14 JULY 2023

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We risk another Dr Death without them , RACGP says .

Heather Saxena

Australian Doctor recently reported on the plight of Dr Vasuki Annamalai and Dr Corinne Glenn , who both say the rules have made Australia an ugly career option .

Dr Annamalai , who grew up in Sri Lanka , says she was forced to redo her GP training from scratch despite having passed all her New Zealand fellowship exams and only having to complete an in-practice assessment . She eventually opted to join the

‘ As an IMG , I was scared to speak out about the system .’

Dr Vasuki Annamalai

Australian GP Training Program rather than the college ’ s fellowship support program so nobody could “ hold power ” over her visa or medical registration . “ Getting through this were the roughest years of my life ,” she said .

“ IMGs are scared that if they speak up about their experiences , there will be consequences — just like I used to be scared .”

RACGP rural chair Associate Professor Michael Clements said Dr Annamalai ’ s story highlighted the “ fear culture ” among IMGs . “ It ’ s a hidden scourge — many IMGs operate in fear of being penalised by AHPRA , their employer or the RACGP .”

He said some practices were taking 30-40 % of billings from Australian-trained GPs , but when it came to IMGs under supervision , it was 50 %.

“ Some IMGs are undervalued . They feel trapped because they might be under visa restrictions or employment conditions that mean they cannot get a job elsewhere .

“ As rural chair , people seek my advocacy for their situation but are worried about being persecuted as a result — that they are jeopardising their jobs and livelihood .”

Professor Clements said the RACGP board gave a “ clear direction ” last year that the college could do more for IMGs , such as improving social

support networks , mentoring and fellowship education . “ We ’ re hoping that , as a college , we can make more connections among IMGs and break down barriers so IMGs do not feel trapped .”

He was speaking following the release of an interim report on IMG bureaucracy , which recommended that GPs who qualified in New Zealand and the UK be offered automatic fellowship in Australia as part of a trial .

But the plan was attacked by the RACGP , which claimed it could lead to another so-called Dr Death scandal , a reference to the manslaughter charges against Dr Jayant Patel , the director of surgery at Bundaberg Base Hospital , 20 years ago .

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Rachel Fieldhouse PATIENTS with COPD or sleep apnoea whose quality of life is not improving with opioid analgesia are among the priority groups for deprescribing , according to world-first guidelines for GPs .

The Evidence-based clinical practice guideline for deprescribing opioid analgesics advises tapering by 10-25 % every week for patients treated with opioids for less than three months . Patients treated for longer than three months should taper down 10-25 % every month , according to the guidance , which is aimed at adults taking opioids for any type of chronic pain .

‘ We shouldn ’ t continue liberal provision of these drugs .’

Co-author Dr Simon Holliday , a GP with a special interest in pain management , called on doctors to “ rethink the paradigm ” of opioid prescribing and reduce its prevalence outside of palliative care .

“ Just because every other doctor in your practice has prescribed someone opiates for many years doesn ’ t mean that you should continue liberal provision of that medication ,” he told Australian Doctor .

Among the 11 recommendations were that any patient who started treatment with opioids agree to a deprescribing plan with their GP , that opioids be tapered rather than stopped abruptly and that patients receive regular monitoring to reduce the risk of physical and psychological withdrawal symptoms .

Deprescribing should be initiated for patients who had no meaningful improvement to their quality of life from treatment , or who were at increased risk of adverse events .

Patients with a greater risk of harm due to high opioid doses or comorbidities , including PAGE 4