Getting GP registrars’ model right

As the Federal Department moves towards handing the totality of the Australian GP Training Scheme to the colleges, the ultimate model for paying GP registrars remains in the air. At present, the registrars are employed by practice businesses on a base rate which is supplemented according to how many patients they see.

The GP Training Advisory Committee – a profession-led committee that advisory committee has put up for discussion a model in which the colleges employ the registrars.

The AMA, on the other hand, has proposed that the government employ the registrars.

The National Terms and Conditions for Employment of Registrars is also under discussion. It is renewed every two years. The registrars argue that they are not paid as well as registrars in other specialities and they are in a weaker position because they are not bargaining with the big teaching hospitals that employ registrars of other specialities.

The profession and government are seeking to address a shortage of GPs. The Australian GP Training Scheme has not met its target since 2017. 

The GP Training Advisory Committee’s discussion paper proposes that the two colleges – the Australian Rural and Regional Medicine and the Royal Australian College of General Practice would be responsible for paying out parental leave and other entitlements as part of the arrangements, which unlike the present set-up would carry over from trainees’ previous public–hospital employment.

These, along with pay rates, would be negotiated through collective bargaining between registrars and each college. MBS payments would also be in the mix.

This would at least satisfy one major concern of general practice registrars – the loss of continuity of employment for entitlements when they move from public hospitals to be employees of practice businesses, often only for the duration of their time as registrar or less.

However, it might not address another concern – the immediate drop in pay when moving from employment in a public hospital to private medical practice. This is why government funding one way or the other might be needed if junior doctors are to be encouraged to specialise in general practice.

One suggestion is that the doctors would continue to be paid by their state or territory public hospital after they begin their GP training.

Whereas, if the colleges became the employer, ultimately private medical practice would be footing the bill, even if indirectly.

Either way, there is a problem with a the colleges being a single employer of all registrars because they would be all at once employer, assessor and standard setter.

Meanwhile, junior doctors are voting with their feet because not enough of them are specialising in General Practice, when other more lucrative specialities are on offer. Inevitably this will lead to continuing shortages of GPs.

The committee will publish its final recommendations next year.

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