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GP VMO Coonamble:

I genuinely love the medical work in Coonamble ... more

Dr Andrew Warnock (NZ GP)

 

Overseas Trained Doctors

It’s an exciting thought about coming to work in Australia but as an Overseas Trained Doctor there are a number of things that need to be considered before taking the plunge.

 Below are some frequently asked questions to help you understand the Australian Medical System.

Ochre Recruitment will assist suitable overseas applicants with Medical Board Registration, Immigration, relocation, and all the other ‘red tape’ associated with commencing employment in Australia as a Medical Practitioner.

Overseas Trained Doctors Frequently Asked Questions

1. What is Medicare?
2. What is a Provider Number?
3. How do I get registered as a Medical Practitioner?
4. What is Area of Need?
5. What is District of Workforce Shortage?
6. What is the Medicare 10 Year Moratorium?
7. What is the Five Year Plan for Overseas Trained Doctors?
8. How do I become a Fellow of the Royal Australian College of General Practice (FRACGP)?
9. What is Medical Indemnity and what do I need?
10. What are the types of Immigration Visas available for OTDs?
11. What needs to happen before I can get Permanent Residence in Australia?
12. What are the English Language requirements?
13. What do I need to get credentialed as a Visiting Medical Officer?
14. How does tax work in Australia?

What is Medicare?

Medicare was introduced in Australia in 1984 as a Federal Government administered Health Insurance. It aims to provide high quality healthcare, which is affordable and accessible to all Australians. Medicare includes free or subsidised treatment from Medical Practitioners as well as some services from Allied Health and Dental Practitioners. It also provides subsidies for prescribed medicines (with a safety net providing free medicines for the chronically ill).

Medicare benefits are paid based on a comprehensive list of services and corresponding benefits which is the Medicare Benefit Schedule (MBS). If the Medical Practitioner provides an eligible service such as a consultation at the MBS recommended fee the patient pays no fee at the point of care and this is often referred to as Bulk Billing. If the Medical Practitioner provides a service and elects to charge more than the MBS recommended fee the patient pays the higher fee and then claims back the MBS fee from Medicare.

Some services under Medicare and at Public Hospitals have long waiting lists and for this and other reasons many Australians have Private Medical Insurance as well as being able to access the benefits of Medicare.

What is a Provider Number?

To work as a Medical Practitioner in private practice in Australia, you must have a Medicare Provider Number. Provider numbers are location specific so you will need one for each location in which you practice. There are different levels of Medicare access under the provider number scheme depending on Medical Board Registration and satisfying the legislative requirements on accessing Medicare rebates.
 
A Medicare Provider Number may allow a doctor to:

1. Raise referrals for specialist services; and
2. Make requests for pathology or Diagnostic Imaging services.

Where the doctor satisfies the legislative requirements, their Provider number may also be used to:

3. Attract Medicare rebates for professional services rendered (that is, treat private patients).

Overseas Trained Doctors (OTDs) are subject to Medicare Provider number restrictions if they require the third type of Medicare Provider number listed above (see the section on the Medicare 10 year moratorium).

These Medicare Provider number restrictions affect where an OTD can work in Australia and are determined by both residency status and when the OTD first registered in Australia. Medicare Provider numbers are issued by Medicare Australia, formerly known as the Health Insurance Commission (HIC), after an OTD has been offered a job and has obtained the relevant Medical Board registration.  

 How do I get registration as a Medical Practitioner?

Due to complex registration requirements some Overseas Trained Doctors (OTDs) may not be suitable for the type of placements we do or they may not be able to work as locums in Australia. If you hold any of the following you are eligible for admission to Fellowship of the Australian College of General Practitioner ad eundum gradum and thus are eligible for Medical Board registration as a specialist to work in Australia in a General Practice setting:

The most common way other OTDs can work in Australia is by working in an Area of Need position. Area of Need registration is location specific and the doctor needs new registration if they wish to change jobs. This makes short term locums difficult for doctors who need this type of registration. Ochre Recruitment will assess the suitability of doctors to gain employment in Australia via this pathway on an individual basis.

Each state in Australia has its own Medical Board and you need to be registered with each State Board that you intend to work in. Medical Practitioners who have never been registered in Australia will need to go in person to the relevant State Medical Board to get registration. There will be a number of documents that the Medical Boards require which differs a little from State to State. In all states you will need to:

What is Area of Need?

An Area of Need (AON) position is any position that cannot be filled by a doctor fully registered in Australia after recruitment efforts have taken place over a period of time. For the most part capital cities and coastal areas are not deemed to be Area of Need. Area of Need positions are location specific (to a town and Medical Practice and/or Hospital) and the condition of the doctors registration is that they can work in that town only and they must be supervised by a fully registered Practitioner who sends regular supervision reports to the relevant State Medical Board.

To get registration in Australia Overseas Trained Doctors (OTDs) can apply to work in a position of Area of Need. However if they have qualifications recognised as equivalent to Fellowship of the relevant specialists college such as the Royal Australian College of General Practitioners (FRACGP) they can apply for full registration (see section of FRACGP).

It should be noted that unlike the Districts of Workforce Shortage (see section on DWS), which are determined by the Australian Federal Government, Areas of Need are determined by the State and Territory Governments and methods of defining them vary. An employer must apply to the Department of Health in their State or Territory to have their vacancy Area of Need approved.  

Our Recruitment Consultants can advise you as to which towns and regions in Australia have been approved as Area of Need.

What is District of Workforce Shortage?

By restricting the Medicare Provider numbers issued to OTDs to Districts of Workforce Shortage, the Australian Government aims to achieve an equitable distribution of medical services across Australia. An exemption from the Medicare Provider number restrictions may be granted if the doctor agrees to work in a location that has been identified as a DWS. Possessing this exemption enables a doctor to be granted a Medicare Provider number and the Medical services provided will then result in payments from Medicare.

In general, capital cities and coastal areas are not District of Workforce Shortage and if you are an OTD you should check with one of our Recruitment Consultants as to what regions and towns in Australia are DWS.  
 
What is the Medicare 10 Year Moratorium?

If you are an Overseas Trained Doctor, or a former overseas Medical Student, and were not registered as a Medical Practitioner in Australia, or had not applied to sit the AMC exams on or before 1/1/97 you may be subject to a 10 year Moratorium on Provider numbers.

This means that you, and your patients, are not able to access Medicare benefits for ten years from when you were first recognised as a Medical Practitioner in Australia (if you were registered between 1/1/97 and 18/10/01) or from when Permanent Residency was granted. Effectively this Moratorium means that Overseas Trained Doctors arriving after 1/01/97 will be required to work in a town or region that has been approved as District of Workforce Shortage. 

Exemptions are granted by the Commonwealth Department of Health and Ageing to doctors working in Districts of Workforce Shortage.

This exemption is called a 19AB exemption. Overseas Trained Doctors may be eligible for a reduction in the 10 Year Moratorium under the Five Year Program for Overseas Trained Doctors which is run in each State. This reduction can decrease the Moratorium from 10 years to 5 years or in some cases as low as 3 years. Once full registration has been achieved and the required time has been worked in a District of Workforce Shortage the Medical Practitioner will be eligible for an unrestricted provider number and can access Medicare payments in all parts of Australia.

 What is the Five Year Plan for Overseas Trained Doctors?

This plan is administered by the States and there are some variations from State to State. This plan can reduce the 10 Year Moratorium for getting an unrestricted Medicare Provider number from ten years down to five or even three years. However the OTD must be able to sit the RACGP Fellowship exam usually within 2 years of registering for the Five Year Plan. This may mean the OTD needs to do two years of recognised General Practice in Australia or two years recognised by the RACGP that have been completed overseas.

How do I become a Fellow of the Royal Australian College of General Practice (FRACGP)?

Doctors who hold the qualifications below are eligible for admission to Fellowship of the RACGP ad eundum gradum. This can be obtained prior to arriving in Australia and requires no further training or exam.

All other OTDs who do not have the qualifications listed above must sit the RACGP examination. The eligibility criteria for sitting the RACGP examination includes having a minimum of 4 years approved full-time General Practice experience or part-time equivalent of which at least 1 year full-time General Practice experience must be gained in Australian General Practice.  The Medical Practitioner needs to apply to the RACGP to have their General Practice experience recognised by the College.

Once the doctor has passed the RACGP exam and has 5 years of General Practitioner experience they will be granted the FRACGP. This allows the Medical Practitioner to gain full registration and supervision will no longer be required. Achievement of FRACGP also means the Medical Practitioner can apply for Permanent Residence. 

 What is Medical Indemnity and what do I need?

Medical Indemnity cover is the insurance Medical Practitioners purchase annually to cover themselves for claims made by patients against them for medical negligence or for assistance if doctors are involved in investigations such as Coronial Inquiries. All doctors including OTDs employed in a public hospital will be Government indemnified and will not need to take out their own private cover.

This is normally arranged prior to the doctor starting and will involve the doctor completing a Service and Liability Contract for the period of the position. This is usually the case also if you are a rural Visiting Medical Officer (VMO). VMOs differ from employed doctors as they work for fee for service rather than an hourly rate. If you are seeing patients privately in your own rooms you will need to have your own annual Medical Indemnity Cover from a government approved Medical Indemnity insurer.

Overseas Medical Indemnity policies will not provide Medical Indemnity cover for you in Australia and you will need to arrange Australian based cover for your time in Australia. If you are applying for Medical Board registration that includes seeing private patients you will need to show them proof of your Indemnity Insurance prior to being granted your Medical Board registration.
 
Australian Medical Insurers now only offer Medical Indemnity on a “claims made” basis – which means that the Medical Practitioner must be insured when an incident occurs and when the patient makes a claim. There may be years delay between when an incident occurs and when a claim is made.

To be covered when the claim is made requires that you maintain your Medical Indemnity policy continuously or that you pay for “extended reporting benefits” (Also called tail cover or run off cover) when you cease paying for your policy. Ask us to explain how to organise your Medical Indemnity Insurance.

What are the types of Immigration Visas available for OTDs?

OTDs once they have gained their Medical Board registration will then need to apply for a visa that allows them to commence work in Australia. It should be noted that this does not apply to New Zealand Citizens who are considered Temporary Resident Doctors indefinitely and do not need to apply for a visa. Other Overseas Trained Doctors can enter Australia to work on either a temporary or permanent visa.
 
In many cases, the most streamlined pathway for Overseas Trained Doctors seeking Permanent Residency in Australia is to initially be employed and sponsored as a Temporary Resident while meeting the requirements to obtain full Medical Registration. Doctors are not eligible for Permanent Residency in Australia until they hold full registration. 
 
The two temporary visa options open to OTDs are: 

Temporary Business (Long Stay) visa (subclass 457)  
The Temporary Business (Long Stay) visa is the preferred Temporary Visa pathway for doctors entering Australia, as it allows applicants to take advantage of streamlined processing arrangements which include the ability to lodge applications over the internet using a special online application form. This type of visa can be valid for 3 months to 4 years. The visa is done online and in three parts as below:

  1. Sponsorship - Employer applies to be a sponsor
  2. Nomination - Employer nominates a position
  3. Visa Application - Employee applies for a visa 

Medical Practitioner visa (subclass 422)

Doctors should generally apply for a Temporary Business (Long Stay) visa (subclass 457) but this visa is an alternative visa for doctors registered to work in Australia. Employers must lodge a separate Sponsorship Application for each doctor sponsored.

In limited situations, such as where a rural community or local council is seeking to sponsor a doctor, this visa will be the most appropriate. It can also be used where the doctor is a contractor and not an employee. It is reasonably common in Australia for Medical Practitioners to work as contractors.
 
Information about visas and Immigration issues can be found on the Department of Immigration and Multicultural and Indigenous Affairs website.

What needs to happen before I can get Permanent Residence in Australia?

A Medical Practitioner can only apply for Permanent Residency once full Medical Registration is held (see section on Fellowship of FRACGP). The Medical Practitioner may then choose to apply for Permanent Residence under one of the following Employer-sponsored or Independent Visas.

What are the English Language requirements?

Many International Medical graduates come from a non-English speaking background and their level of English competency varies greatly.  Through national agreement, all the State and Territory Registration Boards have implemented a consistent English Language Proficiency Policy.  Applicants need to submit evidence to the relevant Registration Authority of competency in speaking and communicating in English as demonstrated by having completed the IELTS examination (Academic Module) and achieved a minimum score of 7 in each of the four components.

Alternative English proficiency tests that will be accepted are:

a)  Completed and obtained an overall pass in the Occupational English Test (OET) administered by the Centre for Adult Education with grades A or B only in each of the four components; or
b)  A pass in the English language component of the United States Medical Licensing Examination (USMLE – previously ECFMG) but not the TOEFL component of the current USMLE examination; or
c)  A pass in the Professional Linguistic Assessment Board (PLAB) examination in the United Kingdom; or
d)  A pass in the English language proficiency component of the New Zealand Registration Examination (NZREX) 
Results must have been obtained within 2 years prior to applying for registration.

An IELTS (or approved equivalent) Test Report Form more than two years old will be accepted as evidence of present level of ability if accompanied by proof that a candidate has actively maintained employment as a Medical Practitioner in a country where English is the native or first language.

An exemption may apply when the applicant can:

Why do I need to get credentialed as a Visiting Medical Officer?

A Visiting Medical Officer or VMO is a hospital appointment by which a Medical Practitioner manages patients at a hospital on a fee for service arrangement. There is no requirement for them to be on site at the hospital unless there is a clinical need or a patient that needs to be assessed has presented.

The Medical Practitioner is therefore on-call and gets called to the hospital either by nursing staff or junior medical staff. To be credentialed as a VMO you will need to present the following documentation and undergo an interview. For short term locums an interview is not required. The documentation is as follows:

If your qualifications are not recognised in Australia it is common to do a supervised clinical attachment in an Australian teaching hospital to have your skills assessed. The supervisor will make an assessment and this assessment can be tendered to the credentialing committee.

How does tax work in Australia?

In general all Medical work done in Australia is taxed in Australia and as such an Overseas Trained Doctor must comply with Australian taxation law. We are not in a position to give taxation advice but would recommend that you look at the Australian Taxation Office (ATO) website at www.ato.gov.au.

If you are working as an employee in Australia you will be required to get a Tax File Number. Employees have their tax deducted prior to being paid. Contractors get paid the whole amount but then must arrange payment of tax to the ATO. If you are a doctor working as a contractor you will need to get an Australian Business Number (ABN) and you may need to become registered for Goods and Services Tax (GST). Please see our link to the Australian Taxation Office on how to apply for a Tax File Number, an ABN and be registered for GST.

If you are a contractor failure to get an ABN may result in the entity you are contracting to deducting tax from your contract payments at the top marginal rate.