Medical Training Review Panel: thirteenth report

Medicare Provider Number Restrictions

Page last updated: April 2010

In 1996, the Australian Government introduced Medicare provider number restrictions to improve the quality of Australia’s medical workforce over the longer term and to address growing concerns about the maldistribution of the medical workforce. Since 1997, doctors who have trained overseas have been required to gain an exemption under section 19AB of the Health Insurance Act 1973 (the Act) in order to access Medicare benefits for the services they provide. Exemptions under the Act are generally only granted if the medical practitioner works in a recognised area of workforce shortage, as defined by the Australian Government.

Restrictions on Practice

Section 19AB of the Act restricts access to Medicare provider numbers and requires Overseas Trained Doctors (OTDs) and former overseas medical students to work in an Area of Workforce Shortage (AOWS), for a minimum period of ten years in order to access the Medicare benefits arrangements. This is referred to as the 'ten year moratorium'.

An Area of Workforce Shortage (AOWS) is a geographic area in which the general population need for health care is considered not to be met. These areas are identified as those that have less access to Medicare services than the national average. AOWS are determined on the basis of a full-time equivalent measure, which takes into account Medicare billing in the area, irrespective of whether or not local doctors are working in a part-time or a full-time capacity. These are updated on a quarterly basis.

In 2009 there were 5,951 overseas trained doctors were granted exemptions under Section 19AB of the Act (Table 5.8).

Table 5.8: Overseas trained doctors with Section 19AB exemptions, 2009.

2002

2003

2004

2005

2006

2007

2008

(a)2009

Total1,3031,7222,2902,8783,6344,4765,4835,951

(a) 2009 figures calculated to 30 June 2009.

Source: Australian Government Department of Health and Ageing administrative data, 2009



Current Distribution of Overseas Trained Doctors

The following figures show the distribution of OTDs across metropolitan, rural and remote areas of Australia for each state and territory. The locations have been determined on the basis of the Rural, Remote and Metropolitan Areas (RRMAs) classification, whereby metropolitan locations are RRMAs 1 and 2, rural locations are RRMAs 3 to 5 and remote locations are RRMAs 6 and 7.

These figures highlight the variation between jurisdictions in the numbers of OTDs which they employ, with some states, notably Queensland and Victoria, employing far higher numbers of OTDs.They also show that the numbers of GPs in particular are fairly similar across locations
within jurisdictions, however, they form a far larger proportion of the workforce in rural locations and, even more so, in remote locations.

Figure 5.1: Overseas trained doctors in metropolitan areas (RRMA 1-2) by state/territory 2009


This bar graph shows the number of Overseas Trained Doctors in metropolitan areas (RRMA 1-2) by state and territory.

Source: Medicare data, Australian Government administrative data, 2009



Figure 5.2: Oversears trained doctors in rural locations (RRMA 3-5) by state/territory 2009


This bar graph shows the number of Overseas Trained Doctors in rural locations (RRMA 3-5) by state and territory.

Source: medicare data, Australian Government administrative data, 2009



Figure 5.3: Overseas trained doctors in remote locations (RRMA 6-7) by state/territory, 2009.


This bar graph shows the number of Overseas Trained Doctors in remote locations (RRMA 6-7) by state and territory.

Source: medicare data, Australian Government administrative data, 2009