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

Location of Temporary Visa New Medical Grants -Regional Demand (2008-09 to 2015-16)

Compared to Location of Temporary Sponsored Nurses –

Sector Demand (2008-09 to 2015-16)

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

Australia’s Growing Preference: For UK Medical Migrants (2008-09 to 2015-18 New Visas)

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

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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