Featured image shows the distribution of population areas according to the Modified Monash Model c/- DoctorConnect site
When working with specialists from countries other than Australia one of the topics we often cover is the issue of Area of Need posts. Area of Need, which is generally abbreviated to AoN is one of a number of aspects of the Australian health care system that is difficult to understand. What is also frustrating is that apart from some notable exceptions it is also difficult to find out how to apply for an Area of Need position. I am writing this post to better inform you about AoN.
Firstly let's answer the question of what is Area of Need and how does an Area of Need post differ from the specialist assessment pathway to specialist recognition in Australia. An Area of Need is a location where there is a demonstrated shortage of suitably qualified medical practitioners. An Area of Need post is a position that is specifically established for an international doctor to work in Australia because it has been difficult to find an Australian doctor to work in that position. Whilst historically Area of Need positions have been declared for both trainee and specialist roles. They are generally now mainly declared for specialist positions. With the exception that Area of Need roles are also often declared for IMG doctors to enter into general practice in a training capacity. Area of Need positions then vary from the specialist pathway in two main ways. Firstly, they are not always related to specialist roles. But mostly are. Secondly, they still require an assessment of the specialist IMG doctor's potential to become a specialist in Australia through the relevant college. But as part of that assessment, the college will also consider the doctor's suitability for the actual Area of Need position.
OK. So now you know what Area of Need is and that it is essentially an add-on option to the specialist pathway. Let's look at a few other aspects of Area of Need that are worth knowing about, including: How are AoN positions declared? How do you find an AoN position? What are the advantages of an AoN position? And how does AoN affect the Specialist Assessment process?
How is an Area of Need Position Declared?
The authority for declaring such positions lies with the state governments of Australia (not the Commonwealth government).
Medical practitioners with limited registration for area of need are working under supervision in an area of Australia where there is a shortage of medical practitioners. They are usually registered to practise in a rural or remote location.
These practitioners have been assessed as having the necessary skills, training and experience to undertake this practice safely. The state or territory Minister for Health (or their delegate) must declare that the area in which the applicant will work is an ’area of need’.
The process can vary between jurisdictions but generally, there are two main criteria that need to be filled before an Area of Need position will be approved.
Firstly, there must be some reason for the vacancy given along with a consideration on the impact upon the community and service delivery as well as access to alternate services and options explored for delivering care in an alternative manner. The impact upon particular populations, such as rural and remote and Aboriginal and Torres Strait Islanders may also be considered.
Secondly, there must be evidence of “labour market testing”. Basically, this involves demonstrating that there have been attempts to find suitable candidates from amongst the Australian trained doctor pool but this has not been fruitful. So for example, attempts at advertising and results of previous recruitment campaigns.
Certain Doctors Cannot Work Under Area of Need.
For fairly obvious reasons doctors with general registration or specialist registration cannot apply for an Area of Need position.
New applicants who are eligible for the competent authority pathway or who already hold the AMC Certificate are also not eligible to apply for limited registration and therefore cannot apply for an Area of Need position.
Finding an Area of Need Position.
You would think with the many doctor shortages in Australia. Particularly rural and remote Australia. It would be relatively easy to find out all the Area of Need positions.
Unfortunately, no central list actually exists. This is because the states and territories are both responsible for declaring Area of Need positions as well as determining how these declarations occur. And there is no requirement for these declarations to then be listed or reported anywhere. So there is no central list. And very few of the states and territories publish a list. Even when this list is published it may be out of date.
At present only NSW Health reports what purports to be an up to date Area of Need list for both General Practice as well as other Specialties. Although I have personally found that when you enquire about some of the positions on the list there is no response or the position has been filled. Western Australia's list is “UNDER REVIEW”. And Tasmania is only currently reporting GP posts. With Specialist posts also under review.
Northern Territory, South Australia, Queensland, ACT and Victoria all have information about Area of Need on their respective health services websites. But no list that I have been able to find.
So. What other options are there for finding an AON position?
Well. Sometimes a job may be advertised as being Area of Need. Here's an example of a Radiologist Position in Victoria advertised on Seek as Area of Need:
But some jobs may also be advertised as seeking or being open to international doctors and you only find out that it is eligible for an Area of Need candidate when you speak to the recruiting person. This can often be the case if they are also hoping to still get a more local candidate or perhaps a specialist from a competent authority country.
AoN jobs are sometimes also posted on college websites.
Area of Need Positions Come with Advantages
Ok. So thus far. It seems like identifying an Area of Need position is becoming more difficult than its actually worth. Why would an international doctor bother trying to find one in the first place?
Well. There are a couple of key reasons why it is in fact worth the bother.
The first reason is that an Area of Need position is a real job. A job which you can apply for and hopefully be appointed to prior to having to deal with issues around registration and visas.
The effect of this is that you enter the specialist assessment process with a specific position that provides the level of supervision that you will likely be required to be given should the college approve you to undergo a specialist assessment period.
A number of IMG specialists are now going through the specialist assessment process with no guarantee of a supervised position afterwards. So they are both bearing the full financial cost of this process as well as the risk that there is no suitable job at the end of it.
In fact, some colleges, like the College of Psychiatrists will not consider you if you do not have a position offer. Probably because they do not want to be in a position of granting false hope to someone.
The second reason for obtaining an Area of Need position is that generally speaking if you have secured such a position then you have an employer who will support you through the process of applying for specialist assessment and your registration (as well as visas if you need one). This generally extends to paying for the costs of the assessment, which can be substantial. And will also extend to the costs of the college supervision if you are given the go-ahead to undertake a period of assessment.
Area of Need and the Specialist Assessment Process
One key difference between Area of Need and the Specialist Assessment process is that with AoN you start off by applying for a job. This job has been declared to be suitable for an IMG specialist and so if you are able to be successful in being offered the position it is likely that you are also a strong candidate for the specialist assessment process. Otherwise, you are unlikely to be offered the position in the first place.
Before you take up the position however you must be assessed by the relevant specialty college to determine your suitability for specialist assessment. Just like any other specialist assessment process.
The process is essentially identical. It is a dual assessment process. The college reviews your general suitability or “comparability” as well as suitability for the AoN post. You may have to fill in slightly more paperwork. There may be an additional fee. The interview questions are likely to be the same.
You can, of course, apply for other suitable jobs if you are an IMG specialist and then seek specialist assessment and this is actually a smart way to do it if you are able to.
What Specialties Require Area of Need?
Wait long enough and most specialties and subspecialties will be listed for an Area of Need position. But here are some of the more common specialties, based on reviewing the past Tasmania list and current NSW and Western Australian lists:
- General Practice
- Physicians (Internal Medicine Specialists)
- Various Surgeons
- Emergency Medicine
Area of Need in General Practice
Doctors applying for registration to work in general practice must provide evidence of a minimum of three years (full-time equivalent) experience working in general practice or primary care. If a doctor has had their experience formally assessed by the Royal Australian College of General Practitioners (RACGP) or by the Australian College of Rural and Remote Medicine (ACRRM) this assessment is reviewed by the Medical Board. Otherwise, the Medical Board assesses a doctors experience as part of the application for registration. There is a minimum requirement that evidence from one of these two colleges that confirms at least three years (full-time equivalent) experience working in general practice or primary care.
Unless you are also applying for specialist assessment as a general practitioner you will also need to sit a Pre-Employment Screening Clinical Interview or PESCI.
Question. How Much Does it Cost to Become a Specialist in Australia?
It is difficult to quantify this question as each specialty differs because each specialty is handled by a separate College. As I have highlighted in this post on UK doctors moving to Australia costs for specialists migrating are certainly going to be in the tens of thousands of dollars when one takes into account the following:
- costs of both the initial college assessment as well as period of supervision
- registration costs
- visa costs
- travel, accommodation and moving costs
The good news is. As I have highlighted above. If you get the right job first the employer is likely to pick up a large part of theses costs.
Question. Is the Process of Specialist Recognition Difficult?
Again. The answer to this depends on a range of factors. The process of becoming a specialist has arguably become a little bit easier and more streamlined in the last few years since the Medical Board has become involved in monitoring the activity of the specialist colleges and setting standards for how specialists are assessed.
In 2017, 52% of doctors were assessed as substantially comparable and 27% were as deemed as partially comparable for specialist recognition. But rates vary between the country that you trained as a specialist in and between specialties.
Its probably reasonable to say that now there is more clarity in the system and for most colleges plenty of information about the specialist assessment process most IMG specialists are probably only applying for specialist assessment now with reasonable confidence that they have the evidence to be deemed comparable.
Question. How Long Does it Take to Gain a Specialist Job in Australia?
Many IMG specialists can search for years and not find a job. Its really hard to put a clear timeframe on how long it may take. Its reasonable to assume that it will at least take a few months. Bearing in mind that the initial job you may gain might not be quite at the specialists level. Particularly if you are only deemed as being substantially comparable.
Question. What Is A PESCI?
International medical graduates (IMGs) applying for limited registration or provisional registration may be required by the Board to undergo a pre-employment structured clinical interview (PESCI).
A PESCI takes the form of a structured interview which can only be conducted by accredited bodies. It is an objective assessment of knowledge, skills, clinical experience and attributes to determine suitability to practise in a specific position. The PESCI consists of a structured clinical interview using scenarios.
Who Needs a PESCI?
The Board has decided that IMGs who are applying for limited or provisional registration to work in general practice are required to have a PESCI. IMGs in the specialist pathway do not require a PESCI as they are assessed by the relevant specialist medical college.
You should generally only arrange a PESCI before applying for registration if you can meet all the required registration standards. There is no point doing a PESCI if you are not going to be registered for any other reason.
At the PESCI, a panel of interviewers assesses your training, knowledge, clinical experience and attributes against the requirements of the specific position for which you are seeking registration. The PESCI process takes into consideration the supports, orientation and level of supervision that can be provided.
The PESCI uses a set of structured questions and scenarios in an interview setting which are tailored to a specific position. The report of the PESCI cannot be transferred to other positions.
The interview panel consists of a minimum of three interviewers which include at least two registered medical practitioners. One member of the panel may be a layperson, other health practitioner or registered medical practitioner. The PESCI panel members will be familiar with the clinical and professional demands of the type of position for which registration is being sought.