20 November 2020

Four ways to fix falling GP training numbers

ACRRM General practice RACGP TheHill

Fixed salaries and portable entitlements are among options proposed by health officials.

Four reforms including the salarying of registrars have been proposed as options for fixing under-enrolment in Australian general practice training.

For a meeting held early this month, the Health Department’s General Practice Training Advisory Committee produced a draft discussion paper that sets out the growing shortfall in training positions filled and the financial reasons why general practice is failing to attract as many graduates.

One proposal is that salaries be paid via either registrars’ college, practice or training organisation. The others are to comprehensively review the National Terms and Conditions for Employment of Registrars, introduce portability of entitlements, or allow registrars to bill Medicare while also being employees of their state or region.

A remuneration gap and loss of entitlements when switching between state-funded hospitals and federally funded general practice positions are the chief reasons why a move towards a “single-employer model” has been advocated in recent years.

“It is believed that such a model would improve the attractiveness of General Practice as a career pathway by bringing remuneration and entitlement arrangements more in line with hospital-based Registrars,” the paper says.

“It is argued that the potential loss of income when transitioning from hospital-based employment to a private general practice for training purposes, coupled with low remuneration, have been potential contributors to reduced interest in GP training.”

The paper notes the contrast between hospital doctors paid under state public service awards, who have been receiving an average 3% annual pay increase, and GP registrars’ 1.6% average annual rise.

GP registrars’ income has been constrained, the paper says, by factors including the need for “acculturation to general practice” and “high levels of direct supervision and in-practice teaching”.

The discussion paper graphs the widening gap between first-year GP registrars’ and at-level hospital doctors’ salaries since January 2015: a $5400 difference that blew out to over $14,000 in just five years.

It also notes that when GP registrars leave the hospital system, they lose all their entitlements earned under the state award.

“While most specialist training occurs in a hospital setting, [GP registrars] are employees in a small business setting. GP Registrars are required to undertake multiple training rotations as part of their training resulting in being employed by multiple employers throughout their training. When a Registrar transitions … to a general practice employment arrangement, all salary and other entitlements previously accrued under their previous hospital employment, are relinquished.”

The four “reform opportunities” it sets out are:

  1. A comprehensive review of the NTCER, the agreement between the registrar and supervisor bodies that sets out the minimum terms and conditions for employment, last reviewed in 2017-18;
  2. Salarying of registrars, which would give GPs a soft landing rather than push them straight into the MBS, allow remuneration to match hospital doctors’ and remove risk for practices and supervisors;
  3. An exemption for GP training like that being trialled in the Murrumbidgee region, in which registrars are employed by the state or local government but be able to access Medicare, which would compensate employers for their salary, and keep accruing their entitlements;
  4. A nationally portable entitlements scheme.

Under option 2, it says, “block funding could essentially be provided through a fundholding arrangement (potentially to the practice, training organisation or College) for salary and oncosts”.

UPDATE: RACGP acting censor-in-chief Dr Tess van Duuren told TMR on Monday: “The RACGP is not considering becoming the employer of GP registrars but is supportive of exploring opportunities for reform of trainee employment arrangements. Our priority is to ensure the highest quality of GP training.”

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3 Comments on "Four ways to fix falling GP training numbers"

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1 year 8 months ago
Hundreds of IMG’s with previous Australian rural General Practice for some years under supervision but limited registration was not renewed in 2017 due not taking RACGP fellowship exam or failing to pass the AMC clinical exam, wishing to work again as GP under supervision to continue their years of experience still possible? Does the medical board of Australia allow these previous IMG GP’s allowed to apply again for limited registration to fill up some of rural GP vacancy in need or can work in their previous employer medical centre. Some issues discouraging these IMG’s are costing of PESCI exams if… Read more »
Matthew Thuy
Matthew Thuy
1 year 8 months ago
1. Financial remuneration of GP registrars The NTCER currently is written as a minimum hourly rate or percentage based on billing, whichever is higher. This paper is unclear to me. Is it suggesting removing the percentage based component of the NTCER? Removing the percentage based component of the NTCER substantially disadvantages GP registrars who do a lot of work. Increasing the minimum hourly rate for GP registrars on the NTCER could attract more GP registrars to enter training but removing the percentage based component of the NTCER is disadvantageous for these GP registrars who generate significant billing. This could drive… Read more »
Glenn Rosendahl
Glenn Rosendahl
1 year 8 months ago
There is a fifth reform that is absolutely critical. The primary problem is the inadequate income that GPs’ get for doing ordinary GP work. The total bulk-billed payment (this includes all business costs for the clinic, as well as GP income, tax and superannuation) is less than $40 for up to 20 minutes work, and essentially $70 for 20 to 40 minutes work. Why work your butt off as a medical student, then accept residents’ and registrars’ pay – and learn to perform at the level of expertise the RACGP expects of you to get your Fellowship – to then… Read more »