1. Introduction Rural & Urban Divisions – RDN Recruitment Workshop
David Dennis
Assistant Secretary
Workforce Distribution Branch
Mental Health and Workforce Division
Department of Health and Ageing
Thank you for inviting me here today to give a brief presentation on section 19AB and the in’s and out’s on district of workforce shortage
My name is David Dennis and I am Assistant Secretary of the Workforce Distribution Branch.
My responsibilities include:

2. Topics
the operations of section 19AB of the Health Insurance Act 1973 (the Act)
districts of workforce shortage
preliminary assessments of district of workforce shortage
ten year moratorium
I am aware that many of you are quite familiar with the operation of section 19AB of the Health Insurance Act as it relates to overseas trained doctors.
My presentation today is a snapshot of:
the operations of both section 19AB of the Act
districts of workforce shortage; and
some current issues such as preliminary assessments of district of workforce shortage and the ten year moratorium.

3. Section 19AB original purpose
originally intended to address a perceived oversupply of doctors in metropolitan Australia by directing doctors to rural communities where they were most needed
The legislation was originally intended to address a perceived oversupply of doctors in metropolitan Australia by directing OTDs to rural communities where doctors were most needed.

4. Section 19AB current situation
since 2003 OTDs able to practice in capital city outer metropolitan areas
at present about 3,500 overseas trained GPs and specialists accessing Medicare
vast majority of GP OTDs practising in rural and remote areas, RRMA 2 locations and the outer metropolitan areas of capital cities
At present about 3,500 overseas trained general practitioners (GPs) and specialists are accessing these Medicare benefits arrangements. The vast majority of these doctors (OTDs) are practising in rural and remote areas, major population centres (RRMA 2) and the outer metropolitan areas of capital cities.

5. Section 19AB Guidelines
the decision making processes for section 19AB exemptions are contained in the ‘Section 19AB Guidelines’
these Guidelines were introduced in 2001
the primary consideration on which section 19AB exemption decisions are based is that applicants must work in a district of workforce shortage
The decision making processes for section 19AB exemptions are contained in the ‘Section 19AB Guidelines’ (Guidelines) as allowed for under S19AB (4A) of the Health Insurance Act The guidelines are on the Department’s website.
These Guidelines were introduced in 2001 and enable delegates of the Minister to consider and make decisions in relation to applications for S19AB exemptions.
The primary consideration on which S19AB exemption decisions are based is that applicants must work in a district of workforce shortage. The delegates however, have wide discretion and may consider such factors as socio-economic needs of the proposed locality and local special needs.

6. Determination of DWS
a district of workforce shortage is a geographic area in which the general population need for health care is not met
population needs for health care will be unmet if a district has significantly less access to medical professional services of the type provided by applicants than the national average

7. Determination of DWS
a population to full-time equivalent (FTE) general practitioner ratio is used to define districts of workforce shortage
In determining districts of workforce shortage, the section 19AB Delegates within the Department primarily utilise a population to full time equivalent GP ratio.
The ratio utilises population figures at the Statistical Local Area (SLA) level from the latest published Population data released by the Australian Bureau of Statistics (ABS).
FTE takes account of Medicare billing in the area irrespective of whether or not local doctors are working in a part time or a full time capacity.

8. Determination of DWS
In determining districts of workforce shortage, the Delegates may also consider:
specific information sought from rural workforce agencies, divisions of general practice, State health authorities;
other Medicare data and relevant health workforce data;
In determining whether a district of workforce shortage exists, Delegates may also consider other factors in conjunction with the doctor to population ratio:
specific information sought from rural workforce agencies, divisions of general practice, State health authorities;
other Medicare data and relevant health workforce data;
number of GPs in an area including skills;
RRMA classification (blanket exemptions for RRMAs 6 and 7);
geographic determinants (eg isolation by water);
after hours (any area);
local circumstances and/or special needs eg low socio-economic profile of community, Indigenous patients, residential aged care facilities, refugees.
Delegates usually do not consider the ‘business’ needs of medical practices in reaching a decision eg appointment books closed, GPs retiring, aged profile of GPs in practice, requirement for female GP.

9. number of GPs in an area including skills
RRMA classification (blanket exemptions for RRMAs 6 and 7)
geographic determinants (eg isolation by water)
after hours
local circumstances and/or special needs
In determining whether a district of workforce shortage exists, Delegates may also consider other factors in conjunction with the doctor to population ratio:
specific information sought from rural workforce agencies, divisions of general practice, State health authorities;
other Medicare data and relevant health workforce data;
number of GPs in an area including skills;
RRMA classification (blanket exemptions for RRMAs 6 and 7);
geographic determinants (eg isolation by water);
after hours (any area);
local circumstances and/or special needs eg low socio-economic profile of community, Indigenous patients, residential aged care facilities, refugees.
Delegates usually do not consider the ‘business’ needs of medical practices in reaching a decision eg appointment books closed, GPs retiring, aged profile of GPs in practice, requirement for female GP.

12. This graph demonstrates the distribution of OTD’s by RRMA and how effective the Medicare provider number restrictions are by placing OTDs in rural areas.

13. Fast tracking of section 19AB exemptions
The following scenarios may be considered as
emergency priority:
one doctor towns
locum positions ( due to extreme circumstances eg illness of doctor / immediate family)
expiry of current 19AB exemptions

14. Fast tracking of section 19AB exemptions
The Workforce Regulation Section should
be contacted for these and any other extenuating
circumstances for their application to be considered
as a priority on (02)

15. Preliminary Assessments of District Workforce Shortage (PADWS)
PADWS were introduced to give an initial indication of DWS status before the employment of OTDs could take place
written confirmation from the Department is valid for a period of six months to allow for registration, advertising and or immigration paperwork

16. DWS Searchable Database improvements
development of fully online facility
new option for ‘No’ advice
As part of efforts to improve the efficiency and responsiveness of the section 19AB arrangements, the DWS searchable database is being revised and changed into a fully online system.
Where a location is added into the database, and where a ‘Yes’ is given, current arrangements will continue to apply ie the advice can be printed off to accompany a section 19AB application.
Where a location is added into the database, and where a ‘No’ is given, current arrangements will change.

17. Current results returned from a “No” locality search
Workforce Mapping & Analysis Section
Current results returned from a “No” locality search

18. Proposed Stage 2 – Preliminary Assessment
Welcome to Stage 2 – Questions to assist in special consideration
You must answer a series of questions in order for your special circumstances to be considered.
Users can click on the submit application button to have their application with special circumstances
considered.
The doctor is replacing an existing restricted overseas trained doctor
The practice provides medical services to a large indigenous clientele or is an Aboriginal Medical Service
The application is sent to a
mail in database to be
processed by the Workforce Regulation Section.
The practice is located on an island with no bridge to the mainland
Vacancy is for after hours work only
Position requires proceduralist with recognised Qualifications
Geographic information related to your
catchment area beyond the Statistical Local Area

19. Workforce Regulation Section
administers section 19AB arrangements
currently consists of 15+ staff
receives on average section 19AB applications per month (new and existing)
processes requests for preliminary assessment of a district of workforce shortage
manages OTD hotline
administers a number of s19AA programs (eg RLRP)

20. Ten year moratorium section 19AB commenced 1 January 1997
1997 ‘cohort’ coming off ten year moratorium in
2007
around 1,223 OTDs sought access to Medicare in
1997
approx 520* with current medical registration
approx 350 accessing Medicare (specialists and
GPs)
balance hospital doctors
In 2007 the first tranche of doctors will be completing their obligations under section 19AB of the Health Insurance Act 1973 (the Act). These are OTDs who were first registered as a medical practitioner in Australia in Altogether, around 1,223 OTDs obtained first medical registration in 1997.
Around 520 of these doctors have current medical registration in 2007 with approximately 350 accessing the Medicare Benefits Scheme. It should be noted that of the doctors who obtained medical registration in 1997, it is anticipated that around 50% have never been subject to the Medicare provider number restrictions as they sat, or were eligible to sit their AMC examinations prior to 1 January  These doctors have not been required to seek exemptions under section 19AB of the Act.
* to be confirmed

21. Ten year moratorium Issues with doctors completing 19AB moratorium:
letters are being written to individual doctors completing 19AB in the 1st quarter 2007
the Department will soon commence sending out more general letters of advice for doctors completing their 19AB requirement later in 2007
very few of the doctors contacted to date have not met section 19AA (post graduate qualifications)
while difficult to quantify as there has been little feedback from the doctors, there does not appear to be widespread plans by doctors to move to metropolitan areas

22. Section 19AB future OTDs will continue to be part of the landscape
fully online application process
new methods of looking at DWS determination

23. The future for mapping Section19AB exemptions

24. Questions?