Health Workforce Mobility: Migration and Integration in Australia

Transcription

1 Health Workforce Mobility: Migration and Integration in Australia Lesleyanne Hawthorne Professor International Health Workforce Centre for Health Policy WHO 4 th Global Forum on Human Resources for Health (Dublin) Health Workforce Mobility Comparing Migration and Integration and Its Gender Dimensions November 2017

2 Trend 1. Recent Growth in Degree-Qualified Migrants Admitted to Australia by Major Field (Compared to ) Field Arrivals Arrivals Engineering 18,790 41,407 Accounting 26,145 35,423 IT 22,630 31,968 Education 15,400 29,464 Nursing/ Midwifery (RN Degrees) 8,584 16,154 Medicine 7,241 12,696 Nursing (RN Diplomas) 5,649 10,194 Pharmacy 1,798 3,005 Dentistry 1,063 2,343 Physiotherapy 755 1,556 Total (All Degrees) 192, ,611

3 The Latest Data: Temporary Compared to Permanent Health Workforce Migration Skilled Category ( to )

4 Skilled Migration Category Only - New Visa Grants by Major Health Field (8 Years to 30 June 2016) TOTAL = 95,873 (46,338 Temporary + 49,535 Permanent) Nursing (RNs) = 48,936: Permanent = 30,132 Temporary = 18,804 Medicine = 33,675: Permanent = 10,903 Temporary = 22,772 Dentistry = 2,467: Permanent = 1,537 Temporary = 930 Pharmacy = 2,251: Permanent = 2,053 Temporary = 198 Physiotherapy = 1,843: Permanent = 1,037 Temporary = 806

5 Trend 2. Reliance on Temporary Migration to Address Workforce Maldistribution Medicine 457 Visa: Employer-selected District of Workforce Shortage locations 22,772 medical migrants selected to Key demand = GPs, RMOs Permanent skilled migration program pathways: Employer-Nominated Points-tested Independent Regional/ State sponsored Recent growth

6 Location of Temporary Visa New Medical Grants - Regional Demand ( to )

7 Compared to Location of Temporary Sponsored Nurses Sector Demand ( to )

8 Trend 3. Ensure Responsiveness to Workforce Demand (Reduction in New Grants for Temporary Health Professionals as Labour Market Tightens (to June 2016). Field Total to Non-Food Trades 13,541 6,499 71,075 IT 8,604 8,923 62,370 Health 6,517 4,196 46,338 Engineering 3,583 1,097 23,643 Education 2,345 1,750 13,434 Accounting 1, ,010 Total Fields 68,481 45, ,777

9 Temporary Migration Declines: Nursing + Allied Health Fields Signals Future Reduced Permanent Migration? Nursing = 4, = 1,066 Dentistry: = = 34 Physiotherapy: = = 77 Pharmacy: = = 41 Growth in domestic student training

10 Compared to Medicine Reliance on Temporary Migrant Doctors to Work in Undersupplied Sectors and Sites ( to ) Year / Total Number Permanent Medical Migrants Number Selected Temporary Medical Migrants Number Selected ,312 3, , , , , , , ,080 TOTAL 33, , ,903 22,772

11 Trend 4. Impact of Differential Entry Pathways + Country of Training on Registration + Employment Outcomes 1. Permanent skilled migrants (128,550 68% of PR s) 2. Temporary workers (94,890 PA s Oct 2016 no cap ) 3. International students (645,000 enrolled stay?) 4. Family migrants (57,400) 5. Humanitarian migrants + asylum seekers (13,500) 6. Syrian refugee special intake (12,000 to March 2017)

12 Top 10 Source Countries for Migrant Health Professionals Selected by Australia: 8 Years to 30 June 2016 = 95,873 as Skilled Migrants Temporary = 46, UK (13,910) 2. India (8,245) 3. Ireland (3,692) 4. Philippines (3,310) 5. Malaysia (2,322) 6. Canada (1,569) 7. South Africa (1,177) 8. Sri Lanka (1,167) 9. USA (1,090) 10. China (1,045) Permanent = 49, UK (10,478) 2. India (9,795) 3. Philippines (4,730) 4. China (3,707) 5. Malaysia (2,954) 6. Ireland (2,180) 7. South Africa (1,400) 8. Korea (South) (1,382) 9. Nepal (1,020) 10. Zimbabwe (1,020) THEN Pakistan, Singapore, Iran, Zimbabwe, Germany, Korea THEN Singapore, Canada, Sri Lanka, Pakistan, HK SAR.

13 The Challenge: Securing Vocational Registration + Health Workforce Employment Pre-migration screening for human capital attributes: YES Skilled migrants (temporary + permanent) NO Family and humanitarian migrants CASE STUDY Refugee doctors Mandatory English language testing IMPACT - By source country and field Access to vocational registration after assessment: Immediate eligibility Australian qualification Conditional registration (with practice limitations) Bridging programs (eg nursing) Re-qualification

14 Australia s Growing Preference: For UK Medical Migrants ( to New Visas)

15 The Impact of English Language Testing on Vocational Registration by Major Field: Australian + NZ Occupational English Test Outcomes ( ) Pass rates: Nurses (17%) Pharmacists (38%), Doctors (52%), Dentists (62%) Candidate pass rate (%) 70% 60% 50% 40% 30% 20% 10% 0% 53% 43% 52% 20% 19% 17% 40% 47% 62% 38% 39% 38% 34% 32% 28% 46% 40% 37% 41% 32% 34% %

16 Defining Exemptions from Australian Medical Council Exams for Migrant Doctors - Variable Registration Pathways 2008+? X Fast Medium Slow Specialists

17 Australian Medical Council: The Competent Authority Pathway (Impacts of Attractiveness of Australia for IMGs) Places of training: 55+ (growing!) Place of prior registration: 1.PLAB Professional and Linguistic Assessments Board examination of the United Kingdom 2.MCC Medical Council of Canada Licensing Examination 3.USMLE United States Medical Licensing Examination 4.NZREX New Zealand Registration Examination 5.GMCUK General Medical Council accredited medical school in the United Kingdom 6.MCI Medical Council of Ireland accredited medical school in Ireland Case study = Doctor qualified in China

18 Intra-OECD Flows Ireland to Loses 1,759 Doctors + 2,918 Registered Nurses to Australia Year Medicine Nursing All Health Fields Temporary Permanent Temporary Permanent Temporary Permanent Temporary Permanent Temporary Permanent Temporary Permanent Temporary Permanent Temporary Permanent Total Temporary Permanent GRAND TOTAL

19 MCQ Examination Pass Rates - Top 10 Candidate Countries (AMC 2016 Annual Report) Australian Medical Council 337 Total candidate Percentage pass

20 Impact of Country of Training: On Australian Medical Council MCQ and Clinical Examination Pass Rates on 1-4 Attempts (2016 Report) Country of Training MCQ No. Candidates Passes 1-4 Attempts Pass Rate Clinical No. Candidates Passes 1-4 Attempts Pass Rate India % % Egypt % % Pakistan % % Bangladesh % % China % % Iran % % Sri Lanka % % Philippines % % Russia % % Nigeria % % Myanmar % % Malaysia % % South Africa % % Total % %

21 Impact of Registration on Employer Choice: Medical Migration Source Countries ( ) Temporary 457 Visa Stock Resident Year to 30 June % = UK, Ireland, Canada, USA Permanent Skilled Category Total Selected Year to 30 June % = UK, Ireland, Canada, USA UK (38%) UK (29%) Ireland (8%) Malaysia (12%) Malaysia (8%) India (9%) India (8%) Canada (7%) Canada (6%) Singapore (5%) Sri Lanka (4%) Ireland (5%) Singapore (3%) Sri Lanka (4%) USA (2%) Pakistan (4%) Myanmar, S Africa, Pakistan (2%) Myanmar (2%) Nigeria, South Africa (1%)

22 Employment in Field of Qualification for Health Professionals by Select Source Country Within 5 Years of Arrival: Impact of Bridging Courses in Nursing (2011) Medicine 57% overall S Africa (83%) UK (74%) Canada (64%) Europe - SE (61%) India (61%) Europe NW (59%) Singapore (56%) Philippines (47%) Europe E (27%) Vietnam (12%) China (8%) Indonesia (4%) Nursing (RNs) 66% overall UK (82%) S Africa (80%) Singapore (77%) India (74%) China (61%) Europe NW (59%) Europe - E (59%) Vietnam (58%) Philippines (56%) Canada (55%) Europe SE (54%) Indonesia (46%)

23 Trend 5: The Productivity Premium Facilitate International Student Two-Step Migration (Health Sector) Qualification Field Australian Graduates (Sample = 371,000) International Students (Sample = 79,000) Accounting 83% 35% Business 76% 40% IT 78% 42% Engineering 86% 44% Medicine 100% 99% Dentistry 94% 96% Pharmacy 98% 96% Physiotherapy 94% 67% Nursing 92% 71%

24 Where Are Migrant Health Professionals Increasingly Selected? By Permanent Skilled Sub-Category to

25 Case Study Where Are Migrant Nurses Now Selected (Permanent Skilled Migration)? Australian Nursing and Midwifery Assessment Council: 10 years back Minimal onshore selection 5 years back Around 1/3 selected onshore data 4,691 applications received 76% selected onshore with an Australian qualification Around 30% have only an Australian degree Main source countries = Philippines (1167) + India (781) NMBA Transformation of bridging course providers C39 to just 9 (with much strengthened QA requirements)

26 Trend 6. Immigration Policy Volatility (Reflecting Expanded Domestic Training) Current temporary visa: Abolished, to be replaced by two eligible lists 215 banned occupations: 17 in allied health fields (including dental hygienists, therapists and prosthetists, mothercraft nurses, psychotherapists) New Medium and Long-Term Strategic Skills List: 178 professions and trades including 66 health occupations (GPs, most medical specialties, most fields of nursing 4 years, scope to apply for extension, and convert onshore to permanent resident status

27 March 2018 Changes to Temporary Migration of Relevance to Health (continued) Short Term Skilled Occupation List: Just 2 (rather than 4) year entry for 253 occupations Eligibility to apply for just one extension No capacity to stay Includes: Resident medical officers (2 nd biggest source of migrant doctors) Dentists, dental specialists and technicians Pharmacists Nurse educators and managers, and enrolled nurses Paramedics Impact on future scale of flows and Australia s global attractiveness as a destination?

28 Select Recent Sources: Data in Presentation Australian Medical Council (2016): Annual Report 2015, AMC, Canberra Department of Immigration and Border Protection ( ): Provision of unpublished skilled migration arrivals data (analysed by L Hawthorne & C Higgs, Centre for Health Policy, University of Melbourne, for forthcoming publication) Hawthorne, L (2013), Health Workforce Migration to Australia Policy Trends and Outcomes , Health Workforce Australia, Adelaide Hawthorne, L & To, A (2013), English Language Skills Registration Standards An Australian and Global Comparative Assessment, Australian Health Practitioner Regulation Agency, Melbourne, 169pp Hawthorne, L (2014), WHO Four Country Study Health Workforce Migration in Australia, Chapter 9 in Migration of Health Workers WHO Code of Practice and the Global Economic Crisis, Eds A Siyam & M Dal Poz, World Health Organization, Geneva, pp Hawthorne, L & To A (2014), Australian Employer Response to the Study-Migration Pathway: The Quantitative Evidence , Highly Skilled Migration: Politics, Processes and Politics Special Issue, International Migration, 52(3): , August Hawthorne, L & To, A (2014), The Early Migration and Career Trajectories of International Medical Students Qualified in Australia, Medical Deans of Australasia, Sydney, 66pp, Hawthorne, L, Hazarika, I & Remedios, L (2014), Review of the Australian Physiotherapy Council Assessment Process for Overseas Qualified Physiotherapists, Australian Physiotherapy Council, Melbourne 127pp. Hawthorne, L (2015), The Impact of Skilled Migration on Foreign Qualification Recognition Reform in Australia, Canadian Public Policy Journal, August, Hawthorne L (2017 in press), International Health Workforce Mobility and Its Implications in the Asia-Pacific Region, World Health Organization, West Pacific Regional Office, Manila Hawthorne, L & Higgs, C (2017 current review), Is Australia s Level of Reliance on International Medical Graduates Changing?, submitted to Medical Journal of Australia November 2017