Fair requirements for overseas doctors to work in NZ

Review the Medical Council's (MCNZ) requirements and process for overseas trained doctors to register and work in NZ. Specifically, the NZREX pathway which is for doctors from "non-comparable'' health systems (e.g. South Africa) who didn't graduate in NZ or Aus and have not specialised. 

Regardless of having experience and completed internships, this pathway requires these doctors to do the following before they may practice in NZ:

1. Write and pass a theoretical exam from USA, UK, Canada or Aus. Suggestion that the relevance of this be reviewed. 
2. Prove they can speak English (write exam) - suggest the relevance of this be reviewed, particularly if a doctor has completed medical school/tertiary education in English
3. Apply for the NZREX exam - note that this is where the journey ends because applications are not open. One must have done the first two steps (exams) within two years of applying for NZREX, so may have to write these exams again depending on how long the wait is for NZREX applications to open. Suggest that this be addressed. Doctors need a fair chance to write this exam but there is little to no opportunity at present. 
4. Sit and pass the NZREX - it is clear on the MCNZ that spots fill up quickly, realistically will be a long time until the exam can be written. 
5. After passing NZREX, complete post graduate training (PGY) within 5 years regardless of work experience (i.e. repeat an internship). Note that the MCNZ website highlights that it is challenging for overseas trained doctors to secure these positions and provides disappointing statistics regarding how people have succeeded in this regard. Suggest that more of these posts be made available.
6. After completing 2 x PGY years (internship) you may apply to practice as a doctor in NZ. 

This pathway in practice takes years and is incredibly expensive (ideally this will be reviewed too), these are years lost in clinical experience if already in NZ (i.e. unable to practice) and are also years lost to the healthcare system, evidently desperate for doctors. 

I understand that these processes are in place to uphold a certain standard of healthcare, and that doctors who practice in NZ need to be fit to do so. The fairness of the current process is questionable and should be addressed. 

Some ideas:

• Instead of proving you are practically capable of working as a doctor through a stimulated NZREX exam (which is not available), other evidence can demonstrate practical ability such as completed internships or work experience. For example, in South Africa, the Health Professions Council (HPCSA) sets out standards and requirements for junior doctors to meet during their 2 internship rotations before they may register for independent practice (e.g. perform c-sections, etc). If a doctor can prove that they have completed their internship years and met the HPCSA standards then surely this is better evidence of practical capability and skill than writing a once-off, simulated NZREX exam (not to mention first writing a theory exam based on the UK/USA/Canada/Aus health care system and proving you can speak English)? 
• If continuing with the current NZREX pathway and practices then at minimum provide more opportunities for doctors to write this exam, and open up posts that they can enrol in afterwards. 

The shortage of healthcare workers, and doctors in this case, puts immense strain on the healthcare system and current staff leading to staff burnout and impacting patient care. Bridging the gap by increasing the workforce could alleviate pressure on the strained healthcare system and favour the best interests of patients and staff alike. Overseas trained doctors could be of value to the healthcare system but many are unable to meet the MCNZ requirements to practice, despite having work experience.