GP and rural generalist registrars get the short end of the stick when it comes to employment entitlements.
Working under a single employer across hospital and community settings just makes sense for rural doctors – both registrars and fellows – according to the Rural Doctors Association of Australia.
The RDAA’s enthusiasm for the so-called single employer model stems from the sad truth that medical students aren’t exactly lining up to study general practice at the moment.
In a new position statement, the association is called for a “suite of coordinated reforms” to curb the workforce shortage and has identified employment arrangements as a good place to start.
“RDAA has received strong feedback from doctor-in-training and recently fellowed members indicating that the complexity of employment arrangements, the challenges around contract negotiations and the loss of entitlements gained during their time working in the hospital sector are all significant barriers to choosing rural generalism [or general practice] as an attractive career,” the RDAA said.
The model is already a reality for registrars in parts of NSW and Tasmania, while the central west region of Queensland has been operating a single employer system for fellowed GPs for around a decade.
While private companies could conceivably run a version of the model, state health services typically act as the employer.
Often, the state health service or local health district will have a formal Memorandum of Understanding in place with individual general practices to set out the terms of a registrar’s placement.
The RDAA currently recommends that practices receive 50% of a registrar’s private billings, while the other half goes to the state employer to offset the cost of their salary.
General practice clinics which participate in the model generally need to be granted an exemption from section 19(2) of the Health Insurance Act 1973, which prohibits doctors from accepting other forms of payment when bulk billing.
Most of the conversation around the single employer model focusses on its potential for attracting registrars, but the RDAA said it would also be supportive of exploring post-fellowship versions of the scheme, provided that it remained optional.
Choice between employment models, the association said, is already afforded to metro-based consultant doctors.
“This will prevent registrars delaying completion of training in an effort to maintain access to entitlements to suit their personal circumstances,” the RDAA said.
“Rural generalist fellows should be able to make a decision based on their own circumstances as to whether they would like to continue working under a single employer model, or transition to a fee-for-service model.”
The RDAA said it was supportive of broader reforms to employment models for primary care registrars, but that the state-based single employer model had shown sufficient promise to be expanded immediately.