The 10-Year Moratorium Explained

Among international medical graduates (IMGs), including overseas-trained medical practitioners, looking to work as general practitioners in Australia, the 10-year moratorium remains a hurdle to where they can work.

An IMG is categorised as someone who:

• graduated from a medical school outside of Australia or New Zealand.
• received their medical degree in Australia or New Zealand as a temporary resident.

At Alecto, we strive to provide helpful information that can help ease you into becoming a full-fledged general practitioner in Australia, including details about the 10-year moratorium and Medicare benefits. This moratorium affects IMGs who want to build a career in general practice, specifically overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS).

Here’s a closer look into what the 10-year moratorium is all about.

Origin of the 10-Year Moratorium for GPs

If you’re unfamiliar with the details of the 10-year moratorium in Australia for GPs, it’s crucial to know some background information about it.

Since the late 1990s, the federal government has actively sought out professionals with medical training from abroad, frequently from nations where there is no recognised equivalence between Australian and country-of-origin professional standards or qualifications.

However, unless they have a Section 19AB exemption, international medical graduates, which includes overseas medical students who first registered with an Australian medical registration board on or after 1 January 1997, are not eligible to receive Medicare benefits for their services for a minimum of ten years.

What Is the 10-Year Moratorium?

International medical graduates are subject to limitations regarding where they can work and use Medicare benefits under Section 19AB of the Health Insurance Act of 1973 or the so-called 10-year moratorium for international medical graduates.

IMGs are obliged to work in a Distribution Priority Area (DPA) if they are general practitioners, with limits put on their Medicare provider number for a period of ten years.

These places categorised as DPAs are those areas that don’t have enough doctors to meet the needs of the local populace. Most DPAs are located in Australia’s rural and outlying regions.

In order to qualify for these particular benefits, medical professionals must  work in the DPA region for a predetermined period of time. This timeframe has typically been ten years (hence, the 10-year moratorium).

These limitations stay in effect until doctors complete their service period and become Australian citizens or permanent residents.

10-Year Moratorium Exemptions

As with any rule, there are also various types of 19AB exemptions. The list of

19AB exemptions include the following:

• Exemption to work in priority areas: You may be granted a Medicare provider number if you work in a DPA for your medical specialty, are taking part in an approved workforce or training program, or work after regular working hours in any location.
• Six-month locum exemption: If you take up a locum GP job, you can access Medicare benefits anywhere for a maximum of six (6) months while arranging for work in a DPA location. This type of exemption cannot be repeated or extended.
• Replacement exemption: If you take the position of a physician who previously held an unrestricted 19AB exemption and who is no longer practising in the local community, this exemption gives you access to Medicare benefits in any location.
• Spousal exemption: If your spouse works as a doctor or skilled immigrant, you might be eligible for a 19AB Spousal exemption.
• Prior employment negotiations: If you started negotiating your employment with the practice when it was within a DPA for your speciality, this exception gives you access to Medicare benefits in any location.
• After-hours exemption: If you work outside regular business hours, this exemption allows you to receive Medicare benefits wherever you are located.
• Discretionary exemption: If you are the primary caregiver for a close relative with a grave or critical medical condition that can’t be attended to properly in a DPA location, you’re eligible for access to Medicare services anywhere. Also, specific exceptional circumstances (e.g., disaster or crisis-related reasons) may qualify you for this exemption.
• Academic exemption: You may request an academic exemption if you satisfy all the requirements have an academic appointment with a medical school in Australia, and your academic appointment entails providing clinical services.

Under Section 19AB, there are numerous categories of exemptions from the 10-year moratorium.

Each type of exemption involves various requirements in terms of eligibility, application, and verification. Therefore, it’s essential to consult industry experts like Alecto to ensure you meet the specific conditions that apply to the exemption you’re after.

How You Can Reduce the 10-Year Moratorium With Scaling

General practitioners can work around the 10-year moratorium through scaling.

By working in remote or far-flung areas, you can decrease the amount of time you spend in a DPA by up to five years. The farther away your work location is, the higher the scaling credits that will be used to calculate your 10-year service requirements.

Once you satisfy the criteria in Sections 19AB and 19AA, you’ll be permitted to work in any location in Australia.

Who Is Eligible for Scaling?

IMGs who meet all of the following conditions may be eligible for moratorium scaling:

• Your moratorium period has officially begun.
• You work in a qualified regional or remote area defined under Section 19AB.
• You are submitting claims for services provided under the Medicare Benefits Schedule as part of your employment.
• You have a $5,000 monthly billing threshold.

Medicare calculates and applies scaling credits automatically by using available billing data.

Scaling eligibility is automatically reviewed every month by Services Australia.

How Scaling Credits Work

The Statistical Geographical Classification – Remoteness Area system is used to calculate scaling credits as demonstrated in the following table:

20.3 days

Source: https://www.health.gov.au/topics/doctors-and-specialists/what-we-do/19ab/moratorium

How to Check Scaling Credits

Scaling calculations are performed by Services Australia on the last day of each month.

Computations include the four previous months but does not include the current month. For instance, the months of December, January, February and March are included in a scaling computation that’s made on April 30.

You can monitor your scaling credits and review Section 19AB exemption information through your Health Professionals Online Services (HPOS) account.

Got more questions about the 10-year moratorium or your path to becoming a bona fide GP in Australia?

Please Contact Alecto today!