Special meeting to discuss the Report on the 2010 Review of the Medicare Provider Number Legislation

Transcript of the special meeting to discuss the 2010 review of the Medicare provider number legislation.

Page last updated: November 2012

A record of the proceedings of the Medical Training Review Panel (MTRP) special meeting, which was held on 20 April 2011, was tabled in Parliament in July 2011.

Transcript of the special meeting on the 2010 review of the Medicare provider number legislation (PDF 120 KB)

Record of Proceedings

A requirement under section 19AD (4) of the Health Insurance Act 1973

Ms Maria Jolly, Acting First Assistant Secretary of the Health Workforce Division, Australian Government Department of Health and Ageing

We might now move into the formal part of the meeting. Today is a Special Meeting of the Medical Training Review Panel (MTRP) to discuss the 2010 Report on the Review of the Medicare Provider Number Legislation. I am very pleased to welcome you to today's meeting to discuss the findings of the Report on the 2010 Review of the Medicare Provider Number Legislation which was tabled in Parliament on 21 February this year, as required under Section 19AD of the Health Insurance Act 1973 (the Act).

My name is Maria Jolly and I am standing in for Kerry Flanagan, who is the Chair of the MTRP. I am the Acting First Assistant Secretary of the Health Workforce Division in the Australian Government Department of Health and Ageing. Kerry sends her apologies; she is unable to attend today due to other commitments.

I would like to welcome you all here today and thank you for your attendance. 27 members of the panel are here today as well as a representative from an organisation considering joining the panel.

As you are all aware, the membership of the panel represents medical schools, specialist colleges, medical students and doctors in training, State and Territory health departments and the Commonwealth.

I would also like to welcome Wendy Hodge of ARTD, the consultant engaged by the department to conduct the 2010 Review and to thank her for her time today. We also have Ms Mari Anile of Pacific Solutions with us today, who will be recording the meeting.

I would like to go through a number of apologies we have for today:

  • Ms Kerry Flanagan from Department of Health and Ageing
  • Prof Shih-Chang Wang from Royal Australian and New Zealand College of Radiologists
  • Dr Craig White from Tasmanian Department of Health and Human Services
  • Dr Susan O’Dwyer from Queensland Health
  • Assistant Professor Chris Baker from Australasian College of Dermatologists
  • Professor Brendan Crotty from Confederation of Postgraduate Medical Education Councils
  • Professor Simon Willcock from General Practice Education and Training Ltd
  • Dr Mark Renehan from Royal Australian and New Zealand College of Ophthalmologists
  • Professor Michael Kidd from Royal Australian College of General Practitioners
  • Dr Alan Ruben from Department of Health and Families NT
  • Dr Peter Keppel from Rural Doctors’ Association of Australia
  • Dr David Hillis from Royal Australasian College of Surgeons
  • Dr Andrew Gosbell from Royal Australian and New Zealand College of Psychiatrists
  • Professor Tony Landgren from Royal College of Pathologists Australasia.

There are three member organisations that have been unable to attend today, and they are:

  • The Royal Australian and New Zealand College of Radiologists
  • General Practice Education and Training Limited
  • The Royal Australian and New Zealand College of Psychiatrists.

These organisations have been provided the opportunity to present their comments on the report in a written format and they will be read out by me as Chair and recorded into the proceedings.

Background to the MTRP. The MTRP is a statutory committee that was established in 1997 to examine the demand for and supply of medical training opportunities and to monitor the impact of the Medicare Provider Number Legislation, s19AA, 3GA and 3GC, that was introduced under the Act in November 1996.

The MTRP is a unique national body bringing together representatives of key stakeholders across the continuum in the field of medical training from university to graduation fellowship. The panel provides a comprehensive annual report fulfilling its monitoring function by supplying data on medical training activities in Australia. The 14th Report has been prepared and presented to the Minister for Health and Ageing and will be tabled in Parliament in the near future.

Section 19AD of the Act requires a review be undertaken every five years on the operations of s19AA, 3GA and 3GC of the Act, collectively known as the Medicare Provider Number Legislation. This section of the Act states that the Minister for Health and Ageing must cause a report setting out details of the operations and impact of s19AA, 3GA to be laid before each House of Parliament by 31 December 2010. The legislation requires medical practitioners to complete postgraduate qualifications and achieve fellowship of a recognised medical college before they are provided access to Medicare benefits. If the medical practitioner is not vocationally recognised, they are then required to be participating in an approved 3GA training or workforce program to enable access to Medicare benefits.

Reviews of the legislation have been conducted every two years between 1999 and 2005. Outcomes from these reviews found the legislation to be operating effectively and it was decided to undertake future reviews every five years thereafter. A key focus of these reviews was to explore whether the intent of the legislation, improving the quality of general practice services, was being undermined by the workforce programs under s3GA.

The 2010 review process saw ARTD consultants meet with key industry stakeholders during the consultation phase. 65 participants engaged in one-on-one interview or group meetings, six organisations provided formal submissions and 37 responses to semi-structured electronic submissions were received. The process was completed with a submission by ARTD consultants of their report and recommendations to the Minister through the department. Minister Roxon approved tabling of the report in February 2011. I trust you have all received a copy of the report, in electronic version and/or hard copy. The report can also be accessed through the department's website.

The purpose of today's meeting is to give you an opportunity as a group to consider and discuss the findings and recommendations presented in the report. Once we have heard and received your views, it is a requirement under the Act that a transcript of today's meeting be tabled in Parliament within 20 sitting days from this meeting. Based on the Parliamentary calendar, the record of proceedings of this meeting will be due for tabling in Parliament the week commencing 4 July 2011. Copies of the transcript will be forwarded to all MTRP members in due course.

After today's meeting, your views and comments regarding support for, or disagreement with, the review recommendations will be considered by the Government. The purpose of this meeting is not to have a debate on the recommendations but to understand the range of views on the recommendations in front of you. Ms Hodge is available to answer your questions regarding the review process and I, or my colleagues, will address those regarding the programs run by the department.

I am proposing today to consider the recommendations under the four groups as they are presented in the report, starting with s19AA recommendations, then s3GA, followed by the s3GC recommendations. We can then end the meeting with any further issues you may wish to raise, or points you would like to make.

For those of you not familiar with these sections of the Act, s19AA restricts Australian citizens and permanent resident doctors who were first recognised as medical practitioners from 1 November 1996 from accessing Medicare unless they hold fellowship of a recognised medical college. s3GA permits those medical practitioners who are subject to s19AA to obtain a Medicare provider number if they are participating in an approved 3GA training or workforce program, a list of which has been provided with your agenda papers for your information.

Section 3GC of the Act established the MTRP to examine the demand for, and supply of, medical training opportunities and to monitor the impact of Medicare Provider Number Legislation, s19AA, 3GA and 3GC, that was introduced under the Act in November 1996.

The above legislation has also been included in your agenda. We will address each recommendation individually, and then seek your views and comments. If there are no comments to be made against a recommendation, we will move onto the next. As this meeting is being recorded, it is important that all members' views are heard clearly. You will notice the microphones on your tables - we have one per three members. I ask that before you present your comments, you provide your name and organisation so that it can be recorded accurately.

To begin the discussion, I would like to ask Ms Hodge to provide you with a summary of the report. Thank you.

Ms Wendy Hodge, ARTD Consultants –

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Good morning, and thanks Maria and to the other members of the Department of Health and

Ageing involved in the Review and, of course, to the members of the MTRP.

Before I start, I would like to acknowledge that more than 100 people have contributed to the review by giving their time and expertise and, I have to acknowledge, within a very short time period. I'm happy to be here with you today to present a summary of the review, but I'm not going to speak for very long, only for about 10 minutes. I'm going to highlight the main findings and focus on some of the possibly more important recommendations.

First, I think it's useful to talk about the context for the review. As you know, it's five years since the last review and in those five years there has been considerable changes in the medical workforce and training environment, so that is the context in which the legislation is operating. In that time we've had a new national assessment process introduced in 2008; we've had a new national registration and accreditation system and a body to oversee that in July 2010; the Health Workforce Australia has been established, responsible for medical workforce planning and, of course, there has been an increase in the number of junior doctors being trained in an effort to increase vocational training places. Lastly, of course, right now we're in the middle of a public health reform process. So that's the context of the review so, there has been changes.

Just to remind you of the terms of reference for the review, they were to report on the operation of the legislation - s19AA, 3GA and 3GC over the last five years. The second term of reference was to look at the progress towards implementing the recommendations from the last review in 2005, and the third term of reference was to identify any emerging issues that might impact on the operation of the legislation.

I will just briefly highlight the main findings. As Maria alluded to, the legislation is operating fairly effectively and s19AA is well accepted in the profession. As for other specialist areas, vocationally trained doctors are now the norm in general practice and indeed I believe around 50 per cent of all general practitioners are now vocationally trained. There was an issue last time around non-vocationally recognised or trained general practitioners, and I will come back to that a little later.

The second finding is that implementing s19AA in conjunction with other related Medicare provider number legislation is quite complex for all concerned, and has caused some anomalies that impact on the way some doctors' ability to practise and receive Medicare rebates. There is probably a need to harmonise some of the other related Medicare provider number legislation, and indeed that's the first recommendation of the Review, that process be done in a systematic way by the department.

I will come back to s3GA, workforce programs, and just remark that the MTRP is highly valued and there is a lot of support for the statutory role to be maintained and possibly expanded to monitor training capacity and demand for training. Secondly, the other main finding around the MTRP is that the panel and Health Workforce Australia (HWA) should have formal links around planning for medical training. I have made some recommendations, that's recommendations 23, 24 and 25.

Another recommendation that was made in the last review, that is common across all the reviews, is the efficiency of the administration processes for allocating Medicare provider numbers. Although there have been some improvements in the last five years it's still quite clear that the process needs to be re-looked at and streamlined because it is placing an unnecessary burden on medical practitioners and making things difficult in getting trainees in positions in certain areas. Recommendation 10 addresses that issue and there are actions for quite detailed recommendations about how that process might happen.

I will go back to s3GA workforce and training programs. The review didn't get a lot of feedback about the effectiveness of training programs as opposed to workforce programs, as Maria has said, the focus was more on the operation of workforce programs, but the feedback we did get about the training programs was that they are being implemented effectively and people are fairly happy with them, although it was noted that the system may be facing some challenges with the increases in the number of junior doctors being trained.

There was a specialist college training program which had a fairly low uptake and guidelines were a little unclear to some of the colleges that they could be used, and that program was about giving private settings an opportunity to train doctors in specialist areas so that the program had a fairly low uptake, and I must say there was some confusion between specialist college training program and specialist training program.

I will go back to the workforce programs. There is no doubt that they are an effective mechanism and they do contribute to meeting some of the workforce shortages out there in rural and regional Australia and in the metropolitan area. Since 2005 there was concern that doctors on that program weren't required to be working towards vocational training, now on all of those programs that is an expectation so that's a big change since 2005.

One of the many findings of the 2000 Review was that there wasn't enough investment in training and quality processes for workforce programs and the 2005 Review called for more money to be invested in that, and there has been some money invested in the Rural Locum

Relief Program (RLRP) - Additional Assistance Program – which has been given more funds but nevertheless it still doesn't meet the demand for the funding for that program. Our finding is that there still needs to be more money invested to support doctors on workforce programs to work towards vocational training.

Another finding is that although we have a new national registration and accreditation system that's looking after consistency in setting conditions of practice and supervision requirements, there is still a feeling out in general practice that the system may not have the capacity to provide that supervision in an adequate manner, or to provide mentoring for those doctors on workforce training programs. Although the supervision requirements may be set, there is some uncertainty about how well they can be met currently.

Since 2005 the guidelines and quality processes have all been strengthened for workforce programs, and that was a main finding that they weren't there in the guidelines. The evidence about the impact on the quality processes and workforce programs, whilst strengthened, those guidelines are rather limited and mixed so we have had some sectors saying yes, it's made a big difference and for some programs there's still some concerns about the quality. As I said, it's very, very limited evidence and all we can say it's limited and anecdotal.

I should have said that I've made some recommendations about investment in training and mentoring of doctors in workforce programs - that's Recommendations 11 and 12. Lastly, one of the findings around s3GA workforce programs is that there seems to be limited opportunity for the sector to comment on operational issues of programs in-between the reviews over the five years so there needs to be a mechanism for operational issues to be addressed as a matter of course in the time between the two reviews, and I've made a recommendation to that effect.

I've already alluded to the status of some of the 2005 recommendations so I want to now come back to the issue of non-vocationally recognised general practitioners and, in particular, those who graduated before 1996, when the legislation to require GPs to be vocationally trained was brought in. Sorry, I'll just go back one step, I just want to comment that there were 22 recommendations last time in 2005, and around half of those have been implemented and some of them have been superseded by the changes in the operating environment that I discussed earlier and for some it's unclear why they haven't been addressed.

The contentious one of those recommendations is the recommendation that Ron Phillips made about providing one more opportunity for GPs who graduated before 1996 to be grandfathered onto the vocational register. That hasn't been implemented and I have again recommended that happen; however, I have to comment that that's not wholly supported by all people in the sector. There was a view that the time has passed now for grandfathering. There was also a view that it may not be feasible under the new national registration and accreditation legislation, but there was also a strong view that it's a fairness issue, particularly with the new national registration and accreditation system in place.

Interestingly, in 2005 Ron Phillips estimated there were 2,500 non-vocationally recognised experienced general practitioners. The estimation that the Royal Australian College of General Practice gave to me this time is around 600 people in that position. I actually agree with the recommendation from last time so, I have again recommended that there be the last opportunity, if feasible, for that group of doctors to be placed on the vocational register, and if not feasible then other strategies looked at in making their position more equitable, given that they meet the standard of registration.

The other recommendations from last time that weren't implemented, just to highlight a couple, were around the links between medical deputising services and divisions of general practice in providing services to residential aged care facilities, so it was a very specific mechanism recommended last time and deputising services being part of aged care panels and provisions of general practice. It doesn't appear to have happened. It may have happened in some places but not in a systematic way. The other part of that recommendation was that the possibility of deputising services providing in-hours care to residential aged care facilities, that's visiting services, also are being considered and I believe that that also hasn't happened. I was unable to find out why those recommendations haven't been forwarded. There are also a number of recommendations around workforce programs that have been superseded since.

I think that's all I had to say. Again, thank you very much for all your help and I will hand you back to Maria.

Ms Maria Jolly –

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Thank you very much. Has anyone got any questions of Wendy? No? Okay, we might move on to talk about each of the recommendations. Does anybody not have the report in front of you? I'm just going to work my way through the recommendations, the first set of recommendations on s19 AA.

The first recommendation is:

DoHA to review all relevant Medicare Provider Number Legislation to address issues in access to provider numbers and the ability of doctors to practice.

Would anybody like to comment on that recommendation? No comments on that recommendation?

Okay, we'll move onto Recommendation 2:

The Government to review eligibility criteria for access to vocational training programs so that OTDs' access to these is assessed on the basis of clinical skills and not on the basis of their residential status.

Would anybody like to make a comment on that recommendation? No? Okay.

Recommendation 3:

Eligibility for grandfathering of non-vocationally recognised (VR) GPs who were qualified before 1996 to be determined in consultation with the profession and the Medical Board of Australia:

Provide one last opportunity to be grandfathered onto the vocational register because this recommendation was not actioned in 2005. If grandfathering is not possible because of the establishment of the national registration system; allow this group to access A1 rebates for a defined period whilst working towards Fellowships with ACRRM or the Royal Australian College of General Practitioners (RACGP).

Would anyone would like to make a comment on this recommendation?

Professor Geoff Dobb, Australian Medical Association –

The Association strongly supports this recommendation. It was a recommendation of the last Review that has not been implemented. It is getting to the time when grandfathering of this particular group is becoming more and more appropriate because it is an ageing cohort of the medical profession.

As you pointed out, five years ago the College of GPs estimated there were around 2,500 of non-vocationally registered general practitioners. The current estimate is around 600, so the cohort is decreasing. This is a great opportunity to recognise the contribution that this group of doctors have made to the profession and to medical services in Australia. If we leave it too much longer there will be no further opportunity to provide that recognition. We know that many of this group work in country and rural areas, there are those who work in some specialist areas or non referred specialist areas within the metropolitan areas, but as a group they have made a significant contribution.

We also know that the rebates under the MBS for this group have been frozen for many years so that not only have they been disadvantaged by not gaining vocational recognition, but also they have been disadvantaged by having the rebates available to their patients frozen. So this is, if you like, a double injustice which there is an opportunity through the implementation of this recommendation to correct so I strongly support this recommendation.

I know that there are some concerns, in particular from the College of General Practitioners. The recommendation is framed in a way, I hope, that will allow them to support the implementation of this recommendation.

Ms Maria Jolly –

Thank you very much. Anybody else like to provide a comment on this recommendation?

Dr Michael Bonning, Australian Medical Association – Council of Doctors-in-Training The extension from that comment to this recommendation is that a nationally consistent system for continuing professional development and a medical education that is now required as part of the registration laws means that the quality of services provided to patients is now very consistent and that now forms a safety net to ensure the quality and standards of practice that occur. Therefore, there shouldn't be restrictions placed on this group of general practitioners given that they're meeting the same requirements for ongoing education as their vocationally registered colleagues.

Ms Maria Jolly –

Thank you very much.

Professor Robin Mortimer, Australian Medical Council –

Could we define the definition of what qualification before 1996 was?

Ms Maria Jolly –

Graduating from university, graduating degree in medicine.

Professor Robin Mortimer –

But that can mean various things.

Ms Maria Jolly –

Sure.

Professor Geoff Dobb –

Perhaps by way of clarification, I can point out that in fact many of those who are non- vocationally registered general practitioners fall into that group, qualified well before 1996, which is why there's an increasing cohort.

Ms Maria Jolly –

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Anybody else would like to provide comment on this recommendation?

Professor Nick Glasgow, Medical Deans of Australia and New Zealand –

It's a question just to the clarification as to what exactly the recommendation is. Do we know whether it is possible to grandfather under the National Registration Scheme or we don't know that yet? And then if we don't know that, what would a defined period of time be or is that to be worked out after? I guess I think it would be a bad look if this last opportunity in five years was another lost opportunity. How many last opportunities will there be?

Ms Maria Jolly –

Thank you for that comment. I think the way that the recommendation is framed does talk about the need for consultation with the Medical Board of Australia, given their role obviously in registration, so that would have to be part of the implementation considerations.

In terms of a defined period of time, I guess I ask the MTRP whether there is a view that they would like to put forward about that in response to this recommendation but it hasn't been defined in the report.

Dr Michael Bonning –

It has been proposed that in line with, I suppose, previous propositions in this area that those non-vocationally recognised GPs who qualified before 1996 would have to show currency of practice for a term of five years that would allow them thereafter to be grandfathered onto the vocational register.

Ms Maria Jolly –

Would anybody else like to make a comment? No. Okay, we might move onto the next recommendation.

Recommendation 4:

For other non VR doctors working in general practice:

DoHA and industry stakeholders to investigate the barriers for non VR doctors in obtaining vocational recognition and how to provide better support to them, and act on the findings of the investigation.

Would anybody like to provide a comment on the recommendation?

Dr Michael Bonning –

While we support in-principle the terms of removing barriers to further training for this group, we also recognise that this recommendation does not address the ongoing financial disadvantage that occurs for other non-vocationally registered doctors. Original non- vocationally registered GP rebates were pegged at 93 per cent of the vocationally registered GP rebates. That cessation of indexation occurred a number of years ago and as of November 1, 2011 the rebates for nurse practitioners will increase beyond the rebates for non-vocationally registered general practitioners, which has been described as an inverse relativity that we do not believe is appropriate for the level of training, continuing professional development and standing which these doctors hold.

Ms Maria Jolly –

Thank you. Anybody else like to make a comment on that recommendation?

Professor Geoff Dobb –

When the non VR MBS rebate was set, it was set at 93 percent of the VR rate and the AMA believes that there should have been indexation of this rebate similar with other items within the MBS and that this should be restored to 93 per cent of the A1 vocationally registered rebate.

Ms Maria Jolly –

Thank you. Anybody else like to provide a comment?

Dr Morton Rawlin, Royal Australian College of General Practitioners –

I think that before the main facts end up being superfluous if the grandfathering can occur it may well mitigate this and as such I think it needs to take into account that people coming onto the register still need to meet the appropriate standards, be working in general practice and continue their CPD.

Ms Maria Jolly –

We will move onto recommendation 5:

DoHA to amend the relevant regulations and/or legislation to allow supervisors to bill for T8 items for specialist trainee doctors performing procedures in private settings.

Would anybody like to make a comment on that recommendation?

Dr Rob Mitchell, Australian Medical Association Council of Doctors-in-Training – With respect to this recommendation, it would be strongly supported by the AMA, particularly the AMA Council of Doctors-in-Training. As members of this panel would be aware, supervisors of surgical trainees have had access to MBS rebates for procedures performed under the supervision by trainees for some years and it would seem to be an anomaly that supervisors of trainees in other procedural specialties haven't been able to access them. If we're going to expand into private settings in a bigger way it's essential that supervisors are rewarded and compensated for the time that they spend supervising their trainees. I would endorse the call that was in the AMA submission for amendments to the Health Insurance General Medical Services table, Pathology Services and Diagnostic Imaging Services table, to enable supervisors to claim for rebates performed by trainees under their supervision.

Ms Maria Jolly –

Anybody else like to provide a comment on that recommendation?

Dr Pam Brown, Australasian College of Dermatologists –

I would suggest that if trainees are being trained in private practice that it's not just procedural supervision but also the consultative supervision that needs to be addressed also, and this is rather limited.

Professor Geoff Dobb –

At the risk of the AMA being seen to be monopolising this discussion, we strongly support this. It is entirely congruent with the programs that have been supported by the extended medical education programs. We need to move medical training, particularly vocational training, into these expanded settings so that there is sufficient capacity to train the medical workforce of the future. We will have probably a better idea by the end of this year of what the needs are going to be in terms of medical training from the programs that have been undertaken by HWA but it is clear, without even having those detailed numbers, that unless we utilise private and community settings for vocational training we're just not going to have the capacity that Australia needs so this is a recommendation that supports other programs and needs to be implemented.

Ms Maria Jolly –

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Thank you. Any other comments? Okay, we might move onto the second set of recommendations. I just note that we intend to break at 10.30 for morning tea so we will see where we get to in the recommendations, but just in case any of you are starting to think about coffee.

Recommendation 6:

6.1: DoHA to update Schedule 5 Pt2 of the Regulations to remove references to s3GA workforce programs that have been discontinued; namely, the Rural and remote Area Placement Program, the Metropolitan Workforce Support Program and the Assistance at Operations program.

Would anyone like to make a comment on that recommendation? No? We'll move on. 6.2:

DoHA to routinely update Schedule 5 of the Regulations when the status of s3GA programs change.

Anyone like to make a comment? Okay. Recommendation 7:

DoHA to remove reference to the RACGP and ACRRM as specified bodies for the Prevocational General Practice Placements Program (PGPPP) as the program is now managed by GPET.

Anybody like to make a comment on that recommendation? Okay. Recommendation 8:

DoHA (or relevant authority) to revise all s3GA workforce and training program guidelines to acknowledge the role of AHPRA in setting conditions for clinical practice and supervision requirements, and monitoring these conditions and requirements.

Anybody like to make a comment on that recommendation?

Professor Nick Glasglow –

Just a clarification, please. What's in mind with the word "supervision" there? My reason for asking is HWA are doing a work in the clinical supervision space and I guess it's just being clear about who is responsible for what bits of the jigsaw.

Ms Wendy Hodge –

Can I answer that? Many of the current guidelines specify supervision of doctors on workforce programs and they're different across the different guidelines so, this is just to say that's not your responsibility as a program manager now to set those supervision requirements. Is that clear?

Professor Nick Glasglow –

No, that's not quite what I was asking. I understand the need to have consistency, I'm asking whether that's a role for AHPRA.

Mr Dave Hallinan, Australian Government Department of Health and Ageing –

Nick, it really goes to doctors with limited registration, or with limited scope of practice as provided under the Medical Board registration arrangements so it's particular to doctors that are working in, say for instance, an area of need position or under particular prescribed circumstances through the registration arrangements so it's to ensure that the guidelines that we've got in operation for 3GA programs reflect the nature of the Medical Board's role and AHPRA's role in providing that information.

Mr Brendan Peek, Department of Health, South Australia –

Can I just add a point of clarification around the role. I know AHPRA is the agency of the boards, is it the responsibility of AHPRA to set the conditions for things like clinical practice and supervision or is it actually the Board's. I would have thought it would have been the Medical Board, AHPRA being their agency.

Dr Morton Rawlin –

I think it's important that we have that clarification within the recommendation because I certainly say from the College of GPs perspective we would be quite concerned about AHPRA telling us what our vocational trainees' level of supervision should be, particularly in general practice, and I'm sure most of the other medical colleges would have exactly the same concern.

Ms Maria Jolly –

Does anybody not support that concern? No? Okay, thank you very much. Any other comments on that recommendation?

Dr Richard Willis, Australian & New Zealand College of Anaesthetists –

This issue is a bit complicated at the moment because the supervision document from the MBA has not been finalised, and I gather it won't be for a few weeks yet. A preliminary document has been doing the rounds, it is reasonably demanding, and I suspect it's going to be pretty similar but I guess that's a complicating factor at the moment.

Ms Maria Jolly –

Thank you. In terms of process, of course the recommendations in the report stand as recommendations but certainly those notes of clarification will appear in this transcript and will form part of our advice on this report. Anybody else like to provide a comment on that recommendation? Okay. Thank you very much.

We will move onto recommendation 9:

DoHA (or relevant authority) to revise relevant s3GA workforce and training program guidelines to ensure that both the RACGP and the ACRRM are both referred to as providers of general practice training, and to ensure that where the guidelines refer to Fellowship of the RACGP, they also reference the Fellowship of ACRRM.

Would anyone like to make a comment on that recommendation?

Professor Robin Mortimer –

Who actually provides the training in general practice? Is it the colleges or is it GPET?

Ms Maria Jolly –

I guess the provider of the training would be GPET to the standards of the college. If that's the point that you're making.

Dr Morton Rawlin –

I think it is an important clarification, that the standards and the end point is the fellowship of the colleges, the training is actually funded through the GPET training program.

Ms Maria Jolly –

Thank you for that clarification. Any other comments on that recommendation? We'll move onto Recommendation 10. I think I'll read out each individually as there are four parts.

Recommendation 10:

DoHA and Medicare Australia to reduce red-tape involved in applying for provider numbers not only for doctors on s3GA workforce and training programs but across the whole sector; and to improve information services about application processes for the sector.

10.1: By 2012, DoHA to allow one application for each doctor on a s3GA workforce or training program to cover all practice locations and for the entire time they are on the program.

Would anybody like to make comment on that recommendation?

Professor Geoff Dobb –

I strongly support this recommendation; it's one that needs to be implemented. It could be argued in the past that having state based or jurisdictional based medical registration was an impediment to the mobility of the medical profession and the ability to meet short-term workforce shortages, particularly through rural locums and so on. That impediment has now been removed and indeed now one of the major impediments to workforce flexibility and the ability to fix short-term workforce shortages is the need to gain a separate Medicare provider number for each practice location. And this, I suggest, is a recommendation that needs to be implemented as a matter of some urgency so that the goals of national registration can actually be achieved.

Prof Lou Landau, WA Department of Health –

Again, we support this recommendation and my comment relates to this one and the next and 11 and 12 basically on research in this area. It also applies within a jurisdiction that doctors practise in an area of unmet need but then for appropriate supervision do have to move to an area to obtain that supervision but because the supervision is available it's no longer an area of unmet need so, I think all of that needs to be addressed in coming up with this conclusion, that one provider number will allow them to move to those areas recognising those needs for supervision.

Ms Maria Jolly –

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Thank you. Anybody else like to make a comment on this recommendation?

Dr Andrew Perry, Australian Medical Association Council of Doctors-in-Training – We fully support the recommendation. An initial observation is that unlike any other recommendation that's tabled here, this recommendation comes with timeframes and I would like to indicate my concerns about how these recommendations are going to be followed up and whether any sort of mechanism will be established to ensure that they're implemented, and if they're not implemented reasons given. I think the fact this recommendation comes with a timeframe is to be especially commended and I would like to foreshadow that at the end of this it would be useful if this group were to make some sort of recommendation on the way in which we can monitor progress of all of the recommendations, not just this one.

Ms Maria Jolly –

Thank you, Andrew. Anybody else like to make a comment on this recommendation? No?

Okay I'll move onto 10.2:

By 2014, Medicare Australia to issue one provider number to each medical practitioner and an identifying code number to each practice location, with the two numbers working in tandem to identify the practitioner and the location at which the service was provided.

10.3: By 2012, Medicare Australia to automatically renew provider numbers for doctors working for AMDSs when the Deeds of Agreement are renewed.

10.4: Relevant parts of the Government to improve information services so that specialist colleges, doctors, practice managers and others can get queries about the allocation of provider numbers answered in-person and in a timely way.

Would anyone like to make comment on any of those sub-parts of Recommendation 10? No? Okay, thank you very much for your consideration of those.

Recommendation 11:

DoHA to invest in support for doctors on workforce programs.

Would anyone like to comment?

Dr Morton Rawlin –

College of GPs would like to support that strongly.

Ms Maria Jolly –

Any other comments about that recommendation?

Professor Geoff Dobb –

Just ask for some clarity perhaps from the writer of the report. It appears, at least in the context of the review, to specifically relate to the adequacy of funding for the program that's covered under Section 3GA but the wording isn't specifically restricted to that. Could we have some clarity on whether it was intended to be specifically restricted to s3GA or whether it's intended to have more general applicability.

Ms Wendy Hodge, ARTD Consultants –

It was intended to be restricted to the 3GA workforce programs because I don't have information about support for other workforce programs.

Ms Maria Jolly –

Would anybody else like to make a comment on that recommendation?

Dr Nick Buckmaster, Australian Salaried Medical Officers’ Federation –

The only other comment that I think is important to say is there should be an outcome statement with this. At the moment the department under that recommendation could invest one cent and that would fulfill the recommendation. So what are we trying to achieve?

Ms Maria Jolly –

Thank you. Anybody else like to provide comment?

Ms Wendy Hodge –

I take your point; I should have said adequate investment.

Ms Maria Jolly –

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We will move onto Recommendation 12:

DoHA to fund a research project that assesses the extent that doctors on s3GA programs access the required level of supervision, and act on the findings of this research project. The research project could include an anonymous survey of doctors' experiences of the quality of supervision.

Would anybody like to comment on Recommendation 12?

Professor Nick Glasgow –

It's just related to the idea of supervision and a lot of work that's being undertaken in that space and just to make sure we're not duplicating effort here but making full use of the work that HWA are doing.

Ms Maria Jolly -

Anybody else like to make a comment on this recommendation? No? Okay.

We'll move to Recommendation 13:

Relevant program areas in DoHA (or relevant authority) to establish a mechanism that allows regular industry input into operational issues in order to identify and address any problems in delivering services under the program, rather than wait for the five year review of the Medicare Provider Number Legislation.

Would anybody like to make comment on this recommendation?

Dr Michael Bonning –

We agree with and support this recommendation in-principle but we want this group to be conscious of the fact that this could provide a rationale for discontinuing of any further reviews and that given this body's strong support for the role of both itself, the MTRP and the five yearly reviews that is noted in the proceedings here and that this review process remains the peak process for providing updates and scrutiny for ongoing workforce programs.

Ms Maria Jolly –

Thank you. Anybody else like to make a comment on that recommendation?

Professor Geoff Dobb –

Certainly strongly support this. As has been pointed out, the recommendation could be used to stop further reviews which have been occurring on a five year basis and I think it's important that it's absolutely clear that there is a need for ongoing regular review of the programs as already provided for, and that needs to continue.

Ms Maria Jolly –

Thank you. Anybody else like to make comment? No? Okay, thank you.

We'll move onto Recommendation 14:

DoHA to add the ACRRM Independent Pathway (a fully accredited independent general practice training pathway) to Schedule 5 of Regulations to facilitate access to Medicare provider numbers for registrars on this pathway.

Associate Professor David Campbell, Australian College of Rural and Remote

Medicine –

This recommendation, just for clarification, represents a current anomaly in the schedule with regard to the fact that the ACRRM Independent Pathway is an AMC accredited pathway, which isn't currently recognised within the schedule for access to provider number and access to A1 rebates so that was the purpose of that recommendation to the review by ACRRM.

Dr Morton Rawlin –

The recommendation should also apply to the RACGP specialist pathway, which also has similar sort of training retirements, particularly overseas trained doctors in general practice independent of the AGPT.

Ms Maria Jolly –

Thank you. Anybody else like to provide comment on that recommendation? Okay, thank you. We'll move on.

Recommendation 15:

15.1: DoHA to add Fellowships of RACGP, ACRRM, The Australasian College of Sports Physicians and the College of Intensive care Medicine of Australia and New Zealand to Schedule 5 of the Regulations, which lists organisations and courses for s3GA of the Act.

15.2: DoHA to routinely update Schedule 5 of the Regulations as Fellowship courses are certified by the AMC.

Anybody like to provide comment on that recommendation?

We'll move onto Recommendation 16, The Approved Medical Deputising Service Program: DoHA to actively monitor the impact of health reforms on the provision of after-hours care by AMDSs and revise the AMDS Program Guidelines as needed.

Would anyone like to make a comment on that recommendation? Okay. Recommendation 17, Queensland Country Relieving Doctors Program:

17.1: Queensland Health to ensure that all junior doctors on a relief placement have access

to direct supervision and endeavour to place more senior doctors in remote relief placements.

17.2: Queensland Health to monitor the achievement of this recommendation and report on its success as the next review of the Medicare Provider Number Legislation in 2015.

Would anyone like to make a comment on this recommendation?

Professor Robin Mortimer –

May I strongly support this recommendation. The completion of relieving placements is a significant source of anxiety for many junior doctors and, more importantly than that, there are some important safety and quality issues associated with recent graduates working in a relatively unsupervised capacity in rural or remote environments. I think there's a strong incentive to both of those fronts for Queensland Health to look at the way the program is rolled out, and particularly about how we could optimise the support and supervision that's given to junior doctors working in those environments.

Ms Maria Jolly –

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Thank you.

Mr Nick Lord, Queensland Health –

We are supportive of these recommendations.

Professor Geoff Dobb –

There's a lot of excellent work that's been done at the moment around clinical supervision, including the work that has been done by Health Workforce Australia. This recommendation reflects the current approach and standards that are expected in terms of supervision, and I think it deserves the strong support of this group.

Ms Maria Jolly –

Thank you.

Dr Andrew Perry –

I just want to comment on the timeframes that are mentioned here - you'd gather I'm a timeframe aficionado. I think it's great that there is a timeframe, given if I wish to report back on this mechanism. I would suggest 2015 is too far ahead in the future and I would think it would be entirely appropriate for an earlier timeframe to be given to report back to the MTRP.

Ms Maria Jolly –

Anybody else like to make a comment on this recommendation? Okay, thank you very much.

The Rural Locum Relief Program, Recommendation 18:

DoHA to fund rural health workforce agencies to provide support for doctors working under the RLRP.

Would anybody like to make a comment on this recommendation?

Dr Morton Rawlin –

I think support to rural doctors and locums is really important. It's really a question of semantics; I think the word support could be interpreted in a thousand different ways and I think it does need to be clarified.

Ms Maria Jolly –

Thank you. Anybody else?

Associate Professor David Campbell –

I think there's general acknowledgment that doctors under the RLRP are not receiving adequate support but I think that this recommendation could be broadened to include consideration for a variety of agencies to provide that support. I don't think it necessarily needs to be confined to rural workforce agencies, the support could be delivered through regional training providers or indeed through specific colleges, either ACCRM or the RACGP for the support, depending on which fellowship the RLRP doctor is planning towards.

Ms Maria Jolly –

Thank you. Anybody else like to make a comment on this recommendation? Okay.

We will move onto Recommendation 19, Prevocational General Practice Placement Program (PGPPP):

GPET to ensure that all junior doctors have access to direct supervision and endeavour to place more senior trainees in remote placements.

GPET is unfortunately an apology today. Would anybody like to make a comment on this recommendation?

Mr Robert Marshall, Australian Medical Students’ Association –

AMSA strongly supports this recommendation, as with others that aim to provide more supervision and senior trainees, particularly in rural settings, because of the positive impacts that has on medical students who are undertaking rural placements in those settings. As is mentioned in 6.1.1 of the review, the current increases and stresses on the system from increasing medical students will mean that junior doctors will need to be well supported, well supervised and well resourced so that they can properly teach medical students in those settings.

Prof Lou Landau –

Even though GPET does provide the administrative programs the level of supervision is usually established by the postgraduate medical councils with regard to the PGPPP programs. I think there should be some education that GPET must provide that level of supervision as required by postgraduate medical councils.

Ms Maria Jolly –

Thank you. Any other comments on that recommendation?

We'll move onto Recommendation 20: Specialist College Trainee Program:

Medicare Australia, in consultation with the specialist colleges, to prepare new guidelines about the parameters of the Specialist College Trainee Program (SCTP) including who is eligible and under what circumstances rebates under the program can be claimed. The guidelines should also describe how the program relates to the Specialist Training Program managed by DoHA.

Would anybody like to make a comment on that recommendation? No? Okay. Thank you. We will move onto Recommendation 21:

DoHA to clarify the items that can be claimed by registrars under the program and expand eligibility to item numbers to more accurately reflect the differing practices of each specialty.

Recommendation 22:

DoHA to review the level of rebates (A2) that can be claimed under the program with a view to making these in line with VR (A1) items.

Would anyone like to make a comment on either of those recommendations that relate to the Specialist College Trainee Program?

Dr Pam Brown –

A clarification. We're just talking about the general practitioner specialist training programs?

Ms Wendy Hodge –

No.

Dr Pam Brown –

It's all specialty training programs that are in?

Ms Wendy Hodge –

Yes.

Dr Pam Brown –

We would support these recommendations.

Dr Marie-Louise Stokes, Royal Australasian College of Physicians –

We support the recommendations but a point of clarification, that recommendations 21 and 22 would also be done in consultation with the colleges, particularly heeding the advice reflecting the different practices of each specialty.

Ms Maria Jolly –

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Thank you. Any other comments on that recommendation? Okay.

We will move onto Recommendation 23:

The Government considers amending the legislation to allow the MTRP to undertake additional activities to monitor health services capacity in providing training places for prevocational and vocational doctors and provide advice to DoHA and/or HWA on these issues.

Would anyone like to make a comment on that recommendation?

Mr Mark Cormack – Health Workforce Australia

A couple of comments. In many ways these apply to Recommendations 23, 24 and 25 but for the purpose of the record I will address 23. Clearly it's up to the government to work out what it needs to legislate. But clearly it's important to note that HWA has been set up under legislation to undertake a range of these activities and it is our current practice and future practice to work very closely with the MTRP to ensure that the activities of both bodies are complementary and consistent with our respective legislations. So our comment would be not to say whether it should be legislated or not. However, I would say that many of the activities suggested can be undertaken through good co-operative arrangements from government to determine whether it wishes to legislate those or not.

Ms Maria Jolly –

Anybody else like to make a comment on Recommendation 23?

Dr Andrew Perry –

Like Mark, I'd like to make my comments addressed at Recommendations 23, 24 and 25 because I do think they are all inter-connected. As Mark has said, I think whether or not legislation needs to be amended or enacted to enable these desired effects to be achieved is something for ongoing discussion. I would like to flag that in the second half of this meeting after we finish this review that I think there is a place for discussion by this group about the relationship between the MTRP and HWA. HWA is currently doing many of the activities that are specified in these recommendations. I think we are all in agreement that duplication is not something that we are in favour of. At the same time, I think we should recognise the expert role that this committee has.

I think we do need to define the relationship the two bodies have. I don't think that relationship is adequately defined, and that's not necessarily a negative reflection on either this panel or the HWA but rather the fact that HWA has only recently been established and the MTRP has only recently been re-established. I would support the principles of these recommendations, indeed the AMA supports the principles, and I think there can be some discussion about the actual specifics about how that can be achieved. Specifically, in regards to whether the legislation needs to be changed.

Ms Maria Jolly –

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Thank you. Are there any other comments? I will just read out the last two recommendations, if we are taking them together.

Recommendation 24: The Government considers amending the legislation to allow the MTRP to monitor the effectiveness of training programs in meeting workforce needs and demands.

Recommendation 25: The Government considers amending the legislation to allow the MTRP to provide advice about medical training and to develop formal links with HWA.

Would anyone like to provide comments of any of those three recommendations other than those we have had already?

Professor Geoff Dobb –

I would just like to say that the AMA strongly supports the continued operation of MTRP. It provides a great body of expertise and reflects the many stakeholders who are involved in medical training, whether it be the colleges, jurisdictions, the professional associations, the Department of Health and Ageing, this really does provide a great peak body to review what is happening to medical training numbers, and we support this body working very closely with HWA.

Dr Linda MacPherson, NSW Department of Health –

I would just like some clarification as to what is meant by the effectiveness of training programs. I am aware that the Australian Medical Council has the role of accrediting college training programs so clarification to what effectiveness is referring to - is it more than just if they are providing suitable training?

Ms Wendy Hodge –

To clarify, it's in terms of meeting the demand of the training, not how well the training is done.

Mr Patrick Tobin, Catholic Heath Australia –

I would like to particularly support the comments that Andrew made about we need to be very clear about the relationship between HWA and this body, certainly as a representative of training providers in the private sector. I think it's fair to say Mark knows this quite well but we're probably struggling a bit at the moment with the degree of requests for information that is coming out of HWA. I think it's very, very important that we both build on the work that has been done previously to HWA's existence but also going into the future is really important that we have a clear and rational approach to understanding these issues and to making requests of others.

Ms Maria Jolly –

Any other comments on those recommendations? No? Thank you.

We will move on now to any final comments and remarks. Before we do so, I will just ask

Dave Hallinan to read out some written feedback we've had, to ensure that's on the record.

Mr Dave Hallinan –

Dr Craig White, who is the MTRP Member representing Tasmanian Department of Health and Human Services has provided a written statement. I will just read that into the record:

"This is a comprehensive and well written report which seeks to address problems arising from the sometimes confusing and inefficient processes and legislation which govern access to provider numbers. Currently, a medical practitioner is required to have a provider number for each practice location. The processes involved are complex and can result in service provision.

The report was prepared after wide stakeholder consultation. Despite initial concerns raised in the submissions from some stakeholders (particularly the AMA and the RACGP) regarding the consultation process, the final report fairly reflects the views of the different stakeholders. On most issues, there was general consensus between stakeholders; however there are still some conflicting views on whether the current legislation achieves the right balance between workforce supply and the delivery of quality care, particularly in rural areas.

If adopted, the recommendations should result in a more flexible and responsive workforce, with practitioners able to move between different locations (or work in multiple locations) more flexibly. Temporary resident International Medical Graduates would have earlier access to training programs, with the result that there would be greater quality control over the care that they deliver. Close collaboration is essential between MTRP and HWA to ensure that medical workforce planning is closely monitored in order to appropriately align with community needs.

It is concerning to note that, of the total number of recommendations from the 2005 biennial review of the Medicare Provider Number Legislation, only half of the recommendations were fully implemented and those that were not addressed remain issues that are still current today. No clear or valid reasons were given for this failure to implement the recommendations. It is hoped that the same problem does not arise with the current recommendations, as they provide an opportunity to significantly improve the care delivered to rural communities.”

Ms Maria Jolly –

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Thank you. During the discussion on recommendations I've heard comments from the group around a desire to have clarity around timing and the role or some visibility of this group around the review process from here and what happens to the recommendations.

Also there are comments from this group around several clarifications around the wording of individual recommendations, and my summary of that is that these tend to be clarity around the role of the colleges, the delivery of training and some technical definitions about supervision and where you get those definitions of supervision and how the interrelationship between the Medical Board of Australia, the colleges and the training programs in terms of where those definitions are held.

That's my attempted summary of some of the discussions I've heard this morning. Certainly it's our intention to work with this group on the findings of the review and responses to that, but I now open up to any final comments that people would like to make. Any rejection of my summary is also welcome.

Dr Michael Bonning –

As was foreshadowed, we have some comments regarding the process for follow-up of these recommendations. The MTRP is an important body enshrined by legislation to discuss the issues that are a consequence of the Medicare Provider Number Legislation. It is also the members of this committee that provided much of the input and information to generate this review and also administer the programs affected by it. It is therefore probably a natural outcome that this committee would appreciate ongoing updates on the implementation of the recommendations, as it is a glaring issue of the 2005 review that a number of recommendations were not implemented and essentially lost because that was not communicated back to members. A recommendation for progressing this is to create a standing item on the MTRP agenda to show the acquittal of review recommendations as they are enacted. This would allow MTRP to monitor the progress of recommendations and provide advice and expert professional lead input to overcome hurdles to implementation, as have been discussed this morning.

This would also serve as an important reporting function to provide information to 3GA stakeholders. This standing item would also be an avenue to provide advice to the profession regarding non implementation, for whatever reason of recommendations, and the members of committee can then determine whether they seek to provide further representations to Government or other authorities as to the importance of recommendations that have not been progressed.

Ms Maria Jolly –

Much more eloquent than me. Any other comments?

Dr Sara Watson, Department of Health and Families, NT –

I am representing Dr Alan Ruben. I would like to echo Dr Craig White's comments. The jurisdiction, as everyone knows in Northern Territory, is characterised by enormous workforce demands and so the recommendations which call for increased flexibility of the provider numbers would certainly assist Northern Territory providing upskilling opportunities for its medical workforce.

Secondly, the recommendations which seek to improve access for overseas trained doctors to vocational training again, this is a section of the workforce which the Northern Territory does rely on, and certainly for the short to medium term will certainly continue to rely on, and so any recommendations which improve the flexibility of that workforce and the ability of it to gain vocationally high quality training is very important to us.

It's not specifically covered in the recommendations but there are many comments in the report relating to support for the trainee workforce. I would also like to echo support for the supervisors providing that particular training, as I'm sure it is of no surprise to anyone that there are a limited number of specialists in the Northern Territory already supervising a whole range of undergraduates and postgraduates and I think increasing support to the supervisors would also be an important element.

Professor Geoff Dobb –

I note that there is no recommendation in relation to the 10 year moratorium on vocational provider number, particularly related to IMGs. I'm aware that there is a current review by Parliament of IMGs but the association would prefer to see that 10 year moratorium abolished and have it replaced with a package of incentives and support for local doctors to work in rural settings and to work through the rural generalist training pathway rather than assisting the 10 year moratorium.

Ms Maria Jolly –

Thank you. The review that you are referring to is the House of Reps inquiry into Overseas

Training Doctors. I understand that technically the moratorium was out of scope for this review but we note your comments and they're being recorded for the record, so thank you. Any other comments?

Dr Rob Mitchell –

Firstly, may I echo Geoff's comments in relation to the 10 year moratorium and, secondly, may I make a brief comment about the PGPPP program. We referred to it in one of therecommendations earlier but I would just like to put on record that the AMA and the AMACDT support that program for a range of reasons. For one, it provides excellent exposure for junior doctors to general practice but in the age of increasing medical graduate numbers it is also an important solution to building capacity. It will be important that we monitor, on an ongoing basis, the number of PGPPP placements and respond to demand as necessary.

Ms Maria Jolly –

Thank you. Any other last comments? No? Okay.

With that I would like to thank you all very, very much for your participation in this morning's meeting. It is very useful and a very important part of the process of this review. Thank you again for your participation in the review process as it unfolded last year. We will now break for morning tea and we will see you all back here shortly. Thank you very much.

Medical Training Review Panel Special Meeting to discuss the Report on the 2010 Review of the Medicare Provider Number Legislation

20 April 2011

The Parkroyal Melbourne Airport

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List of Participants

Australian Government Department of Health and Ageing

Ms Maria Jolly Acting Chair, Medical Training Review Panel and Acting First Assistant Secretary, Health Workforce Division

Dr Andrew Singer Principal Medical Advisor, Acute Care and Health Workforce

Mr Dave Hallinan Assistant Secretary, Medical Education and Training Branch

Ms Deborah Gaudie Secretariat, Medical Training Review Panel

Ms Ella Homersham Secretariat, Medical Training Review Panel

MTRP Attendees

Dr Linda MacPherson NSW Department of Health

Mr Dean Raven VIC Department of Health

Mr Nick Lord Queensland Health

Mr Brendan Peek Department of Health, South Australia

Prof Lou Landau WA Department of Health

Dr George Cerchez Tasmanian Department of Health & Human Services

Dr Sara Watson Department of Health and Families, NT

Dr Richard Willis Australian & New Zealand College of Anaesthetists

Ass/Prof David Campbell Australian College of Rural and Remote Medicine

Ass/Prof Dennis Pashen Australian General Practice Network

Prof Geoff Dobb Australian Medical Association

Dr Michael Bonning Australian Medical Association Council of Doctors-in-Training

Dr Andrew Perry Australian Medical Association Council of Doctors-in-Training

Dr Rob Mitchell Australian Medical Association Council of Doctors-in-Training

Prof Robin Mortimer Australian Medical Council

Mr Robert Marshall Australian Medical Students’ Association

Dr Nick Buckmaster Australian Salaried Medical Officers’ Federation

Dr Pam Brown Australasian College of Dermatologists

Dr Chris May Australasian College for Emergency Medicine

Professor Nick Glasgow Medical Deans of Australia and New Zealand

Dr Deryck Charters Royal Australian and New Zealand College of Obstetricians and Gynecologists

Ms Penny Gormly Royal Australian and New Zealand College of Ophthalmologists

Dr Morton Rawlin Royal Australian College of General Practitioners

Dr Kim Hill Royal Australasian College of Medical Administrators

Dr Marie-Louise Stokes Royal Australasian College of Physicians Ms Kellie Hardy Royal Australasian College of Surgeons Ms Jenny Johnson Rural Doctors Association of Australia

Guests:

Mr Mark Cormack Health Workforce Australia

Ms Wendy Hodge ARTD Consultants

Observers:

Mr Patrick Tobin Catholic Health Australia

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