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"Medical schools are trying to produce doctors fit for the purpose in the environment they're working in," he says. In developing countries that might mean concentrating "predominantly on infectious diseases, where there's limited diagnostic modalities or treatments". Such training simply might not shoehorn into general practice in outer-metropolitan Sydney.Andrew Dix, the registrar and chief executive of the NSW Medical Board, says he has "no evidence that there is higher concern about the competence or conduct or performance" of overseas-trained doctors,oracle 10g dba compared with Australian graduates. In fact, he says, junior doctors who come to Australia to plug holes in regional hospital rosters may be less likely to attract complaints - because they are working in a structured environment with senior colleagues.The board's brief, Dix says, is to ensure individual doctors are suitably qualified and experienced for a particular job. For temporaryred hat certification "area of need" positions this involves an interview and assessment process, after which 20 to 30 per cent of candidates are knocked back.Those who succeed receive on-the-job supervision, including progress reports to the board at intervals set individually.If a person does not make the grade, Dix says, that is the end of the matter. Despite the urgent need for medical staff, the standard should not shift. Nevertheless, he says, "we don't operate in a vacuum. We'd be stupid not to be aware [of the doctor shortage], and we'll look for different ways to make sure appropriate standards don't become ossified."Of about 1500 overseas trained doctors working in NSW, about three or four have their registrations curtailed or withdrawn annually, Dix says, because their actual practice fall short of what the assessment suggests.Proposed national standards for overseas trained doctors will involve -vmware certification training except for graduates from Britain, Ireland, New Zealand the United States or Canada, and those applying for specialist jobs - supervision based on individual assessment.But NSW Health has so far resisted the streamlined assessments, out of concern they might add an extra hurdle for well-qualified would-be medicos.That is no idle worry. The number of vacancies for rural GPs in NSW recently crashed through the 200 threshold, after hovering at about 120 for most of this decade. "In terms of the overall picture for rural GPs, we have a fairly pessimistic view for the next 10 years," says Mark Lynch, the general manager of Rural Doctors Network NSW, the agency that brokers medical appointments in the bush.Baby-boomer GPs are reaching retirement age; younger doctors are less willing to adopt the long hours traditionally synonymous with country practice. "I think it's going to get worse before it gets better," says Lynch, who believes communities will need to adjust their expectations of doctors and employ nurses to cover more routine work. His organisation has focused on getting the pool of medically trained individuals already resident here into the state's workforce. But depending on where they trained and how long ago, it may still be unrealistic to give some doctors a leg-up into Australian practice.How could a prosperous nation, socially conscious and a leader in medical research, have devised a skills shortage so severe it threatens to cripple the provision of health care in some regions? From the vantage point of 2007, it seems inconceivable that only a decade ago bureaucrats feared not a doctor shortage but the oversupply of medics. The wanton distribution of Medicare provider numbers, they thought, would lead to a blow-out in health care costs. Strict containment of student numbers was the solution.Professor Allan Carmichael says nobody anticipated how changing career expectations among medics would combine with shifting population demographics and personal expectations to pull supply and demand in opposite directions."I don't think those factors had hit home," says Carmichael, the president of peak group Medical Deans Australia, which represents medical schools. "People are living longer and wanting access to [operations] in their 80s or 90s that even 15 years ago you'd have have thought twice about giving to people in their 70s."