Foreign medical graduates. The experience of the Australian Medical Examining Council and the Australian Medical Council, 1978-1989: implications for medical immigration and the medical workforce.

From July 1978 to March 1989, 1703 foreign medical graduates who entered Australia as immigrants took the examinations of the Australian Medical Examining Council (AMEC) and its successor since 1986, the Australian Medical Council (AMC). Of these, 821 (48.2%) passed the multiple choice question examinations and, of these, 627 (76.3%) passed the clinical examinations. The overall pass rate was 36.8%. The majority of those who passed required more than one attempt to do so. Graduates of medical schools from South Africa, Canada and the United States were, in general, more successful than those from other countries by a large margin. Most candidates were graduates of medical schools in third-world countries and Eastern Europe, and although substantial numbers ultimately passed, few of them had reached the same level of competence as graduates from South Africa and North America. There are many probable reasons for their generally poor performance, the most likely being the quality of their medical education in preclinical and clinical sciences and their lack of substantial postgraduate experience. A second factor for some is their inadequate command of English. A third factor is age. Of 547 candidates who presented for the first time in 1988 and 1989, 258 (47%) were 35 or more years old. Since 1984 medical immigration has trebled and is still rising. At the present rate of growth, foreign graduates sitting the AMC examinations for the first time in 1994 will number approximately 482, which (assuming all pass) will be equivalent to 40% of doctors expected to graduate from the 10 Australian medical schools in that year. In spite of a more than adequate supply of locally qualified doctors, Australia, through easy immigration, has become a target country for foreign medical graduates. The high failure rate in the AMC examinations has led to immigrant-activated political pressure for bridging courses and other concessions. If, as a result, the majority of the immigrants were to pass the AMC examinations and so enter general practice, medical immigration will increase at an even faster rate than it has since 1984, with significant changes in the medical workforce. Some reforms which might avert this are suggested.