Growing Your Practice How Rural Supervisors Can Attract Registrars
Jessica
Good evening, everyone. My name is Jess from the RACGP rural team, and I will be hosting tonight's webinar. This instalment of the rural health webinar series will explore key strategies rural supervisors can use to recruit and retain registrars in their practices. Our presenters will share practical tips on attracting registrars to your practice, address common challenges, and showcase the unique benefits of rural practice.
Whether you are new to supervising or looking to expand your team, this session will help you create an environment that attracts and supports the next generation of rural GPs. Our presenters this evening, Associate Professor Michael Clements and Dr Ian Kamerman. Associate Professor Clements operates three general practices across the Townsville region and Magnetic Island and conducts outreach clinics into Northwest Queensland. He is Co-Medical Director of the Rural Generalist Training Pathway, Chair of the RACGP Rural Council, and a member of the RACGP Board. Doctor. Dr Clemens also serves as a Councillor for AMA Queensland, sits on the AMA Queensland Council of General Practice, and is a GP representative on the state-wide rural and remote clinical network.
Dr Ian Kamerman is a principal at Northwest Health with more than 20 years’ experience in rural general practice. He has a keen interest in training the future health workforce and is the principal training supervisor in the practice. Ian enjoys all facets of patient care. He has specific interests in addiction medicine, the management of viral hepatitis, and is both a designated aviation medical examiner and a medical review officer. Ian is currently on the board of the Hunter, New England Local Health District. We would like to begin tonight's webinar by acknowledging the traditional owners of the lands that we are coming together from and the land on which this event is being broadcast.
I would like to pay our respects to their elders past and present and would also like to acknowledge any Aboriginal or Torres Strait Islander people who have joined us this evening, and just before we start, a few housekeeping things to cover. Participants are set on mute to ensure that the webinar is not disrupted by background noise, but we encourage you all to use the Q&A chat to ask questions, and finally, the webinar has been accredited for one-hour educational activities, CPD. To be eligible, you must be present for the duration of the webinar. We also kindly ask that you complete the short evaluation at the end of the webinar.
This should only take a few minutes to complete and will help us improve the format and content of future webinars. By the end of this webinar, you will be able to identify key strategies for recruiting registrars to general practice, understand the challenges and opportunities in attracting registrars to rural settings, develop a compelling recruitment pitch highlighting the benefits of rural practice, and identify key support systems for registrars and how to implement them in practice, but for now, I will hand it over to Michael to get things started. Thank you, Michael.
Associate Professor Michael Clements
Wonderful. Thank you very much, Jess, and always a pleasure to be here presenting with you and with Ian today. I just realised that you need to update my CV there and give a fresher version that, some of those roles have changed since more slightly, but it still gives you a bit of a theme of where I have come from and what I am doing. Now can you see my PowerPoint slides? I am just trying to share. We can have a little bit of a chat today about some of the features of recruiting doctors out to rural areas, in particular trainees, and I will be talking for a little while, particularly focusing on people that are going through the Australian general practice training program, and Ian will focus a bit on international medical graduates, overseas trained doctors and how they can apply and come through.
As we said, just want to acknowledge traditional owners and that it is a responsibility for all of us, particularly when we are working in rural and remote communities, that we provide culturally safe and appropriate care, that is responsive to community needs. For me, I am in Cloncurry today. I am about to take on a new practice at Cloncurry, that is the, Kalkadoon and Mitakoodi people out here, and I am very honoured to be able to provide medical services out here and treat and support some of their community. We have talked a little bit about the housekeeping. We are going to be using the question and answer function. Please feel free to use the chat room function. I cannot really watch that while I am talking to you on the Zoom.
Ian will be answering questions for this. Please, do ask questions in the Q & A function, and then I will have a go at answering questions when Ian is talking. There will be time at the end for question and answer. As we said earlier, I am a GP practice owner. I have got I think I am up to number six now, but we will be number six when I take over Cloncurry, and training our future generation of trainees is something that I do for both passion as part of the apprenticeship model as per the properties, but also because it is part of the business plan, and if we are going to provide long term sustainability to our rural and remote communities in terms of workforce, we need to be teaching the next generation and giving them a positive experience, and that is everything from medical students all the way through to fellows and those that are nearing the end of their fellowship training.
I am going to give you some key tips, that I have noticed, remembering that trainees are choosing you. They are not just being told that they have to go to your practice. You actually have to try and attract them. RACGP does not force registrars into certain practices. It is up to you to offer a training environment that they want to apply for. Now, I have just got some key things that make common sense, but it is always worth pointing out. If you are going to try and attract a trainee to your practice through any of the pathways, you want to show that you have got a supporting learning environment, and this is one of the hardest things to show sometimes, but it is clearly something that is highly rated in registrar feedback, and when registrars talk to each other about which practice they go to and which practice they recommend, they talk about this learning environment. What do I mean by that?
They want to know that if they are coming to your practice and if you are going to be their supervisor or there will be other supervisors, they want to see that there is open communication. They want to know that they can walk in and out of your room. They can access you as they need to if they feel a bit out of place or even if you are not there, that that other doctors are approachable, and that you are available to provide them with the support that they need. Many of our junior doctors, particularly in their first placements, are quite nervous about becoming a GP. It is quite nerve wracking particularly in that first term, and they want to know that you or see evidence of, your communication and approachability.
One of the other things you can do is show them that you do have a structured induction that is tailored to their practice. You might show them through a recruiting package or through your website or after you have that initial conversation with them. You might talk to them and say, well, when you first come to our community, we are going to be making sure that you get a good induction. You are going to be spending time with admin and reception, time with the nurses. We are going to take you around the community. We are going to show you the benefits of linear less community.
This is a photo of Cloncurry Dam. The med super out here used to be Cameron, and every medical student and doctor took Cameron and the dogs for a walk around the dam. That was part of the structured induction into the Cloncurry community, and as you can see from the photo, it is a beautiful spot. They want to know that there is going to be an opportunity for feedback and improvement and peer support systems. Most registrars do like being able to work with others and see interact with others, and so peer support is important. Knowing how they can interact with and deal with other registrars, maybe not in your practice, maybe in similar practices nearby, or maybe in a hub like a lot of bigger centre, but show them what the peer support systems are. They like mentorship.
If you can show them that, if they come to your practice or if they come to your town, if you can point out some of the mentors or the career mentors that they can see and associate with, even if they are not the formal supervisor, if you can show them the kind of environment to the people that they are working with, particularly if you have got some of the imminent rural practitioners, that is going to be attractive to them as well. The other thing that I often find after I have given them a brief about why I think they should come and work with me and what I am trying to achieve for them as a practice owner, I then offer them to speak to any of my registrars. I do not tell them which registrar they are allowed to speak to. I say these are all of my registrars.
These are people you can ask to speak to any of them, and I will pass you on their details, but X Y Z are the common ones that registrars will talk to. It is a two-way interview. You are interviewing them and they are interviewing you. Make it available for them to talk to your previous trainees or current trainees. When you are thinking about rural training and people selecting your practice for rural training, generally people are choosing rural practice because they are interested in the diversity. They are interested in a wide scope of practice, they are interested in developing themselves to the broadest capacity, and they are looking for experiences, and part of that is you trying to show that if they come to your practice in your rural town, you are going to be able to give them or to help them develop a wide variety of skills. For example, I talk to all my registrars and I say, by the end of your term with me, I want you to be able to do shoulder injections and musculoskeletal injections.
I want you to be able to feel comfortable with a standard skin check and doing a standard excision. You would be surprised how many people can get through the whole GP training without feeling confident with a proper skin exam with a dermatoscope. You will be surprised how many trainees will get through the whole program never ever, giving anybody a steroid injection into a trochanteric bursa or a shoulder. Teach them, show them, tell them when you are trying to recruit them the kind of things that they are going to learn and do that they might not get to do in an urban practice or another practice. That might be everything from skin cancer to mental health to aviation medicine, which is one of my interests, to marinas, to pipette sampling, to colposcopies. Whatever it is that your rural practice can offer, show them that if they come and choose to train with you, these are what they are going to be able to experience.
These exposures are going to be something that they can build that confidence in. Now I certainly encourage you to include skills and experience in aged care practice. You would be surprised or maybe you would not be, how many trainees can get through the whole training curriculum and pass through exams in an urban area, without ever stepping foot inside an aged care facility. Whereas in your rural and remote communities, it is just part of the normal business. Talk to them and show them what kind of things they get. In an age where the federal government is trying to force us and encourage us more into multidisciplinary teams and multidisciplinary funding models, rural and remote have always led the way here in terms of how we work with nurse practitioners and nurses and allied health, show that if they come and join your team, show how you work with other team members, show them that they are going to get a really good experience and learn how to work with these other teams and get the most out of it.
Ask them about their special interests. They might say they have got a special interest in mental health or special interest in women's health or men's health or skin cancer medicine or menopause. Ask them what their special interests are, and then link that with your practice, say, oh, yes, well, actually, I have got a doctor that is special interested in menopause. She is really, really good at these consults. This is the way she manages them.
We will make sure that if you do a placement with us that you get some time shadowing her. It is often her to be honest, so shadowing her, and so that you can feel really confident in that skill. Do ask them and then show them that by coming with you, they can do that. Now that is a photo of Rainbow Beach, just near, K’gari, the old Fraser Island, on a flight I did a couple weeks ago. If you are going to try and attract trainees, you have got to show them that you invest in teaching and supervision. You need to prove to them why you are the better practice than every other practice that they can choose from, and they can choose from a lot of practices. They should ask you and you should tell them, is there protected teaching time? Can you show them the roster? Can you show them that your current training is already booked at?
Now I like to open up my best practice book and say, yep, see here, this is where we have got our protected teaching time every time, and if you can show them a list of what your current training has been taught, that backs that up. Show them how they are going to teach and learn, K’gari, which is at a wonderful model led by Cameron here. Part of their protected teaching time is every morning of the week, from eight to nine, all of the doctors at hospital and the general practice meet together, do case discussions, multidisciplinary care, and teaching, five hours a week every week. That is a really attractive part of what they do here. Show them that how you are going to encourage them to reflect and do self-directed learning. Talk to them about some of the funding packages that are available through workforce agencies, to pursue their own education needs, whether that is everything from injections and ultrasound skills all the way through to the mental health and skills, and then talk to them about how you will support them, and you will provide, you will teach them, but you will also provide them constructive feedback and performance reviews.
Try and give them examples of where you have been able to do this and how you are going to talk to them and review their billings and review their notes and review these aspects to the professionalism so that you can help them grow. The other thing that we know from a newer generation of trainees, to which the generations are always evolving, but something that we certainly know from our new generation of trainees entering, they are very interested in making sure that they can balance their career development and their career interests with their own sets of well-being. One of the beauties of general practice training, and general practice fellowship is the ability to control our hours. We do not have to work every weekend. We do not have to work at nights unless we choose to, and we can choose to work the hours of the week or the hours of the day that suit us in our family.
Show them in your recruiting for the training how you embody that in your practice. Tell them that you as an employer are flexible during their training. Tell them that you will offer them nine-day fortnights. Tell them that you offer them reduced hours. Tell them how you will support them during their exam times, and maybe if they do not want to take time off work, tell them how you reduce their patient load so that they can have some extra headspace for studying. Show them how you are going to support them during all of those phases, and then as for the other aspects of career development, some of them are interested in leadership. Some of them are interested in everything from social media or academic research or teaching and education. Talk to them about how you are going to foster those aspects of the career development through you or other practice movements, or if you do not have that as it available in your practice, maybe you can say to them, listen, what we will do is we will make sure you get to spend some time with the med super at the hospital in this rural town, and they can help you on these aspects of your career development.
Always, always, always show them that you prioritise their work life balance the way that they want it, and that you are going to be there to support their mental health, their welfare, and their development. Give them examples where possible of where you have been able to show achievements and celebrate the successes of your previous trainees and your doctors as a way of building up morale and building up the teams in these rural remote areas. That is all the fluffy stuff. I am just going to quickly run through some of the really technical stuff, and I am just going to run through this quickly. You can ask questions in the Q&A or Google afterwards. If you want to recruit RACGP trainees, which I guess is why you are listening to this webinar, the first step is making sure you are accredited with the RACGP. If you Google, accreditation RACGP expression of interest to become a trained practice, there are applications or expressions where you can say you want to take on an AGPT or a fellowship support pathway trainee.
At the moment, they are separate accreditations, but we are merging them, so soon it will be one application process. First, you have to be recognised by RACGP as a training practice. Then you get access to the training management system where you upload things like your practice policies, your practice demographics, your practice capacity to treat, so you declare how many positions you could take on. You put advertising, you talk about pay rates, you can put a web link to information so that potential trainees can look at your website and decide if they want to go with you. Then there is a formal recruitment period that occurs where trainees will look, where it is opened up that training management system is live, where trainees will look at practices in the region that they want to work. Your practice would come up in that region as having capacity.
They will look at your practice and look at your website, then they will decide whether they want to nominate and come and see you, and so there is a short time period where you match. I call it the Tinder period because I, as a practice owner, have to accept somebody else that that that wants to come to me, and they have to nominate me as somebody that I want to talk to. It is quite a hectic week to be frank, and it is quite nerve wracking for many, but that is the way it happens in RACGP, and soon after that formal offers are made. Fellowship support pathway and PEPs, Practice Experience Pathways for comparable and substantially and non-substantially comparable trainees, those are more done direct. These applicants will normally come direct to you. You can advertise direct in the normal advertising online that you want to take on FSP or PEP trainees or you advertise for overseas trained doctors to come and join you, and they just apply to you direct outside of that training management system.
ACRRM, because they are certainly a big recruiter out there. I certainly have ACRRM trainees and RACGP trainees. Again, you talk to them about becoming an accredited training practice. You then get their version of our training management system, which is called the RG HUB, where you put up the same information. You do declare to ACRRM what your capacity is, but they are a little bit more liaison fair. I am already, for example, getting people from ACRRM trainees looking for positions next year that are just emailing me out of the blue, and ACRRM supports them if they just want to contact you out of the blue outside the RG HUB and start wheeling and dealing and making deals.
Briefly, and then I am going to hand over to Ian. The traditional way of taking on a trainee as an employee, there are the NTCER the National, Terms and Conditions for Employment Registrars, is a way of engaging the registrars. That is a negotiated agreement with the registrar's association. It is quite a low pay or a percentage of their income, whichever is higher. I know many practices pay only the minimum. My personal view is if you want to attract the best, you have got to pay the best, and so I certainly pay well above NTCER rates, and so you can pay above NTCER rates if you think you can afford it and certainly many registrars are looking for practices that are offering above the base minimum. You can offer job shares so they can do half time with you and half time with a hospital or half time with you and half time doing an advanced skill or half time with you and half time at a special interest practice today.
You can certainly talk to them about that. You can also talk about the single employer model in rural areas. I could do a whole talk just on single employer model but if you are interested in going with this, you must engage with your local hospital, your local rural hospital, find out if they are offering single employer model contracts, which is an agreement between the practice and the hospital, where essentially the trainee is employed by and paid by the hospital, but working within your practice. There is no single model, in fact, every State is different and even within the one State, there are different agreements with different hospitals. There are differences within about how we pay for them.
For example, they might get a base rate from Queensland Health for being in my practice, and then I pay back Queensland Health 50% of their receipts or 60% of their receipts or in some cases, I pay back a fixed rate per hour of whatever the registrar is doing, back to Queensland Health, but the trainee gets a fixed salary from Queensland Health and all of the Queensland Health benefits and salaries, and I am just going to mention Tenant Doctor or Contracts, that is a typical contractor. I am certainly of the view, and I know Ian's of the view that you cannot bring a trainee into your practice, but still call them a tenant doctor or a contractor.
That just does not make sense to me, and I am not sure that it passes muster, but I am aware that people under FSP or PEP or others, have been offered tenant doctor or contractor models of employment where they are essentially just pay the percentage of their income. I do not think that passes the test that ATO might look at or the States might look at us, but you are welcome to discuss that with your own accountants and financial planners, because I do know that others do that. I will pass on to Ian. Thank you, Ian.
Dr Ian Kamerman
Thank you, Michael, and look we actually do have a question, and the question is, how many trainees can a supervisor take on for each intake? I think that is an interesting question because there is two different ways to answer that.
Associate Professor Michael Clements
Do you have the formal answer as the supervisor liaison officer?
Dr Ian Kamerman
I suppose the first answer to that is for each intake, you can take on as many trainees as you have the capacity for. Now for AGPT, the RACGP will set how many trainees that you can have on AGPT. There is a cap there. From a supervision role, each supervisor can only supervise three registrars, three trainees, and that is a universal cap. It is not an intake cap, and that is to do with the workload that supervision takes, and we really do not want to burn out supervisors by saying, oh, yeah, we will let you take on seven or eight or whatever. Now the other issue, of course, is there are multiple different types of trainees, and, yes, there is another question here about full time equivalent.
It is a full time equivalent. You can supervise an FTA of three, and that is across all pathways or colleges or whatever, and that is an RACGP ruling. You really need to count how many you have got that you are supervising on behalf of APRA. APRA has got a cap of four for doctors unlimited registration. You think about, well, right, I have got three my own practice and I am an RVTS supervisor, I am supervising one off-site. In reality, from an RACGP perspective, three is a maximum that you can take, and I hope that answers the question.
Associate Professor Michael Clements
I will just add to that. As Ian said, there are caps that RACGP decide based on workforce needs, so I have got a practice with, I think it is 10 potential or six potential supervisors and total of 10 doctors. We could have taken on lots of trainees, but RACGP limited us to one this term because they did not want us to fill up at the expense of the rural towns near us. You might have more capacity to train, but there will still be caps applied to you based on wider workforce needs.
Dr Ian Kamerman
Normally those caps are per practice and per supervisor. They might be totally different numbers, but, my practice, it is one per supervisor from a workforce distribution model and one per practice. It means I can take one, but, of course, FSP is not under that cap. PEP specialist is not under that cap, but, anyway, I thought I would move on and talk a little bit about the nomenclature. IMG's, a lot of international medical graduates do feel that that term is somewhat becoming derogatory. Unfortunately, I tend to lapse into using it, recognising that it is what the statistical models call it. It is the terminology internationally. Bureaucrats use it.
The term that I believe is preferred is an Australian doctor trained overseas, and I think we should acknowledge that, certainly, if I do lapse into the term IMG, I certainly mean no disrespect and that they do form a significant, meaningful, and vital part of the Australian health care system, and that is essentially been the case for a long while in rural Australia where substantial numbers of our doctors that provide excellent service to our rural communities, have been trained overseas.
Might move on to the next slide, Michael. Michael touched on a whole lot of this. Before you actually take a registrar on or trainee on, you need to consider that you have actually got the space for them, that you do have a patient population that they can care for, that you are able to provide supervision, that your practice has got adequate resources, the nuts and bolts. You have got to buy out of a room, but if you got the equipment where the trainee can work from. You need to think about, is your practice got a training focus or is it purely workforce that you are after?
And, unfortunately, there has been a whole lot of examples, and Australia can get a bad rep internationally where practices have essentially advertised multiple positions, when in reality, they have only got one that is available, and they will accept multiple doctors, particularly who are sitting overseas who are not aware of the Australian system and believe they have all got jobs, and, unfortunately, they get part of the way through the process, spend a lot of time and some money, and find that there is no position there available. Certainly, Michael and myself, we both go into this very much with a training focus, and my belief very much is if you actually provide really good support and really good exposure to your practice and to patients and the community, it is much more likely these doctors are going to stay on.
I think there has been a shift. I mean I go back ten years or so and we would have this revolving door of doctors who would arrive in your practice and promptly leave after gaining fellowship. I must admit, I am finding that I am retaining more and more as time goes on, certainly because we show them that being in the bush is a really good lifestyle. It is really good medicine. The community appreciates them, and if you can get that message across and show that support particularly early on, and I cannot really oversell the comment that first impressions really do count. I do not know about Michael, but I always ensure that I have got housing organised for my trainee when they arrive and a vehicle, and these I am talking about doctors that are arriving directly from overseas because it is a thing that they really need that amount of support with because you arrive from overseas, you cannot get a loan to buy a car.
You have not got references for housing, all that sort of stuff. I suppose one of the most important messages I would start with is pretend you are just arriving in the country and think about what you would need or go back to your past experiences of how difficult you found things, particularly if you are listening here and you have come from overseas. What would have made that difference for you? Next slide. Thanks.
You have got to think about recruitment, and you really do need to think about how desperate you are and how desperate they are, and it can become really, problematic if you are desperate for workforce, the temptation is to take anyone with a pulse and has some sort of oxygen level in their blood and their breathing, but in reality, you want to make sure that this doctor is a fit for your practice. Do not just accept someone there because they will say they will join your practice, and similarly, you have got to recognise that this is high stakes for them, and again, we are talking about the overseas trained doctor. They are moving across country across countries, across the world, to find a place, and they might be leaving a community where they are not being paid well.
They are in a regime which they do not particularly support. They are trying to leave with some form of desperation, because that is what is taking them to move whether it is they are desperate because they are leaving the they are working in the NHS in The UK and they are feeling terribly unsupported. I believe now there is a whole lot of unemployed GPs in the UK who are looking for jobs or if you are in a place like Iran and the largest percentage of overseas trained doctors that are now coming into the system are Iranian or Persian, and they are seeking to leave that environment. This is before the most recent violence that has been happening over there. These people are quite desperate to leave.
I think it is really important to think about that sort of context. Know what sort of package you offer and be really aware of that as far as how much money you are going to put into them. Do your sums and think about what you are going to offer them and stick with it. Do not go changing that around too much. Do not promise the world and then find that they are going to arrive and you think "oh, I am going to have to give you a pay cut because I cannot afford that. You are not making enough money." I have certainly seen that happen as well. Also, do not underestimate the amount of educational uplift and support that you need to provide. These doctors have all worked in very different environments even if they are quite similar to Australia.
I am thinking about UK doctors. The issues of working with our medical software, the issues around Medicare billing, what the MBS means, the issues about working in totally different cultures, the conversations that need to happen between doctor and patient that need to work really well from day one because word-of-mouth about the first patients that have seen these doctors really spreads through rural communities. It is really important that some sort of positive feedback happens between doctor, your staff and the patients that are out there. As I said here, do not be afraid to say no to a poor fit. If you get iffy vibes at interview, feel free to say no. Look, thanks. I do not see this as being a good fit. If you get a really good candidate, do not be afraid to give them a good offer because you really want to do get them across the line, and people seem to be paying a premium out there for doctors. I think that is largely your desperation due to workforce.
We are going to work through some of the pathways. I am a bit procedural here. This is from an AHRPA perspective, people coming directly from overseas or there might be already in Australia, but they do not have an Australian or New Zealand qualification. Standard pathway, these are doctors who have trained in virtually any medical school around the world. There are some medical schools that are not recognised, and there is a list of several 100 that you can go through, but essentially, most medical schools are recognised. They will have got the Australian Medical Council. I cannot remember what CAT stands for. It is something assessment test MCQ. Essentially, it is part 1 of the AMC.
Now, they can join the standard pathway by either having the AMC clinical examination, which is the second part obviously. A workplace-based assessment, which is only done in hospitals, so that is equivalent to the second part of the AMC. Michael, I think you and I and the rural faculty should really be pushing for getting workplace-based assessments back into general practice. Why is that? Because it enables doctors to move from limited registration onto general registration. The third and most common way of doing it is through a pre-employment structured clinical interview, which is a PSCI. If they get a job, their AMC, MCQ plus a PSCI plus English language testing, then essentially, you can put in a pile of paperwork, and your doctor will be granted limited registration under level 1 supervision. Level 1 supervision requires basically the patient to be discussed with their supervisor before the patient has left the building, which is a very onerous requirement.
Consequently, not shared by a lot of practices out there is my view is these doctors should not necessarily be remunerated quite highly, simply because they are essentially working as interns in general practice. I tend to look at what the state health intern award is for remuneration, which is nowhere near what a lot of doctors’ think is the market, but I cannot overestimate what level 1 supervision, how onerous it is for a supervisor.
Registration under limited registration is limited. Generally, they have got four to five years to gain specialist registration via any of the fellowship pathways or general registration via getting the AMC clinical or going through the workplace-based assessment.
Next pathway is the competent authority pathway. Essentially, these are for doctors who have completed internship with the UK, USA, Canada, Irish or New Zealand qualification. They will do a PSCI for general practice, so they immediately get provisional registration. In other words, they get an intern equivalent, and they get general registration after 12 months of supervised practice. These are doctors who have not done any sort of specialist training. They have just completed internship, but for those specific countries that recognise being close enough to Australian qualifications, they get an easy entry into Australian general registration.
These are the specialist pathways that both GP colleges essentially offer. RACGP does not require a job offer. It is a paper-based assessment. If they are substantially comparable, they get the fellowship. If they are partially comparable, they enter the specialist PEP training pathway. If you are going down the ACRRM line, again, they do not require a job offer. It is a paper based plus an interview assessment. If you are a Canadian or New Zealander specialist, you get an ACRRM or a FACRRM ad eundem gradum. If you are partially comparable, you get a FACRRM after completing further requirements that their college might well set.
We have got this new pathway that came out last year of which the medical board set up under pressure from government essentially. General practice was the first specialty that got access to this pathway. Essentially, it is for Irish, New Zealand and UK fellow specialists in those countries. They are automatically, if they go through the application process, granted specialist registration with conditions. The conditions are these three: Six months of supervised practice, orientation to the Australian health system, and cultural safety education. After those are ticked off, the registrar applies for their conditions to be removed and specialist registration is granted. There is no Australian fellowship that is associated with this pathway. These doctors do not need any contact with the RACGP or with ACRRM, and they can work as specialist GPs from that point on independently within Australia. There have been reasonable numbers. Michael, I think you would probably know the current state of play as far as numbers go.
Associate Professor Michael Clements
Last I heard it was less than a 100, but certainly, it is on the increase.
Dr Ian Kamerman
Yeah, I think it was less than a 100 and plus one psychiatrist just got through the expedited specialist pathway. One might expect that to grow with how poorly the NHS is treating general practice and probably the community in the UK.
How to get registered. Once you have done all those steps with the exception of the expedited pathway, you need a supervised practice plan and a supervisor's agreement for limited or provisional registrants. If that is the pathway you are again through, which is the standard pathway or the competent authority pathway, and that form is called an SPPA 30. You have to put in a position description in a standard format. You have got to provide a CV in the approved format, and you have also got to provide an application for Limited Registration for Postgraduate Training or Supervised Practice or an Area of Need application.
There is a whole lot of documentation to the medical board for them to actually grant registration, and that process does take a couple of months. Theoretically, the process has improved, and people who have been dealing with the Medical Board might well have found that there are now all these online portals to upload information. That is a new process. I am not sure how well it is working.
My criticism of the medical board with the applications that I have put in is if you miss dotting an i, if you miss crossing a t, you find out a month later when they say, "you have not done this quite right. Can you expand on that? Can you do that?" Which means it is a further month delay. It is then got to go before a committee. The committee decides, and it used to be, and I hope it still is not now, back and forth between the practice and the board. Registrars get really lost in this system, potential trainees, because it is a totally new system for them. They think why have not I been accepted? Is there something wrong with me?
It is like, no. It is just the medical board and it is just the bureaucracy, and it is Australia and, this takes time. Generally, from start to finish, a minimum six months. Expedited pathway might well be a bit less. It might be four months. The problem is that my understanding is I have talked to New Zealand people, and they say, I could be working there and registered in six months. I talked to Canada, and they say, I can be working there and registered in two months. It is an international market out there. Of course, Australia is much better. We have got better weather. I will not mention the beaches. Michael is on the coast, of course. Australia is a popular place, but if we make the bureaucracy too hard and too lengthy, and that is why we have got the expedited pathway, people will choose to go to other countries.
Immigration. I think the best advice I have got, I have done it myself once, it is like never again. I would rather pay an agent. I value my practice management team. I value my time hiring agent. Essentially, they come through two different visa classes. Temporary skills shortage or 482 essentially allows work for an approved sponsor for up to four years, and there is a potential pathway to permanent residency. These people can be either employees or contractors. What everyone wants coming from overseas is a 186. A 186, essentially, they arrive in the country as a permanent resident. They know that they are not subject to being removed from the country so that automatically on arrival, they get a Medicare card, that their children can attend school at no cost through the public system. If you come in on a 482 visa, you have actually got to pay for your children's education. For 186, you could only be an employee, and you must be under 45. If you are over 45, your only pathway is to go down a 482 road. Though that is the language that most of the overseas trained doctors who are looking at Australia, they are very well aware of, and everyone wants a 186.
Provider numbers, I think most people will be across that. Just a reminder, IMGs are subject to both 19AA and 19AB of the Health Insurance Act. Provider numbers will require specialist registration. You can only access a provider number whilst on a 3GA program to gain fellowship, and there is a 10-year moratorium. The pre-fellowship pathway is a pathway that allows IMGs to work and gain general practice experience prior to joining fellowship training. They get A7 rebates, which is 80 of what you get for an A1 rebate. They have all those different item numbers, and there is an absolute maximum of two years that they can spend on it. No exception. In other words, they have got to join a fellowship training pathway within two years of starting on this pre-fellowship program pathway.
What do you do while they are waiting? This is what my standard advice is while they are sitting overseas. Go on to the best practice or the medical director website or Genie or whatever program you are using. Show them where it is and say, "look, upload this. It is totally free and play around with it." Let them use the trial software and see how it works.
I tell them all to use the time to get their mental health training, level 1 training, so they can bill a 2715 straight as soon as they start. On that topic, I also get them to do their non-directive pregnancy counselling, so they can bill a 4001 as soon as they start. Cultural awareness modules, extremely useful, and familiarity with Australian resources, particularly therapeutic guidelines. Most of them know about it. Talking about knowing about it, one cannot overstate the fact that all these doctors have very well-formed social media groups. They all talk to each other both in Australia and outside of Australia. They are aware of what everyone is getting paid. They are aware of everything we have talked about tonight. They know the resources. They essentially know the lay of the land. The problem is they actually think they know it, so often there is a little bit of fake news out there about what goes on in the world or what goes on in Australia. Some of which may be true, some of which may be exaggerated, but they do have a general idea of what is going on. I am pretty sure that's my last slide. Absolutely. I think it is now time for questions.
Associate Professor Michael Clements
Excellent. Thank you very much. Great cantering through the options. It is a lot of work. I certainly agree with using a migration agent to balance it. I do like your point about they are often better informed about many of these policies and procedures and needs than I am because it is their life. As you say, it is very, very important for the international medical graduates. It is worth pointing out the way that we use the phrase IMGs is fraught with difficulty. The only thing I will note is that our committee, RACGP, have stood up a committee representing these doctors, and they decided to call themselves the IMG committee. It is a title that would still stay with us for a while because there are not many other better ones. I do not have any formal open questions there. Did anybody want to pipe in with the Q&A with any last queries, concerns, and even if you want to put in something, if you joined the webinar hoping for another bit of information or if there is another question not including what we have talked about in terms of teaching, education or recruiting, feel free to put that into open questions. We will not labour the point otherwise. It is being recorded and it will be shareable and able to watch again with others. Both Ian and I are on the rural council and we are happy to have you reach out to us or contact us or have your colleagues contact us, if you want follow-up on any of these issues or advocacy or couriers or concerns. Hopefully, this has given you a little bit of a background in how you might be able to increase your attractiveness to trainees to come and fill your rural vacancies. We are expecting a bumper season at the beginning of next year in terms of the number of trainees across both rural and nationally training general practice, so it should be a good time. Wonderful. Well, we might call it there. What do you think, Ian?
Dr Ian Kamerman
Oh, yes. Otherwise, we could talk about tips and tricks as where we find doctors.
Associate Professor Michael Clements
Oh, yeah. Actually, do you want to do that? Also, Canon has just asked, is there any financial help available to practice to recruit the IMGs? Did you want to comment on that, from a rural workforce agency?
Dr Ian Kamerman
Well, I would have thought, yes. Rural workforce agencies will often offer some sort of relocation subsidy and CPD subsidy. I should have looked it up beforehand. I think they offer 5,000 or so plus some educational offers in New South Wales. I do not know what they would offer in Queensland, Michael. Some communities will also offer reasonable amount of monies for doctors that are joining the town. I am sure you would be aware what is available in your own community as far as that sort of assistance goes. There are government programs to bring doctors into communities, not in New South Wales. You have got them up in Queensland, Michael?
Associate Professor Michael Clements
Yes. We have got some, Health Workforce Queensland, does have grants. If you bring a doctor in from overseas and put him in a desirable area, generally MMM3 and above, there are relocation packages. After they arrive and start working, they can normally seek reimbursement for certain travel costs, about 5,000, maybe up to 10 if you are lucky. Once they have worked for a little while, they are eligible for some of those CPD education offerings up to $10,000 for training and education. It does not pay back visa fees. It does not pay back college training fees, etc. It is not supposed to be used for that. Occasionally, there are state government offerings, and there have been this year for Queensland and this year for Victoria.
I do know that Tasmania has very generous health workforce program options and funding and travel and support, so each state. The way that you would answer this is just email your local state health workforce agency and say you are thinking about bringing some in. What are the options? Those options include, advertising for you and assisting with some of the recruitment aspects and some money. It is easily in the order of $30,000 to $40,000, especially if you are using recruiting agents plus the visa fees for the agents, and plus the fact that for the first few months, they are not really earning much money. There is additional in your systems, and you are still paying them, so it is an investment. On the upside, often you will find that the doctors that are coming in from overseas programs like this are hard workers. They are there to work. They are there to earn money, and they want to earn money. They are trying to support their families. They are often working full time and working hard whereas many locally trained graduates are more likely to drop back to part time when they can or part time once they get their fellowship. There are benefits as well.
Dr Ian Kamerman
It is probably worthwhile thinking about where some of these international medical graduates do come from. We have talked about the NHS causing an exodus of UK doctors. I also think about the recognition that the RACGP now provides for doctors who are considered partially comparable and hence can join specialist PEP. Anyone who has got, what is a very popular qualification, which is the MRCGP International from South Asia. It is only South Asia. In other words, the college of GPs in The UK has an international fellowship. If you happen to have set it with the South Asian faculty branch, you are considered partially comparable. Now these are doctors who are largely from India, Pakistan, Sri Lanka, Nepal, and I am finding a whole lot of those doctors are sitting in places like The UAE and Saudi Arabia. These are doctors who have been there for 10-15 years working as specialists in those countries. In other words, they are not moving here for money.
The reason they are moving is because their children are hitting tertiary education, which is unobtainable for their children in those countries. They are moving so their kids can get tertiary education in Australia. That is one of the carrots that Australia offers, particularly if they are coming in and you can give them permanent residency under 186, so there is a sweet spot there. Another country that is now recognized for their specialist qualifications is Philippines. I have just had a doctor start this week in my practice who is a Filipino specialist, and she has moved here with her family and young child.
If I was looking at limited registrants, and again, I am just talking about my personal experience. As I said before, lots of Iranians are desperate to move to Australia. Again, I am not trying to minimise any other country's experience, but they are extremely well trained. They seem to work well within Australian communities. They have got a great support of other Iranian doctors here. Again, moving countries, cultural support is really, really important. When I offer positions to these doctors when I am doing interviews, I am very careful to hopefully find another doctor within my practice who is from the same culture to join that interview panel. I also tell them, can they get halal food? Where is the nearest mosque? Where is the nearest Hindu temple? Those sorts of things are very important to say that you have those sorts of communities.
There is a question here from Conan to sponsor for 186, should I consider only a three-register rule or can I sponsor any number of candidates? You can sponsor as many as the Department of Home Affairs would like, but obviously, you are still subject if they are going down the FSP pathway. You are capped at only being able to supervise three registrars at the same time. If you want more than three, you are going to have other supervisors there who are able to support them and supervise them. My advice is start slowly. If this is the first time you have done it, start with one. Another requirement is, although it is not mandatory these days, it is looked favourably if you have got some ads running. Do not forget to actually advertise within Australia that you have got positions. It makes that visa application and sponsored process a lot easier.
Associate Professor Michael Clements
I think it is still mandatory. I have had to put one out.
Dr Ian Kamerman
It actually is not. It was removed with the latest. Both Michael and I use the same immigration agent, Alex.
Associate Professor Michael Clements
We are going wrap it up there. Just to reinforce. I have got one doctor whose first degree is from Iran. I have got one already here and one coming from The Philippines where their original degree was. One who was working in the UAE. I have had two from the UK, one from America. I actually love having a diverse background. I actually pick and choose to have a variety. I think it is wonderful for my patients. It is wonderful for the community to bring all these cultures in. It is a great opportunity. Thank you very much. That is time. Thank you, Ian. I really do appreciate your time and your expertise and energy. Thank you, Jessica, for running a good show and to Dimitri in the background who I know is not with us right now. Please feel free to reach out to us if anybody needs any more information. Thanks all.
Jessica
Thank you, everyone. Just a quick reminder to please complete the evaluation that will pop up in a moment when the webinar session closes. It takes no more than a minute to complete. Certificates of attendance will become available on your CPD statements within the next few days. Any non-RACGP members who would like a certificate of attendance, please email us at rural@racgp.org.au. On that note, thank you very much, everyone, and good night.