Father Samir Haddad is angry. He’s a parish priest and also runs the Australian Syrian Charity, a group that settles and supports Syrian refugees. Haddad had himself fled persecution there more than 20 years ago.
Haddad meets many gifted refugees, he says, whose talents and qualifications are unrecognised in Australia, leaving many distraught and unsatisfied. He is particularly incensed about those with dental qualifications and many years of professional experience – in Syria, or often in Iran or Iraq – who now face an arduous process of accreditation. Many, he says, have abandoned the costly process. “I know a man who worked as a dentist for [a] long time and he works in Coles now,” Haddad says. “Can you imagine? I know some people who have given up. They become very sad. But I say to them always: ‘Don’t give up – we should change the system.’ ”
Haddad’s concerns about the squandering of potential medical talent are shared by the Refugee Council of Australia. The advocacy group’s senior policy adviser, Louise Olliff, tells The Saturday Paper she believes there are hundreds of refugees who have arrived with dental qualifications yet are struggling with a lengthy and costly accreditation process. “People who come here as refugees, or have sought asylum and been granted protection, have significant professional skills, and those are just going to waste,” she says. Moreover, it’s unappealing for employment services working with refugees and people on permanent visas to take on the burden of navigating accreditation processes that are time-consuming, expensive and complex, she says.
“The dentists I heard from were like, ‘The employment service that I’m engaged with were very happy to pay for my transport and to pay for my tools if I want to go and work, you know, fixing people’s blinds. But they’re very reluctant to want to support me through an 18-month process that costs $10,000 and has a low success rate, to be accredited to be a dentist.’ ”
The accreditation of dentists whose original qualifications were achieved overseas is conducted by the Australian Dental Council, an independent non-profit organisation appointed by the Dental Board of Australia. With some countries, Australia has a reciprocal arrangement – a mutual recognition of the others’ qualifications. But people from countries that don’t share in that arrangement must submit to the ADC’s accreditation process. Its mandate is clear: “Accreditation protects the public by ensuring only suitably trained and qualified health practitioners can register and practise in Australia.”
The process, as would be expected for the accreditation of health practitioners, is rigorous. In its latest annual report, the ADC declared that of 2246 applicants who sat the written examination in the previous financial year, only 24 per cent passed. The pass rate was even lower for the 1385 people who did the practical examination. The ADC is also experiencing significant increases in applications: they reported 50 per cent more in 2022-23 compared with the previous financial year.
The question some in the industry are asking is how the process might be streamlined without compromising the integrity of the accreditation. One man, who had 20 years’ dental experience in Syria and Saudi Arabia and has just recently been accredited here, told The Saturday Paper the process took five years and cost him about $25,000.
Earlier this year, the federal government released an interim report it commissioned on the regulation of overseas-qualified health practitioners. “This review has heard that our end-to-end process for regulating overseas health practitioners is complex, slow and costly,” it read. “From the applicant’s perspective, assessments and processes can often be unclear, lack transparency and result in inconsistent outcomes … The end-to-end journey is sequential, making it slow and difficult to navigate with the visa, employer and professional recognition processes duplicative and sometimes inconsistent. Only applicants with qualifications from a small number of countries and professions are eligible for the streamlined pathways.”
The result, the report said, was “[s]ome employers no longer consider applicants from countries without expedited registration pathways as the process is too hard and outcomes uncertain. Australia is often no longer the country of choice for the health workers we want and need.”
Following the release of the interim report, federal Health Minister Mark Butler agreed there were ways to reduce “red tape” without compromising professional standards. In response to questions about the process, the minister’s office referred The Saturday Paper to the Health Department, which responded: “Overseas Trained Dentists (OTDs) who wish to practise in Australia must meet the same standards of safety and quality as Australian trained dentists … [the Australian Health Practitioner Regulation Agency] and the Dental Board regularly consider ways to streamline accreditation process and other opportunities for improvement. For example, the recent public consultation on possible changes to the National Boards’ English language skills requirements, considering expanding the range of recognised countries and a possible change to one element of the English test results accepted by the National Boards (including the Dental Board).”
The department also pointed to the Kruk review – the independent assessment of how Australia regulates overseas-qualified health practitioners – and said that work was already occurring on implementing the interim report’s recommendations to remove bureaucratic duplication and to help “streamline the accreditation process”. Robyn Kruk’s final report is due by the end of the year.
“The health minister has admitted that there’s too much red tape and that it takes too long,” the Australian Dental Association’s new president, Dr Scott Davis, tells The Saturday Paper. “It costs too much for the potential candidates – they’re often low-income individuals, and it takes years. So we’re looking forward to the reduction in red tape and improved efficiencies, that not only shortens the period of assessment, but makes sure it’s cost-effective for students to make Australia an attractive destination.
“If they want to speed things up, it just needs more resources – they need to put some money into it. And it’s in the national interest to have healthcare providers, so [we need] improved efficiencies and increased resources for those working in this sector to get it done.”
The important context of this policy discussion is dental shortages. Jobs and Skills Australia, a statutory body attached to the Department of Employment and Workplace Relations, monitors the labour market and maps skills shortages. Dentistry – and several of its subcategories, such as hygienist, assistant and anaesthetist – are acknowledged as being in short supply nationally. But there is a geographical discrepancy: the shortages are pronounced in rural and remote areas.
Davis tells The Saturday Paper basic economic scales are at play: a small dental surgery requires a population of about 6000 people to sustain it. The average cost to establish one dental chair – factoring in equipment, rent and registration, among other capital costs – is between $100,000 and $150,000.
Earlier this year, during hearings and in written submissions to the Senate’s Select Committee on the Provision of and Access to Dental Services in Australia, a particular theme was recurring: the geographic inequity of access. “Rural and remote Australians have poorer oral health, have access to fewer dental practitioners, travel further and have limited transport options to available services than their metropolitan counterparts,” the Office of the National Rural Health Commissioner wrote in its submission. “Furthermore, rural and remote residents are less likely to have access to fluoridated drinking water and face increased costs of healthy food and oral hygiene products.”
The submission also noted people in regions without dental services had to travel for care, which meant visits were often postponed until the need became critical. “Thus, dental-related hospitalisations increase with rurality. If locally accessible dental care is available for preventative and routine care, hospitalisations will likely decrease. Yet the current status of access is poor, with disproportionate numbers of rural and remote Australians needing to travel more than one hour to access a dental service.”
Scott Davis says the “maldistribution” of dental services has long been a problem in Australia. “But we’ve talked with government about [some potential solutions] and we’re hopefully going to get some cooperation,” he says.
“Certainly, the Senate inquiry agrees [with the proposition], which is that if you have a private-practice dentist who sets up a practice in regional Australia, and half the population is eligible for public care, that they can be able to provide both public and private patient support. The Senate inquiry acknowledges that’s a good strategy, that we could move more people into more remote areas if they’re able to service the entire community with that one clinician.”
The Senate inquiry is scheduled to table its final report in February, at which point the dental industry will expect to discuss its recommendations with the government. Meanwhile, Louise Olliff says, “We really want also to disrupt that narrative that refugees come here and are some sort of deficient, needy, vulnerable people – they actually come with profound skills.”
This article was first published in the print edition of The Saturday Paper on December 2, 2023 as "Dental records".
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