Temporary Resident Doctors (TRDs)
TRDs usually enter Australia to work in medical positions designated as being ‘area of need’ by the relevant State or Territory health authority. Alternatively, they may enter as occupational trainees to undertake clinical specialist training.
TRDs are generally granted conditional registration in Australia. These doctors are also subject to supervision by an appropriately qualified Australian medical practitioner. Currently there is no formal assessment of the level of theoretical and clinical skills expected of TRDs.
TRDs cannot access Medicare rebates unless the Minister for Health and Ageing or a delegate of the Minister makes a determination under section 19AB of the Act specifically recognising the doctor for that purpose. This determination does not affect the ability of these doctors to prescribe pharmaceuticals, order diagnostic tests and refer patients to another medical practitioner.
Exemptions under section 19AB of the Act are generally only granted if overseas-trained doctors commit to work in a district of workforce shortage. A district of workforce shortage can effectively be categorised as one in which the community is considered to have less access to medical professional services than that experienced by the population in general either because of the remote nature of the community or because of lack of supply of services or a combination of the two factors.
In making decisions to grant exemptions, the delegate will consider a range of factors. These include Medicare data, available workforce data and evidence of unsuccessful attempts to recruit an Australian medical practitioner to positions. The delegate will also liaise with relevant State or Territory health authorities regarding the ‘area of need’ classification of positions.
Exemptions granted under section 19AB of the Act are time and location specific and are dependent upon compliance by TRDs with employment arrangements, medical registration requirements and visa restrictions.
The Commonwealth Government has responsibility for ensuring that growth, distribution and standards of the medical workforce are appropriate to the needs of the Australian community. There is nationally an oversupply of general practitioners (GPs) in metropolitan areas and a shortage in rural areas. There is also a shortage of specialists in many rural areas, and some specialties are also in undersupply in the public hospital system in metropolitan areas.
Overseas-trained doctors (OTDs) or former overseas medical students (that is, persons who were not Australian citizens or permanent residents when they commenced study for their medical degree in Australia) can come to Australia on either a temporary basis (temporary resident doctors) or as permanent residents. Rules regarding medical registration of overseas-trained doctors differ depending on the immigration status of the doctors and the requirements of the State or Territory in which they intend to practise.
Changes to Commonwealth legislation have severed the automatic link between medical registration and access to Medicare rebates for overseas-trained doctors and new Australian graduates. However, all doctors with Australian medical registration can obtain a provider number from the Health Insurance Commission that enables them to prescribe pharmaceuticals, order diagnostic tests and refer patients to other doctors.
Overseas-trained doctors wanting to work in private practice, either as general practitioners or specialists, require exemptions from restrictions in the Health Insurance Act 1973 (the Act) to obtain Medicare provider numbers which enable them to provide services which attract Medicare benefits.
Doctors who intend to migrate to Australia as Permanent Residents
The Government has not included medical practitioners on the “skilled occupations” list for the Skilled-Independent and Skilled-Australian Sponsored visa categories (the points tested categories). To be eligible for a visa under these categories applicants must have both recognised skills and recent work experience in an occupation on the list. Doctors are unable to meet this requirement and cannot be granted a visa under the points tested categories.
The Employer Nomination Scheme (ENS) and the Regional Sponsored Migration Scheme (RSMS) are designed to enable Australian employers to recruit highly skilled workers from overseas, if they are unable to fill vacancies locally.
OTDs can apply either on or offshore under these schemes. Nominations for permanent appointment by Australian employers must be lodged at a Department of Immigration and Multicultural Affairs (DIMA) Business Centre. Applicants must provide evidence that positions have been fully labour market tested or that the relevant State and Territory Health Department has advised that skills applicable to positions are not available in Australia (that is, that positions have been given area of need status).
Permanent residents and Australian citizens
In order for overseas-trained doctors or former overseas medical students who are permanent residents or Australian citizens to practice long term in Australia, their qualifications must be assessed as acceptable by the Australian Medical Council (AMC). OTDs without recognisable specialist or general practice qualifications are required to sit and pass a multiple choice question examination and a clinical examination and complete a period of supervised medical practice under the direction of a State Medical Board. The period of unsupervised work is normally 12 months, but as State registration requirements vary, there may be some disparity in supervision requirements.
Overseas-trained specialists who meet basic eligibility criteria are able to apply through the AMC for assessment of specialist skills by a relevant Specialist Medical College in Australia. Training and experience of applicants is assessed against the training and examination programs of the relevant College and the standard required for admission to Fellowship of that College.
When overseas-trained specialists are assessed as competent to practise in Australia as specialists, they are granted formal recognition and their eligibility to apply for registration with conditions (registration limited to the designated field of specialty) in any State or Territory is confirmed with the Medical Registration Boards by the AMC.
In some States and Territories, overseas-trained general practitioners can seek recognition from the Royal Australian College of General Practitioners (RACGP) that their overseas qualifications or experience meet the standard required for award of Fellowship as an alternative to undertaking the AMC examination. General practitioners assessed through this process are able to obtain registration with conditions (registration limited to the field of general practice).
The AMC contact details are as follows:
Australian Medical Council
PO Box 4810
KINGSTON ACT 2604
Ph (64) (02) 6270 9777
Fax (64) (02) 6270 9799
New Zealand Doctors
Doctors with primary medical qualifications obtained in New Zealand are automatically granted general registration in Australia and are not required to undergo the AMC assessment, as NZ medical schools are accredited by the AMC.
While most New Zealand postgraduate qualifications are recognised in Australia, doctors with these qualifications are advised to seek confirmation from the AMC.
It is important to note that New Zealand citizens are able to enter and remain in Australia on a special form of temporary visa. For the purposes of the Act, New Zealand doctors are considered temporary resident doctors who usually require exemptions under section 19AB of the Act (see above) to provide services which would attract a Medicare benefit.
If New Zealand doctors obtain Australian citizenship, and their primary medical qualifications are from medical schools outside Australia, they are considered overseas-trained doctors (OTDs) for the purpose of access to Medicare benefits (see below).
Provider Number Restrictions
Australian medical graduates and OTDs who are permanent residents or Australian citizens are required under section 19AA of the Act to obtain recognised postgraduate medical qualifications before they can provide services that attract a Medicare rebate.
In addition, OTDs who were first recognised as medical practitioners under the Act on or after 1 January 1997 are ineligible to provide services that attract Medicare benefits for a period of 10 years (under section 19AB of the Act). Exemptions to section 19AB can be granted to OTDs working in districts of workforce shortage.
All doctors who are registered with an Australian Medical Registration Board and who wish to practise medicine in Australia, should apply to the HIC for provider numbers. There are different categories of provider numbers, some of which are issued to allow doctors to refer patients to private specialists or consultant physicians, and to request diagnostic imaging services and pathology services. Other provider numbers allow access to Medicare benefits.
Rural Locum Relief Program (RLRP)
The Rural Locum Relief Program, administered by the Rural Workforce Agencies in each State and Territory, allows permanent resident doctors who are not otherwise eligible to attract Medicare benefits to work in rural general practice under supervision.
The Department of Health and Ageing is not involved in the recruitment of overseas-trained doctors. Any doctors interested in working in Australia should consult the positions vacant sections in medical journals and newspapers, contact recruitment organisations or write to the Health Department in the State or Territory in which they are interested in working. .
Also check out the following links:
-RxPG FAQ Section on Australia