can't fail.

    To a lesser extent, it is common practise to buy drivers licenses, that probably explains the poor driving skills.

      True but misinformed. Sure some people have the ability to buy medical degrees in their country of origin but there is a very tough entrance exam to practice in Australia - I should know, I help as a patient in it. Sadly that exam has a huge fail rate because it is such a selective exam. Lots of quality doctors have to drive taxis for over a year to feed their families while waiting to sit this exam because their OS qualifications don't carry over. It is quite interesting chatting to OS trained doctors

    Australia has been bludging on other countries for doctor for decades.
    Why not stop doing this.

    Let's not forget that despite our government's protestations to the contrary, we are still quite a racist country (even if the racism is underground), so quality of care aside, it still (sadly) makes sense that international doctors cop a lot more than homegrown docs.

    Although the article specifically states that language isn't an issue I have had problems with overseas medical staff (including nurses) solely because of language problems. One of these was a canadian who spoke English as a first language but had been home schooled in a rural area and seemed not to understand any coloquialisms and everything had to be explained in the most formal language. This is the same issue as outsourced technical help for my computer. I find it extremely frustrating trying to describe something I don't understand myself to someone who needs every third word repeated or explained and who lacks the skills to give a clear and concise explanation in return.
    It was worse for my late mother who was put into a rehabilitation ward after having a knee replacement. She had had a stroke and struggled to find her words but to make matters worse most of the nurses were RECENT arrivals. They were good enough nurses and very kind but the dual language barrier was tortuous.

    State and federal governments need to increase funding to medical schools in our universities. This will increase local applicants and students.
    From personal experience there are definitely language, gender, communication and cultural disparities with all overseas trained staff, including medical officers. However, as medical officers have the higher "power", prestige and responsibility for patient care, these issues must be addressed.
    Australia has a significantly high standard of medical officer training and this must continue!

    I worked with a provincial medical association in Canada and this problem is similar there. Even though there are very tough standards to practice, it seems some IMGs (International Medical Graduates) struggle. Incidentally, many times it's not just their medical skills but also there inter-personal skills and understanding of western culture. Unfortunately, like Australia, not enough Canadian trained grads want to work in rural and back-country regions or become general practitioners when they see specialists making significantly more money.

    Having lived overseas in a country were public hospitals are horribly under-equipped but interestingly enough, doctor have surprisingly better skills and knowledge than in their Australian peers. I think it's a complex problem. Having access to technology doesn't equate to skills, It's the love and care for the fellow human being that drives doctor's skills, not love for the $ and squeezing as many 15m consultations as you can per work day

    Why is that as soon as we criticize an Asian country, everyone jumps on the racist bandwagon.

    I can tell you from experience that some overseas trained doctors are absolute rubbish and are a danger to our own health. Even worse, when you provide feedback to the hospitals informing them of your concerns the only response you get back is a letter from lawyers to defend themselves. They refuse to acknowledge that they could improve there processes and skills to better help the people that need it most.

    I dare anyone to come forward who has had a bad experience with a doctor and say that it wasnt from an oversea's trained doctor.

      @commonsense, I have had so many bad experiences with locally trained and educated people than with those with overseas training, not just in regards to the medical profession.

      This reminds me of the start of the movie "The Best Exotic Marigold Hotel" and let's face it, that's a fact.

      In terms of bad experiences, we have bad experiences from all, even our own relatives, so ... unless you can play the card that they are from abroad or outsourced.

      dude, only 3 out of 7 countries (Nigeria, Egypt, Poland, Russia, Pakistan, the Philippines and India) are technically Asian.

      Dare accepted you racist douche. There have only ever been 2 doctors I have had a bad experience with. Both were white Australian males in their 50s.

      Today, I wasn't treated very nicely by a doctor from overseas. In the last eighteen months, I have gone to five doctors who trained overseas to get a minor medical condition treated and none of them will do it. It's very hard sometimes.

    Actually current numbers of medical students are probably adequate (or even more than adequate) for our future needs, even including rural staffing. After medical school, training continues, whether as a specialist or as a GP, generally for at least 4 more years - and it is these postgraduate training places which are the current bottleneck, not medical student places. Often postgraduate training places are also geographically misplaced (for example, training too many specialists in Melbourne when there are shortages in Qld, and inadequate incentives to train as GPs in the country to assist rural retention) and in the wrong disciplines (for example, we have chronic shortages of psychiatrists in many areas and regularly import them from overseas, while we are training too many of some other specialists).

      Thank you Lloyd. I undestand about post-graduate training for disciplines. Recently there have been articles about GP's retiring in rural areas and no replacements eg: Moree. I hear of overseas trained doctors completing their mandatory rural placement only to move to the city at the end of placement. Then more training places are needed for post-graduate training.

    One thing that might have been overlooked in this are the countries that are mentioned. Rather than look at them from a racial perspective, look at them from a cultural perspective, they are countries where there is a very distinct hierarchy. The Doctor is a very important person that can get away by throwing their authority over the patient. In contrast to our society, where the doctor is just another bloke that cannot drink bu we can and end up with them taking broken bottles and glass splinters and worse from our body and cavities. So when one of these Doctors does try to exercise their authority ... squeal like a girl and complain... plus the bloke was not even Aussie, he was from overseas.

    I do wonder sometimes, what do we call Aussie? Who is Aussie? Every one apart from the indigenous population is an immigrant, it's just about when they moved in. So because we have new neighbours moving in, we call them outsiders and ourselves the locals? Or is it all based on the country of origin? That is downright hypocritical and racist.

    Wow. Lot of opinions, most with valid EXPERIENCES but with incorrect reasoning.

    Apologies for the /rant /long post but damn this should've been a more thorough article over such an important issue that affects so many people's LIVES AND FAMILIES!

    Let me put the situation very simply to all of you. In order to practice as a doctor IN YOUR OWN RIGHT, you MUST be what is known as a "Fellow." Look at your doctor's brass shingle next time. You should see something like FRACGP (Fellow, Royal Aus. Coll. of Gen. Prac), FRACS (same... college of surgeons), etc.

    UP UNTIL YOU GET YOUR LETTERS YOU ARE *NOTHING*.

    Yes, you are a doctor, yes you did 4-8 yrs at a medical school, but you are still *nothing*.

    The general public does NOT understand that graduating means you're fit to practice. It means we're fit to kill people (sic). Graduation is literally the START of training for a Doctor. Post-grad qualifications take anything from 4-10 years MORE depending on your sub-specialty. And if you think it's over THEN, forget it. There's Continuing Medical Education (CME) requirements set by the Gov't. as well! DO NOT DO MED IF YOU HATE EXAMS AND STUDY!

    Now, get it OUT OF YOUR HEAD that the government controls this. The colleges are run by the specialists themselves. So the older retired buggers set the scene for your specialty. They set the standard, the quality control and the numbers. At least that's the theory altruistically. In reality, we don't want outside competition!

    In all reality, the way the gov't and the colleges work is to shuffle ALL Internationally Trained Doctors (ITD's) into either permanent hospital positions, or funnel them into General Practice, away from the Specialties. Why is it that Surgeons qualified at Stanford, Harvard and Princeton (all top 10 in the WORLD), cannot qualify for the Australian Medical Council (AMC) surgical exams due to the ridiculously set standard? It's not to say that standards are BAD, but when the LOCAL trainees can't even get CLOSE to 20% in the same exam, it says something! (BTW no Aussie school is in the top 100, and the best school is Flinders in SA with a 10yr AMC certification). [@commonsense, there are LOTS of Aussie colleagues that I wouldn't refer my dog to!]

    So you end up with the coal face situation of:

    A. Lots of doctors from o/s whom may have varying degrees of ability and communication skills in PUBLIC HOSPITALS. Get it clear, these guys are under 'supervision,' and hence the variable experience. We are not McDonalds and have badges of "Trainee" or cute "L" stickers, but if you are in a PUBLIC hospital, you're in a TEACHING facility. Free treatment for the fact that you get to be practiced on. Suck it up. In the US they'll still bill you and you'd still get treated by med students!

    B. Stacks of pissed off overseas SPECIALISTS working as GP's. Yes, in Australia we effectively tell you to stuff your 10 yrs of surgical/physician training. How would you feel.

    C. A whole load of ITD's, usually from Urban backgrounds, being shoved literally out bush. Same with med students. It's the equivilant of forced labour. Example. No one will "force" you to work out bush, however if you want to bill Medicare, you need a Provider number. Oh, and all the "new" provider numbers are 1000kjm away from the nearest tertiary hospital! But here's a stethoscope, a mobile phone and good luck!

    And before you stick it to us for being rich arrogant f*** (admittedly there ARE some out there, but I'd say there are more of those types in Banking and Finance, and Law), consider this:

    1. Med training takes a bloody LIFETIME. 4 yrs med school, 1 yr intern, 3 yrs residency, 6 yrs specialization. 14 yrs average IF YOUR GOOD AND DON"T FLUNK ANY YEARS! The training is bloody difficult (40hrs at school, about 4-8hrs study at home) because it NEEDS to be.
    2. We don't have the power to heal; we really just help the body heal itself. We do, however have the power to KILL. Our decisions affect not only patients, but their families and the greater community. EVERY decision. That's an awesome responsibility.

    3. Average GP makes about $110,000. Now tax takes 50%, insurance is about $12,000-$16,000 and then you have to do overheads such as rent, receptionists, nurses etc.
    3a. Medicare = Government = ATO. so you can't go around doing dodgies with your Tax

    NOW let me tell you a case in ED last weekend.

    Stitching up a 23 yo FIFO worker from the mines. Guy was pissed as a newt, abusive, high on ice. After taking a swing at me he let fly that he could "Farkin buy you ya cu***," and that he made $190,000, and has been after he dropped out of school.

    I say WTF. Do you think I get remunerated appropriately?

    Why the hell could I not drop out, get drunk and stoned and get paid this much? Why did I give up my early adult years to get so badly screwed over?

    My name is Phil. I am a Doctor. I put up with this crap because I feel I can make a genuine difference. But please, I get fed up of basically having my good nature and intentions taken advantage of by the Government (Pay and Hours), as well as patients (who think i'm privileged.)

    I HAVE worked damn hard to get here. I have made MAJOR sacrifices (Move from O/S, Longterm GF breakup, and a divorce) because I'm passionate about what I can do. And dammit I bloody WORK for my paltry pay relative to the amount of responsibility and training I've done! (We did a calculation; per hour, our nurses make more than us, but NO ONE makes more than a plumber at $80/hr!)

    Think about it before you complain next time. And a "Thanks Doc, you made me feel better" really WILL make your Doctor's day.

      Well said! As someone who is currently training to be an allied health professional I have enormous respect for doctors and the training they must do to become registered. It really is phenomenal.

      DrPhil, Thanks for a truly informative and "wider perspective" point of view.

      Well said Dr Phil. As an au trained country doc, you are right on the ball. Unfortunately the lowest common denominator lets all docs down.

      Thanks so much for voicing this, my father was an ITD with 15 years of experience and he had to come here and do everything all over again as you mentioned including being shipped off to a rural town (whilst we stayed back in Sydney). He did really well in all his qualifications but was not allowed to specialise in Pediatrics since he wasn't locally trained (that was literally the case) and he got shuffled into general practice, the only upside now is that he sees more children than any of his other colleagues because his patients referred all their friends to him...regardless of how nice a place Australia is, we can't ignore the fact it is still pretty racist and professions such as these are prominent 'old boys' club.

        Pretty racist? I'm multi-ethnic (not anglo), my significant other is of indigenous descent and while there is racism here, I would hardly categorise Australia as 'pretty racist'. Your aspersion is hardly fact. What annoys me is that you and far too many others go around with that thought in your head and you never challenge that perspective. You've bought into a groupthink meme. Travel is a great way to broaden one's mind. Inevitable comparisons are made. Australia might not be a paragon but I'd say its 'pretty' close to.

      Was the move from overseas to practise as a medical officer here? why not your original country?

    My first Dr's visit in Australia happened to be with one from an Asian descent. I can honestly say I was stunned by the lack of attention to detail. Draw some blood and prescribed a pain killer!! No blood pressure test, no use of stethoscope, nothing.

    I then went on the hunt for an Australian doctor.
    Within 10 minutes this doctor isolated and identified the problem and referred me to someone who could help.

    So I really don't mind being called a racist, but I now know how I like the origin of my doctors if I'm able to choose one. Once bitten, twice shy.

    As a university graduate in the health field who attempted entry into the field if medicine with an upper percentile UMAT, band 6 science and maths and yet I was not eligible for medical school as there were insufficient places at Australian Universities. The fact of the matter is we let other countries take Australian jobs and when a study shows they do a substandard job people just say the author is incorrect or being inflammatory. It is time that we invest more in our own citizens rather than that of other countries. When someone comes to Australia to practice medicine they should be completing the entire 6 year university degree including an english literacy test.

      LOL we take huge numbers of medical students. More so than intern places nation wide now (eek, but that's another story). You want to know why you didn't get it? You flunked your interview because you're a douche

      I've have to agree there, its really not that hard to get into med school. If you indeed had good enough grades. Gotten in 3 times (stupidity of youth - long story) without great difficulty. You must either a) grades not been good enough or b) failed your interview

    As a physio working in a public hospital, I have seen countless examples of shocking lack of cultural awareness from Indian and Asian doctors, both towards other members of staff and to patient themselves.
    Patients have every right to complain if their doctor is not treating them with respect - they may be public patients, but they still have a right.

    And truth of the matter is, I trust Australian-trained doctors a heck of a lot more than Indians/Asian doctors. European doctors seem to work jsut as well as the Australian ones, from experience at my hospital.

    @biker

    I must also advise that equally as I am involved in TEACHING, there are numerous interns that I've dealt with ACROSS the races/nationalities where I've been left befuddled and thinking "how the hell did you get *IN* to medical school?"

    Equally, some of my Australian colleagues would not be fit to treat a pet rock!

    Unlike in the US, there is no BLANKET examination at the end of training, so and therefore there's a wide variation between the standard of graduate students.

    Understand also, that given the time pressures in General Practice, in order to be FINANCIALLY VIABLE, doctors are forced to do examinations that SHOULD take 1hr in 10 mins. I have actually seen colleagues go bankrupt because they were not able to keep to a furious pace of 5-6 patients/hr, and their patients were unable to make Gap payments.

    Realize this: the Medicare rebate has on average gone up 0.5 tracked to CPI. So when the cost of living goes up 2%, doctors fees only go up 1%. Receptionists and Nurses, landlords and utility companies all don't say "Hey, you're only getting 1/2 a rise, we'll give you a break."

    Also, if you read my tome above, was your "Asian" GP perhaps from ANOTHER specialty? As a student, I was actually once treated by a former Pathologist! For those of you who don't know, Pathologists look down microscopes at specimens, and prefer their patients dead and preferentially cut in small pieces in formaldehyde. They also have an annoying propensity to always be right with 20/20 hindsight. As you can imagine it doesn't usually attract THE most personable of personalities, so it turns out that I was the first "live" patient she'd seen since she was an INTERN... 25 years ago!

    Luckily, as a 3rd year, I was able to assist her with a bit of prompting so we bumbled through my consult and examination!

    I have no doubt that she would have been a brilliant pathologist, but as a GP, frankly, she had a lot to catch up on. As above, the reason is simply political.

    If you want to change it, start grass-roots level. Complain to your MP, write to the Health Minister. Start a facebook page!

    Firstly, it is unusual to see an article like this in a tech-focused article. I can only guess it's here because it would be of interest to Lifehacker's audience demographic (as reflected by the comments).

    Secondly, it's worth linking to the original study - it's available as a free-to-access publication. https://www.mja.com.au/journal/2012/197/8/risks-complaints-and-adverse-disciplinary-findings-against-international-medical

    It is worth bearing in mind the limitations of the research findings and that inferences are not made which are not supported from the study. This study used aggregate data on complaints made by members of the public; it does not examine clinical outcomes or adverse health events. Perhaps there is a correlation but we do not have data in this particular study to link these.

    Whilst complaints may be due to adverse events, they can also arise from factors such as communication barriers and cultural differences. Many IMGs work in areas of need (such as rural areas) with larger caseloads than average. It would have been interesting for the study to investigate complaint odds ratios when stratified according to RRMA regions.

    The article published by Medical Journal of Australia is seriously flawed.

    For details, please go to: http://australian-doctors.blogspot.com/

    The discussion is also launched on the the website of British Medical Journal:

    http://doc2doc.bmj.com/forums/off-duty_news-media_racism-xenophobia-science-research

    Angus thanks so much for your article. I found it very true. Complaining doesn t bring much relief, as I am aware nothing happens most times. Can t we try to change that? I‘d be one of the thousands of people willing to do something.

    Seriously, last time I went to see a doctor, first I went to see a GP (australian) and he was quite but he referred me to an indian specialist who charged me $200 for checking me 10 minutes after that he asked me to get another medical procedure which was going to cost $2000. Please, I cannot trust indian doctors as they are here only for the money. I they really cared about helping people they would be in their countries where i'm sure there is even more needs for doctors than in Australia. Do you really think the doctor thinks about your health, he doesnt he just cares about their holidays, cars etc. An getting back all his "youth spent studying medicine" so they can make loads of money with your diseases. It's time that people wake up and realize that doctors are just people like everyone else and they have other motivations "mostly financial" and most of the treatments and procedures are just a business to them. Please people take full responsibility for your life and health and do not blindly trust a doctor (specially if it is overseas trained). Go for a second and even third opinion, research do not accept what this so doctors tell as they are in for the money otherwise they would be helping people in their homelands.

    How bizarre this study is? you can fool the general public but not a qualified medical graduate
    Questions that need to be answered here:
    1.) Is there enough local training given to Overseas trained doctors to practice in Australia?
    I know the diseases don't change but their incidence and prevalence do.
    2.)It is not easy to adapt a different culture specially for people coming from overseas (Pakistan,india, Bangladesh etc)from a completely different environment
    3.)If Australia is so keen in improving the health sector why doesn't it adapt US based system where everyone has to go through a USMLE and then given training for 3 years before they start to practice

    Blaming vulnerable is so easy.it is really imperative to find the root causes and eliminate it

    Here is first hand evidence from Egyptian medical schools(directly from students, doctors and professors) showing the incompetence of Egyptian trained medical students. Look up the investigation done by Al Jazeera.
    "Egypt: Medicine for Sale - Al Jazeera World"

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