Key points

• Australia is competing globally to secure healthcare workers from overseas.
• Some health policy experts say poaching healthcare workers from countries raises ethical questions.
• Thousands more healthcare workers are needed if the Coalition and Labor’s election promises are to be met. 

Shiying Tan is paid $20 an hour to take care of up to 24 patients as a nurse in her home country of Singapore, where there are severe staff shortages. In Victoria, she would be paid more than double to look after a maximum of four patients in fully staffed hospital wards.

It’s no wonder that Tan, 33, was tempted to join the state’s healthcare system after searching online for the incentives the state government was offering: A $10,000 stipend to work in the city and $13,000 to move to the regions. Tan applied for a visa.

“Australia is so much better in terms of lifestyle,” she says.

Australia is competing in a global race to lure experienced doctors and nurses, in a bid to ease staffing shortages and prepare for potential COVID-19 waves in the future.

Much like oil or iron ore, healthcare workers are a valuable commodity – and during a pandemic, they come at a premium.

Australia is among many wealthy nations, including the UK and US, launching aggressive, multimillion-dollar recruitment drives and streamlining accreditation processes to help bolster a workforce that has been depleted by the years-long pandemic.

While nurses have the right to pursue employment wherever they chose, chief executive of the International Council of Nurses, Howard Catton, argues countries like Australia must be more self-sufficient.

“High-income countries are effectively exporting the cost of educating and training their nurses to low and middle-income countries, many of which can ill-afford to lose their precious nursing staff,” Catton said.

While state governments and hospitals responsible for healthcare staffing are leading the recruitment drives, election promises to boost employment in healthcare will inevitably require foreign workers.

Opposition Leader Anthony Albanese meets healthcare workers at Cessnock Hospital, in NSW, last month.Credit:Alex Ellinghausen

Labor leader Anthony Albanese admits overseas workers are needed as a “stopgap” measure to fulfil his $2.5 billion aged care election pledge to put a registered nurse in every aged care facility.

Prime Minister Scott Morrison’s promise to create 1.3 million new jobs in five years, which will likely help plug shortages in healthcare settings, won’t be possible without a pipeline of foreign workers, business groups warn.

According to federal health department modelling, an extra 14,000 nurses would be needed to deliver the Morrison government’s commitment to have a registered nurse on-site in aged care facilities for 16 hours a day by October 2023. An additional 2500 more would be needed to meet Albanese’s promise to mandate 24/7 registered nurses from July 2023.

But poaching healthcare workers from countries that desperately need the medical expertise during a pandemic raises serious ethical questions. Public health experts also say that more doctors are graduating in Australia than we need. So, why do we look offshore?

Australia has proved a coveted destination for healthcare workers. Credit:Peter Braig

Australia leads the globe in doctor, nurse imports

Australia’s relatively high wages and high-quality healthcare system have rendered the country a coveted destination for doctors and nurses from the UK and New Zealand, while the Philippines and India deliberately train excessive numbers of nurses in the hope they will work abroad and send money home.

More than half of Australia’s doctors and more than one-third of the country’s nurses are born overseas, an OECD analysis from 2020 shows. One in five nurses working in Australia did their training here on temporary visa permits.

Australia is more reliant than any other OECD country on the supply of foreign-born healthcare workers, who play a vital role in filling vacancies in regional and remote hospitals and aged care settings.

But the International Council of Nurses warns of a global shortage of six million nurses, with another 4 million nurses expected to retire in the next decade. Up to 180,000 health workers died in the first year of the pandemic, according to the WHO, while many have burnt out or quit.

State government health agencies desperate to replenish their battered workforce are actively poaching. Victorian government has offered a sixfold increase in financial incentives to lure foreign healthcare workers, Western Australia is running a $2 million recruitment campaign and New South Wales is advertising overseas and using recruitment agents to attract workers.

The Australian Health Practitioner Regulation Agency has fast-tracked the re-registration of clinicians, amid warnings from the Royal Australian College of General Practitioners of a looming shortage of GPs.

Registered nurse Simon Spalding, who works with his wife Dr Sarah Romilly at the Balnarring Medical Centre, spent $25,000 on an agent, including legal and visa fees, to help them find a new GP from the United Kingdom.

The couple had spent almost five years trying to recruit new GPs domestically, but to no avail.

A ‘failure’ in workforce planning

Australia’s elite research universities urged whoever wins government at this month’s federal election to fund 1000 extra places every year for domestic medical students, warning it was unsustainable to recruit as many overseas medical graduates annually, as there are domestic graduates from Australian schools.

Dean of the Royal Australasian College of Physicians, Andrew Coats, supported the call, but also warned of the need for substantially more places in the healthcare system for them to complete on-the-job training.

But some say the problem is not so much the number of healthcare workers, but getting them where they are needed.

A lack of co-ordination between universities, hospitals and government policy has culminated in a glut of medical graduates who can’t find traineeships or jobs at resource-strapped hospitals. Meanwhile, undersupplied specialities or neglected parts of the system, such as regional hospitals, continue to face chronic shortages.

Professor Stephen Duckett argues it is wrong to poach healthcare workers from lower income countries.Credit:Jeremy Piper

Grattan Institute health director Stephen Duckett said Australia’s dependence on skilled healthcare workers from overseas was a “failure” in workforce planning. He said it was wrong to poach workers from lower income countries “to work in places that Australian graduates don’t want to work”, he said.

Australia’s medical workforce grew to 104,461 from 2015 to 2019 – an annual growth of 3.3 per cent, outstripping an annual population rise of 1.6 per cent. There is an oversupply of emergency medicine physicians, but an undersupply of psychiatrists, while some graduates move overseas or drop out.

Medical colleges and unions warn not enough is being done to improve exhausting conditions for workers who are battling through their third year of the pandemic.

Nurses need incentives to stay in hospitals, such as more flexibility, better pay, clinical supervision and improved leadership opportunities, Australian College of Nursing chief executive Kylie Ward said.

Ward was recently notified about a nurse at a Victorian aged care facility who wet himself while caring for a deteriorating patient because he ran out of time to go to the toilet, due to a lack of back-up staff on site.

Those aren’t the sort of working conditions that Singapore-based nurse Tan is expecting. In Singapore, where she is waiting for her visa to approved, Tan said she has “practically no time to complete all of [her] work in one shift”.

She plans to move to Victoria with her two-year-old child and is willing to move to a regional town.

“I think in Australia, it’s more family orientated,” Tan said. “From what I understand from my friends … they are more flexible when you have family. If your child is sick, or somebody at home is sick, they’re more understanding of your situation.”

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