Australia

Racism/bias in Aussie medicine.

This post has some of my thoughts on racism and bias in Australia and within the medical/college assessment/workforce systems.

Disclaimer: DDU are made up of white Australian males.

I read an article recently about the Australian College of Emergency Medicine (ACEM) . The article said ACEM had commissioned a report following revelations white Emergency Med doctors were 13 times more likely to pass ACEM’s specialty exams then non-white applicants. Complaints about racism had been raised by the non-white applicants following the results.

ACEM’s interim report (I understand the formal report is published sometime in October 2017) into these results concluded that an “unintentional” and “unconscious” bias had in fact influenced its clinical exams since 2015.

At some point I was going to blog about about racism in Australian society and how it impacted overseas trained doctors and international medical grads at all levels going through college assessment and/or the recruitment process.

The ACEM report prompted me to bring it forward although I’m no expert in racism.

I’m a white male Australian citizen living in the 21st century. I’ve hit the world history jackpot. What I know definitively about the experiences of racism you could etch on Peter Dutton’s tie pin. I know it exists in Australia. I hear it. I see it. But I don’t experience it. I’m white.

Discrimination law in Australia makes it illegal for employers to discriminate against persons because of race, ethnicity, country of origin, gender, sexual orientation, religious or political beliefs, parental status. But it does not specifically address bias in respect to an individual’s medical training in a particular country.

Before I got into medical recruitment, I thought medicine was medicine and if a job applicant met the universal standard then it it should be logical that your skills are universally respected and treated equally. Right in principle, wrong in reality I found out.

As with so much of Australia, there are two sides of a coin. A dilemma lies in the so-called urgent demand for certain skills Australia claims it needs. It markets itself using sophisticated PR campaigns and techniques (koalas, Nicole Kidman etc) to a worldwide talent pool of all professions and skill sets. A growing economy and population needs you!

This warm and fuzzy image can be contradicted by the cold realities of a workforce culture that insists on a successful job applicant having local “Australian” experience. This casual disdain for your hard earned skills and professional dignity is all too commonplace in this migrant society. A society that has a strong thread of historical racism and which has become increasingly suspicious of the outsider.

On one side of this coin picture yourself as a skilled migrant. You’ve spent months filing out skilled migration application forms, you paid the money, you have been approved for migration! Yippee! As you prepare for departure, you reread with excitement the formal Australian government documentation stating your hard earned skills and qualifications are in high demand in Australia. Now all you need to do when you land is get a job! Living the dream!

The other side of the coin. Your visa application money has been banked long ago by the Australian government. Its been 3 years since you arrived and you haven’t been able to secure a job in your chosen profession despite the supposed skills shortage and volume of  vacancy adverts online.

To make matters worse you are paying tax  to support the country that promised you the world before you arrived. You are part of the new gig economy driving or working for less then minimum wage in the 7 Eleven for next to nothing whilst lesser qualified, less experienced native born Australians swan into the jobs you migrated here to do. What can you do?

Having heard this horror story countless times I can only imagine a tiny bit of  of the fractured hopes and dreams of so many skilled migrants who came to Australia in the last 20 years only to be sold a pup.

Whilst I do believe racism is a major factor in many industries I don’t believe it plays such a central part in medicine as it does elsewhere. However, what I do believe is there is conscious bias towards countries with specific medical training.

It is true there aren’t many unemployed doctors (at levels of training/experience) sitting at home in Australia twiddling their thumbs who have trained within the following 5 training authorities approved by the Medical Board of Australia:

  • General Medical Council.
  • Medical Council of Canada.
  • US board certified.
  • Medical Council of New Zealand.
  • Medical Council of Ireland.
  • And South Africa – more informally.

What is also true is that there are many doctors trained in training authorities other then the above who are sitting at home unemployed, doing volunteer (unpaid) work at the local hospital or working in a completely unrelated job.

Despite following rigid process via a spousal visa or via skilled migration, they find themselves in a “no-mans land”. Australian public services will prefer to spend money on importing junior, middle grade doctors from the 5 approved authorities then hiring someone from a non-competent authority currently in Australia who has migrated here on good faith believing the demand for doctors implied a job on arrival.

Is this down to racism, cultural awareness issues (both ways: employer and employee) or bias towards the quality of training in particular countries?

In my experience most Consultant/Specialist doctors migrating to Australia from the UK – for example – tend to have been born outside of the UK. Of these, they were most likely born in India, Pakistan or Sri Lanka.  This doesn’t indicate a deep institutionalised racism.

Yet, there are racist elements in Australian society. Everyone knows this. Certainly, violent attacks on Indian students were well known some years ago and one current stupid populist view is Chinese house buyers are the cause of un-affordable house prices. Ridiculous!

The 2011 Australian census stated 56% of Australia’s general practitioners and 47% of its specialists were born overseas. Approx. 40% were trained in other countries, with the largest numbers coming from the Indian subcontinent, Southeast Asia, and sub-Saharan Africa.

The Guardian website in 2016 reported a Queensland study where a doctor with Pakistani training credentials who had qualifications, education comparable to one with Australian credentials was less likely to be hired. The Guardian also said foreign-born doctors were also more likely to be treated disrespectfully by patients and other doctors indicating a deep rooted xenophobia.

This is backed up by a parliamentary committee finding in 2013. I nearly spat out my decaf, soy-skimmed flat white all over my screen when I read the following extracts. This is a testimony from an overseas trained Physician, a Dr Lemeiszek:

“On one occasion, Dr Lemieszek alleges he was advised by a supervisor:

…top marks are reserved for the top 3% of best performers, and as you are overseas trained you can not belong to this group.”

On another occasion, Dr Lemeiszek claims that the same supervisor told him that:

We will keep you like a dog on a leash. If you are a good puppy we will extend your leash, if not we will tighten it…If we trust you, we will let you progress, if we do not we will limit your progress and and shut you up…

Another IMG..advised the committee of his experiences when commencing work in the South Australian town of Whyalla:

…I was met at the front door of the hospital by an Adelaide Professor of Surgery and informed that I was unwelcome in South Australia…I like you but we will never accept you as a specialist surgeon in South Australia. “

No doubt you are now all ripping up your South Australian job applications.

Of course it is not just OTDs who experience bullying in the workplace in Australia. But OTDs are particularly vulnerable and in their situations are often afraid to speak out because of

…”local xenophobia, institutional bullying and the threat of losing their job and, thus, visa to remain in Australia. ” 

Evidently, the Australian system for assessing and hiring overseas trained doctors (OTDs) is skewed and reflects a bias towards training authorities and the status of the doctor.

An example that further demonstrates this bias in my opinion is the situation where OTDs who completed specialist training outside of UK, Ireland, NZ, Canada, USA (and South Africa although not formally recognised) – the rest of the world (ROW) – are unaware that even if they are favourably assessed by a particular college to be substantially comparable to an Australian trained Consultant/Specialist, this  does not mean they will find a job.

In fact, it is evident that applicants trained in the listed comparable countries listed above with exactly the same college outcome of those Consultant/Specialists trained in ROW will be far more likely to get a job – as the ACEM report suggests.

And this, after having paid a fortune in college application fees, travel costs for interviews (some colleges insist on a face to face interview in Australia) and the opportunity cost of the preparation put in. These college outcomes will expire after a period of time – many doctors trained in ROW will therefore fail to get a job despite the most favourable outcome. Very frustrating.

Is Australia racist?

Despite Australia being an incredibly successful multicultural country built by migration, it can still shock as to how openly racist many people can be here.

In my experience in medical recruitment I have not heard a hiring manager utter a racist comment or discriminate at any stage of the recruitment process because of a doctor’s ethnicity or race.

But, I’ve worked with racists (in non-medical related jobs) in Australia, I’m related to Australian people who hold racist views. It would be therefore naive to believe there are no racists in decision making positions in in Australian medicine.

However, when considering what is going on in the US with Trump and contemporary American white supremacy it is worth noting in Australia between 1788 and 1945, the White Supremacists actually won their battles and achieved their aims. Not only did they invade a richly populated continent, they stole land and wilfully committed racist genocide in the name of the British state.

Then, statues were erected of the architects of this colonisation and ethnic cleansing. In the USA  these confederate statues are slowly being pulled down. In Australia their equivalents still and will stand for many years.

In 1945 Australia realised it had to end it’s “white Australia” migration policy. In the 1960s, Indigenous Australians were allowed to vote.

Currently, the Australian state locks up coloured children whose parents happen to be asylum seekers who arrived in Australian territory on a boat.  They lock them up in offshore gulags and deny them proper medical treatment. 

Comments, thoughts please!

Photo credit of Brisbane, CBD:

Zachary Staines

Photo surgery:

Piron Guillaume

Photo credit of crowd:

Ethan Weil

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2 replies »

  1. I have definitely witnessed this racist approach in Australia. Being white myself, I rarely am on the receiving end, but in an inter-racial marriage I can see how my MD husband gets treated. Thankfully he’s in a large cohort with children of migrants, all of which who are now specialising and doing exceedingly well, but I have noticed that my partner is hesitant to work outside large city hospitals unless it’s REALLY rural – like, practise medicine in a shack style rural. Some small communities are certainly extremely bigoted, even towards vocation-inspired medical practitioners.

    Like

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