International medical graduates: the Australian perspective.

Australia, like many other developed countries, has faced medical workforce shortages. This situation has been attributed to the increasing demands from an aging population and a decline in the hours worked by medical practitioners. These shortages, which are usually in the areas of greatest medical need in Australia, have led to an increasing dependence on international medical graduates (IMGs). The Australian government is slowly moving towards self sufficiency by expanding education and training opportunities for Australian doctors. In the interim, Australia relies heavily on IMGs to supplement the medical workforce. Australia's population is concentrated in the coastal regions, and IMGs are often required to service the more sparsely populated rural and remote areas, which find it difficult to attract and retain local medical graduates. Health funding in Australia is provided jointly by the federal (central) government and six state and two territory governments. Funding from the federal government provides for university based medical education and general practice postgraduate training. State and territory governments fund postgraduate specialist training and provide funding for a public hospital system. Although a national accreditation process for IMGs exists, many IMGs are recruited directly to Australian hospitals and community practices without adequate assessment of their qualifications or language and clinical skills. The current two-tiered system, in which service demands can override quality and standards, can no longer be tolerated. There is an urgent need for a uniformly applied national standard for all IMGs entering Australia and for a strategy to implement it.