Dialogue: Qualifications Authority not fit to judge doctors

Many New Zealanders may be unaware that more than a third of our doctors are foreign graduates and that they come from 97 countries. No one who knows of that mix of doctors can claim that the Medical Council applies a fortress New Zealand policy. The figures speak for themselves.

The fundamental aim of legislation surrounding competency assessment of foreign medical graduates should be to ensure that the doctor can demonstrate clinical and communication competence for the benefit and safety of the public.

Ken Shirley's private member's bill, due to be debated in Parliament tomorrow, has the premise that foreign medical practitioners who ought to be allowed to practise medicine be registered as practitioners and obtain the necessary certificates.

It sounds fine, but the bill is flawed when it transfers the task of competency testing from the highly experienced Medical Council to the inexperienced and unsuitable Qualifications Authority, which does not even want the job. The Overseas Trained Doctors Association reportedly says it has faith in the council alone.

The bill will not fix or change the commercial behaviour of medical practitioners. There has been talk of patch protection and unfair competition in some places. If there is inappropriate behaviour, it should be sorted out by the Commerce Commission.

The Government may claim that the Shirley bill is irrelevant because it professes to be addressing medical manpower planning and is also putting up its own Health Professionals Competency Assessment Bill.

The best people to establish competency in a specific field, whether it be law, engineering or accountancy, are those practising in the field themselves. To ask an outside body such as the Qualifications Authority, which has no practical skills in medicine or surgery, to assess clinical competency is inappropriate.

The only experience the authority has had assessing medical competency was between 1991 and 1996, when it demonstrated a stunning inability to judge the competence of foreign medical graduates.

There is a perception that there are hundreds of doctors who ought to be able to practise here. Many of them came to this country because of immigration laws that did not take into account New Zealand medical registration. Some of those graduates are extremely competent and have passed the exams and make an important contribution. But there are others who have repeatedly failed the entrant examination and would have little chance of registration in other comparable countries. The Government has set up a bridging programme which should enable at least a further 100 to be registered.

The Medical Council receives thousands of applications from foreign medical graduates every year. Over the past few years it has gone to enormous lengths to make the process of competency assessment transparent and as objective as possible. In the past there has been valid criticism of undue process and lengthy delays. The council must work hard to ensure those problems are streamlined.

If the authority were to take on the responsibility of testing, who would be the first to howl if a foreign medical graduate made a botch-up?

Even with very stringent competency testing, there will be mistakes. Fresh in the public mind is the Gisborne cancer inquiry, which centred on a foreign medical graduate. Remember also the former Christchurch cardiothoracic surgeon Dr Keith Ramstead, and the disaster of "Dr" Milan Brych.

Joint responsibility between the authority and the council, as advocated by the Shirley bill, is also quite inappropriate. A single body should take ultimate responsibility.

While there may be many anecdotes of doctors who say they are given a difficult time by the council, many of those doctors had not bothered to carefully check out our registration requirements before coming here. They would have to do that in Australia, the United States, Canada or Britain.

There is no doubt that foreign medical graduates make a significant contribution to the health of New Zealanders. It is also important that the public is aware of the generally very high standard of medical care carried out by New Zealand graduates. Having worked in six countries, I have no doubt that our graduates are as good as any.

The reality of medicine and surgery is that failures occur. We want to minimise that, but the Shirley bill is more likely to do the very opposite. If his bill were passed into law, the public would be less safe.

The only justification for allowing the bill to be introduced would be to allow public scrutiny in a select committee. This would establish how inappropriate it is.

That scrutiny might also give the public the opportunity to realise the huge responsibility and expertise with which the Medical Council assesses foreign medical graduates.

* Dr Paul Hutchison is the National Party associate spokesman on health.