OTP pathway for rheumatology not worth the effort?

4 minute read

In the face of Australian shortages, a Sri Lankan consultant rheumatologist’s experiences leave her questioning whether there’s any need – or desire – for OTPs.

In the face of Australian rheumatology workforce shortages, the experience of Sri Lankan consultant rheumatologist Dr Geetha Kapuduwage leaves her questioning whether there’s any need – or desire – for OTPs.

In your article “Are overseas rheums the answer to shortages?” (Rheumatology Republic, 23 June 2022), it was interesting that you have given details of two doctors from Brazil who have been successful in getting into the stream.

But not everybody is as lucky, and funding may not be the only problem in OTPs getting training positions in Australia.

I will tell you my experience as I am still unsuccessful, and I don’t expect miracles to happen during the next year.

I visited Australia for the first time in 2013 when my husband and I got permanent residency visas in the skilled migrant category.

At that time, I had already completed 2 years of senior registrar training in Sri Lanka, done a year of registrar training in the UK in rheumatology and possessed an MBBS, MD (Medicine) and MRCP(UK).

I tried my best to get into the rheumatology field and failing that, I did AMC parts 1 and 2 and obtained an SHO post in Caboolture Hospital in Queensland. There were no rural training positions in Queensland for rheumatology.

I knew if I wanted to get into the rheumatology stream, I would need to sit exams again from the beginning, so I left Australia in 2015, leaving my husband here.

Back in Sri Lanka, I got board-certified that year as a consultant rheumatologist as I had completed all necessary requirements, and in 2019 – after working for 4 years as a consultant rheumatologist – I applied for the RACP specialist pathway to be assessed as an OTP. 

The process was costly, but I applied as I wanted to join my husband in Australia.

The RACP assessment was comparable to that for an Australian-trained rheumatologist, with the need of peer review for 12 months. They mentioned the requirement to “practise as a consultant and at minimum at senior registrar level”!

Soon after my assessment in 2019, the pandemic started and the RACP added two additional years, totalling up to 4 years from 2019, for me to start my peer review – which will end in 2023. As it was difficult to find a job offshore, I arrived in Australia in February 2022.

I have been trying to find a suitable position since the outcome of the assessment but have failed. I feel funding is not the only issue. Following are some of my thoughts on my past experience:

Firstly, if there’s no way of giving a training job to someone from overseas due to the lack of positions for training Australian rheumatologists, why not close the OTP pathway for rheumatology? By the time someone reaches the point of searching for peer review positions, they have already spent around AU$7,000 on this assessment process, since even the peer review – considered as the best option – will need such a position for 12 months for the person to get specialist recognition. This is a substantial amount, given that most OTPs searching for jobs are from middle-income or third-world countries.

Secondly, the obvious priority is for locally trained rheumatologists and there is discrimination against OTPs, or is there no need of them? For some positions I got turned down within 5-6 hours of applying, even before the application closure. At one point, I was told a position was for local graduates and I had better apply for something with a longer period – when I had applied for a position which was advertised for 6 months. With some job advertisements, I felt clearly they had already selected someone even before advertising the job!

Finally, at one interview, I was told that to prescribe biologics I will need specialist registration and without that I can’t practise as a consultant. Is the RACP aware of this when they give assessment outcomes?

With my experience and my struggling to find a suitable position after so many paid assessments, I don’t recommend anyone apply through the OTP pathway anymore.

Dr Geetha Kapuduwage

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