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Health Workforce Mobility:Migration and Integration in Australia
Lesleyanne HawthorneProfessor – International Health Workforce
Centre for Health Policy
WHO 4th Global Forum on Human Resources for Health (Dublin)Health Workforce Mobility – Comparing Migration and Integration and Its Gender
Dimensions
14-17 November 2017
Trend 1. Recent Growth in Degree-Qualified Migrants Admitted to Australia by Major Field 2006-11
(Compared to 2001-05)
Field
2001-2005
Arrivals
2006-2011
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) 192,940 347,611
The Latest Data: Temporary Compared to Permanent Health Workforce Migration Skilled Category (2008-09 to 2015-16)
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
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 2008-09 to 2015-16
Key demand = GPs, RMOs
Permanent skilled migration program pathways:
Employer-Nominated
Points-tested ‘Independent’
Regional/ State sponsored
Recent growth
Trend 3. Ensure Responsiveness to Workforce Demand (Reduction in New Grants for Temporary Health Professionals
as Labour Market Tightens (to June 2016)
Field 2012-13 2015-16 Total 2008-09
to 2014-15
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 1,530 982 9,010
Total Fields 68,481 45,395 418,777
.
Temporary Migration Declines: Nursing + Allied Health Fields –
Signals Future Reduced Permanent Migration?
Nursing � 2008-09 = 4,073� 2015-16 = 1,066
Dentistry:� 2008-09 = 156� 2015-16 = 34
Physiotherapy:� 2008-09 = 102� 2015-16 = 77
Pharmacy: � 2008-09 = 16� 2015-16 = 41
Growth in domestic student training
Compared to Medicine –Reliance on Temporary Migrant Doctors to Work in
Undersupplied Sectors and Sites (2008-09 to 2015-16)
Year /
Total Number
Permanent
Medical Migrants
Number Selected
Temporary
Medical Migrants
Number Selected
2008-093,758
970 3,312
2009-10 1551 2,673
2010-11 1018 2,927
2011-12 1544 3,299
2012-13 1736 2,855
2013-14 1468 2,440
2014-153,139
1267 2,063
2015-164,080
TOTAL 33,675
1349
10,903
2731
22,772
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 2016 - stay?)
4. Family migrants (57,400)
5. Humanitarian migrants + asylum seekers (13,500)
6. Syrian refugee special intake (12,000 to March 2017)
Trend 4. Impact ofDifferential Entry Pathways + Country of Training on
Registration + Employment Outcomes
Top 10 Source Countries for Migrant Health Professionals Selected by Australia: 8 Years to 30 June 2016 = 95,873 as Skilled Migrants
Temporary = 46,338
1. 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)
THEN Pakistan, Singapore, Iran, Zimbabwe, Germany, Korea…
Permanent = 49,535
1. 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 Singapore, Canada, Sri Lanka, Pakistan, HK SAR….
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
The Impact of English Language Testing on Vocational Registration by Major Field: Australian + NZ Occupational English Test Outcomes (2007-11)
Pass rates: Nurses (17%) Pharmacists (38%), Doctors (52%), Dentists (62%)
53%
20%
40% 38% 39%
46%
37%
43%
19%
47%
34%
28%32%
34%
52%
17%
62%
32%
38%40% 41%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
Can
did
ate
pass r
ate
(%
)
2005
2010
2011
Defining Exemptions from Australian Medical Council Exams for Migrant Doctors - Variable Registration Pathways 2008+
Specialists
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?
X
Fa
st
Me
diu
m
Slo
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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
Intra-OECD Flows – Ireland 2008-09 to 2015-16 Loses 1,759 Doctors + 2,918 Registered Nurses to Australia
Year Medicine Nursing All Health Fields
2008-09
TemporaryPermanent
13716
16371
338112
2009-10
TemporaryPermanent
17428
15496
391151
2010-11
TemporaryPermanent
15924
165101
425154
2011-12
TemporaryPermanent
21648
236161
601254
2012-13
TemporaryPermanent
17347
316147
656266
2013-14
TemporaryPermanent
17759
210275
479451
2014-15
TemporaryPermanent
16348
167256
378405
2015-16
TemporaryPermanent
22664
160240
424387
Total
TemporaryPermanent
1425334
15711347
36922180
GRAND TOTAL 1759 2918 5872
MCQ Examination Pass Rates - Top 10 Candidate Countries 2015-16 (AMC 2016 Annual Report)
337
246 238
151137 130 126
11097 88
58.569.9
59.7 62.342.3
70.8 73.851.8 44.3
69.3
Australian Medical Council
Total candidate Percentage pass
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
PassRate
Clinical No. Candidates
Passes 1-4 Attempts
PassRate
India 337 197 58% 347 98 28%
Egypt 246 172 70% 52 18 35%
Pakistan 238 142 60% 231 73 32%
Bangladesh 151 94 62% 226 62 27%
China 137 58 42% 75 19 25%
Iran 130 92 71% 131 39 30%
Sri Lanka 126 93 74% 129 37 29%
Philippines 110 57 52% 115 26 23%
Russia 97 43 44% 72 20 28%
Nigeria 84 44 52% 49 4 8%
Myanmar 82 60 73% 115 39 34%
Malaysia 50 35 70% 32 14 44%
South Africa 34 26 76% 21 15 71%
Total 2418 1447 60% 1997 571 29%
Impact of Registration on Employer Choice: Medical Migration Source Countries (2015-16)
Temporary 457 Visa StockResident Year to 30 June 2016 54% = UK, Ireland, Canada, USA
Permanent Skilled Category Total Selected Year to 30 June 2016 41% = 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%)
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%)
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%
Where Are Migrant Health Professionals Increasingly Selected? By Permanent Skilled Sub-Category 2008-09 to 2014-15
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
� 2016-17 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)
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
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 (2nd biggest source of migrant doctors)Dentists, dental specialists and techniciansPharmacistsNurse educators and managers, and enrolled nurses Paramedics
� Impact on future scale of flows and Australia’s global attractiveness as a destination?
Select Recent Sources: Data in Presentation
Australian Medical Council (2016): Annual Report 2015, AMC, Canberra
Department of Immigration and Border Protection (2016-17): 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 2004-2010, 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 109-132
Hawthorne, L & To A (2014), ‘Australian Employer Response to the Study-Migration Pathway: The Quantitative
Evidence 2007-2011’, Highly Skilled Migration: Politics, Processes and Politics – Special Issue, International Migration,
52(3): 99-115, 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, http://msod.webd3.com.au/publications-reports/other-reports
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, http://www.utpjournals.press/toc/cpp/41/Supplement+1
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