AMA Policy on Non-Vocationally Registered General Practitioners

27/06/2013

Background

The Government introduced vocational registration in 1989 to recognise general practice as a discipline in its own right, to improve professional standards and to reward high-quality practice.

Between 1989 and 1995, medical practitioners already practising in general practice who met the eligibility criteria could apply to be grandfathered on to the Vocational Register (VR). The grandfathering period for the Vocational Register ended in November 1996.

As in other specialist areas, VR medical practitioners are now seen as the norm in general practice. In July 2010, a national registration system managed by the Australian Health Practitioner Regulation Agency (AHPRA) commenced that recognises general practice as a medical specialty accessible through Fellowship of the RACGP (FRACGP) or ACRRM (FACRRM); or on the General Practice Vocational Register.

The introduction of the Vocational Register effectively created two classes of GPs: those who were vocationally registered (VR GPs) and had access to higher A1 Medicare rebates, and those who were not (the Non-VR GPs) and only had access to lower value A2 Medicare rebates. The A2 rebates were set initially at 93 per cent of the A1 rebates but have never been eligible for annual indexation and so are proportionally worth much less than A1 rebates over time.

There are programs available that offer Non VR GPs access to the A1 rebate, such as the Medicare Plus for Other Medical Practitioners (MOMPs) Program, which requires Non VR GPs to practice in Districts of Workforce Shortage. After being in the program for five years, Non VR GPs are able to continue to attract the higher rebate regardless of where they subsequently practice. 

Non-VR GPs currently have the option to become vocationally registered either by applying to the General Practice Recognition Eligibility Committee (GPREC) for certification of eligibility for vocational registration or by undertaking, with either the Royal Australian College of General Practice (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM), a pathway to Fellowship for Non VR GPs that take into account their commitment to the profession, their past experience and their involvement in continuing professional development. The RACGP offers a Practice Eligible Route to Fellowship, which is open to doctors who have at least four years of fulltime general practice experience with at least one of these years in Australia. Doctors following the Practice Eligible Route do a three-part practice-based assessment of their skills before being awarded FRACGP. Likewise, ACCRM offers an Independent Pathway to Fellowship for experienced GPs, which is delivered to doctors enrolled in the Remote Vocational Training Scheme.

Key issues for patients

The difference in rebates coupled with non-indexation means that patients who attend Non-VR GPs now receive a significantly reduced Medicare rebate, in comparison to patients who attend VR GPs. These patients also potentially face higher out-of-pocket expenses, making access to their GP less affordable.

For example, the rebate for a 15-minute consultation for the patient of a Non-VR GP is $21, compared to that for a similar (Level B) A1 consultation of $36.30.

Key issues for the Government

The Government should act on the recommendations of the 2005 Biennial Review of the Medicare Provider Number Legislation, which were reiterated in the Report on the 2010 Review of the Medicare Provider Number Legislation (Recommendation 3) and provide one more opportunity for doctors who meet the necessary criteria to be grandfathered on to the Vocational Register. This is particularly important given that a number of these medical practitioners, while eligible, were excluded from the Vocational Register because at the time of their application they were on maternity leave, raising a family, undertaking further training, or overseas, and missed the opportunity to apply.

Recommendation 3 of the 2010 review of the Medicare Provider Number Legislation also states that, if grandfathering is not possible because of the establishment of the national registration system, Non VR GPs should be allowed to access A1 rebates for a defined period whilst working towards Fellowship with RACGP or ACRRM.

Having recently increased the number of GP training places to help address shortages in the GP workforce, the Government could further enhance the immediate availability of experienced medical practitioners to the GP workforce by addressing the longstanding anomalies that exist in funding and recognition of Non-VR GPs.

AMA POSITION

Non-VR GPs should be recognised for their considerable experience in both general practice and other areas of medicine. Grandfathering these practitioners will help retain and increase their numbers in the general practice workforce and encourage them to increase their hours.

Specifically, the AMA calls for a final round of grandfathering for all of the Non-VR GPs who had access to GP Medicare rebates prior to 1 November 1996 and have predominantly been in general practice for a minimum of five years since that date.

In addition, in order to further reduce the inequity in rebates for any remaining Non-VR GPs, after this grandfathering opportunity, the A2 rebates should be increased to reflect the differential that existed when the vocational recognition structure was introduced. For those practitioners who are not eligible for grandfathering to the vocational register, A2 rebates should be increased to 93 per cent of the A1 rebates and indexed appropriately on an annual basis. This would address the inequity in these fully qualified medical practitioners receiving a rebate similar to, and in the future potentially less than, that received by lesser-trained health providers such as nurse practitioners.

According to the Department of Health and Ageing’s general practice workforce statistics, there are around 2,000 full-time equivalent Non VR GPs, two thirds of whom access A1 rebates through workforce programs. Those already having access to A1 rebates will not represent any increase in expenditure for the Government. Of the remaining Non VR GPs (approximately 700), the AMA estimates that fewer than 30 per cent would qualify for the final round of grandfathering, with the rest eligible for rebates at 93 per cent of A1 rates. This would represent a $54 million total increase in expenditure for the Government.

Comments

Submitted by Anonymous (not verified) on

Are these Doctors then manipulating the public into thinking they have 'exactly' the same qualifications as the VR doctors, or are they correct in saying the have all the qualifications necessary to be registered as VR doctors?
http://www.youtube.com/watch?v=ST_LRPdBQK8

Submitted by Dr Walker (not verified) on

Anonymous, firstly it might have been more polite to use your name, before you make accusations. Secondly, it would have been also polite to explain your agenda, and why you are offended at these GPs fight for "equal Medicare for equal work and responsibility" ... (After all, even "nurse practitioners" now get GP Medicare rates for the work they do: the very same Medicare payments these Aussie GPs have been denied for 21 years!!) We have always said that these 4000+ GPs left in this outrageous bureaucratic bucket are identical to the majority of GPs practicing in Australia. I therefore find your post disingenuous and offensive to these highly qualified GPs who are identical to the majority.

Submitted by James Moxham (not verified) on

This AMA policy may need updating as the vocational register no longer exists. It was repealed by an Act in 2010 http://www.comlaw.gov.au/Details/C2010A00048/8a5067f3-f35f-41f6-b14c-b2a... and there are two relevant paragraphs - section 3 (b) which redefines a GP and is a catch all for the various Area Of Need schemes, and more importantly, section 10 which simply repeals the definition of a vocationally registered GP. A FOI request for the list of Non VR doctors initially was quoted at costing over $100k, but when taken further, DoHA had to admit they no longer had the list. What they do have is the list of doctors on A1 and A2 rebates but that is a different thing altogether. The reason they don't have the list is because the definition has been repealed.
What matters now is access to A1 rebates. The figures in this AMA policy are out of date, and there are now more than 4000 GPs who would be classified as Non VR if the vocational register still existed, but only a small number of these are actually on A2 rebates.
Over the last decade there have been a number of programs where GPs can access A1 rebates. In the old parlance, they can become "VR" but this no longer has any meaning. The practical outcome is these doctors become indistinguishable from Fellows and Grandfathered GPs, and they access higher rebates and they do QI and CPD and their qualifications are the same as all the grandfathered GPs. The RACGP recognises this on their QI&CPD website http://qicpd.racgp.org.au/program/information-for-gps/medicare-australia and there are seven groups that do CPD, only two of which are the old "Fellows and Grandfathered GPs". These groups all access the higher rebates, do CPD, and if they do not do CPD they go back to the lower rebates.
The AMA policy may need updating to remove all references to the vocational register because this no longer exists. What the policy now needs to say is that the A2 rebate needs to be increased to 93% of the A1 rebate. It is a much simpler policy and such a policy may also help guide the AMA with respect to other lobbying, eg this AMA policy https://ama.com.au/system/files/node/5354/Pesce+to+Flynn+re+specialist+r... which conveniently left out 4000 doctors. That failed AMA lobbying has conservatively cost AMA GP members over $6 billion since 2010.
There is little support within DoHA and the government for the AMA idea of grandfathering A2 doctors up to A1 rebates, because these doctors are seen as a resource that can help relieve doctor shortages in areas of need.
The VR/Non VR fight is over, and it is now time to reunify general practice.

Submitted by Anonymous (not verified) on

How an IMG with AMC MCQ and OET Clinical part 1 , Observer ship experience can get an opportunity work in rural hospital