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Doctors in No Man’s Land

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The AMA has consistently argued that non-Vocationally Registered (VR) GPs should be recognised for their considerable experience in both general practice and other areas of medicine, and continues to opportunistically press the case for a final round of grandfathering, a lifting of the A2 rebate, and its ongoing indexation.

As a member of the General Practice Recognition Eligibility Committee (GPREC), I am constantly reminded of the plight of those GPs who missed out being grandfathered to the Vocational Register.

In many ways, these GPs are in no man’s land. 

Non-VR GPs or Other Medical Practitioners (as they are referred to in the Medicare Benefits Schedule) are eligible only to claim A2 Professional Attendance MBS items, unless they are participating in one of the Government’s workforce programs under which they can access A1 rebates.

These are programs such as the Rural Other Medical Practitioners (ROMPs) Program, the MedicarePlus or Other Medical Practitioners (MOMPs) Program, the After Hours Other Medical Practitioners (AHOMPs) Program, the Outer Metropolitan Other Medical Practitioners (OMOMPs) Program or the Temporary Resident Other Medical Practitioners (TROMPs) Program.

From the outset, the Vocational Register effectively created two classes of GPs.

The A2 rebates were initially set at 93 per cent of the A1 rebates, and have remained frozen in time – they have never been eligible for annual indexation, meaning they have been steadily declining in value against the A1 rebate.

The low rebates not only affect non-VR GPs. Their patients get a lower rebate, and potentially face higher out of pocket expenses.

It is hard to find employment. Check the GP wanted advertisements – most want VR GPs.

If they sub-specialise in order to keep their practice viable, this can affect eligibility for recognition under alternate pathways to Fellowship of the RACGP. 

There are varying reasons why some medical practitioners did not make the VR.

The hardest luck cases are those who had been issued ‘certificates of eligibility’ before 1996, which would enable them to be placed on the Vocational Register once they were predominantly in general practice.

However, a change in legislation in 1996 rendered these certificates not worth the paper they were written on.

Those who were overseas furthering their education, or doing humanitarian work, or off work while they cared for sick family members or having their children, were caught out by the legislative changes – potentially excluded forever from the Vocational Register.

GPREC was established to assess the eligibility of a number of medical practitioners who had applied for inclusion on the Vocational Register.

Those not assessed as eligible have the right of appeal, with appeals being considered by the General Practice Recognition Appeal Committee (GPRAC).

Once all the outstanding applications and appeals have been assessed and finalised, the legislative amendment effectively removing the provisions for the Vocational Register will then be proclaimed, and it will cease to exist.

Other than through special workforce programs, non-Vocationally Registered GPs can only access A1 rebates by becoming a Fellow of the RACGP or the Australian College of Rural and Remote Medicine.

Those already in general practice can have their education and experience assessed and recognised via the General Practice Experience (Practice Eligible) Pathway. They can either sit the College exam once assessed as eligible, or go through a Practice Based Assessment.

We need to continue our vigilance to ensure that new inclusions to the Vocational Register are also granted, upon application to the Medical Board, recognition in the specialty of general practice.

We do not want to see another situation where eligible GPs are left stranded in no man’s land.