Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
EMJ Online First, published on November 27, 2014 as 10.1136/emermed-2014-204129 Short report
The Medical Boomerang: Will it come back? Cian McDermott,1 Michael Sheridan,1 Katie Moore,2 Andrew Gosbell2 1
Emergency Department, The Geelong Hospital, Geelong, Victoria, Australia 2 Australasian College for Emergency Medicine, Melbourne, Australia Correspondence to Dr Cian McDermott, Emergency Department, Geelong Hospital, Geelong, VIC 3220, Australia; [email protected] @cianmcdermott Received 2 July 2014 Revised 8 October 2014 Accepted 10 November 2014
ABSTRACT Objectives To explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and New Zealand. Methods The Victorian Emergency Registrar Study was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013. As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working as registrars in Australasian EDs. Results UK and Irish EM registrars make up the largest proportion of IMGs working in Australian and New Zealand EDs. These figures have increased from 34% in 2008 to 45% in 2013. In 2013, there was the highest yearly intake of UK and Irish ED IMG registrars, representing 41% of registrars joining the Australasian EM training programme. Current data show that >25% of all ED registrars working in Australasian EDs studied for their primary medical degree in a university either in Ireland or the UK. Conclusions While there have been anecdotal reports of increased outflow of junior EM doctors from the UK and Ireland, we provide quantitative data on the extent of the recent (5-year trend data) emigration of UK/Irish EM trainees to Australia and New Zealand and discuss the impact of this on both the UK/Irish and Australasian health systems.
Boomerang – A returning boomerang is designed to be thrown in a closed arch path, which returns to the thrower; A course of action that backfires on the originator.
To cite: McDermott C, Sheridan M, Moore K, et al. Emerg Med J Published Online First: [ please include Day Month Year] doi:10.1136/emermed-2014204129
Australia and New Zealand have historically relied on international medical graduates (IMG) to supplement medical workforce supply needs.1 2 Currently, 23.5% (16 186) of the Australian medical workforce is composed of IMGs, which is similar to the proportion of Australians born overseas.3 IMGs have long enjoyed hyper-mobile employment status due to a high degree of transferrable medical skills. The Antipodes has been a timehonoured destination for emergency medicine (EM) doctors-in-training from the UK and Ireland, seeking to gain short-term experience in an English-speaking healthcare system before returning to their country of origin. Recent years has seen a significant variation to this trend, with increasing numbers of UK and Irish EM doctors remaining in Australasia for the duration of their training and beyond. Several push factors contribute to explain this phenomenon. The impact of current working
conditions and lack of time and opportunities for training in the UK hospital system have resulted in disillusionment with NHS.4 The global financial downturn caused acute repercussions throughout Western Europe. While Australia has been sheltered from this financial crisis,5 there have been impacts on income, working hours and cost of living in the UK and Ireland.6 For EM, this is further exacerbated by other factors including constant pressure to achieve performance against the NHS 4 h target impacting on the ability of emergency departments (ED) medical staff to provide high-quality care,7 the large numbers of unfilled consultant posts in EM8 and growth in attendances at EDs.9 As a result, many UK EM consultants feel that their current work conditions are unsustainable.10 The net result of outmigration of UK EM doctors has also contributed to severe difficulty in the recruitment and retention of doctors willing to specialise in EM in the UK.11 This crisis is reflected in the high number of unfilled Acute Common Care Stem training posts and an over-reliance on locum doctors.12 13 To combat this problem, from August 2014, Health Education England and the College for Emergency Medicine (CEM) will be actively recruiting overseas doctors to undertake 4-year EM training opportunities in the UK.14 By contrast, the Australasian medical workforce has been bolstered by the influx of highly trained and motivated IMGs from Ireland and the UK. EM trainees from the UK and Ireland come to Australasia to benefit from many favourable conditions offered by the Australian and New Zealand EM systems. These include a 38 h working week, guaranteed protected teaching time, 16 h per day of ED consultant supervision, adequate remuneration for hours worked and educational activities, in addition to other positive lifestyle factors. Australia and New Zealand have seen a steady increase in the number of EM trainees registered with the Australasian College for Emergency Medicine (ACEM), from 1654 in 2009 to 2258 in 2013 (table 1); 8% annual growth over this 5-year period. IMGs from the UK and Ireland have consistently been the largest proportion of IMG trainees working in Australasian EDs. Furthermore, the annual growth rate for the UK/Irish IMGs trainee cohort, at 16%, is double that of all trainees from 2009 to 2013, such that by 2013, UK/Irish IMG trainees represent one-quarter of all EM trainees in Australia and New Zealand. The growing proportion of UK/Irish IMGs training in EM in Australia and New Zealand is also reflected in the trainee intakes over the past five years (table 1). In 2013 alone, the largest number of IMGs from Ireland and the UK registering with ACEM was recorded. At 41% of doctors commencing the ACEM training programme, this inflow of
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
Short report Table 1 Trends in Australasian emergency medicine registrar numbers 2009–2013 Trainee intake
2009 2010 2011 2012 2013
All trainees
All new trainees
New trainees from the UK/Ireland
Proportion new trainees from the UK/ Ireland (%)
Total trainees
UK/Ireland IMG trainees
Proportion UK/Ireland of total IMG trainees (%)
Proportion UK/Ireland of total trainees (%)
308 329 238 275 391
69 93 69 89 159
22 28 29 32 41
1654 1952 1973 2078 2258
329 413 437 481 566
34 36 38 41 45
20 21 22 23 25
IMG, international medical graduate.
UK/Irish IMGs was the major factor in the overall increase in new trainees seen in 2013 compared with previous years. At fellowship level in 2013, 28% (31/110) of new fellows elected, following completion of the ACEM training pathway, obtained their primary medical degree from a UK or Irish university. A further 41% (14/34) fellows accepted to ACEM following the overseas-trained specialist pathway (which facilitates recognition of overseas specialist qualifications)15 were already in receipt of fellowship of CEM and are now practising at consultant level in Australia. A tenet of contemporary Australian health planning policy is ensuring that the future medical workforce is both adequate to meet the medical care needs of the community and sustainable for the long term.16 Increasing medical graduate numbers in Australia from the mid-2000s17 and national health workforce reforms since 2010 aim to facilitate a more self-sufficient and sustainable medical workforce.18 A subsequent consequence of the increasing medical student, intern and registrar numbers is now a growing demand for ED training, revealing key issues for the future of medical training in Australia19; namely practical constraints to supervisory capacity and availability of placements in existing teaching hospitals. In the very near future, more early-career doctors than ever will be competing for junior medical officer and vocational training positions.20 This will most likely impact on the inflow of junior IMGs to Australia. In May 2014, the Australian Medical Association lodged a submission to the Australian government requesting changes in entry criteria for overseas doctors applying via 457 visa, the main point of entry for UK and Irish IMGs.21 The proposed changes to immigration policy would force hospitals and health departments to attempt to fill vacancies locally before recruiting internationally trained doctors, similar to the situation that currently exists in European Union member countries. As such, there may be a limit to the number of UK and Irish IMGs who can travel overseas to follow the ‘Australian dream’. These Australian circumstances can also be interpreted as a window of opportunity for those concerned with the future of EM in the UK and Ireland. Rather than encouraging immigration of doctors from less developed countries, a policy long regarded as ethically questionable,22 23 UK health strategists should focus on retaining the specialist workforce and attracting ‘home-grown’ junior doctors to pursue EM as a viable career option. Furthermore, expatriate EM doctors may be tempted to return to NHS if new and improved conditions were implemented.24 It is incumbent upon the Department of Health and CEM to continue to negotiate to achieve these improvements, as set out in previous policy documents.14 25 There are many reasons IMGs, particularly from the UK and Ireland, leave their country of origin to work in Australia and
New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to NHS to work at consultant level. However, data from ACEM and the VERS-2013 study1 show that these doctors are now emigrating to Australia for the long term, which will leave EDs the length and breadth of the British Isles with a deficit of new EM consultants, adding to the pressure on already overstretched senior EM decision-making personnel10 and jeopardising the training of the future EM specialist workforce. Meanwhile in Australia, continued IMG influx is at odds with the health workforce planning objectives of increased self-sufficiency and sustainability. The projected increase in demand from home-grown junior doctors for vocational specialist training placements26 and recent political pressure on the Australian Federal government to modify medical immigration policies may reduce the numbers of IMGs working in Australia. The challenge is now before the UK and Irish governments, in conjunction with CEM, to enhance the attractiveness of EM as a fulfilling and sustainable career option.
2
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
Contributors CMcD prepared the original manuscript, edited all drafts and coordinated communication between the relevant parties. MS devised the original VERS study, supervised the project and edited draft. KM provided the data from ACEM. AG provided the data from ACEM, edited drafts and provided extra material and references. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1
2
3
4
5
6
7 8
9
Sheridan M, Pugh J, Keating S, et al. Who is working in your emergency department? The Victorian emergency registrar study (VERS) 2013. Emerg Med Aust 2014;26(Suppl 1):35–6. Hawthorne L. Health Workforce Migration to Australia Policy Trends and Outcomes 2004–2010. https://www.hwa.gov.au/sites/uploads/HAWTHORNE-%20Health WorkforceMigrationFullReport30May_0.pdf Australian Bureau of Statistics. Reflecting a Nation: Stories from the 2011 Census 2012–2013. http://www.abs.gov.au/ausstats/[email protected]/Lookup/2071.0main +features902012-2013 McGowan Y, Humphries N, Burke H, et al. Through doctors’ eyes: a qualitative study of hospital doctor perspectives on their working conditions. Br J Health Psychol 2013;18:874–91. Sweet M. Lessons from the GFC for health workforce planning and policy. 2013. http://blogs.crikey.com.au/croakey/2013/11/20/lessons-from-the-gfc-for-health -workforce-planning-and-policy/?wpmp_switcher=mobile Chalikonda L. Why are Irish doctors emigrating? R Coll Ireland Student Med J 2013;6:93–8. http://www.rcsismj.com/wp-content/uploads/2013/ ChalikondaL-Emigration.pdf Letham K. The four-hour target in the NHS emergency departments: a critical comment. Emergencias 2012;24:69–72. The College of Emergency Medicine. The Drive for quality. How to achieve safe, sustainable care in our Emergency Departments? System benchmarks & recommendations—Report. 2013. http://secure.collemergencymed.ac.uk/code/ document.asp?ID=7030 Health and Social Care Information Centre. Accident and Emergency Attendances in England—2012–13. 2014. http://www.hscic.gov.uk/searchcatalogue?
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
Short report
10
11 12
13
14 15
16
productid=14120&q=title%3a%22accident+and+emergency+attendances% 22&topics=0%2fHospital+care&sort=Relevance&size=10&page=1-top The College of Emergency Medicine. Stretched to the Limit A Survey of Emergency Medicine Consultants in the UK 2012–2013. http://www.collemergencymed.ac.uk/ Shop-Floor/Professional Standards/Consultant Working and Job Planning/Stretched to the limit The Royal College of Physicians London. Hospitals on the Edge? The time for action. 2012. http://www.rcplondon.ac.uk/projects/hospitals-edge-time-action The General Medical Council. Medical Education’s Frontline: A Review of Training in seven emergency medicine departments. 2013. http://www.gmc-uk.org/education/ 23174.asp The College of Emergency Medicine. The spend on Locum Doctors in Emergency Departments. 2014. http://www.collemergencymed.ac.uk/Public/Latest News/CEM Statements/ Health Education England. Emergency Medicine Overseas Development Project. 2014. http://hee.nhs.uk/work-programmes/em/ The Australasian College for Emergency Medicine. Overseas Trained Specialists (OTS) Specialist Assessment. http://www.acem.org.au/Education-Training/ International-Medical-Specialist-Programs/Specialist-Assessment.aspx Joyce CM. The medical workforce in 2025: what’s in the numbers? Med J Aust 2013;199(5 Suppl):S6–9.
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
17
18 19 20 21 22 23 24 25 26
HealthWorkforce Australia. The effect of medical graduate expansion in Australia. 2012. http://www.hwa.gov.au/sites/uploads/20120326_effects_of_medical_ graduate_expansion.pdf HealthWorkforce Australia. Health Workforce 2025 Doctors, Nurses and Midwives volume 1–3. 2012. http://www.hwa.gov.au/resources/publications Chong A, Weiland TJ, Mackinlay C, et al. The capacity of Australian ED to absorb the projected increase in intern numbers. Emerg Med Australas 2010;22:100–7. Killen A, Gosbell A. The need to maintain quality and build capacity for emergency medicine training. Emerg Med Australas 2013;25:390–2. Rollins A. Close 457 loophole for junior doctor positions: Australian Medical Association. 2014. https://ama.com.au/ausmed/close-457-loophole-junior-doctor- positions-ama Scott ML, Whelan A, Dewdney J, et al. “Brain drain” or ethical recruitment? Med J Aust 2004;180:174–6. Dwyer J. What’s wrong with the global migration of health care professionals? Individual rights and international justice. Hastings Cent Rep 2007;37:36–43. Sharma A. Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand. J R Soc Med 2012;105:25–34. The College of Emergency Medicine. 10 priorities for Resolving the Emergency Crisis. 2013. http://www.collemergencymed.ac.uk/Public/Latest News/CEM Statements/ Australian Government Department of Health. Medical Training Review Panel: 17th Report. 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pubs-mtrp-17
3
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
The Medical Boomerang: Will it come back? Cian McDermott, Michael Sheridan, Katie Moore and Andrew Gosbell Emerg Med J published online November 27, 2014
Updated information and services can be found at: http://emj.bmj.com/content/early/2014/11/27/emermed-2014-204129
These include:
References Email alerting service
This article cites 10 articles, 1 of which you can access for free at: http://emj.bmj.com/content/early/2014/11/27/emermed-2014-204129 #BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
EMJ Online First, published on November 27, 2014 as 10.1136/emermed-2014-204129 Short report
The Medical Boomerang: Will it come back? Cian McDermott,1 Michael Sheridan,1 Katie Moore,2 Andrew Gosbell2 1
Emergency Department, The Geelong Hospital, Geelong, Victoria, Australia 2 Australasian College for Emergency Medicine, Melbourne, Australia Correspondence to Dr Cian McDermott, Emergency Department, Geelong Hospital, Geelong, VIC 3220, Australia; [email protected] @cianmcdermott Received 2 July 2014 Revised 8 October 2014 Accepted 10 November 2014
ABSTRACT Objectives To explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and New Zealand. Methods The Victorian Emergency Registrar Study was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013. As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working as registrars in Australasian EDs. Results UK and Irish EM registrars make up the largest proportion of IMGs working in Australian and New Zealand EDs. These figures have increased from 34% in 2008 to 45% in 2013. In 2013, there was the highest yearly intake of UK and Irish ED IMG registrars, representing 41% of registrars joining the Australasian EM training programme. Current data show that >25% of all ED registrars working in Australasian EDs studied for their primary medical degree in a university either in Ireland or the UK. Conclusions While there have been anecdotal reports of increased outflow of junior EM doctors from the UK and Ireland, we provide quantitative data on the extent of the recent (5-year trend data) emigration of UK/Irish EM trainees to Australia and New Zealand and discuss the impact of this on both the UK/Irish and Australasian health systems.
Boomerang – A returning boomerang is designed to be thrown in a closed arch path, which returns to the thrower; A course of action that backfires on the originator.
To cite: McDermott C, Sheridan M, Moore K, et al. Emerg Med J Published Online First: [ please include Day Month Year] doi:10.1136/emermed-2014204129
Australia and New Zealand have historically relied on international medical graduates (IMG) to supplement medical workforce supply needs.1 2 Currently, 23.5% (16 186) of the Australian medical workforce is composed of IMGs, which is similar to the proportion of Australians born overseas.3 IMGs have long enjoyed hyper-mobile employment status due to a high degree of transferrable medical skills. The Antipodes has been a timehonoured destination for emergency medicine (EM) doctors-in-training from the UK and Ireland, seeking to gain short-term experience in an English-speaking healthcare system before returning to their country of origin. Recent years has seen a significant variation to this trend, with increasing numbers of UK and Irish EM doctors remaining in Australasia for the duration of their training and beyond. Several push factors contribute to explain this phenomenon. The impact of current working
conditions and lack of time and opportunities for training in the UK hospital system have resulted in disillusionment with NHS.4 The global financial downturn caused acute repercussions throughout Western Europe. While Australia has been sheltered from this financial crisis,5 there have been impacts on income, working hours and cost of living in the UK and Ireland.6 For EM, this is further exacerbated by other factors including constant pressure to achieve performance against the NHS 4 h target impacting on the ability of emergency departments (ED) medical staff to provide high-quality care,7 the large numbers of unfilled consultant posts in EM8 and growth in attendances at EDs.9 As a result, many UK EM consultants feel that their current work conditions are unsustainable.10 The net result of outmigration of UK EM doctors has also contributed to severe difficulty in the recruitment and retention of doctors willing to specialise in EM in the UK.11 This crisis is reflected in the high number of unfilled Acute Common Care Stem training posts and an over-reliance on locum doctors.12 13 To combat this problem, from August 2014, Health Education England and the College for Emergency Medicine (CEM) will be actively recruiting overseas doctors to undertake 4-year EM training opportunities in the UK.14 By contrast, the Australasian medical workforce has been bolstered by the influx of highly trained and motivated IMGs from Ireland and the UK. EM trainees from the UK and Ireland come to Australasia to benefit from many favourable conditions offered by the Australian and New Zealand EM systems. These include a 38 h working week, guaranteed protected teaching time, 16 h per day of ED consultant supervision, adequate remuneration for hours worked and educational activities, in addition to other positive lifestyle factors. Australia and New Zealand have seen a steady increase in the number of EM trainees registered with the Australasian College for Emergency Medicine (ACEM), from 1654 in 2009 to 2258 in 2013 (table 1); 8% annual growth over this 5-year period. IMGs from the UK and Ireland have consistently been the largest proportion of IMG trainees working in Australasian EDs. Furthermore, the annual growth rate for the UK/Irish IMGs trainee cohort, at 16%, is double that of all trainees from 2009 to 2013, such that by 2013, UK/Irish IMG trainees represent one-quarter of all EM trainees in Australia and New Zealand. The growing proportion of UK/Irish IMGs training in EM in Australia and New Zealand is also reflected in the trainee intakes over the past five years (table 1). In 2013 alone, the largest number of IMGs from Ireland and the UK registering with ACEM was recorded. At 41% of doctors commencing the ACEM training programme, this inflow of
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
Short report Table 1 Trends in Australasian emergency medicine registrar numbers 2009–2013 Trainee intake
2009 2010 2011 2012 2013
All trainees
All new trainees
New trainees from the UK/Ireland
Proportion new trainees from the UK/ Ireland (%)
Total trainees
UK/Ireland IMG trainees
Proportion UK/Ireland of total IMG trainees (%)
Proportion UK/Ireland of total trainees (%)
308 329 238 275 391
69 93 69 89 159
22 28 29 32 41
1654 1952 1973 2078 2258
329 413 437 481 566
34 36 38 41 45
20 21 22 23 25
IMG, international medical graduate.
UK/Irish IMGs was the major factor in the overall increase in new trainees seen in 2013 compared with previous years. At fellowship level in 2013, 28% (31/110) of new fellows elected, following completion of the ACEM training pathway, obtained their primary medical degree from a UK or Irish university. A further 41% (14/34) fellows accepted to ACEM following the overseas-trained specialist pathway (which facilitates recognition of overseas specialist qualifications)15 were already in receipt of fellowship of CEM and are now practising at consultant level in Australia. A tenet of contemporary Australian health planning policy is ensuring that the future medical workforce is both adequate to meet the medical care needs of the community and sustainable for the long term.16 Increasing medical graduate numbers in Australia from the mid-2000s17 and national health workforce reforms since 2010 aim to facilitate a more self-sufficient and sustainable medical workforce.18 A subsequent consequence of the increasing medical student, intern and registrar numbers is now a growing demand for ED training, revealing key issues for the future of medical training in Australia19; namely practical constraints to supervisory capacity and availability of placements in existing teaching hospitals. In the very near future, more early-career doctors than ever will be competing for junior medical officer and vocational training positions.20 This will most likely impact on the inflow of junior IMGs to Australia. In May 2014, the Australian Medical Association lodged a submission to the Australian government requesting changes in entry criteria for overseas doctors applying via 457 visa, the main point of entry for UK and Irish IMGs.21 The proposed changes to immigration policy would force hospitals and health departments to attempt to fill vacancies locally before recruiting internationally trained doctors, similar to the situation that currently exists in European Union member countries. As such, there may be a limit to the number of UK and Irish IMGs who can travel overseas to follow the ‘Australian dream’. These Australian circumstances can also be interpreted as a window of opportunity for those concerned with the future of EM in the UK and Ireland. Rather than encouraging immigration of doctors from less developed countries, a policy long regarded as ethically questionable,22 23 UK health strategists should focus on retaining the specialist workforce and attracting ‘home-grown’ junior doctors to pursue EM as a viable career option. Furthermore, expatriate EM doctors may be tempted to return to NHS if new and improved conditions were implemented.24 It is incumbent upon the Department of Health and CEM to continue to negotiate to achieve these improvements, as set out in previous policy documents.14 25 There are many reasons IMGs, particularly from the UK and Ireland, leave their country of origin to work in Australia and
New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to NHS to work at consultant level. However, data from ACEM and the VERS-2013 study1 show that these doctors are now emigrating to Australia for the long term, which will leave EDs the length and breadth of the British Isles with a deficit of new EM consultants, adding to the pressure on already overstretched senior EM decision-making personnel10 and jeopardising the training of the future EM specialist workforce. Meanwhile in Australia, continued IMG influx is at odds with the health workforce planning objectives of increased self-sufficiency and sustainability. The projected increase in demand from home-grown junior doctors for vocational specialist training placements26 and recent political pressure on the Australian Federal government to modify medical immigration policies may reduce the numbers of IMGs working in Australia. The challenge is now before the UK and Irish governments, in conjunction with CEM, to enhance the attractiveness of EM as a fulfilling and sustainable career option.
2
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
Contributors CMcD prepared the original manuscript, edited all drafts and coordinated communication between the relevant parties. MS devised the original VERS study, supervised the project and edited draft. KM provided the data from ACEM. AG provided the data from ACEM, edited drafts and provided extra material and references. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1
2
3
4
5
6
7 8
9
Sheridan M, Pugh J, Keating S, et al. Who is working in your emergency department? The Victorian emergency registrar study (VERS) 2013. Emerg Med Aust 2014;26(Suppl 1):35–6. Hawthorne L. Health Workforce Migration to Australia Policy Trends and Outcomes 2004–2010. https://www.hwa.gov.au/sites/uploads/HAWTHORNE-%20Health WorkforceMigrationFullReport30May_0.pdf Australian Bureau of Statistics. Reflecting a Nation: Stories from the 2011 Census 2012–2013. http://www.abs.gov.au/ausstats/[email protected]/Lookup/2071.0main +features902012-2013 McGowan Y, Humphries N, Burke H, et al. Through doctors’ eyes: a qualitative study of hospital doctor perspectives on their working conditions. Br J Health Psychol 2013;18:874–91. Sweet M. Lessons from the GFC for health workforce planning and policy. 2013. http://blogs.crikey.com.au/croakey/2013/11/20/lessons-from-the-gfc-for-health -workforce-planning-and-policy/?wpmp_switcher=mobile Chalikonda L. Why are Irish doctors emigrating? R Coll Ireland Student Med J 2013;6:93–8. http://www.rcsismj.com/wp-content/uploads/2013/ ChalikondaL-Emigration.pdf Letham K. The four-hour target in the NHS emergency departments: a critical comment. Emergencias 2012;24:69–72. The College of Emergency Medicine. The Drive for quality. How to achieve safe, sustainable care in our Emergency Departments? System benchmarks & recommendations—Report. 2013. http://secure.collemergencymed.ac.uk/code/ document.asp?ID=7030 Health and Social Care Information Centre. Accident and Emergency Attendances in England—2012–13. 2014. http://www.hscic.gov.uk/searchcatalogue?
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
Short report
10
11 12
13
14 15
16
productid=14120&q=title%3a%22accident+and+emergency+attendances% 22&topics=0%2fHospital+care&sort=Relevance&size=10&page=1-top The College of Emergency Medicine. Stretched to the Limit A Survey of Emergency Medicine Consultants in the UK 2012–2013. http://www.collemergencymed.ac.uk/ Shop-Floor/Professional Standards/Consultant Working and Job Planning/Stretched to the limit The Royal College of Physicians London. Hospitals on the Edge? The time for action. 2012. http://www.rcplondon.ac.uk/projects/hospitals-edge-time-action The General Medical Council. Medical Education’s Frontline: A Review of Training in seven emergency medicine departments. 2013. http://www.gmc-uk.org/education/ 23174.asp The College of Emergency Medicine. The spend on Locum Doctors in Emergency Departments. 2014. http://www.collemergencymed.ac.uk/Public/Latest News/CEM Statements/ Health Education England. Emergency Medicine Overseas Development Project. 2014. http://hee.nhs.uk/work-programmes/em/ The Australasian College for Emergency Medicine. Overseas Trained Specialists (OTS) Specialist Assessment. http://www.acem.org.au/Education-Training/ International-Medical-Specialist-Programs/Specialist-Assessment.aspx Joyce CM. The medical workforce in 2025: what’s in the numbers? Med J Aust 2013;199(5 Suppl):S6–9.
McDermott C, et al. Emerg Med J 2014;0:1–3. doi:10.1136/emermed-2014-204129
17
18 19 20 21 22 23 24 25 26
HealthWorkforce Australia. The effect of medical graduate expansion in Australia. 2012. http://www.hwa.gov.au/sites/uploads/20120326_effects_of_medical_ graduate_expansion.pdf HealthWorkforce Australia. Health Workforce 2025 Doctors, Nurses and Midwives volume 1–3. 2012. http://www.hwa.gov.au/resources/publications Chong A, Weiland TJ, Mackinlay C, et al. The capacity of Australian ED to absorb the projected increase in intern numbers. Emerg Med Australas 2010;22:100–7. Killen A, Gosbell A. The need to maintain quality and build capacity for emergency medicine training. Emerg Med Australas 2013;25:390–2. Rollins A. Close 457 loophole for junior doctor positions: Australian Medical Association. 2014. https://ama.com.au/ausmed/close-457-loophole-junior-doctor- positions-ama Scott ML, Whelan A, Dewdney J, et al. “Brain drain” or ethical recruitment? Med J Aust 2004;180:174–6. Dwyer J. What’s wrong with the global migration of health care professionals? Individual rights and international justice. Hastings Cent Rep 2007;37:36–43. Sharma A. Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand. J R Soc Med 2012;105:25–34. The College of Emergency Medicine. 10 priorities for Resolving the Emergency Crisis. 2013. http://www.collemergencymed.ac.uk/Public/Latest News/CEM Statements/ Australian Government Department of Health. Medical Training Review Panel: 17th Report. 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pubs-mtrp-17
3
Downloaded from http://emj.bmj.com/ on January 27, 2015 - Published by group.bmj.com
The Medical Boomerang: Will it come back? Cian McDermott, Michael Sheridan, Katie Moore and Andrew Gosbell Emerg Med J published online November 27, 2014
Updated information and services can be found at: http://emj.bmj.com/content/early/2014/11/27/emermed-2014-204129
These include:
References Email alerting service
This article cites 10 articles, 1 of which you can access for free at: http://emj.bmj.com/content/early/2014/11/27/emermed-2014-204129 #BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
