Medical Training Review Panel: thirteenth report
Chapter 6: Special Purpose Training Programs
This chapter reports on the Special Purpose Training Programs established under section 3GA of the Health Insurance Act 1973 (the Act). Section 3GA programs target particular workforce requirements. These include vocational training, vocational recognition and other training needs.
Special Purpose Training Programs also provide for those doctors seeking vocational recognition, but who are not involved in a specialist or general practitioner training program. Many of the Special Purpose Training Programs offer a range of incentives to doctors. The two most common incentives are access to a Medicare provider number and access to the higher A1 Medicare rebate. Other incentives may involve access to an alternative vocational training pathway, the opportunity to broaden the range of clinical experience within an existing training pathway or special support in achieving vocational recognition.
Some of these programs specifically cover doctors who have trained overseas to assist with their integration into the Australian workforce, as well as meeting specific workforce shortage needs.
BackgroundSection 19AA of 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.
Section 19AA of the Act applies to all medical practitioners who:
- 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 and/or recognition from a Specialist Medical College.
- Australian citizens or permanent resident; or
- temporary residents who have completed their commitment to section 19AB of the Act.
Table 6.1 summarises the number of providers, as a headcount, on workforce programs and some specialised training programs under section 3GA of the Act from 2004–05 to 2008–09. Data on the number of providers only relate to services rendered on a fee-for-service basis for which claims were processed by Medicare Australia. This data does not include services to public patients in hospitals and through other publicly funded programs. All the programs are location specific with the exception of the Temporary Resident Other Medical Practitioners Program (TROMPP) and the Approved Placements for Sports Physicians Program (APSPP).
Table 6.1: Providers on approved 3GA program placements(a), 2004-05 to 2008-09
|194 - Approved Medical Deputising Program||108||141||165||206||215|
|197 - Approved Private Emergency Department Program||..||6||19||14||18|
|187 - Approved Placements for Sports Physicians Programs(f)(g)||8||8||7||8||14|
|414 - Sports Physician Trainees||..||16||22||21||27|
|617 - Metropolitan Workforce Support Program||8||8||4||1||0|
|178 - Prevocational GP Program||21||56||81||134||182|
|177 - Queensland Country Relievers Program||161||260||301||293||340|
|190 - Rural Locum Relief Program||660||554||551||583||657|
|179 - Special Approved Placement Program||7||13||14||37||49|
|198 - TROMP Program(c)||70||84||98||106||105|
|176 - Remote Vocational Training Program Trainees||10||10||13||16||26|
(a) Providers had to have claimed for at least one service on a valid date for the program in question.
(b) Statistics for 2004–05 and 2005–06 had regard to claims processed up to the end of October 2006.
(c) Statistics for 2006–07 had regard to claims processed up to the end of October 2007.
(d) Statistics for 2007–08 had regard to claims processed up to the end of September 2008.
(e) Statistics for 2008–09 had regard to claims processed up to the end of October 2009.
(f) Not a location specific program.
(g) Based on advice from Medicare Australia, providers on Program 187 were only counted if they had an end date on or
before 30 June 2010 and they had a service on a valid date for this program. Medicare Australia uses code 187 for
3GA and non-3GA providers.
Source: Australian Government Department of Health and Ageing administrative data
Section 3GA Programs
Approved Medical Deputising Services ProgramThe purpose of the Approved Medical Deputising Services Program (AMDSP) is to expand the pool of available medical practitioners who may work for after hours deputising services. This program works by allowing otherwise ineligible medical practitioners to provide a range of restricted professional services, for which Medicare benefits will be payable, where the medical practitioner works for an approved medical deputising service.
The AMDSP was established under section 3GA of the Act in 1999 in response to concerns about the shortage of medical practitioners providing after-hours home visit services in metropolitan areas. The Australian Government Department of Health and Ageing administers the program.
A review of the AMDSP in 2001 recommended the extension of the program to include 'after hours' only clinic based services operated by an approved medical deputising service.
Approved Private Emergency Department ProgramThe Approved Private Emergency Department Program (APEDP) allows advanced specialist trainees undertaking emergency medicine training to work under supervision in accredited private hospital emergency departments. The program was established to enhance public access to private emergency departments by expanding the pool of doctors able to work in private hospital emergency departments.
Approved Placements for Sports Physicians ProgramThe Approved Placements for Sports Physicians Program (APSPP) was introduced in April 2004. At the time, sports medicine was not recognised as a medical specialty under the Act.
This 3GA program was specified in Schedule 5 of the Health Insurance Regulations as an interim measure to allow medical practitioners who gained fellowship of the Australasian College of Sports Physicians (ACSP) after 1 January 2004, and who are subject to the provisions of section 19AA of the Act, to gain access to a Medicare provider number. Once the placement has been approved, Medicare Australia registers the placements using specification code 187. Providers are then able to access attendance items from Group A2 and Group A16 of the Medicare Benefits Schedule, as well as relevant procedural items for the nominated period of the placement.
The Minister for Health and Ageing approved the recognition of Sport and Exercise Medicine as a medical specialty in November 2009. Providers will continue to access attendance items from Group A2 and Group A16.
Sports Physician TraineesPractitioners in this program are eligible to be registered under section 3GA of the Act as an Australasian College of Sports Physicians (ACSP) Trainee for specific practice locations using specification code 414. These placements entitle the practitioner to access Group A2 attendance items in the Medicare Benefits Schedule, including relevant procedural items for the period of registration and at approved locations. Medicare Australia receives advice on placements directly from the ACSP and registers the placements for Medicare purposes.
Metropolitan Workforce Support ProgramThe Metropolitan Workforce Support Program has been discontinued. The program was established in 2003 to alleviate the undersupply of general practitioners in the outer metropolitan areas of Perth. The program was also required to provide participating doctors with the necessary support to assist their achievement of vocational recognition by 31 December 2006. It is included in this year's report because one practitioner was recorded as providing a service under this program in the current reporting period.
Prevocational General Practice Placements ProgramThe Prevocational General Practice Placements Program (PGPPP) encourages junior doctors at all levels to take up general practice as a career.
Placements are available in rural and remote areas classified using the Rural, Remote and Metropolitan Areas (RRMA) classification as RRMAs 3–7, as well as designated urban areas, such as outer metropolitan areas and Areas of Workforce Shortage (AOWS). PGY2 and PGY3 doctors undertake placements for an average of 12 weeks and are able to bill Medicare at the A1 rate.
General practice placements in this program commenced in January 2005. The number of completed supervised general practice placements has increased each year from 111 in 2005-06 to 173 in 2006-07 and to 248 in 2007-08. It is expected that up to 315 placements will be completed in 2008-09.
Queensland Country Relieving ProgramThe Queensland Country Relieving Program (QCRP) provides locum services to Queensland Health's rural medical practitioners by drawing on a pool of junior medical staff employed within the State's public hospitals. The role of these junior doctors is limited to that of a junior doctor without vocational qualification.
The 3GA exemptions are only necessary for practitioners relieving in medical superintendent or medical officer positions with rights to private practice. Therefore, not all practitioners in the program require the 3GA exemptions. These positions with rights to private practice are specific to Queensland and do not exist in other jurisdictions. These positions are generally in small rural locations where the hospital doctor also fulfils a general practice role. The 3GA component of the QCRP enables medical practitioners to provide services that attract Medicare benefits.
The QCRP currently provides relief to approximately 70 rural medical practitioners throughout Queensland. Many of these are solo medical practitioners who would have limited opportunities for relief if they were reliant upon the recruitment of private locums. The QCRP contributes towards maintaining a medical service to rural and remote communities in the absence of the community's permanent doctor.
Rural Locum Relief ProgramThe Rural Locum Relief Program (RLRP) was introduced in 1998. It enables doctors who are not otherwise eligible to access the Medicare Benefits Schedule to have temporary access when providing services through approved placements in rural areas. Rural Workforce Agencies (RWAs) in each state and the Northern Territory administer the program on behalf of the Australian Government. Doctors without postgraduate qualifications who fall within the scope of the restrictions under section 19AA of the Act are eligible to make an application to their respective state or territory RWA for a placement on the program. For overseas trained doctors who are subject to the restrictions under section 19AB of the Act, practice locations must be considered to be an Area of Workforce Shortage (AOWS).
Locations eligible to receive approved placements through the program are:
- small rural and remote areas, and large remote centres (RRMAs 4–7);
- large rural centres (RRMA 3) that are AOWS;
- Areas of Consideration, as determined by the Australian Government Minister for Health and Ageing; and
- all Aboriginal medical services, including RRMA 1 and 2 locations.
Remote Vocational Training SchemeThe Remote Vocational Training Scheme (RVTS) was introduced in 1999 to address health service needs in Australia's remote communities. The scheme provides registrars with a vocational training program supported by distance education and remote supervision.
The RVTS provides an alternative route to vocational recognition for remote practitioners who may otherwise find that leaving their practice to undertake the AGPTP is not viable. RVTS registrars are eligible to sit for fellowship of the RACGP and the ACRRM.
Up until 28 February 2007, the Remote Vocational Training Scheme (RVTS) was a 3GA program under the auspices of the Royal Australian College of General Practitioners (RACGP). Since 1 March 2007, legislative changes and the incorporation of RVTS Ltd have enabled the RVTS to be recognised as a 3GA program in its own right.
Since the inception of the pilot program in 1999, 62 registrars have participated in the RVTS. In January 2007, funds were made available to increase the intake of registrars to 15 per year. From 1 January 2011, the number of places will increase to 22 ongoing training places.
By July 2008, 22 medical practitioners had successfully achieved fellowship of the RACGP and/or ACRRM through the RVTS.
Special Approved Placements ProgramThe Special Approved Placements Program (SAPP) was established under section 3GA of the Act in December 2003. The program allows medical practitioners to access Medicare benefits in metropolitan areas if they can demonstrate exceptional circumstances that make them unable to participate on any other workforce or training program under section 3GA of the Act.
Exceptional circumstances that would normally be considered are:
- where it can be demonstrated that there is substantial hardship, due to a particular family circumstance, resulting in the medical practitioner not being able to access the Medicare benefits in other suitable locations under section 3GA of the Act;
- where serious illness relating to the medical practitioner, or his or her immediate family members can be demonstrated, including where the treatment for the condition is limited to a particular location(s); or
- other exceptional circumstances peculiar to the individual case.
Temporary Resident Other Medical Practitioners ProgramThe Temporary Resident Other Medical Practitioners Program (TROMPP) was established in 2001. The program was introduced to overcome an unintended consequence of amendments to the 1996 Medicare provider number legislation, which would have resulted in a number of long-term temporary resident medical practitioners losing access to the Medicare Benefits Scheme. This affected temporary resident medical practitioners who had entered medical practice in Australia prior to 1 January 1997 and who were not vocationally recognised.
The TROMPP provides access to Medicare benefits at the A2 rate for these eligible medical practitioners.