Medical Training Review Panel: sixteenth report

Medicare Provider Number Restrictions

Page last updated: 09 April 2013

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 of Practice

Section 19AB of the Act restricts access to Medicare provider numbers and requires overseas trained doctors (OTDs) and ‘foreign graduates of an accredited medical school’ (FGAMS) from April 2010 to work in a District of Workforce Shortage (DWS) for a period of generally ten years in order to access the Medicare benefits arrangements. This is referred to as the ‘ten year moratorium’.

A DWS is an area in which the general population’s need for health care is considered not to be met. These areas are identified as those that have less access to medical services than the national average. They are determined on the basis of a full-time equivalent measure, which takes into account latest 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 for general practice and annually for the other medical specialties.

On 1 July 2010 the Australian Government introduced the scaling initiative as part of the Rural Health Workforce Strategy. The scaling initiative allows OTDs and foreign graduates of an accredited medical school to receive significant reductions in their restriction period under the ten year moratorium if they practice privately within an eligible regional, rural or remote area. The greatest discounts are available to medical practitioners who practise within the most remote locations in Australia.

Further advice regarding the scaling initiative is available from the Doctor Connect website: http://www.doctorconnect.gov.au/

As at 30 June 2012 there were a total of 8,455 overseas trained doctors who had been granted exemptions under Section 19AB of the Act (Table 5.8).

Table 5.8: Overseas trained doctors with Section 19AB exemptions, 2012

Note: 2012 figure calculated to 30 June 2012.

Source: Australian Government Department of Health and Ageing administrative data, 2012

20022003200420052006200720082009201020112012
Total
1,303
1,722
2,290
2,878
3,634
4,476
5,483
5,914
6,892
7,785
8,455

Current Distribution of Overseas Trained Doctors

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

Table 5.9 shows how some jurisdictions, particularly Queensland, Western Australia and the Northern Territory, are relatively more reliant on OTDs to provide services.

Table 5.9: Overseas trained doctors by state/territory, 2012

(a) General practitioners include section 3GA (under the Health Insurance Act 1973) placements and Specialists include assistant specialists.

Source: Australian Government Department of Health and Ageing administrative data as at 30 June 2012

General practitioners(a)Specialists(a)Total
New South Wales
1,301
875
2,164
Victoria
1,477
666
2,140
Queensland
1,504
968
2,477
South Australia
471
272
739
Western Australia
643
371
1,003
Tasmania
154
149
302
Northern Territory
126
69
192
Australian Capital Territory
65
96
161
Australia(b)
5,403
3,067
8,455

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The following figures show the distribution of OTDs across states and territories and by remoteness (Figure 5.1 to 5.4). These figures highlight the variation between jurisdictions in the overall and relative numbers of overseas trained doctors, as well as where they are working.

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 general practitioners and three-fifths of overseas trained specialists worked in Major cities (Figure 5.1), where just over two-thirds of the population reside. Almost one-third of both overseas trained general practitioners and specialists worked in Inner regional areas (Figure 5.2), where one-fifth of the population resides.

Queensland has relatively high numbers of overseas trained doctors across all Remoteness Areas, while Western Australia stands out for the relatively higher numbers in Remote and Very remote areas.

Figure 5.1: Overseas trained doctors in Major cities by state/territory, 2012

Figure 5.1: Overseas trained doctors in Major cities by state/territory, 2012 D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2012

Figure 5.2: Overseas trained doctors in Inner regional areas by state/territory, 2012

Figure 5.2: Overseas trained doctors in Inner regional areas by state/territory, 2012 D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2012

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Figure 5.3: Overseas trained doctors in Outer regional areas by state/territory, 2012

Figure 5.3: Overseas trained doctors in Outer regional areas by state/territory, 2012 D

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2012

Figure 5.4: Overseas trained doctors in Remote and Very remote areas by state/territory(a), 2012

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

(a) Data for Remote, Very Remote and Migratory classes have been combined.

Source: Medicare data, Australian Government Department of Health and Ageing administrative data, 2012