Medical Training Review Panel: fourteenth report

Medicare Provider Number Restrictions

Page last updated: 11 March 2011

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 (referred to as ‘foreign graduates of an accredited medical school’ from April 2010) to work in a District of Workforce Shortage (DWS) for a minimum period of ten years in order to access the Medicare benefits arrangements. This is referred to as the ‘ten year moratorium’.

A DWS 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. They 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. Areas are defined on a quarterly basis.

In 2010 there were 6,576 overseas trained doctors who had been granted exemptions under Section 19AB of the Act (Table 5.10).

Table 5.10: Overseas trained doctors with Section 19AB exemptions, 2010

2003200420052006200720082009(a)2010
Total
1,722
2,290
2,878
3,634
4,476
5,483
5,914
6,576

(a) 2010 figures as at 30 June 2010.

Source: Australian Government Department of Health and Ageing administrative data, 2010

Current Distribution of Overseas Trained Doctors

There is marked variation in the reliance on overseas trained doctors across jurisdictions and by remoteness.

In all states and territories the number of overseas trained doctors corresponded closely with their proportions of the overall population, with the exception of Queensland, where almost one third of all OTDs were working (Table 5.11).

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Table 5.11: Overseas trained doctors by state/territory, 2010

General practitioners(a)Specialists(a)Total
New South Wales
933
663
1,584
Victoria
1,045
518
1,551
Queensland
1,266
770
2,025
South Australia
335
219
571
Western Australia
505
280
775
Tasmania
121
113
233
Northern Territory
102
45
147
Australian Capital Territory
29
56
85
Australia(b)
4,157
2,470
6,576

(a) General practitioners includes 3GA placements and Specialists includes assistant specialists.
(b) OTDs may work in more than one location across different states/territories.

Source: Australian Government Department of Health and Ageing administrative data as at 30 June 2010

The following figures show the distribution of OTDs across states and territories by remoteness (Figures 5.1 to 5.4). These figures highlight the variation between jurisdictions in the overall and relative numbers of overseas trained doctors. They also show how some jurisdictions, particularly Queensland, Western Australia and the Northern Territory, are more reliant on OTDs to provide services. Whereas in South Australia OTDs comprise a relatively low proportion of the workforce.

Remoteness of locations has been determined on the basis of the Remoteness Area (RA) structure within the Australian Bureau of Statistics Standard Geographical Classification (ASGC). Due to the small numbers in more remote areas, data for Remote, Very Remote and Migratory classes have been combined in the last figure.

Although OTDs constitute a far higher proportion of the medical workforce in more remote areas of Australia, the majority work in Major cities and Inner regional areas. More specifically, half of overseas trained GPs and 70% of overseas trained specialists worked in Major cities (Figure 5.1), where just over two thirds of the population reside. A further 40% of both GPs and specialists worked in Inner regional areas (Figure 5.2), where one-fifth of the population resides.

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Figure 5.1: Overseas trained doctors in Major cities areas by state/territory, 2010

Figure 5.1 shows a graph of overseas trained doctors in major cities areas by state/territory, 2010 D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2010

Figure 5.2: Overseas trained doctors in Inner regional areas by state/territory, 2010

Figure 5.2: shows a graph of overseas trained doctors in Inner regional areas by state/territory, 2010D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2010

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Figure 5.3: Overseas trained doctors in Outer regional areas by state/territory, 2010

Figure 5.3 shows a graph of overseas trained doctors in Outer regional areas by state/territory, 2010 D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2010

Figure 5.4: Overseas trained doctors in Remote and Very remote areas by state/territory, 2010

Figure 5.4 shows a graph of overseas trained doctors in remote and very remote areas by state/territory, 2010D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2010