If you are reading this as a doctor from another country interested in working in Australia, I’d like to ask you not to feel discouraged by the thought of working in Rural areas of Australia. Work location is one of the less difficult aspects when it comes to IMGs working in Australia.

But do IMGs have to work in rural Australia? Well, the Australian government rules require IMGs to work rurally for a period of time. International Medical Graduates and Medical Students studying in Australia from other countries are both subject to a 10-year restriction on accessing Medicare benefits which can prevent doctors from working in certain locations. This restriction is known as the 19AB restriction. However, the rumours that international doctors can only work in rural parts of Australia is not true.

Australia is the sixth largest country, vast with densely populated cities in the coastal fringes and smaller populations in most of the landmass. The areas with smaller populations often lack a range of services in relation to the people based in cities. One of which is Healthcare and Medical services.

As a result, the Federal Government has placed restrictions for IMGs to serve in rural areas while providing a range of incentives to attract doctors, as a viable option to control and distribute healthcare accessibility across the country.

The Government regulates the supply of IMGs in doctors in two ways, through Medicare billings and Visa restrictions.

What is Medicare?

Medicare is Australia’s universal health insurance scheme that guarantees Australians access to multiple medical services at low or no cost.

The Medicare Benefits Schedule lists all services covered by Medicare. The Medicare Benefits Schedule also provides details on how much the Government pays you or the patient for the healthcare service.

Medicare Provider Number

A Medicare Provider Number is a unique number you get if you are an eligible healthcare professional recognized for Medicare Services. You need a Medicare Provider Number to claim, bill, refer or request Medicare Services. Most doctors have more than one Medicare Provider Number. The Federal Government is able to restrict doctors to certain locations by tying provider numbers to geographic locations.

19AB Restriction

The Section 19AB in the Health Insurance Act 1973 (commonly known as ‘the Act’) restricts Medicare benefits for a period of 10 years. It applies to International Medical Graduates (IMGs).

You are an IMG if you:

·       Got your medical degree outside of Australia or New Zealand

·       Enrolled in a medical school in Australia or New Zealand as a temporary resident

To charge for Medicare services, all doctors including Australian graduates and those subject to 19AB restriction need to be recognized as a specialist since General Practice is recognized as a Specialty in Australia. This means the Doctors should be “Vocationally Registered” in order to charge for Medicare services.  

Doctors who are not Vocationally Registered, you should be on a 3GA Program in order to access Medicare benefits regardless of whether you are a doctor trained in Australia or Overseas. Working with 3GA Programs enable access to a Provider Number that can ensure your patients receive 100% of the Medicare Rebate.

The current fellowship programs are:

•             The Australian General Practice Training Program (AGPT)

•             ACRRM Independent Pathway

•             More Doctors for Rural Australia (MDRAP)

•             Practice Experience Program (PEP)

•             After Hours Medical Deputizing Services (AMDS)

•             Remote Vocational Training Scheme (RVTS)

•             Rural Locum Relief Program (RLRP)

These programs support doctors on a training pathway to General Practice.

However, if you are a doctor affected by the moratorium, you can only apply to train under the rural pathway on the AGPT program. Both the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) offer rural pathway training.

10 Year Moratorium

If you are an International Medical Graduate, the 10-year moratorium applies to you. The 10-year moratorium is an Australian Government policy that requires Overseas Trained Doctors and Foreign Graduates of an Accredited Medical School to practice in areas where there are doctor shortages for 10 years from the date of their first registration in Australia.

The 10-year moratorium restricts doctors from accessing Medicare rebates. You need an exemption to apply to access Medicare benefits at your practice while under the moratorium. To get the exemption you will have to practice in either:

·       A Distribution Priority Area (DPA) for General Practitioners

·       A District of Workforce Shortage (DWS) for specialists

The 19AB restrictions and the moratorium will end after 10 years if the doctor is a permanent resident or citizen by this time. Most overseas doctors who have come this far will be eligible for permanent residency. However, if doctors remain a temporary resident, the moratorium will still apply to them until they become a citizen or permanent resident.

By the time you become a permanent resident, if you do not have a fellowship qualification, you will be subject to restrictions under 19AA, which will require you to work with a 3GA program.

DWS & DPA

Under the 19AB restriction, you are required to work for 10 years in a Distribution Priority Area (DPA) if you are a GP or work in a District of Workforce Shortage (DWS) if you are a Specialist.

You can check the DPA/DWS status of a practice area through the Health Workforce Locator Tool which can come in handy when you want to locate where in Australia Doctors are needed.

The workforce locator can depict the Modified Monash Model (MMM) which is used to define whether a location is a city, rural, remote or very remote.

The MMM measures remoteness and population size on a scale of MM1-MM7 where MM1 is a main city and MM7 is very remote.

Likewise, the Distribution Priority Area (DPA) classification uses MMM boundaries.

The DPA system considers Gender, Age, and Socio-economic status of the patents living in the area.

Moratorium Scaling

So, is there an exemption for the 10-year moratorium or to reduce this duration? Moratorium Scaling does allow you to reduce the time you are supposed to work in a DPA or DWS classified location.

You can scale the moratorium if all of the following apply:

ü  You are an international medical graduate working in an eligible regional or remote area under 19AB

ü  You are claiming Medicare Benefits Schedule items for services as part of your employment

ü  Your monthly billing threshold is $5,000

Working in eligible locations grants you ‘scaling credits’. The more credits you have, the sooner you can work in any location across Australia you want, provided you also satisfy other requirements.

The more remote it is, the more scaling points you may receive. The Scaling locations are based n the Australian Standard Geographic Classification—Remoteness Area System. This acts as a strategy to overcome healthcare workforce shortages in areas that need it the most.

While the moratorium is a minimum of 10 years, if you have enough scaling credits, you can have a class exemption for the remaining time-period of your moratorium. Which then allows you to work in an area not classified as DPA or DWS.

International Medical Graduates might be required to work in Rural Australia for a period of time as per the system. However, it does not necessarily mean that you will work far away from urban locations. The experiences of international doctors have taken this path before have often been positive.

If you are an IMG who considers Australia as your career destination and need some support and guidance on this journey, reach out to us via helpdesk@medfuture.com.au and we will be more than happy assist you.