SubmissionNo 0 ~Date Received II ~4):)

JointStandingCommitteeon Migration

Inquiry into ovetseasskills recognition, upgrading andlitensing

Reporton therecognitionprocessofoverseasphysiotherapistswithmigrationpurpose

EmanuelaCaniniApril 2006

To Dr Habib Vahed

PhysiotherapistfromAfghanistan

In memoryMurray Bridge(SA) - February2003

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Erratacorrige:

Pag. 13

‘1havealso encloseda letterfrom an employerin a hospitalin QLD (App. 8).”

Pleaseread:

“I havealsoencloseda letter from an employerin a hospitalin BallinaCommunityHealth— NorthernNSW (App. 8)”

Contents

• Introduction• Personalexperience• Anomaliesanddiscrepanciesin theprocess— Therole oftheseveralGovernment

DepartmentsandProfessionalOrganisations:- RegistrationprocessandthePhysiotherapyRegistrationBoards- Acopraandtheprocessofrecognition- AustralianUniversitiesandtheir courses- AustralianPhysiotherpayAssociation(APA) andits position- DIMIA andits mis/contributionto theprocess- DESTandits role

• Conclusion• A possiblesolution• Requests• Appendices

N.B. All thepapersin theappendicescanbe availablein original on request.

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Introduction

Overseasphysiotherapistsareattractedto Australiaby thegreatamountofjob proposalsandtheGovernmentpromotionto fill theshortageofskilled professionalsespeciallyinthehealthsystem.

On arriving in Australia,theyfind themselvesunableto workbecausetheiroverseasqualificationis not recognisedby thePhysiotherapyRegistrationBoard,evenif acceptedby Universitiesto attendapost-graduateMaster’sDegree.

This preventsthemfrom applying for skilled migrationasregistrationwith theprofessionalbodiesis essential.

Theprocessfor assessmentis long, expensiveandunfair, so theseprofessionalswhodecidenot to give up immediatelyfind themselvesin theofficesof theDepartmentofImmigrationtrying to find awayto stayin thecountryto completetheprocedureforregistration.

Letmeassureyou that thereis no suitablevisafor thepurposeofcompletingthe longandarduostaskofregistrationor for havingyourskills recognized.

Moreover,thesequalifiedmedicalprofessionalsareoftenunableto do otherjobsrelatedto theprofession,for exampleasaphysiotherapyassistant- becausethis is missingin thelist oftheskilled jobsof DIMIA, if notanyjob atall becausetheyareunableto find asponsorshipwithoutarecognisedqualificationandalsodueto themanyemploymentrestrictionsapossiblesponsorhasto abideby.

Duringthis time, physiotherapistslosemanualskills andknowledgetogetherwith aconsiderableamountof money.

Morethanthat, theyloseconfidencein theirprofessionalcapacitybecausetheyareconsideredincompetentanddangerousto thepublic andconfidencein their ability tobecomeintegratedin theAustraliancommunitybecausetheyare“unwanted”asmigrants.

My personalexperienceledto meto sharemy concernsfor suchaphenomenonwithsomecolleaguesin thesamesituation,to revealattheendanationalandhistoricaltrendnotonly for overseasphysiotherapistswhoseekfor temporaryorpermanentresidencebutalsofor Australiancitizensqualifiedoverseas.

I havegatheredmanyofthesecolleaguesin agroupto bringthis phenomenonto theattentionof theappropriateInstitutionsandalsoto themedia.I havepersonallyconductedinvestigationsandcollectedinformation,documentsandothers’storiesandevidencethatshowtheanomaliesoftheprocessandthediscrepanciesin theregulations

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oftheseveralGovernmentandprivateOrganisationsthatdo not allow usto proveourskills andthis countryto fill theshortageofprofessionals.

You will find in theappendicesafile containingmy colleagues’depositions(App. 13).Somearein Australia,someareoverseas.Theyareonly fewofthegreatnumberI am intouchwith regularly,manyofthemchosenotto partecipateofficially for fearofablacklistrepercussion.

This reporthasbeendrawnup consideringeverybody’sopinionsandevidence,sotoreflectthewholeprocessin anationalandworldwidepicture.

My soleaim is to providetheCommitteewith enoughinformationso it canbe abletowork out abetterapproachto migrationofskilled people,to haveabettercost-effectiveprocessfor both,andfinally abetterintegrationofoverseasprofessionalsin theAustraliancommunitythat certainlyatthisstageis sufferingfromthelackoflabourforce,especiallyin thehealthsystem.

I stronglytrusttheCommitteeto readcarefullythis reportasit containsimportantandusefuldatathatwill allow aclearview of theconditionmigrantphysiotherapistsput upwith in Australia.Especially,I hopetheCommitteewill considermy suggestionsandrequeststo behelpfulto theimprovementoftheprocedure,andapplicablein shorttimeto give overseasphysiotherapiststheirprofessionaldignity back.

My voiceis thevoiceofhundredsof physiotherapiststhat areexperiencingthis situation,nowandin thepast.We all thanktheCommitteeto havegivenusthis opportunitytocontributeto thegrowthofthis country.

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Personalexperience

• EmanuelaCanini,over 30s,qualifiedin Italy in 1995asaphysiotherapistwith a3year-full time-course,severalpost-qualificationcourses(including someAustraliantechniques),8year-workexperience,verygood level of English(IELTS overallscore7 attheendof 2003).

• Jan2004:Arrival in Australiawith astudentvisato attendapost-graduateMasterof SportsPhysiotherapyat Curtin UniversityofTechnologyin Perth,thinkingWA RegistrationBoardrecognisesMasterofPhysiotherapyfor full registrationascited on theirwebsite.My purposeis to be grantedpermanentresidenceon thebaseof my skills.

• After acoupleofmonthsI discoverthat “Masterof Physiotherapy”doesnotmeananytypeof Masterrelatedto Physiotherapybut it is basicallyatwo year-courseofferedto peopleholdingaBachelorin arelatedprofessionthatcanbecomephysiotherapistandobtain registration.

• My enquiryto WA Boardaboutthevaluegivento aMasterof SportsPhysiotherapyafterhavinginsistedin gettingan answer,endswith thepromisetohavemy casediscussedin theirnextboardmeeting.After sometime a letterinforms mesimplythattheoutcomeofthemeetingsaystheMasterof SportsPhysiotherapyis not recognisedfor full registration.No particularreasonsarementioned(Appendix1). To noticethattheHeadofthePhysioSchoolatCurtin isalsoamemberoftheBoard.I haverecentlyrequestedtheminutesofthemeeting.I havebeentoldtheyarenotavailableto thepublic, but I canapplywith theFreedomofInformationAct, whichI will do.

• Too late for pulling out from thecourse,I completetheMasterof Sportsattheendof2004.Costover20,000$plus costof living. To noticethecourseinconjunctionwith theMasterof ManipulativeTherapyis attendedby over26students:21 full time overseasstudentsfrom all over theworld, andonly 5 parttimeAustralianstudents.

• I apply for eligibility for theprocedureof recognitionwith Acopra,theorganisationofficially accredited.Cost495$,plusIELTS Englishtestabout250$andcostoftranslationandcertifiedtruecopiesof documentsin Italy over 1,000$.

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• I enroll forthe first writtenexamduein March 2005.Cost 1,100$.BecauseAcopraprovidedcandidateswith the list oftheir emailaddresses,I get in touchwith acolleaguein Perthandwe studytogether.He is athis 3rd attemptandhisstory andotherrumoursarequite discouraging,asit looks thatalmostno-onecancleartheprocedureat first attemptso protractingthetime largely overayear.

• In spiteofthe lackofresourcesandindicationsabouttheexamprovidedbyAcopra, I manageto study atmy bestwith thehelpofthat“experienced”physio.Unfortunatelyaftermorethan6 week-waiting, resultssayI havefailed theexam,missingthepassmarkonly for 4 questions.Veryvaguefeedbackis givenon thephoneaboutthat, notevenknowingwhatthepassmarkwas.

• In themeantimeI apply for a sponsorshipwith an employer.After havingappliedfirstly with theEmployerNominationSchemeto employmeasaphysiotherapist,becauseunableto getregistrationaftertheMaster,he decidesto sponsormeasamassagetherapist,positionalsoneededin his clinic, with aTemporaryBusinessLong Stayvisa457.Xraysandmedicalexaminationarerequired,with relatedcost.Thevisais approvedbutsoonaftertheemployerdecidesto withdrawthesponsorshipandI havecommunicationby DIMIA thatmy visawouldhave beencancelled(Feb2005).No refundgiven for both applications.I haveneverstartedto work for thatemployer.

• I re-enroll for asecondwrittenexam.Other 1,100$.BecauseAcopraprovideswrittenexamsonly twiceayear,I try to avoidcancellationof thevisa, looking forotherjobsbutunsuccessfully.No employersareavailableto give meajobasamasseusewith amm 35hrs/p.w.and/or39,100$mm grosssalary.Mostoftheproposalsinvolve part timejobs andpaymenton precentage.Althoughplenty ofthesetypeofjobs,DIMIA doesnot acceptmorethanoneemployerasasponsor.

• June2005, still waiting for my visacancellation.Worried,I contactDIMIA andapparentlythewithdrawalofthesponsorshiphasnotbeenrecordedyet.

• Luckily an Italian nursinghomelookingfor an Italian speakingphysiotherapyassistantdecidesto sponsormewith an OccupationalTraineeVisa.Thecontractis supposedto endin September2005,but in Octobertheapplicationis still underprocess.Eventuallytheapplicationfails,not only becausethetime ofthecontracthasgonebutalsobecausethenursinghomeis not ableto providethetraining/employmentplanasattheir first experienceof training/sponsorship.DIMIA advicesto withdrawtheapplicationto avoidarefusal.No refund.

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• I sit thesecondattemptoftheexamin September2005.The level ofthetestisunrealistic,not relatedto dailyphysiotherapypractice,alsowith questionsmeaslidingandconfusingevenfor Englishmother-tonguecandidates,andI findmyselfhavingto guessmostoftheanswers.About six week-waitingto discoveranotherfail togetherwith 86% ofthecandidates(App. 2). Werealisetheprocessis unfairanddecideto startan official groupprotest.I collectenoughevidencetoshowwhat goeson behindthescenes.SeveralInstitutionsarecontactedandthenewspaperTheSundayTimesagreesto publishour story (issued27/11/05).

• My visa is goingto be cancelledsoonandI go to askfor onemoreweektimetofind asponsorhip.While speakingto theofficerat migrationoffice, I noticeonthecountersomebagstheyaregiving for free:on top written “Australianeedsskills”.

• Duringthesamedays,I alsoattendan expoin Perthin November2005, organisedby DIMIA to encourageskilled migration.By chance,I meettherearepresentativeofWA DepartmentofHealth,shewaspromotingmigration forhealthprofessionalsandwasabsolutelyunawareof thedifficulties in therecognitionprocess.I explainedmy situationsothat I hadtheDepartmentinvestigatingon theprocedurein WA.

• Theextraweekis grantedandluckily I canapply for aTemporaryBusinessLongStay457 visawith acontractwith RoyalPerthHospitalasaphysiotherapistassistant(App.3). OtherXraysandmedicalexams,othercosts.Old Xrays arestill valid, but I amrequiredto do themagain.Reason/nonsense:“becausethepositionrequiresalsobloodtests”.TheDepartmentof Healthhelpsmewith theprocedure.Thehospitalmakespressureto havemeto work soonasthevacantpositioncausesincoveniencebut thetimeto processthepapersby DIMIA is toolong. Readyto work, trained,providedwith theequipmentanddonethe inductioncourse,theday beforestartingto work, DIMIA calls thehospitalandtheDepartmentofHealthadvisingto withdrawtheapplicationto avoidarefusalas“physio assistant”doesnotappearin thelist of DIMIA skilledjobs. No refundofcourse.

• Dec2005: ContactedMP Don Randall,throughinformationand contactdetailsgivenby Ombudsman,I manageto haveatouristvisa for threemonthssothatI

rdcansit theexamfor a3 time. Other 1,100$.I sit theexamin March 2006.

• Whenmy visaapproachesagainto an end,I haveachanceto be trainedby RoyalPerthHospitalasaphysiotherapistnot only to helpmewith theclinical exam~which is thestepafterclearingthewrittenexam,but thehospitalis alsointerested

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in employingmeasaphysioonceI getregistered.TheOccupationalTraineeisthesuitablevisa.DonRandallandthesameDIMIA follow thecase.EventuallyIfind impossibleto apply, aseveryhospitalrequiresaprofessionalinsurance,which is givenonly to peoplewith temporaryregistration,which in WA isavailableonly to candidateswho haveofficially clearedthewrittenexam,so notbeforethe6week-waitingafterbeingassignedan official placementandanofficial supervisorby Acopra.

• Luckily I amgrantedotherthreemonthsasatouristto be ableto getmy examresults.

• In themeantime,InMotion, AustralianPhysiotherapyAssociation’smagazinepublishesanarticlein March 2006,describingthecandidatesthatfailedSeptemberexamasincompetentanddangerousfor thepublic, definitelynotbeingatthesamelevel oftheAustraliangraduatedstudents(App. 4). I write acomplaintletter to theeditor,theAPA andAcopra,concernedaboutthebadimagethearticlegivesaboutusto thepossiblefutureemployersoncewe clearthewholeprocedure,preventingusfrom beingselectedfor ajob. I askto havemyletterpublishedto tell ourversion.No reply yet.

• Next stepwill be obtaininga working or trainingvisa, completinga six weekplacementin ahospitalorganisedby Acopra,costaround2,500$ (notmentionedin Acoprainformation),sit theclinical exam,cost 1,700$andbe finallyregistered.

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Anomalies and discrepanciesin the process— The roleof the severalGovernmentDepartmentsandProfessionalOrganisations

Registration processand thePhysiotherapy Registration Boards

Criteria for registrationaredifferentin severalStatesof Australia.

Full registration

All theBoardsrecogniseAustralianqualificationsthroughMutualRecognition.All theBoardsrecognisealsoqualificationsfrom NewZealandthroughtheTransTasmanianAct(WA introduced it only last year).

Interestingly, WA Board recognisesCanadian qualifications.

Temporalyregistrationfor employmentpurpose

It is atthediscretionoftheBoardsandthepapersoftheapplicantsmustbe assessedtomeettheminimumrequirements.Practicemustbe supervisedrind theemployer/supervisormustmeetsomerequirements,thoughI believethat supervisioniswhat any ethicallycorrectemployerwould useasbeingresponsiblefor public health,evenon full registeredemployees,of everynationality.

Working-holidaymakerscanmakeuseofit usuallyfor 12 months,changingemployereverythreemonthsaccordingto thevisarequirementsandre-applyingagainwith thenewemployerfor anothertemporaryregistration.

Eligible overseasphysiotherapistsfor temporaryregistration:

Tasmania:working-holidaymakersonly if from UK, Ireland,SouthAfrica, Canada.Alltheothersarerequiredto getasponsoringemployerphysiotherapist.

Victoria: all overseasphysiosfor anotspecifiedtime.

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South Australia: working-holidaymakersfor ashortperiodandapprovedoverseasemploymentexchangeprograms.Thewholethinghasto be arrangedwith theBoard,therearenotspecifiedparameters.

NSW: working-holidaymakersfor a yearandexchangeprogramworkers.

NT: physiotherapistsqualifiedin UK, IrelandandCanadacanbe eligible for temporaryregistration(2004data).

WA andQLD: do not give anytemporaryregistrationfor employmentpurpose.

No regulationsarespecifiedforpermanentresidentsorAustraliancitizensqualifiedoverseas,but it appearsthat theyarenoteligible to any temporaryregistrationsof theabove,asshowedin the letterof apermanentresidentin NSW qualifiedin Indiathatwithajoboffer hasbeendeniedtemporaryregistration(App. 5).

Theanomalies:

TheAustralianPhysiotherapyCompetencyStandardshavebeenestablishedandmeanttobethesameall overthecountry.Issuesarisingfrom thesedata:

- Canadiansmeet thestandards in WA but not in theother States

- A permanent residentor an Australian citizen has less rights than a temporaryvisa holder

- In WA and QLD a supervisedpractice can be obtained only in a full timeinternational feepaid Master at University

- After 365 day-work an overseasphysiotherapist is back to be considereddangerousfor the public.

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Australian Universities and their courses

A considerablenumberoftheoverseasphysiotherapiststhatapply for theprocedureofrecognitionhavecompletedapost-graduateMasterin an AustralianUniversity,butstilltheyareunableto cleartheprocessatfirst attemptandin thetimeexpected.It is hardtobelievethatanexamset to reflectthegraduatingknowledgeofphysiotherapistscannotbe passedby successfulgraduatesof anAustralianMasterof Physiotherapy.

TheseapplicantshaveaDegreeofPhysiotherapythat is recognizedby theAustralianUniversitytheystudiedat, buton theotherhandit is not recognisedfor registration.

TheHeadsoftheSchoolsarealsomembersoftheBoards.

Mastersare attended mainly by overseasstudents,paying 30% extra feecomparedto an Australian student, what will happen if Universitieswould not acceptoverseasPhysiotherapists?They would discontinue the courses.

In thehearingwith theHouseof RepresentativesMarch 2003with theStandingCommitteeon Ageing (www.aph.gov.au/hansard/reps/committee/R6337.pdf,p.324)followingthequestionfrom aMemberoftheParliamentif it shouldbe thecasetoencouragemorephysiosto be trainedto compensatefor theshortageofprofessionalsinthecountry,theAPA (AustralianPhysiotherapyAssociation)ExecutiveOfficer - MrMalonerepliesthatthe lackofphysiosis ahugeissueandit is a toppriority oftheBoardsDirectors.FortheoccasionMr. Malonewentto ameetingin Newcastleaweekbeforethehearing(March2003),wheretheHeadsof thePhysioSchoolsconfirmedtheissuewashigh in their agenda.

Amazingthatonly somemonthslater,NewcastleUniversitydeclaresthatphysiotherapycoursewill be harderto get into togetherwith thefactthatcut-offswill be slightly higherbecausethedemandjust goesup everyyearasdetailedby theABC news,19/12/03,www.abc.net.au/news/newsitems/200312/s1013261.htm.

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APA (Australian Physiotherapy Association) and its position

TheAPA report,datedMay 2005, expressesconcernabouttheprocedureofassessmentthatdoesnotallow to fill theshortageof Physiotherapistsin Australia:

“The APA is concernedthat current examinationrequirementsfor overseas-trainedpractitioners are a disincentive for ‘working holiday’ Physiotherapists. Limitedregistration has been introduced in many jurisdictions but it is unavailable inQueenslandand WesternAustralia. Whereit hasbeenintroduced, there are indicationsthatproblemsmayarise at the endoflimitedregistration.For example,apracticein oneStatehasemployeda UK trainedPhysiotherapistfor nearly12 months.At theendofthe12 monthslimitedregistrationwill expire. Thepracticeis happywith thePhysiotherapistand has asked the Physiotherapists’ Registration Board how at 365 days thePhysiotherapistcan be deemedcompetentto practiseandat 366 daysno longer be ableto practise.

Where limited registration is unavailable, the applicant mustcomplete a three-stageassessmentprocess before being able to register. This involves assessmentofqualifications, a written examinationand a clinical examination. Obviously this isimpracticalfor holidaymakers.Protectionofthepublic is ofparamountimportancebutpresumablywhatis safein onejurisdiction is safe in another.The APAstronglysupportsa nationallyconsistentapproachto the assessmentofoverseas-trainedPhysiotherapistsfor bothpermanentandholidayemployment.”(www.apa.advsol.com.au/independent/documents/submissiOns/PrOductivityCOmmissiOnSubmissionMay05.pdf,p.20).

It’s interesting to notice that the main concernof theparagraph in the report isabout temporary workers.

I have triedto contactAPA, and so havemy colleaguesin theotherStatesto try andformagroupfor seekingfor adviceandopinions.I havenot heardbackfrom anyoneandmysurpriseceasedwhenI sawthattheDirectorofAPA is alsoaDirectorofAcopra.

In March2006,theAPA magazineInMotion publishesan article“Low passratecausesfrustration”,referredto thegroupofoverseasphysiotherapists(86%ofthetotal includingmyself)that failed lastSeptember2005writtenexamprovidedby Acoprafor therecognitionof theiroverseasqualifications(App. 4).Thearticlegivesabadimageof usthreatheningour opportunitiesfor a futureemploymentevenaftersuccessfullycompletingtheprocedureofrecognition.

I wrotea letterofcomplaintto theEditor, theBoardsandAcopra(App. 6), SO did othercolleagues,includingsome“frustrated” working with temporaryregistrationandmembersof APA theirselves(App. 7). I askedto haveit publishedasfor equal

thopportunitywehavetheright to tell ourversion.No replyto meto 10 April.

I havealsoenclosedaletter from an employerin ahospitalin QLD (App. 8).

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Department of Education, Scienceand Training (DEST) and its role

As from thesubmissionto this Committeeon July 2005(http://www.aph.gov.au/house/committee/mig/recognition/subs/sub091 .pdf)DEST statesthat

“...contributesbyensuringtheprocessesfor skillsrecognitionare in placeanddo notcauseunduedelaysto theprocessingofmigrantapplications.DEST’sprimarycontributionis tofacilitate the recognitionofoverseasprofessionalsskillsthrough:approvingassessingauthoritieswhichassesstheskillsofprofessionals(like Acopra) andprovidinga qualification recognitionservice.

The approvalprocessis designedto ensurethat thenominatedprofessionalbodyhasthecapacityto delivereffectiveprofessionalqual~fication assessmentthatis consistentwithAustralia‘s qualityandstandardsandlabour marketinterests.”

Is DEST effectively continuing its role of inspector to ensureAcopra is following theguidelinesfor a correct assessment?

DESTcanassessitself qualificationsthroughits OverseasQualificationUnit. Theassessmentis notsuitablefor migrationpurposebutonly for employment.It is possibleforphysiotherapiststo submittheiroverseasqualificationsandobtainaftera50$ feeacomparativeassessmentto an AustralianBachelordegree.

TheOverseasQualificationUnit consultstheNationalAcademicRecognitionInformationCentrefor theUnitedKingdom. If aqualificationis consideredcomparableto aBritish Bachelor(Honours)degree,thenit is alsocomparableto anAustralianBachelordegree.

Thereis evidence(App. 9) thataDESTdeclarationofacomparablequalificationis notacceptedevenfor employmentpurpose,asit is not acceptedby thePhysiotherapyBoard.Ofcourse,it is alsoknown thatevenaBritish hasto go throughAcopraprocessofrecognition.

Whatis thentherealroleof theDepartmentofEducationin this procedure?

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Department ofImmigration (DIMIA) and its mis/contribution to theprocess

Recognitionprocedureconsistsof a writtenexamanda clinical exam.Thewrittenexamis providedalsoin somecities overseaswhile theclinical examwith thesix week-clinicalplacementis compulsoryin Australia.Of course,thoughoverseasphysiotherapistshavetheopportunityto sit thefirst examin otherlocationscloserto theirresidentialcountry,mostof themchooseto moveto Australia,which is requiredanywayfor thesecondexam.

Getting acontactwith theAustralianhealthsystemprior to theexamis certainlyconvenientfor candidates,whowantto experimentandverify theirknowledgein relationto theAustralianphysiotherapystandardthroughtrainingor work. Moreover,it is surelyuseful to gatherwith othercandidatesto form study groups,to accessresources,andtocompensatefor the lackof guidelinesgivenabouttheexam.

Oncecandidatesarein thecountrywith considerablefinancial investment,theyexpecttostayfor thewhole time requiredby theprocedure,which is minimumalmostayear,providedto passeveryexamat first attempt.Howevermanycandidatesfoundtheirselvesto fail morethanonceextendingthetime of stay.

In bothcases,overseasphysiotherapistshaveconsiderableissueswith DIMIA, not onlyto stayin thecountrybut alsoto obtainaworking or trainingpermissionto keeptheirskills activetill registrationis gained.

While permanentvisas(Skilled IndependentandEmployerNominationScheme)arenotavailablewithoutregistrationwith theBoard,thereis anumberoftemporaryvisaswhichcandidatescanofficially use,but eachof thempresentssomehurdles.

Thepossibletemporaryvisascurrentlyavailableare:

Working/holiday:mainlyusedby youngphysiotherapistsbecauseit is availableonly to under30 yearsold applicants,andit is probablytheeasiestvisato obtain.Moreoverin all StatesbutWA andQLD, theycanhavetemporaryregistrationwith theBoardwithoutany assessmentthroughexaminationfor thevisalimitedtime.

Usually, thesevisa holdersdo nothaveintentionto settlein thecountry,but theironly purposeis to improvetheirskills in physiotherapyjoining thepleasureof aholiday.

This visainvolvesalsochangingemployereverythreemonths.It is evidentthat itis not asufficienttimeto gainconfidenceofcolleaguesandpatientsof thefacility employing,notto mentionthatassoonastheemployeesacquirethework

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routineandcan givetheirbest,theyhaveto changeemployer.

• Temporary BusinessLong Stay 457: throughasponsorship,overseasphysiotherapists,who cannotbe registeredtemporary,canfind theirwayto workin afield relatedto physiotherapy.You will agreethat an experiencedphysiotherapistcanhardlyhaveothertypesof qualificationsandwork experienceto be ableto find asponsorshipin anotherfield.

Theonly two jobsanon recognisedphysiocando are:massagetherapyandphysiotherapyassistance.Giventhatemployeesarenot usuallyinclinedto waitfortime ofapprovalof theapplication,too long for theirneeds,norto disclosetheirbusinesspapersto DIMIA, let’s seethechancesto getan employmentwiththosetwo typesof position.

As amassagetherapist,thevacantpositionson offer cannot guaranteetheminimumhoursworkedaccordingto thevisa (35hrs/p.w.)northeminimumsalarythreshold(39,100$p.a.).Massuesesareusuallyrequiredto built up theirownclientsandarepaidon percentage,not to mentionthat is notadvisableorhealthyto work for thatweeklyamountoftime asit is aphysicalwearingactivity.In spiteofthis, thereis plenty of offersofparttime jobs, but thevisaconditionsrequesttheapplicantto haveonly oneemployer.

As aphysiotherapyassistant,therearecertainlymorechancesto find a full time-on wage-positionespeciallyin hospitalsor in agedcarefacilities. Unfortunately,457 visa canbe grantedonly to sponsorshipregardingjobsappearingin DIMIA’sskills list. This list includes528 skills of everykind, from chemistto pianotuner,from engineerto horseor dogracingofficial.

Physioassistantdoesnot appearon the list soanyvisaapplicationto DIMIA forthatposition is refused,unlessthejob is in aregionalarea.To noticethat theoption“regional area— list requirementwaiver” is notmentionedin theinformationprovidedby DIMIA websitenor in theappropriatebooklet.

Regionalareas,unlessreasonablycloseto themetropolitanarea,makedifficultfor theexamcandidateto form studygroups,to accessenoughresourcesto study,plus all thesocialandfacilities inconvenienceofdaily life in thecountryasforwhich eventheAustraliancitizenswould ratherwork in thecity.

• Occupationaltrainee visa: a candidatecanbe trained/employedasaphysiotherapistin a facility that is approvedandholdstrainingprograms,usuallyonly hospitalsalreadyactingasclinical placementsfor AustralianUniversitiesstudents.Privatebusiness,nursinghomesandotherfacilitiesusuallycannotprovidethisservice.

Becauseoftheshortageof physiotherapistsin Australia,somehospitalsarehappyto offer unpaidtraining basedon workafterthecandidatehasclearedthewritten

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exam,sothat thetraineecanpractiseto sit theclinical examandcompletetheprocedureofrecognition,andthehospitalhasapotentialnewemployeeassoonasgainedregistration.

Unfortunately,professionalinsuranceis neededevenfor training,but this isprovidedonly to temporaryorfull registrationholders.TemporaryregistrationinWA andQLD is grantedonly afterhavingpassedthewritten examinationandassignedan official placementandsupervisorby Acopra,which is notnecessarilythehospitalofferingtheposition.

• Studentvisa: internationalstudentsarerequiredto be enrolled in a full timecoursewith compulsoryattendance.It would be impossiblefor thestudenttocompletethe6week-placementatthesametime, not to mentionthedoublestudycommittment.

• Visitor visa and Short StayBusinessVisa: theyarenotsuitableto attendthesixweek-placementin thehospital.

As you cansee,in spiteofthewide rangeof visaproposed,therestrictionsappliedoneachofthemdo notallow thecandidateto completetheprocedureofrecognitionin areasonableway andtime, unlesshe or sheis an Australiancitizenoratemporaryorpemanentresidentthroughaspouse/defacto visa.

Onceoverseasphysiotherapistscompletetheprocedureonly thentheycanapply forpermanentresidencethroughan IndependentSkilled orEmployerNominationSchemeVisa. Boththesetypeof visasrequirerecentwork experience,which is usuallythreatenedby thelossof skills andthe impossibility to practiseasaphysiotherapist.

It might be usefulto spendalsosomewordsabouttheorganisationandthepositionofDIMIA asit appearsfrom theapplicantview.

DIMIA is verysparingwith providing information.I appreciatethat DIMIA’s taskis notadvisingapplicantson themoresuitablevisafor theirneeds(thoughI wonderwhy not).Mainly the informationprovidedarelimited to thenumberofbookletregardingthevisatheapplicantis enquiringabout.

Thesebookletsareoftenmissingor misleadingimportantinformation,examples:

- TemporaryBusinessLongStay457 (Booklet 11): assaidbefore,theoption“regional area/skills’list waiver

- EmployerNominationScheme(Booklet5): sponsorshiprequiresafull timethreeyear-contract.This is adisincentivefor employers,asthethreeyear-termis ascaringcommittment,notknowinginsteadthat theyarenotobligedto abidebytherule, northevisaapplicanthasto. This informationis notavailableto thepublic.

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- OccupationalTrainee:thetrainingbasedon workcanbe alsounpaid,thoughDIMIA webistespecifiesthetraineemustbe employed“underAustralianindustrial relationslaw andrelevantCommonwealth,Stateor Territory awardsandconditionsfor the industry” (http://www.dimia.gov.au/allforms/otv/Ol.htm),which leadsto understandthat thetraining mustbepaid.

Moreover,theapplicantshaveto keeptheirselvesup to date,asthemigrationlegislationprocessis in continuousdevelopmentandit canbe evenpossiblethatanapplicantafterhavinginvestedall his orher efforts towardsatypeofvisa,eventuallycannot applyanymore.Manythenpreferto rely on migrationagentswith furtherexpenses.

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Acopra and theprocessof recognition

The examinationis saidto bebasedon theAustralianPhysiotherapyCompetencyStandards,thatarecurrentlyunderreview,forwhich Acoprahascontracted,for119,780$,PPRConsultingPty Ltd, averysuccessfulgroupspecialisedin providingpolicy, planningandreview(from Acopra2005Financialreport— availableatASICAustralianSecurities& InvestmentsCommission).

Theprocessof recognitionrequiresthreesteps:eligibility, written examinationandaclinical examafterarecommendedsix week-placement.Detailshavebeenalreadyprovidedby Acoprathroughtheir previoussubmissionto this Committee.Thisparagraphwill limit to questiontheseveralparametersoftheprocedure.

Costoftheprocedure

Thecostoftheprocessis approximately6,000$(includingtheclinical placement),plusrepaymentofthefeeof theexamfailed. I stronglybelievethis is excessive.

Accordingto Departmentof Education,ScienceandTraining (DEST)“thecostsofassessmentto clientsshouldbe determinedon a not—profit cost—recoverybasis~~(DESTsubmissionno.91 to theCommittee,http://www.aph.gov.au/house/committee/mig/recognition/subs/sub091 .pdf,p.20).

Acoprais registeredasacharitableorganisation,with GSTconcession,FBRrebateandincometaxexemption(http://www.abr.business.gov.au/(wwxo155Slacxp1 r0txzwcv55)/search.aspx?SearchText=28108663896&StartSearchTrue).I supposeany organisationconsideredascharitableby thetaxationofficehasto providethereasonfor thecharity.

Whatcharity is Acopradoing andwhoto?The taxationoffice told menot to havethatinformation.

FromAcopra’s2005 financialreport(availableatASIC — AustralianSecurities&InvestmentsCommission),it appearsthat in spiteoftheconsiderablerevenue,attheendtheprofit is just 3,774$,sodemonstratingtheyabideby therulesascharitable.To noticethough,thatAcoprahasotheractivitiesandthenot-profitfinal valueis notjusttheresultoftheassessmentofoverseasphysiotherapistsbasedon costrecovery.

In 2005 the incomefrom theexamswasabout400,000$.Plusthereweredonationsforabout500,000$andtotal assetsfor over 600,000$.

Thedonationsreceivedby Acopraareprobablythegrantscoming everyyearfrom theRegistrationBoardsasit appearsfrom severalBoards’financials(seeexampleswww.physioboard.qld.gov.au/DocsLibrary/Physio%2OAnnual%2ORepOrt%2O2003-

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04.pdf,p.12; www.physioreg.health.nsw.gov.au/hprb/physioweb/pdf/physar01 .pdf,p.8).Of theannualregistrationfee,that everyAustralianphysiotherapistpaysto theBoard,about4$ aretransferredto Acopra.TheBoardgrantsarestatedto coverthecostoftheotheractivitiesabovementioned.

How canacharitableorganisationchargeandhaveassets?Is it like goingto feedthehomelessandthengivethemacost-recoverybill? Thatwould be “not-profit” but not“charitable”.

Thewritten examconsistsof20 caseswith relatedmultiple choicequestions.Everycaseis an intellectualpropertyvalued200$asstatedby Acopra(App.10), for atotal of4,000$.Thewrittenexamis providedtwiceayearandit is thesameall overtheworldandapparently,thequestionsarerecycledin severalexams,so eventuallytheeffectivevalueofthe intellectualpropertyis certainlylessin reality.

Theclinical placement,includingprofessionalinsurance,indemnityandtemporaryregistration,costsabout2,000-2,500$dependingon thehospitalcharging.At theirsay, itis theonly wayto obtain an appropriatesupervisionandto havetheplacementorganisedin ashort time.

Theplacementis asix weekfull time-attendancein ahospital,wherethecandidateexpectsto be guidedin theprocessoflearningorverifying theAustralianstandardproceduresin assessingandtreatingpatientswith different pathologies.

Beingessentialfor candidates,especiallyif neverbeingin contactwith physiotherapyinAustralia,to assurethemapassfor theclinical exam,theplacementthoughjustrecommended,becomes“compulsory”.

However,thecost is not mentionedin theinitial informationgivenby Acopraasalsothroughall theprocess,till eventuallythecandidateclearsthewritten exam.

Acoprastatesnotbeinginvolved in thesearrangements.Well, I think it shouldbe instead,becausetheclinical examhasacostof 1,700$to thecandidateandI believethereisplentyto conductan exam,which involvesthepresenceof anexaminatorforthreehoursandthreepatientspickedin ahospital.Somaybe,Acoprashouldorganiseapropersupervisedplacementatno extracost.

So, in light ofthefacts,did the400,000$covertheircostsenough?

The factthatAcopramentionsthefeesarecomparableto Dental$5,210andPharmacy$3,500doesnotrepresentajustification, indeedit is furtherevidencethat thewholesystemneedsto be investigated.

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Timefor theprocessto becompleted

Almostoneyear,providingto passall theexamsatfirst attempt.As overall, nearlyayearis neededfor aMCQs test,six week-placementanda clinical exam.If thecandidatefailsthewritten examthenan extrasix month-waitingis neededfor anotherattempt.

Themoreevidenttime wastingis thesix to eightweeksto know theresultof theMCQstest througha computerand thetwo monthsto havetheclinical placementorganisedtostart.

Often time is themain enemyof amigrant.In all this time thephysiotherapisthasto dealwith visa extension,financialissues,lossofpracticeandmanualskills.

Theexam

Thewritten exam(Multiple ChoiceQuestionsTest)is themainhurdleto thecompletionof theprocedure.In spiteofthefactAcoprapresentedtheir2005datawith its submissionto this Committeeasto showthatmostofthecandidatespassthewrittenexamatfirstattempt,this is notwhathappensin reality.

First ofall, thosedataarenot correct.TheItalianphysiotherapistin QLD listeddid thewrittenexamthreetimesandnot two aswritten.TheIndianphysiotherapistin WA Istudiedwith did theexamthreetimesandhe is not listedatall. Theyboth clearedtheprocedurein 2005.I couldnot be ableto verify theotherdatafor themoment.

Moreover,thosedatarepresentthe59 out of 102candidatesthatcompletedtheclinicalexamin 2005. It wouldhavebeeninterestingif Acoprawouldhaveshowedalsotheother43 candidates’data,theonesthat failed theclinical exam.

In spiteoftheclaimedaveragepassrate(around50%,andonly lastMarch ‘05 around60%),it appearsthatmanyofthe lucky 50%passingcandidatesarestill thephysiotherapistshavingtriedtheexammorethanonce.

Last Septemberexamthathadafail rateof86%wasjustthe laststraw.I do not wanttobelievethatit wasset in suchawayto compensateMarch ‘05 highpassrate.

We would like to raiseanumberof issuesregardingtheexaminationandtheprocedureAcopraundertakesthat makesthis examinationalmostimpossibleto pass.Theseingeneralregard:

• Preparation offered and level ofdifficulty oftheexamWeak,unsatisfactoryguidelinesandresources,inconsiderableamountof readingtime allocatedfor theexamination.Thereis very highstandardof specific

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questionsabovenewgraduatelevel. This includesconfusingmultiplechoicequestions.In somecasesthe“most correctanswer”will suffice.

Acoprastatesthat it providesageneralstudylist, thentheyaskspecific questionsthat arein no wayconsideredto begeneralknowledge.How is this compatible?It seemsthattheMCQsoftendo not relateto thegivencasestudy,andthatmakesit impossibleto usethegiven informationofthecasestudyto answerthe questionthroughphysiotherapeuticreasoning.

Theultimategoal for avalid assessmentofclinical competenceis to testwhatthephysiotherapistactuallydoesin theworkplace,but this is not thecase.ThejournalistofTheSundayTimes went to testexperiencedphysiotherapistswith thesampleMCQsprovidedby Acopraon theirwebsiteandmostofthemcouldnotanswer.Thatsample,which is theonly oneAcopraprovidedfor years,is mucheasierthantherealexam.

Acoprastatesthe levelof theexamreflectsthestandardexpectedofAustralianstudentsgraduatingfrom final yearoftheirphysiotherapyeducationprogramme.Acoprahasnevertestedtheexamon thosestudents,sowe do not seehowtheycanassertthat.

Thelackof consistencyin responsesto questionsin Septemberexamis usedtosupportthefactthatquestionsweresetatacorrectlevel. Howeverin speakingtoanumberof candidatesfollowing theexam,thecommonresponseis thatcandidateswereforcedto guesstheanswersto anumberofquestions,whichI amsureyou will agreeis unlikely to giveconsistentresults.

Only afterSeptemberexam,theydeclaredtheywouldhaveproposedthewholetestplannedfor March‘06 to somestudentsto verify theirresponseto that. We donotknow, ofcourse,theresultof thatexperiment,andit would be interestingtohavesomedata.

• Poor feedbackafter examination.In mostcasestheresponsesfrom Acoprahavebeenof a“politically correct”nature. Following our protestafterSeptemberbig fail, wemanagedto obtain theexampapers backto checktheanswers,while in thepastwewereallowedto getonly thenumberofcorrectanswersfor eachcase(example:Paper1: Case1: 35yearold man~ith asthma— 1/6 ; Case2: 70 yearold manwith repairofabdominalaortic aneurysm— 3/6, etc.,App.11),which is notan appropriatefeedbackto preparethenextattempt.

Thosepapersarecopyrightedastheyareintellectualpropertyandit is commonusein Australianot to sharetheexampapersaccordingto them.We hadto sign adisclaimerto havethem,sothatwe cannot showthemto anyonebutcandidates’studygroups(App.12).

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• Passmark not statedto candidatesprior to theexamination.It would seemthat Acopra is using this systemof movingthepassmark toeffectively limit thenumber of successfulapplicants through eachround oftheexaminationprocess.

Is Acoprasettingtheexamto testtheknowledgeoftheapplicantsor settingsimplythenumberofpasses?

Acoprais not following DepartmentofEducation,ScienceandTraining (DEST)criteria,asit saysit shouldbe an “easily understood,equitableandtransparentprocess”.Well it is not.Why can’twe knowtheexampassmarkbeforetheexam?Why doesit haveto changeaccordinglyto how manycandidatesdo well or bad?Why can’tI seemy papersandthetestaftertheexam?

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Conclusion: safetyissueor protectionism?

In spiteoftheshortageofphysiotherapistsin Australia,thestandardshouldnotbeloweredasaquick fix of theworkforcecrisis, saysAcopra, APA andtheBoards.Publicsafetyis paramount.

We arelabelledasincompetentprofessionalsbecausewecannotpassan examwhich weconsidertotally inappropriateto assesstheskills of aphysiotherapist.

- In theAPA reportMay2005(http://apa.advsol.com.au/independent/documents/submissions/ProductivityCommissionSubmissionMay05.pdf):APA is concernedthatAecopprocedureis adisincentivefor “working holiday” physiotherapists.Thesephysiotherapistsworkfor about12 monthswithoutany assessmentandattheendofthe“holiday” theygo backto their countries,leavingthepositionto anotherholidaymakeror justvacant.

- In thehearingwith theHouseofRepresentativesMarch2003with theStandingCommitteeon Ageing (www.aph.gov.au/hansard/reps/committee/R6337.pdf,p.323-4): APA PresidentMs Nall underlinestheimportanceofthephysiotherapyassistantsthat underthedirectionofthephysiotherapistsdo thework anditrevealsto be avery cost-effectiveintervention.I havecertainlyseenassistantsdoingphysios’job andI agreethat is very convenient.

- In thesamehearing:Ms Nall’s words “Given thatourstudentshaveto hit thegroundrunning— we don ‘t havean internyear;theyare registeredat thecompletionoftheir course— we haveto makesure thatpeopleare safebeforetheyare let looseon thepublic. A lot ofone-on-oneinterventionis required.Forexample,physiotherapygetsabouttwo-thirdsofthefundingthat medicinegets,yetmedicinehasan internyear, asyouknow, andthat is wherenewgraduatesreallystart to learnprocedures;whereasourshaveall hadto learn theirprocedures.“(p.324).

• Holiday makersnotassessed?• PhysioAssistants?• New graduatesthat don’t know theprocedures?

Arewetalking aboutsafetyissuesor is therean actualeffort to fill theshortageofprofessionalsor is it justblatantprotectionism?

I amnot talking aboutprotectionismtowardsoverseasmigrants,sometimesI havetheimpressionthat this is extendedevento Australiansandnot justbecausetheexamsseefailing alsoAustraliansqualifiedoverseas.

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If Acopracontinuesto setexamsofthis natureit will surelyguaranteethatAustralianphysiotherapistswill be in highdemandandearnahigh rateofpay andenjoythebenefitsof aclosedmarketplace,whereall ofthephysiotherapistsaretrainedthroughAustralianUniversities.However,it will closean opportunityto learnnewtechniquesandknowledgelearntfrom overseasin apracticalway from foreignphysiotherapists.

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A possiblesolution

The following is whatI believemight be a valid assessmentof clinical competencefor aprofessionalasit testswhatthephysiotherapistactuallydoesin thework place.

ASSESSMENTTHROUGH TRAINING IN HOSPITALS:

• Publichospitalssetanumberofpositions(in relationto the localshortage)and an approved training program made available for overseasphysiotherapistsseekingfor recognition.

• The candidatesare requiredto apply for a full time training position,providing they hold the minimum requirements(suchasthree year-fulltime-courserecognisedin theirown country), selectedin relation to theircurriculum (postgraduatecoursesand work experience)andtheirEnglishif not first languagespoken.

• Theunsuccessfulapplicantscan makeuseof degreeconversionprogramsor bridging coursesat Universities,or re-try after having gained themissingrequirements.

• Applicationsfor the position in the hospitalscan be lodged onshoreoroffshore.In both cases,the candidatesselectedmustbe guaranteeda visathat allows them to stay or to enterthe country for the period required,plustemporaryregistrationwith theBoard.

• The clinical placement consists of three months (for example) ofsupervised practice in the main physiotherapy areas (neurology,cardiorespiratory,orthopedy and outpatients),and they are constantlyassessedby thesupervisorthroughcontinousfeedback.Thecandidatesareprovided with specific guidelinesabout the exam and accessto studymaterial.

• At the end of the threemonths, the candidatessit a practical examthatreflects the training provided in the same hospital, assessedby thesupervisor,arepresentativeoftheRegistrationBoardandarepresentativeof the Departmentof Health. If successful,the candidatesobtain fullregistration. If unsuccessful,a further placementcan be consideredtoimprovetheknowlegein thearearequired.

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ADVANTAGES:

1. Hospitalscanfill theshortageof physiotherapistsatno cost.

2. No significativerateof examfails.

3. TheBoardscandealwith theprocesslocally with subsequentabolitionofAcopraasassessorofoverseasphsyiotherapists.

4. Resolve issuesquickly due to tighter communicationbetweenexaminersandRegistrationBoards.

5. No time wasting for the physiotherapistand especiallyno lossof practiceandmanualskills.

6. Betterpreparedand monitoredphysiotherapistswith advantageof theAustraliancommunityandits safety.

7. More opportunitiesfor thetr~iined physiotherapistto get full employment,evenwithin the samehospital, asalready integratedin theAustralianHealth Systemandphysiotherapyenvironment.

8. No visaissuesto solve.

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Requests

I would like to concludethis report with somerequeststhat we feel to be urgenttoestablisha fair systemtowardsprofessionalsoffering their skills and at the sametimeconvenientfor thecountryto increaseits work force:

1. Sameregistrationcriteriafor everyBoardall over Australia

2. No discrepanciesbetweenRegistrationBoardsandUniversities

3. Establishmentof a Skill RecognitionVisa

4. Reasonabletime of approvalfor applicationsby DIMIA to avoidemployersbeing

discouragedto offer sponsorships

5. Inclusionof “physiotherapyassistant”in DIMIA’s skills list

6. More considerationfor over 30 years old migrant professionalsas they arecertainlymoreexperiencedandcapable

7. Collaboration and information exchange among the several GovernmentDepartmentsandtheprot~essionalorgariisations,so thateachof them is awareoftherequirementsneededin all theaspectsofa skilled migrationprocess

8. Full inforriiation in details aboutthe processprovided before skilled migrantsdecide to leave their own countries(for exampleduring expos organisedbyDIMIA overseas,or throughinternetby theprofessionalorganisations)

And especially:

9. Respectfor professionalsthat areoffering their skills andawarenessthat, in spiteof Acopra negativecriticism about physiotherapyin the rest of the world,overseastrained physiotherapistscan bring different knowledge and differenttechniquesand enrichfurther more the standardof theAustralianphysiotherapyandall thecommunitycantakeadvantageofthat.

Your sincerely

Canini

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