19AB & DPA Update

We know how confusing 19AB restrictions can be, so we have put together a little cheat sheet to walk you through the who, what, when, where, and why! 

WHO IS RESTRICTED BY 19AB?

Any Doctor who completed their degree outside of Australia or New Zealand, or was enrolled in their Australian degree while they were a temporary resident will be restricted by 19AB. 

WHAT IS THE 19AB RESTRICTION? 

19AB will require you to work in a Distribution Priority Area (DPA) for a period of 10 years (referred to as the ‘moratorium’) to be able to access Medicare benefits. 

DO I HAVE TO ACCESS MEDICARE BENEFITS? 

No. You can apply for a refer and request Medicare Provider number and still see patients. However, patients will not get bulk billed or be able to get a rebate from Medicare for seeing you as a Doctor. 

CAN I REDUCE THE MORATORIUM? 

Yes. By working in an more rural or remote area you can scale down your moratorium as much as 5 years. 

IF I BECOME A CITIZEN OR PERMANENT RESIDENT OF AUSTRALIA, AM I STILL RESTRICTED?

Yes. You should also be aware that if you get residency or citizenship before you have achieved Fellowship then you will also be restricted by 19AA. 

IF I GET FELLOWSHIP, WILL I STILL BE RESTRICTED BY 19AB?

Yes. 

IF I DON’T GET RESIDENCY, DO I STILL COMPLETE 19AB?

No. If you don’t become a resident of Australia, you will continue to be restricted by 19AB until you do.  

ARE THERE EXEMPTIONS FROM 19AB?

Yes. These are: 

Spousal Exemptions

To be eligible for a spousal exemption, your spouse must be either: 

  • A Medical Practitioner with an unrestricted exemption from 19AB or who is not restricted by 19AB. This includes Australian Trained Doctor spouses. 
  • If your partner migrated to Australia within the last 10 years on a skilled occupation visa, currently lives here and is working in that skilled occupation

As a part of the assessment for eligibility, they will take into consideration where you are intending to practice and where your spouse works. They do not define a distance, other than to specify it should be ‘reasonable’. 

There is an application form that must be completed, and you’ll need to include the requested list of supporting documentation. This can be submitted separately for AGPT only, otherwise must be submitted alongside a Medicare Provider Application for a specific location. 

Replacement Exemption

To be eligible for a replacement exemption, your practice will require: 

  • A Statutory declaration from the General Practitioner who has left advising that they will no longer work within the location and
  • Confirmation that local provider numbers have been closed within 12 months of your application

These must be submitted alongside a Medicare Provider Application for a specific Doctor at the practice location that the departing Doctor left. 

Academic Exemption

The academic class exemption covers overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS) who are employed into an academic position by an Australian medical school to teach medical students. To be eligible for an academic exemption, you would need to:

  • have been appointed into an academic position by a university medical school; and
  • have a contract of employment with the university medical school for the purpose of the academic appointment.
  • have satisfied the vocational recognition requirements of s19AA before they can be included under the academic class exemption. If the doctor does not hold vocational recognition in their specialist field (generally this will be Fellowship of the relevant Australian specialist college) they will not qualify to be covered by the class exemption, even in the case that they hold an academic appointment with a medical school.

Academic exemptions will allow the doctor to have limited access to Medicare Benefits Schedule (MBS) rebates for clinical services they are required to perform when discharging the requirements of their academic appointment. This class exemption does not provide an eligibility to claim MBS rebates for any services that are unrelated to the academic appointment and does not support:

  • private practice that is unrelated to teaching responsibilities; or
  • employment engagements between the doctor and a private medical practice (even in the case that the medical practice has entered into an agreement with a University to teach medical students).

To apply, you’ll need your contract with the medical school in evidence alongside a Medicare Provider Application for a specific Doctor at the practice location.  

Locum Exemption

To be eligible for a locum exemption, you would need to:

  • Work with any practice for a maximum of 6 months

This will be for a six month period from the approval of the number, with no extensions made due to extenuating circumstances or part time work. If you cease practice there before the six month period, you will not be permitted to apply for the provider number again until you are unrestricted. 

To apply, you would need to advise in the practice letter of support the 6 month time period that you are working and that you intend to work as a locum, alongside a Medicare Provider Application for a specific Doctor at the practice location.  

After Hours Exemption

To be eligible for an after hours exemption, you will be required to work: 

  • After 6pm and prior to 8am weekdays
  • Saturdays & Sundays
  • Public Holidays

To apply, you would need to advise in the practice letter of support that these would be the only hours you are working, alongside a Medicare Provider Application for a specific Doctor at the practice location.  

Aboriginal & Torres Strait Islander Clinic Exemption

To be eligible for an ATSI exemption, you will be required to work

  • In a Aboriginal and Torres Strait Islander specific primary health care service

To apply, you would include confirmation of the clinic’s eligibility, alongside a Medicare Provider Application for a specific Doctor at the practice location.  

Hospital Exemption

Although not technically an exemption, if you are a doctor working in the hospital system you will be able to work in non-DPA areas as you do not require a Medicare Provider Number that allows you to access Medicare Benefits but rather a Refer and Request Provider Number. 

To apply, you would select ‘Refer and Request Only’ on Question 22 of the Medicare HW019 form.

Other Exemptions

You may also be eligible for an exemption if: 

  • You started negotiations to work with a practice whilst they were a DPA location, but now they’ve lost DPA

You would need to provide supporting evidence (ideally a signed contract) proving you were in touch with the clinic whilst the location was a DPA, along with the application for Medicare Provider Number. 

Just so you know…

If you’re restricted by 19AA, you are unable to apply for these exemptions. 

You can apply for a spousal exemption if you are applying to the AGPT program however; this is the only case that will be considered, according to written confirmation from the Department of Health. 

Keep in mind… 

If you’re on a visa you’ll need to get a Health Workforce Certificate to be sponsored on your visa. This means even if you have an eligible 19AB Exemption, you may still not be able to work in a metropolitan area unless they hold a Health Workforce Certificate.

DO YOU NEED HELP? 

Our team offer General Practitioners assistance with finding jobs and a career pathway, and Medical Facilities to find a new Medical Practitioner. We also help with the full application process with AHPRA, RACGP, ACRRM, Department of Health, Medicare including 19AA & 19AB. If we can help, please contact us at [email protected]
People Medical Consulting are a team of professionals with a passion for guiding those specialising in the Medical industry to find their career pathway and settle into Australia. Working with both Australian trained and Overseas trained professionals, we have extensive experience in Recruitment of General Practitioners and Document Assistance for those requiring support with RACGP, AHPRA, 19AA and 19AB Medicare Exemptions.

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