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RACGP urges Medicare rule change for IMGs
‘Bureaucracy is hampering potential recovery efforts’: The college is calling for changes to rules which mean some IMGs cannot legally practise outside of their clinic during a time of natural disaster.
A person uses a paddleboard on a flooded street in Port Macquarie, New South Wales. (Image: AAP/Lindsay Moller)
In rural communities across Australia, more than 50% of GP positions are staffed by international medical graduates (IMGs).
But when practices in these communities are struck by a natural disaster – and when their patients need them most – many of these doctors are currently unable to practise, and the RACGP is calling for that to change.
As it stands, Medicare provider numbers are for a fixed address, and RACGP Rural Chair Associate Professor Michael Clements said the college is aware there are some ‘opaque provisions’ for using the provider number from another location during a disaster, such as calling an evacuation centre a ‘home visit’.
‘But rules are not clear, and IMGs often suffer additional barriers,’ he said.
‘IMGs who are offered to work from a new address or an alternative clinic site are faced with a decision on either not supporting their community or stretching Medicare and Australian Health Practitioner Regulatory Authority (AHPRA) rules to be able to access rebates for their patients.’
The reason for this is that, in most cases, IMGs and temporary residents training to become Fellows of the RACGP are required to have fixed practice locations listed as part of their AHPRA registration, restricting them from legally practising from any other location, even in a crisis.
Associate Professor Clements told newsGP the college is calling for AHPRA and Medicare to build in temporary exemptions and flexibility in declared disaster zones.
‘When a practice floods, if the practice is able to open up in a car park across the road or down the street on the other side of town, all of the Australian-trained graduates and so forth can apply for an immediate provider number or they can work under some of the emergency provisions,’ he explained.
‘But these international graduates, not only can they not support their community, but they can’t actually work themselves and earn money unless they breach the law.
‘This is just a simple case where bureaucracy is hampering potential recovery efforts and so, we’re calling on the Federal Government to apply an exemption and a process that means in a declared disaster zone, some of those restrictions can be temporarily paused or waived.’
Associate Professor Clements is hopeful the Federal Government will heed the college’s calls, as it did following flooding events in South East Queensland and northern New South Wales in 2022, when the RACGP lobbied for the 12-month face-to-face consultation requirement for Medicare-subsidised telehealth services to be waived during natural disasters.
The college’s latest advocacy is part of a renewed push for governments at all levels to actively involve GPs in disaster planning, and the prioritisation of re-opening medical practices to support communities recovering from natural disasters.
It follows recent floods in NSW, where six general practice training practices in the Taree and Forster region were left with no option but to temporarily close.
Among them was Health Hub Taree and Awabakal Medical Service, an Aboriginal community-controlled health service in Cardiff, where they had no power for four days. With about 200 patients seen at the practice daily, the closure caused significant disruption to care delivery.
Dr Simon Holliday, who works at the Health Hub Taree, said it took advocacy from local MP Tanya Thompson to get the power back on in his clinic. He said better planning could have avoided the level of disruption experienced, allowing him and other GPs to treat members of the community elsewhere while the clinic was closed.
‘We had 25 centimetres of water through the place,’ he said.
‘From when the sparkie first had a look at the place to when the power got turned on would have been 48 hours.’
Associate Professor Clements says the experience in NSW clearly indicates that the important role general practices play is not being considered.
‘GPs weren’t really part of the disaster planning, they weren’t thought of in that respect, and it took a Member of Parliament to lobby directly for those practices before they actually could get the electricity support that they needed,’ he said.
The Rural Chair, who is based in north Queensland, has experienced the impacts of natural disasters on communities firsthand and the vital role GPs play in keeping people close to their homes and out of emergency departments.
‘When I staffed an evacuation centre during the Townsville floods, the most urgent thing was that people had left their houses without all of their medications,’ he reflected.
‘They knew they were taking 15 tablets, they just didn’t know what they were, and I needed to figure out with them which ones were absolutely critical that they had within the next 24 hours.
‘What was happening is they were presenting to the emergency department saying, “I need a script” and the emergency department saying “well, we’re not set up for that, we don’t know how to investigate that, that’s not our job” and were sending them back.
‘Then in the first week after, people are often trying to get back in and clean their houses as soon as they can, and they come in with wounds that are at high risk for infection. Then over the next several months and years even, the GPs are dealing with the aftermath of mental health distress and concern and trying to help them get back on their feet.’
The RACGP’s proposed changes are part of its key recommendations for the inclusion of GPs into evacuation centres, which include:
- local PHNs play a critical role in establishing lists of GPs and other medical personnel who can assist in emergencies ahead of time
- general practices be designated and prioritised as essential services during disasters
- dedicated funding be allocated to general practices for preparation, response, and recovery from disasters
- a reduction in red tape that affects GPs in emergencies, including Medicare compliance activities
- the RACGP and PHNs be included in national, state, territory and local government disaster and emergency planning groups and committees.
Associate Professor Clements said it is essential that GPs be formally included in government disaster and emergency planning groups and committees at all levels going forward, including the National Emergency Management Agency.
‘This is an increasingly frequent issue due to climate change – and every time we have a natural disaster, we learn more about how to do things better next time,’ he said.
‘As a college, we’re part of that review process. We support our members, we listen to them, and we build on it.’
The RACGP has created a resource to guide GPs working in evacuation centres during an emergency.
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