Abstract
Dear Sir,
Australia is experiencing a shortage of addiction specialists, which limits access to the expertise needed to support consumers with complex needs.1−2 The current under-supply of addiction specialists is amplified in rural settings, with the workforce heavily skewed in favour of metropolitan services. This was highlighted in the RANZCP’s submission to the National Mental Health Workforce Strategy 2021-2031. 2 Whilst efforts are being undertaken to increase the workforce, the numbers of trainees and addiction specialists remain particularly low due to a chronic lack of investment in training and specialist positions. New South Wales, by way of contrast to Victoria, has almost six times the number of addiction doctors in training, as well as funded addiction specialist positions within each health service. Regardless, this has been recognised as insufficient to meet the demand for these services in that state. 1 Even with adequate investment, training this highly skilled workforce and providing adequate supervision will be challenging and take considerable time.
Traditionally, Australian and New Zealand health services have looked to Specialist International Medical Graduates (SIMGs) to fill workforce gaps. However, the ability to attract international addiction psychiatrists through the substantial comparability pathway is particularly challenging, given that there is no direct avenue for recognition of subspeciality training and certificates in addictions gained abroad. This means overseas-trained addiction psychiatrists face significant barriers to practise within their field of expertise and makes direct recruitment into addiction posts from abroad a challenge for employers.
Equivalence in training for SIMGs is assessed using the RANZCP comparability pathway assessment frame work checklist. This checklist does not reference addictions nor allow for reflection on advanced training or subspeciality attainments. 3 On the contrary, additional years of subspeciality work make comparability increasingly difficult as the training requirements should have been met over the past 10 years and thus favour recent fellows over experienced psychiatrists.
To meet the significant need for recruitment and training of addiction psychiatrists, clear criteria and pathways are needed to recognise overseas training in addictions. The criteria need a framework that allows consistent assessment and application to be useful, considering a wide range of international approaches to training addiction psychiatrists. 4 Both SIMGs and local fellows, who largely complete training in metropolitan settings, will need support to understand the rural context if pursing work in rural Australia. 5 This needs to occur alongside increasing training posts in addiction psychiatry, to address the challenges and ambitious targets facing services in the region.
