Clinical activity of overseas-trained doctors practising in general practice in Australia

Introduction: Medical workforce shortages in Australia have led to increasing reliance on overseas-trained doctors (OTDs) to work in general practice in areas of need, particularly in rural areas. These OTDs do not have Australian postgraduate training in general practice, and we know little about how they practise. Objective: To determine differences in practice style between a self-selected group of overseas- trained general practitioners undertaking the Alternative Pathways Program and GPs who are Fellows of the Royal Australian College of General Practitioners (FRACGP), and whether such differences can be explained by other practitioner, practice and patient characteristics. Method: A self-selected sample of 89 OTDs from the Alternative Pathways Program were compared with FRACGPs in a continuous national study of GP activity (n=1032). Each GP provided details about themselves and their practice and recorded data about patients, morbidity and treatments for 100 encounters. Results: OTDs were younger, less experienced, worked more sessions per week, in smaller practices. OTDs saw fewer children and elderly patients, more new patients, health concession card holders and Indigenous people. OTDs managed less general, urological, social, skin and pregnancy problems, and more cardiovascular problems, urinary tract infections, tonsillitis and conjunctivitis. They provided more medications, other treatments and referrals, and ordered more pathology and imaging tests. Conclusion: This study suggests that OTDs see a different patient mix and range of morbidity and provide different management to that of FRACGPs, generating higher costs of care. Regular study of the clinical activities of a representative sample of overseas- trained GPs is needed. (author abstract)