Locked Out Abroad - Motherhood, Migration and a Medical System That Won’t Let Them In

As Australia faces a healthcare workforce crisis, Australian-citizen international medical graduates, many of them mothers - remain shut out of clinical practice, not because of a lack of skill, but because no clear pathway back exists

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We met in a local café and talked about politics, family, medicine and migration. It was only when the conversation turned to Udaya having to leave her young children behind again to jump through another bureaucratic hoop that her eyes filled with tears. Udaya is the founder of IMG Collective, a grassroots organisation representing Australian-citizen International Medical Graduates and advocating for practical, supervised pathways back into clinical medicine.

“I will have to leave my children soon to train in a regional hospital for three months, with no certainty it will help me secure employment where we live,” Udaya said.

Her experience is shared by dozens of Australian citizen International Medical Graduates who describe being locked out of clinical medicine, not because of a lack of skill or commitment, but because no clear pathway exists to return safely to practice.

Australia is facing a well-documented healthcare workforce shortage. Hospitals are stretched, regional and outer-metropolitan communities remain under served, and governments continue to invest heavily in recruiting doctors from overseas. Yet quietly, a group of doctors already living here - Australian citizens who are internationally trained, qualified and motivated - report a sense of being unseen, as existing systems do not clearly recognise or accommodate their re-entry into clinical practice.

Many of them are mothers.

The unseen struggle

Recently, through IMG Collective, several Australian-citizen International Medical Graduates (IMG) came together for a workshop to share their experiences of attempting to return to clinical practice. Their backgrounds varied, but their stories echoed one another: resilience, frustration, and a system seemingly unwilling to accommodate their re-entry into medicine.

One doctor, the mother of a five month old and a three-year-old, described the impossible bind she faces. She wants to return to medicine now yet her clinical gap has grown due to caregiving responsibilities. She explained that she cannot place her children in daycare, not because she undervalues childcare, but because recent incidents have made her fearful of leaving them in care she does not trust.

“I keep being told I need recent Australian experience,” she said. “But where do I get that experience if no one will hire me? How do I get referees when I’ve never been allowed to work here? I’ve approached clinics to observe and learn, even unpaid and I was turned away.” Her experience is consistent with accounts shared by other Australian-citizen International Medical Graduates.

The inconsistency of the system

This exclusion is often justified in the name of patient safety. Yet the inconsistencies are stark. Newly graduated Australian medical students enter the workforce under limited registration with Level 1 supervision, despite having no independent clinical experience. Doctors who change careers later in life even in their 40s or 50s are celebrated and supported through structured, supervised pathways.

So the question arises: if supervision is considered safe for new graduates and career changers, why is it not considered safe for citizen IMGs who have already completed medical degrees, passed high-standard Australian exams, and often worked clinically overseas?

This is not about lowering standards. It is about applying them consistently.

Paid programs, unpaid outcomes

Some IMG mothers are directed toward clinical readiness or re-entry programs. These programs often:

Cost $20,000 or more, are unpaid, do not guarantee employment and are inaccessible to many due to rigid “recency of practice” rules. For families already balancing childcare, rent and cost-of-living pressures, participation can be financially devastating, particularly when there is no clear pathway into work.

As one mother explained: “We are not asking for consultant jobs. We are asking for entry-level roles, supervised roles, a way in.”

Advice that demoralises

Several mothers reported being advised to abandon clinical medicine altogether and redirect their careers into non-clinical roles such as research, administration or policy.

One mother shared: “You talk about feminism, but in my experience, it is women giving this advice. I was told by a mother in a leadership position to explore non-clinical roles because of my gap. That conversation destroyed my confidence. Moving into non-clinical roles should be my choice, not something decided for me by someone else. I won’t return to myself until I get an opportunity. Now I’m stuck, should I do further exams or not?”

These are not disengaged doctors. They are highly motivated professionals whose confidence, identity and livelihoods are being eroded by systemic inertia.

Recruiting migrants but wasting their skills

Australia prides itself on being a global leader in skilled migration. Through points-based visas and workforce-targeted recruitment, the message to migrants is clear: your skills are needed here.

But for many, that promise collapses on arrival.

Highly qualified professionals are recruited, welcomed and then often left to navigate fragmented accreditation systems alone. Overseas qualifications are devalued, experience is discounted, and the burden of integration is placed squarely on individuals.

International Medical Graduates sit at the sharpest edge of this contradiction.

Despite being actively recruited to address workforce shortages, many IMGs including Australian citizens find there is no clear, affordable or time bound pathway into clinical practice.

According to Udaya, she is aware of close to 100 families nationally who are being negatively impacted by the absence of such a pathway. In some cases, doctors have left medicine altogether despite being deeply committed to the profession, with consequences for their mental health.

“This isn’t just affecting individual doctors it’s affecting families,” Udaya said.

The true cost of migration for IMG doctors

For International Medical Graduates, the financial cost of migrating to Australia and becoming a citizen is substantial long before employment barriers are factored in. From the point of migration, IMG doctors typically spend $20,000 to $40,000 or more in direct costs, including medical skills assessments, English language testing, Australian Medical Council examinations, visa applications, medical and police checks, and migration or legal fees.

This figure does not account for the far greater opportunity cost of lost income, which can amount to hundreds of thousands of dollars for doctors unable to practise while navigating registration and workforce barriers. For many, Australian citizenship is not simply a status it represents years of financial investment, professional sacrifice and family disruption, made in good faith on the expectation that their skills would be used.

Comparable countries facing similar workforce shortages have taken a markedly different approach.

In Canada, internationally trained doctors typically enter paid, supervised practice-ready assessment programs, often in underserved or regional communities. While licensing costs still apply, doctors are able to earn an income while meeting requirements, significantly reducing both financial strain and skills attrition.

Australia, by contrast, places the financial and professional burden almost entirely on individual doctors requiring compliance with standards before access to supervised work, without guaranteeing that such work is available. The result is a system that extracts skills, commitment and money from migrant doctors, while failing to integrate them into the workforce it urgently needs.

Deferred responsibility, delayed action

These concerns have been raised by IMG Collective repeatedly with health leaders, regulators, politicians and ministers. Each time, responsibility is deflected: hospitals cite regulations, regulators point to employers, and policymakers refer to AHPRA or the Medical Board.

Yet AHPRA and Medical Board itself has acknowledged that this is a collective problem requiring coordinated action.

Even if the number of affected doctors were small, the principle remains the same. Three doctors sidelined unnecessarily is still too many.

Government responses

A spokesperson for the Department of Health, Disability and Ageing said all health ministers have prioritised implementing reforms following the Independent Review of Australia’s regulatory settings relating to overseas health practitioners. The spokesperson said this includes work to introduce streamlined registration pathways for highly qualified medical practitioners to practise in Australia while maintaining patient safety.

The Department also confirmed that a review of the supervised practice framework for International Medical Graduates and supervisors is currently underway.

The Department said doctors must meet registration and recency-of-practice requirements set by the Medical Board of Australia, and that supervision arrangements are made through employers and state and territory governments.

A spokesperson for the Department of Home Affairs said the Australian Government is committed to supporting the healthcare sector to fill skills shortages where no suitably qualified Australians are available. However, the response did not address how Australian-citizen International Medical Graduates are expected to access supervised entry-level roles in practice.

Stakeholders argue that closer coordination between health, migration and workforce agencies could improve outcomes for both public health delivery and skilled migration by more effectively aligning visa, registration and employment pathways.

Further clarification was sought but not provided before publication.

The office of the ACT Minister for Health requested an extension; however, due to editorial deadlines, an extension was not possible.

A solution

At a time when governments are grappling with long standing productivity challenges across the public sector and the broader economy, better utilisation of skilled migrants represents a clear opportunity. Many migrants from Asia arrive through highly competitive skilled pathways, bringing strong professional experience, high labour force participation and a demonstrated commitment to work. Ensuring these skills are recognised and effectively integrated would support productivity, service delivery and workforce sustainability.

Structured, supervised pathways that safely integrate citizen IMGs already exist in concept. Proposals put forward by IMG Collective such as the Australian Integration Pathway, offer a practical, evidence based model.

What is missing is not competence or commitment. It is will.

“I’m tired of empathy without action,” Udaya said. “Empathy alone won’t lead to change, so we will have to keep fighting. My children see me fighting, and I need to show them that we do belong here in Australia and that building a life here has been worth the sacrifice.”

For these doctors, the cost is professional, emotional and financial. For Australia, the cost is lost talent and avoidable workforce shortages.

If you would like to share a similar experience or you would like to be connected to the IMG Collective please email elise@ladynews.com.au.