Medical Training Review Panel: sixteenth report
Approved Medical Deputising Services Program
The 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 allows 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 Program
The 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 Program
The Approved Placements for Sports Physicians Program (APSPP) was introduced in April 2004. At the time, sports medicine was not recognised as a medical specialty.
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 were 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 were then able to access attendance items from Group A2 of the Medicare Benefits Schedule, as well as from relevant procedural items, for the nominated period of the placement.
‘Sports and exercise medicine’ was recognised as a specialty under the Act in November 2009. Recently the Approved Placements for Sports Physicians Program has been discontinued as all sports medicine physicians are now recognised specialists and can access the relevant Medicare item numbers without requiring a 3GA program.
Sports Physician Trainees
Practitioners in this program are eligible to be registered under section 3GA of the Act as an 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.
Prevocational General Practice Placements Program
The Prevocational General Practice Placements Program (PGPPP) encourages junior doctors at all levels to take up general practice as a career and enhances their understanding of the integration between primary and secondary care.
Placements are available in all locations, however there is a requirement that 50% of placements occur in rural and remote areas classified using the Australian Standard Geographic Classification – Remoteness Area (ASGC-RA) index as Remoteness Areas (RA) 2 to 5. Placements are generally for a period of 12 weeks.
General practice placements in this program commenced in January 2005. The number of completed supervised placements has increased each year from 111 in 2005–06, 173 in 2006–07, 248 in 2007–08 and then to 338 in 2008–09. After 2008–09, data on the number of completed supervised general practice placements was collected on a calendar year basis. In 2009, there were 353 placements. A total of 400 completed the 12-week placements in 2010.
On the 15 March 2010, the Government announced that it will more than double the number of placements from 380 in 2010, to 910 in 2011, and to 975 placements in 2012 onwards. For the 2011 training year, there were 686 placements filled from the 910 placements available. This shortfall was due predominantly to the significant growth in the number of placements (from 380 up to 910) and a requirement that 85% of placements were to be in rural areas. The rural requirement has now been reduced to 50% of placements to align with the rural quota for the AGPTP and will apply from 2012.
Queensland Country Relieving Doctors Program
The Queensland Country Relieving Doctors (QCRD) Program 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. The exceptions however, where a hospital based position attracts Medicare benefits a 3GA letter is still required. 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 QCRD program enables medical practitioners to provide services that attract Medicare benefits.
The QCRD program currently provides relief to over 100 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 QCRD program contributes towards maintaining a medical service to rural and remote communities in the absence of the community’s permanent doctor.
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 Health Workforce Australia through the 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 RWAs 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 within a District of Workforce Shortages (DWS).
Locations eligible to receive approved placements through the program are:
- rural and remote areas, (RRMAs 3-7);
- Areas of Consideration, as determined by the Australian Government Minister for Health and Ageing; and
- all Aboriginal medical services, including those in RRMA 1 and 2 locations.
Doctors who are registered to practise in a particular state or territory and have been assessed as having suitable experience and skills to practise in the particular location may fill these placements.
Special Approved Placements Program
The Special Approved Placements Program 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 Program
The 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 Medicare benefits. 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.
Remote Vocational Training Scheme
The Remote Vocational Training Scheme (RVTS) was introduced in 1999 to address health service needs in Australia’s remote communities. The Scheme allows registrars to remain in one location for the period of their training, supported by distance education and remote supervision. The RVTS provides an alternative route to vocational recognition for remote practitioners who are in solo doctor towns or where there departure would otherwise have a detrimental impact on the local community. RVTS registrars are eligible to sit for Fellowship of the RACGP and/or the ACRRM.
Up until 28 February 2007, the RVTS was a 3GA program under the auspices of the RACGP. Since 1 March 2007, legislative changes and the incorporation of the Remote Vocational Training Scheme Limited have enabled the RVTS to be recognised as a 3GA program in its own right.
The Government announced an increase in the annual intake of RVTS registrars from 15 to 22, which commenced from 2011. Since the inception of the pilot program in 1999, 64 registrars have completed the RVTS. As at July 2012, 69 registrars are training on the RVTS.