How will the upcoming annual District of Workforce Shortage (DWS) review affect your medical centre?

How will the upcoming annual District of Workforce Shortage (DWS) review affect your medical centre?

At the end of February, the Department of Health will announce the result of the latest review of DWS areas.

It is clear many doctors, practice owners and managers are still unclear on many aspects of Section 19AB of the Health Insurance Act and how these potential changes will affect them.

This blog aims to provide a simple overview of Section 19AB of the Health Act and answer questions relating to DWS and the impact of the upcoming review. More complex answers are available by following the links!

 

What is Section 19AB of the Health Insurance Act (1973)?

Section 19AB of the Health Act requires all Overseas Trained Doctors (OTDs) and Foreign Graduates of Medical Schools (FGAMS) to practice in a DWS area for a period of 10 years. This is often referred to as the 10-year moratorium. For this blog, we will refer to FGAMS as OTDs.

What is a District of Workforce Shortage (DWS)?

A district of workforce shortage is a geographical area in which the population are deemed to have less access to medicare subsidized medical services, compared to the national average.

In short, there are not enough General Practitioners providing primary care services to the community.

The Department of Health use the Statistical Area 2 (SA2) boundary layer to define a geographical area for the purpose of DWS. This is of importance when considering the Spousal Exemption, covered below.

You can check the status of a location by following this link and selecting the DWS layer of the map. http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

 

When does the DWS review happen and how will I be informed?

The review happens each February and is expected to be update on DoctorConnect towards the end of February. There is no formal announcement, so you will need to regularly check the site for the update.

This review will be final and not reviewed again until February 2019.

 

Will our current OTDs (in their moratorium), still be able to work at the practice, if the location loses its DWS status?

Yes. All doctors currently working at the practice will be unaffected by any change.

 

Will we still be able to recruit OTDs to our practice if the location loses its DWS status?

If you are already in advanced discussions with an Overseas Trained Doctor and can prove this to the Department of Health, then it is highly likely that the doctor will still be able to join your practice.

The Department of Health will usually request an email trail and signed contract, dated prior to the annual review date.

If you are in advanced negotiations with an OTD and the location is currently categorised as DWS, it is strongly recommended to finalise a contract before the middle of February.

OTDs who apply to your practice after it loses its DWS status, will not be eligible to work in that location until or unless:

  1. The geographical regains its DWS status at a future annual review
  2. The doctor is eligible for a specific 19AB exemption (see below)
  3. Your practice has a ‘DWS replacement provision’ (see below)

 

What is a DWS replacement provision?

A DWS replacement provision allows a practice in a non-DWS location to apply for a 19AB exemption, should a doctor leave their practice. This is only applicable if the exiting doctor holds a 19AB DWS exemption, given at a time when the location was classified as DWS.

It is important that the practice asks the doctor to close their provider number and provide evidence of the closure. This comprise of two documents:

  1. A Statutory Declaration by the doctor that they have closed their provider number(s) for the given SA2 location (see Doctor Connect) and ceased providing primary care services
  2. A letter from medicare to the doctor, confirming the closure of the provider number for the given SA2 location

The practice must then submit these documents to medicare (for review by the Department of Health), when they apply for a provider number for a doctor still in their moratorium.

 

What 19AB exemptions are open to us and how do we apply for them?

There are several 19AB exemptions, but we will focus on the three most common options here.

  1. Locum Exemption

The locum exemption allows a doctor still inside their moratorium, to work in a non-DWS for a maximum period of 6 months. This exemption cannot be extended and doctors are not eligible to apply for another locum exemption in the same location, following the completion of the 6 months.

It is important to check that the doctor can access A1 medicare rates for that location, if they do not hold vocational registration. As long as the location is listed as RRMA4+ (see DoctorConnect), then the doctor should be eligible for A1 rates by completing a ROMPs form with the Provider number application.

  1. Spousal Exemption

Due to the complex nature of assessment of eligibility for this exemption, it is advised to contact the Department of Health (Access Policy Section) at 19AB@health.gov.au with the specific details of both the doctor and spouse.

The definition of this exemption states that the spouse:

  • does not have to be a GP or healthcare provider
  • must not be restricted by 19AB themselves
  • should also work in the same SA2 location, although exceptions have been known
  • must reside in Australia
  1. Academic Exemption

An overseas trained doctor may apply for an academic exemption if the following requirements have been met:

  • They have a proven track record in education and training
  • They have a Clinical Appointment with an accredited medical school recognised by medicare (see the list of recognised medical schools on the provider number application form)

It is important to note that the length of the exemption is usually the same length as the Clinical Appointment contract that the doctor has signed with the university.

This expiry date should be noted, and steps taken 3 months prior to expiry of the contract, to ensure the number can be extended.

More information on these exemptions can be found at https://www.legislation.gov.au/Details/F2016L00134/Explanatory%20Statement/Text

Section 19AB of the Health Act and the affect of changes to DWS and potential exemptions can seem incredibly confusing and complex.

For more information about anything covered in this blog, please contact Darren to discuss your specific situation.

Darren Compton (B.Sc. Hons)

m: 0405 234 852

e: darren.compton@dxcmedical.com.au

 

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