19AA & the 3GA programs

There has recently been an article posted about a Perth General Practitioner who gained Permanent Residency and, unfortunately, was no longer able to work in his suburban practice.

I took the time to read not only the article, but the comments underneath. Some commenters were right on the money but the vast majority couldn’t fathom what had occurred or differentiate between the 19AA and the 19AB rulings.

I remember when I first started as a recruiter working with General Practitioners and being absolutely stumped by the vast amount of knowledge required for just the simplest  most uncomplicated GP – let alone one that gets a bit complicated, which – let’s be honest – is about 1 in 3!

So today, I want to see if I can clarify this a little bit – hopefully I can!

The Department of Health are doing their best to encourage GP’s into rural areas, at least for a short period. It sounds mean, and frustrating and in some cases, it’s unfair but it is what it is and the theory is good even if when put in practice, it all goes a bit pear shaped.

Our regional areas in Australia suffer from higher mental health issues and chronic disease, but have less access to the health services of the CBD. Yet without rural Australia, we city dwellers wouldn’t have the same great economy that we do. I’m not here (today) to spout the benefits of rural Australia though, just to try and put in perspective why DoH have the 19AA and 19AB rulings in place.

Right – What is 19AA?

Section 19AA of the Health Insurance Act 1973 (the Act) was introduced in 1996 to recognise and support general practice as a vocational specialty, as well as to provide a framework for achieving long term improvements in the quality of doctors working in Australia. – Doctor Connect (Link Below)

All medical practitioners are subject to restrictions of section 19AA of the Act if they:

  • held medical registration by an Australian Medical Board on or after 1 November 1996 and
  • are Australian permanent residents or Australian citizens and
  • do not hold continued recognition by the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine, or by a recognised specialist college.

Basically, 19AA requires any NON Vocationally Registered Australia Permanent Resident or Citizen to be registered on an approved 3GA program prior to commencing work to be able to gain access to Medicare benefits.

This restricts both people born here in Australia and those who have become Australians.

What does this mean?

Basically, there is a list of “training programs” (check out the links below) that allow doctors wanting to work in General Practice to work, and be able to bulk bill and for their patients to be able to get a rebate from Medicare.

Once you sit your fellowship exams and are recognized as a specialist doctor, this restriction no longer applies.

If you’re billing 100% privately, and your patients do not expect to get a rebate from Medicare, this restriction doesn’t apply. It only applies to those who want to be able to bulk bill and their patients have the ability to claim on Medicare.

OK, so what about these programs?

The most relevant programs for GP’s include:

Australian General Practice Training or the “AGPT” program is the program that DoH would like all General Practitioners to work through. It’s a great program that provides a lot of support to GP’s – Applications open each year in April and commence the following January and they take on about 1500 registrars each intake. It’s a 4 year program, which includes one year in the hospital and 3 working in various clinics as a GP registrar.

  • PRO: You will have so much support and guidance towards fellowship, with supervisors that have been vetted by the training institutions that govern the program.
  • CON: There are limited places, competition is fierce and there is no guarantee you won’t be placed in far north Queensland, 1800klms away from your family.

The Rural Locum Relief Program (Or RLRP) is a 4 year program which requires you to have two years of General Practice experience assessable by RACGP. Without this experience, you may be granted access to a short term bridging program to give you time to access AGPT. This program will require you to work in a “RRMA 3 or higher” (check out the brief below about RRMA) which are areas outside of capital cities and their suburbs.

  • PRO: It gives you more control over your career, and it’s great for General Practitioners coming in from overseas with 5+ years’ experience as you can work for as short a time as you need to on this program. It does has a max of four years though so watch out for that!
  • CON: You’re going to have to relocate from the CBD or have a minimum 1 hour commute

The After Hours Medical Deputising Program – or AMDS program provides General Practice support to patients primarily in their homes, although there are a few clinics around, in the “after hours”. These hours are from 6pm weekday nights until 8am, and from 12pm midday on a Saturday right through til 8am on Monday morning (including all of Sunday). Public holidays are also eligible. This program will allow you to work in the CBD and there are plenty of options of organisations for you to work for, so make sure you shop around to get a good percentage and a good working environment. One thing to note: the RACGP now calculates MDS experience at 50% of the time worked (e.g. 1 year working in AMDS is counted as 6 months).  A maximum of 2.5 years (assessed) of after-hours can be considered towards fellowship. Regardless of your previous experience you are required to also have 6 months in-hours (Australian day-time clinic) to be eligible to sit Fellowship.

  • PRO: You get to work in the CBD and the income can be pretty good – a consult between 6pm – 11pm is about $129 per patient and after 11pm is about $157 per patient. You also get to have your days to yourself when everything is open!
  • CON: It is still in the after hours, and it means it will take longer to get to your FRACGP, plus eventually, you’ll still have to do the 18 months rurally.

Remote Vocational Training Scheme or “RVTS” is an ACRRM pathway. It has incredibly strict criteria for entering the program, which include restrictions similar to the RLRP criteria with added extras and only offers 22 places each year. I’ve put the link below to information on this program.

Independent Pathway is another ACRRM pathway. It IS NOT a 3GA program however with as DoH recognizes it as a pathway to fellowship and will grant access to a specialized program if you are training on this pathway. It’s important to note that the process for gaining entry to this program is similar to AGPT, and it is an expensive option. I’ve put the applicant’s guide in the links below.

The Special Approved Placements Program or “SAPP” is a program limited to doctors with extenuating circumstances requiring them to stay in a metropolitan area i.e. medical conditions of themselves or their close family, or legal reasons requiring them to stay where they are whether it’s metro, rural or otherwise. It’s important to note here that family circumstances are not taken into account.

Important to Note: Becoming an Australian Permanent Resident / Citizen DOES NOT negate the 19AB / DWS requirement that all doctors who completed their degrees outside of Australia, or who were not residents when they completed their Australian degrees are also restricted by. Some of the 3GA programs also have specific 19AB requirements linked to them.

So, what now?

This, all in all, is a brief summary of this part of the health act. The aim is to encourage people into rural areas and give them the tools and the support to provide great healthcare. The issue is that when you put it into practice – people have set up their lives somewhere and relocating can be challenging and frightening.

It’s important to look at your options and make a decision based on what is best for you and your family. Don’t be afraid of change, because you never know what amazing things and new friendships you can build in our rural areas.

There are lots of people here to help take you through the options and we will wait patients whilst you decide what it is that you want to do.

Hopefully this is clarified it all a bit! If not, comment below and I’ll do my best to clarify some more.

Signing off, to manage a 1 in 3 complicated GP situation (or two!)

Links and Definitions

What does Vocationally Registered mean?

When referring to General Practitioners, it means that they have sat their fellowship exams via RACGP or ACRRM and becoming a Fellow in General Practice. This is also referred to as being a “VR” or “FRACGP” or “FACRRM”

What is RRMA?

If you have a look at the doctors connect map, some programs like RLRP and ROMP’s are still using the old model to base their assessments from.

Links to check out

 About 19AA: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/section19AA

About the 3GA Programs: http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-pubs-mtrp-16-toc~work-pubs-mtrp-16-chapter-6~work-pubs-mtrp-16-chapter-6-section-3ga-programs

The Actual Programs:

Doctors Connect Map: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator