Can someone explain the ten year moratorium in simple terms

[imgyg]

For example as an IMG who has undergone GP training in AUstralia

---

Members don't see this ad.

 

[Turtle27]

If you have trained in Australia (ie you received your medical degree from an Australian university), this 10 year moratorium does not apply to you. You are not considered an IMG in Australia if you have completed your undergraduate medical education in Australia. For the purposes of internships however, your citizenship / PR status DOES contribute to your priority to secure a position.

If you have trained as a GP in another country (say Canada or the US), and register to practice medicine as a general practitioner in Australia, you are required to practice in underserved communities and rural settings for 10 years.

 

[bashwell]

If you have trained in Australia (ie you received your medical degree from an Australian university), this 10 year moratorium does not apply to you. You are not considered an IMG in Australia if you have completed your undergraduate medical education in Australia. For the purposes of internships however, your citizenship / PR status DOES contribute to your priority to secure a position.

If you have trained as a GP in another country (say Canada or the US), and register to practice medicine as a general practitioner in Australia, you are required to practice in underserved communities and rural settings for 10 years.

Just beware there is also postgrad medical education here in Australia. Not sure if this changes anything regarding the moratorium (I don't have to worry about so I've never looked into it), but just to clarify for others.

 

[Andology]

If you have trained in Australia (ie you received your medical degree from an Australian university), this 10 year moratorium does not apply to you. You are not considered an IMG in Australia if you have completed yourundergraduate medical education in Australia. For the purposes of internships however, your citizenship / PR status DOES contribute to your priority to secure a position.

This cannot be more wrong. You are subjected to the 10 moratorium even if you graduated from an Australian school, even later you become a permanent resident or Australian citizen. As long as you entered Australian medical schools as an international student, you are subject to the 10 year moratorium. It is the same for Overseas Trained Doctor (OTD) who did not graduate from Australian schools but passed the licensing exam by AMC.

http://www.agpt.com.au/ArticleDocuments/186/2017 AGPT General_Rural Pathway Eligiblity Guide.pdf.aspx

If you are subject to 10 year moratorium, you can only train in Rural Pathway. It doesnt matter you go for GP training or specialist training. So staying in Sydney or Melbourne or any capital cities are impossible, 10 years in rural areas at least.

Read the GP guildlines here, they even have a category for FGAMS (Foreign Graduate of Accredited Medical Schools):
http://www.agpt.com.au/ArticleDocuments/178/2017 Applicant Guide WEB.pdf.aspx

Note that FGAMS will compete with OTD for rural training spots, not with Australian students in General Pathway. OTD after passing the AMC exams can participate in GP training, and there can be heaps of those OTD on 457 visa. Be aware.

 

[imgyg]

So basically as a GP it won't affect your earning power but will affect your ability to practice in a big city?

 

[pitman]

If you are subject to 10 year moratorium, you can only train in Rural Pathway. It doesnt matter you go for GP training or specialist training. So staying in Sydney or Melbourne or any capital cities are impossible, 10 years in rural areas at least.

This is incorrect, unless the system has been radically changed. Your training location is not affected, except for GP (which training starts 2+ years after working as a medical officer in any training hospital in the country). The exception there is if you do a procedural year as part of your GP training (e.g., in anaesthetics) you can go back to a metro hospital for that.

Basically, the Moratorium simply prevents you from billing Medicare for up to 10 years after the earlier of getting full registration (when internship is completed) and permanent residency (so for most people, from when you finish internship). The period is reduced from 10 years depending on how rural you work, down to 5 years if you're remote.

The brunt of it is, once you've finished training, you won't be able to work privately for the remainder of your Moratorium period unless you have an exemption, which you get by working in a designated Area of Need. Areas of Need are all over and depend on the specialty. For example, you can do GP work under the Moratorium within 30mins of Brisbane.

 

[pitman]

So basically as a GP it won't affect your earning power but will affect your ability to practice in a big city?

As a GP, you'd likely be making more in a rural setting, in part because there are financial incentives to go rural. The exception to this is that it's less likely you'd be able to 'specialize' (e.g., in skin lesions or erectile dysfunction) and bill accordingly as a rural or non-private GP.

Also keep in mind that typical GP trainees will have completed at least half their Moratorium time by the time they get fellowship.

 

[Turtle27]

If you have trained in Australia (ie you received your medical degree from an Australian university), this 10 year moratorium does not apply to you. You are not considered an IMG in Australia if you have completed your undergraduate medical education in Australia. For the purposes of internships however, your citizenship / PR status DOES contribute to your priority to secure a position.

If you have trained as a GP in another country (say Canada or the US), and register to practice medicine as a general practitioner in Australia, you are required to practice in underserved communities and rural settings for 10 years.

Hey all, I stand corrected on what I said previously! I had misread this page here: https://gpra.org.au/understanding-the-moratorium/ in the section on "Who does the moratorium apply to?"

I'm curious as to how the CMI factors into this then. If you sign a ROS in a rural setting for 1 year, and you end up working as a GP, I assume that you will still be bound rurally until the balance of your 10 years is up? Or does the CMI provide a different avenue for fast-tracking past the moratorium?

Would subspecialies of GP like sports medicine etc. also be bound by the moratorium?

I assume that any additional specialty training (internal medicine, oncology, etc.) immediately qualifies you to work outside the conditions of the moratorium?

 

[pitman]

The Moratorium applies to all specialties. The exemptions are while you're training (except for GP, which requires those under the Moratorium to do the rural pathway, with the exception of a year of procedural training as per above), or if you're working in an Area of Need.

After internship, you would typically spend a second year as a hospital medical officer (variously called an RMO, house officer, JHO...). Then after joining one of the GP colleges (RACGP or ACRRM), you would be required to work in an RA2 or above rural location, which just means anywhere not in a metro region. See the map of rural designations here:
http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/ra-intro

The only 'fast-tracking' is through working rural, as per above. For example, if you did all your training in RA2, the Moratorium would be 9 years, while if RA5, it would be 5 years.

 

[Kakaonkaka]

Thanks pitman and Andology. This topic definitely needed clarifying. As I understand it, different specialties have different geographic regions where the moratorium can be shortened based on need for that particular specialty in that region? So a psychiatrist may only need to serve 7y under the moratorium in a town 2h from Sydney, versus a GP who may be subject to 8y. -Based on what RA(1-5) classification the town is in.

http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

Is this correct?

 

[pitman]

No. The Moratorium period is reduced only by going more rural/remote, as per above. Period. Need for a specialty only defines whether the area counts as an exemption (to allow Medicare billing) while under the Moratorium.

 

[drvfedorov]

Is there a chart that shows the regions which are labelled rural/remote. @pitman mentioned that 30mins from brisbane is considered rural, if that's the case it's really not as bad as everyone says? Because at times when people say "rural" the connotation assumes literally in the middle of nowhere.

 

[Andology]

Is there a chart that shows the regions which are labelled rural/remote. @pitman mentioned that 30mins from brisbane is considered rural, if that's the case it's really not as bad as everyone says? Because at times when people say "rural" the connotation assumes literally in the middle of nowhere.

It is out of nowhere I think, especially when you have to do your training in the rural areas, there can be only 1 hospital within 200km. After your training 4-6 years, you can go to these less rural places and practice, could be after a few years extra to have enough experience to set up your own practice. Lots of people go to Alice Springs just for internship alone. Rural areas in Australia also have lots of nopes, that's why most of the population are in metro areas.

 

[pitman]

Again, for training, the only people really affected are GP trainees. Their requirement is to train in RA2 or above, which is everywhere except for inner metro regions (at least this was the case up to a few years ago -- it's possible that GP trainees must now be in RA3+, which was discussed but which change I haven't heard about). Note that trainees also compete for where they are placed, so you shouldn't count on getting an RA2 spot. See the map for details.

The RA map however does not show the Districts of Workforce Shortage (apologies, I was using the term 'Area of Need' which is for IMG trainees before they get PR). These vary by speciality. After you finish training, you can either work publicly without issue, or you can work privately and/or as a GP (attracting Medicare billing) in a District of Workforce Shortage for the remainder of your Moratorium. I don't know of maps for DoWS by specialty. For GPs, these tend to be pretty much anywhere RA3 or above.

As an example: I am a former int'l student. I graduated 8 years ago and have been on the Moratorium for 7 years. I did my internship and JHO (Junior House Officer aka PGY2) hospital training years in RA1 (metro) locations in northern Brisbane. I completed a year of "rural" GP clinic training in the centre of Cairns (RA3; pop 150,000 w/ a local tertiary hospital with a catchment area of all of FNQ down to within a couple hours' drive of Townsville).

After locuming rurally (RA2-5 in Qld, NSW, and WA) for a number of years, and a year back in a tertiary hospital for anaesthetics training, I now have just under a year to go under the Moratorium.

As a full-time locum tenens, if I work in a GP clinic (where I would thus have to bill Medicare), I need a 19AB exemption to the Moratorium to work. When the clinic is attached to a public hospital, this is pretty easy because the clinic will invariably be in a DoWS, or the hospital can apply for it to be (I still don't quite understand how this is done, since DoWS are supposed to be based on population statistics, but it happens -- OTOH it makes sense that any GP clinic that had to be run by the local hospital implies a local shortage of GPs). The paperwork tends to take a week or two to be processed.

However, most of my work is in state-funded (public) hospitals, in EDs and med/ICU wards, so I don't need to apply for an exemption. In other words, aside from my year of clinic work in Cairns (ACRRM requires only one year whereas RACGP requires up to two), I have not really been restricted by the Moratorium.

 

[imgyg]

As a GP, you'd likely be making more in a rural setting, in part because there are financial incentives to go rural. The exception to this is that it's less likely you'd be able to 'specialize' (e.g., in skin lesions or erectile dysfunction) and bill accordingly as a rural or non-private GP.

Also keep in mind that typical GP trainees will have completed at least half their Moratorium time by the time they get fellowship.

I see. Is pre-GP employment as a doctor in australia counted towards the moratorium? Eg med/surg rotations

 

[imgyg]

As regards finances: you're saying that trainees subject to the moratorium are likely to be high earners as there are financial incentives rurally even though you can't bill privately (or via medicare or whatever it is)?

 

[pitman]

The Moratorium starts after you finish internship, so if after internship then...yes. In fact, if you do nothing for 10 years after internship, you will have completed the Moratorium. You won't reduce the time to less than 10 years by not practicing, though.

GP trainees get the same rural incentives as GPs who are rural. The program is called GPRIP:
http://www.health.gov.au/internet/m...t/general_practice_rural_incentives_programme

The amount depends on how rural you go and how many years you're there (see the pdf under Program Guidelines). For example, for the most rural locations, it's $25,000 for the first year. Base pay for advanced rural GP trainees will also be more if you're hired as a Senior Medical Officer at a rural hospital (e.g., most advanced ACRRM trainees, who will help run an ED and medical wards...however increasingly, to do this you need to have completed a procedural year in anaesthetics or O&G). There are also other incentives when you're rural like a car allowance, and in some locations, your accommodation is free. After training, rural GPs can also often negotiate pay as a higher percentage of their total Medicare billings with a practice than can metro GPs, because GP shortages are more acute in rural locations.

 

[Skittsie13]

Does the moratorium apply to Australian citizens who are IMGs/have done their clinical training abroad?

 

[Andology]

Does the moratorium apply to Australian citizens who are IMGs/have done their clinical training abroad?

Yes, you will be classified as overseas-trained doctors (OTD).

 

[Andology]

I see. Is pre-GP employment as a doctor in australia counted towards the moratorium? Eg med/surg rotations

Yes, after the general registration (means after your internship), the 10 year clock starts. For GP training, only 3 providers are sponsoring 457 visa for international student as of this year, which can change in the future:
http://www.agpt.com.au/ArticleDocuments/186/2017 AGPT 457 Visa Geographic Training Region Supporting List.pdf.aspx
GP training is getting more and more competitive with way more applicants than the 1500 spots available.

 

[imgyg]

Thanks for responses. Are IMGs able to train eg as GP registrars in metropolitan areas? (Prior to finishing training)

 

[imgyg]

Also, pittman when you say you are full time locum, does that mean you are a fully qualified GP who does shifts on a prn basis in EDs/wards in addition to doing locum shifts in actual GP practices?

 

[pitman]

For GP training, only 3 providers are sponsoring 457 visa for international student as of this year, which can change in the future

This is not relevant for int'l students, but for IMGs. International students will have gotten permanent residency by the time they start GP training.

 

[pitman]

Also, pittman when you say you are full time locum, does that mean you are a fully qualified GP who does shifts on a prn basis in EDs/wards in addition to doing locum shifts in actual GP practices?

I work when I want to, flying out to places where there are shortages (pretty much everywhere RA3+). My agency will keep an eye out for opportunities that match my preferences (type of work, pay, region, hours), and make suggestions. I'll say yay or nay, and then they submit my CV to the hospital which then accepts me or not. The agency then organizes transportation and the hospital my accommodation and local transportation. Some hospitals I go back to routinely, other times I opt to go somewhere new, like in a part of Australia that I'd like to explore.

 

[imgyg]

I work when I want to, flying out to places where there are shortages (pretty much everywhere RA3+). My agency will keep an eye out for opportunities that match my preferences (type of work, pay, region, hours), and make suggestions. I'll say yay or nay, and then they submit my CV to the hospital which then accepts me or not. The agency then organizes transportation and the hospital my accommodation and local transportation. Some hospitals I go back to routinely, other times I opt to go somewhere new, like in a part of Australia that I'd like to explore.

I see. And are they ED/hospital shifts or GP shifts? Is the remuneration good?

Also, a few posts above you mentioned that if you do nothing for ten years the moratorium will end. Does this mean you don't need to be on the gp training scheme or even in medical employment once you are an australian permanent resident/citizen? Ie all you have to do is simply wait ten years from general registration?

 

[Andology]

This is not relevant for int'l students, but for IMGs. International students will have gotten permanent residency by the time they start GP training.

International students can only apply for PR after their internships, not enough time for PR processing before May deadline, unless they want to wait for another year. There are also speculation that the government will remove medical professionals from the SOL list next year, so there are possibilities.
http://www.peakmigration.com.au/new...o-be-removed-from-the-skilled-occupation-list

 

[pitman]

International students can only apply for PR after their internships, not enough time for PR processing before May deadline, unless they want to wait for another year. There are also speculation that the government will remove medical professionals from the SOL list next year, so there are possibilities.
http://www.peakmigration.com.au/new...o-be-removed-from-the-skilled-occupation-list

If they remove docs from the Skilled list, that's one thing, but the politics would dictate that there would be some accommodation for former int'l students.

There's now a May deadline for applying to GP colleges for starting the following year?? There also used to be two intakes per year...no longer the case? I suppose worst case then is a third year as a Senior/Principle House Officer. I used my 3rd year out to locum as a PHO, which was later recognized by ACRRM towards college training.

 

[pitman]

I see. And are they ED/hospital shifts or GP shifts? Is the remuneration good?

Also, a few posts above you mentioned that if you do nothing for ten years the moratorium will end. Does this mean you don't need to be on the gp training scheme or even in medical employment once you are an australian permanent resident/citizen? Ie all you have to do is simply wait ten years from general registration?

I'm a rural generalist, which is a GP who does work in any combo of clinics, EDs, med wards, and various other jobs. My work by personal preference is chiefly in ED, then med wards, and least in clinics.

If you were to wait 10 years following internship, I'm not sure who would hire you. But yes, after ten years you'd have satisfied the Moratorium.

Remuneration is IMO better than as a public specialist. As a hypothetical, if you're a GP with significant ED or ward experience (i.e., a rural generalist) but without accredited procedural skills, in Qld or WA (the top paying states) one should expect ~$1800-$2000 per day for RA3-5. Proceduralists command about $200 a day more. NSW pays a bit less, but they pay for superannuation which when factored in makes it close.

 

[imgyg]

I'm a rural generalist, which is a GP who does work in any combo of clinics, EDs, med wards, and various other jobs. My work by personal preference is chiefly in ED, then med wards, and least in clinics.

If you were to wait 10 years following internship, I'm not sure who would hire you. But yes, after ten years you'd have satisfied the Moratorium.

Remuneration is IMO better than as a public specialist. As a hypothetical, if you're a GP with significant ED or ward experience (i.e., a rural generalist) but without accredited procedural skills, in Qld or WA (the top paying states) one should expect ~$1800-$2000 per day for RA3-5. Proceduralists command about $200 a day more. NSW pays a bit less, but they pay for superannuation which when factored in makes it close.

Can you dictate your entire schedule as regards working hours? Sounds quite cool.

The reason I asked is I will have PR soon and am considering leaving australia for a couple of years and then returning to do GP scheme. Was hoping those years would count towards the moratorium. The money sounds good. Finances are important to me, not because I want flash cars or big houses but because I want to be able to be financially independent and able to retire if I want to. Does it take a long time after finishing the GP scheme to start earning good money?

 

[pitman]

I work when I want to, yes.

If you leave for a couple of years and don't practice medicine, you will find it more difficult to secure work. It could be that on return, the only job you'd get was as a junior house officer. I wouldn't risk it.

Qld is moving towards requiring locums to have a fellowship or a procedural skill. Other places you can start locuming long before then, and if you train towards being a rural generalist, you'd be competitive as a senior registrar to make money comparable to the above. But it takes planning -- spending more time training in EDs, and gettings appropriate certificates like APLS and EMST.

 

[alumni]

Does the 10 year moratorium only affects GPs or does it affect all specialities? Thanks.

 

[Turtle27]

It applies to all physicians. Effectively, it's your moratorium against your medicare billing number. However if a specialty requires you to be at a certain location for training etc., then you will be allowed to practice there and have your time count. For example, your intern and JMO years might need to be rural (this is also excluded if you get accepted to a particular training program at an urban hospital), however if you are applying for RACS and continued surgical training, you'll be able to get back to an urban centre no problem, and the continued training time (next 8 years after) counts towards that 10 year limit.