The Australian health system has failed to train an adequate number of doctors to meet our workforce needs.   Incompetent planning by government with no regard to working hours, feminisation of the medical workforce or expansion of services meant large numbers of overseas-trained doctors entered the Australian work place, this often at the expense to their own under-doctored countries.

The problem of poor selection and supervision was dramatically illustrated by the Bundaberg disaster, the repercussions of which have affected every jurisdiction in Australia, somewhat failing to recognise that had normal processes been in place the problem would not have occurred.

One such impact that has occurred is the requirement for a high level of English competency to be achieved before being allowed to practise in Australia.

This is not unreasonable for those wishing to go into independent practice but for overseas trainees in supervised public hospital posts it is excessive.

Indeed, Dr Death was extremely articulate and it may well have been his command of the English language that enabled him to continue for as long as he did in Bundaberg: a less articulate surgeon may well have been brought to account much earlier.

The exchange of trainees into and out of Australia is vital for our regional standing and for our surgical trainees to be denied opportunities to work in South-East Asia or Europe in appropriately supervised positions because their Bahasa is less than fluent would be ludicrous.

It may be useful for government and medical boards to start to understand the consequence of their actions.

Just as their understanding of the workforce needs was misguided, so too is their grasp of English language requirements.

Hospitals and regulators, if they are satisfied with the supervisory structure around overseas trainees, should be able to approve their employment in the system.   These individuals benefit greatly from the training experience offered in Australia and usually return home to further health care in their country.

If care is not taken, the major advantages and long-term linkages from overseas doctors working with Australian doctors will be lost.

Guy Maddern is professor of surgery at the University of Adelaide. St Anywhere is fictitious, but the events and issues are real.

Peter Fray

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