Remuneration

So what do GPs and GP Registrars earn? How many hours do you work a week on average? These are questions all of us contemplate when choosing a specialty training career, but the answer, especially in GP-land, may not be so easy to come by. This article outlines some basic facts and minimum terms and conditions and then includes some real examples of what GP Registrars have reported earning.

Full-time Registrars work a minimum of 38 hours/week. This includes education time and administration time. The actual hours of consulting (seeing patients) are usually 27-33 hrs/week. This can vary, especially in rural areas.

Remuneration is really determined by how many patients are seen and whether there is bulk billing or private billing. The GP Registrar can negotiate an hourly rate of pay and/or payment of a percentage of gross billings generated.

GP Registrars are guaranteed minimum terms and conditions of employment as agreed by GPRA and NGPSA. For each stage of training, there is a minimum salary/hourly rate of pay OR the Registrar is paid a
minimum of 45% of gross billings (whichever is greater). In 2006, Basic term Registrars (first six months of General Practice) earn a gross minimum of $60 084 p.a. ($1155.46/week 30.41/hr). In the Advanced term, this is $75 745 p.a. ($1456.63/ week or 38.33/hr). This rate is indexed and increases annually by 2.5%.

There have been many changes to Medicare rebates recently which have improved GP remuneration. These include an increase from 85% to100% of the Medicare schedule fee for rebates for bulk-billing and additional
bonuses for bulk-billing in areas of doctor shortage.

Once settled into their new practice, most registrars would see 3-4 patients/hour and be entitled to 45% of gross billings. Most of these consults are likely to be level B (also known as item number 23) which equates to <20 mins of consulting time. A standard bulk-billed level B GP consult is rebated by the Medicare Benefits Schedule to the value of $31.45. Private billing for a level B consult may range from $40–60 (the patient then claims back $31.45 from Medicare). Longer consults for more complex problems are rebated at higher rates (level C, <40 minute consult, $59.70; and level D, at least 40 min consult, $87.90).

So once established, a GP Registrar may bill anywhere from about $100-$240 per hour of patient consulting. They would then be entitled to receive 45% of billings = $45- $108/hr = $1215-$2916/ week. As an employee, the GP Registrar is also entitled to 9% superannuation and four weeks annual leave which is paid for by the practice.

Those GP Registrars who do on-call and hospital VMO work also earn a minimum of 55% of the hospital billings.

Some Registrars work in salaried practice, especially ADF registrars, those in Aboriginal Medical Services and some rural and remote hospitals that also provide GP services to the community.

Below are some approximate examples of the real
amounts earned by registrars in 2003-2006 (before tax).

Training stage	Location	Practice Style % of Billings pd	On-Call	Avg Patient Consult. Hr/wk	Hrly ($)	Wkly ($)	Annual ($)
Basic	Outer metro	45%, Mix Billing	N/A	26-30 hrs	$37	$1,131	$58, 828
Advanced	Remote	Salaried Hosp. based Med. Officer, proc.wrk	1 in 2-3	60-80 hrs	N/A	$2,658	$138,262
Subsequent	Rural	50% Mix Billing, hosp. admit rights, proc. Wrk (anaes)	1 in 6 7-10 on call	28-30 hrs	$66	$2,670	$138,860
Locum (immed, after comp. training)	Rural	60% Mix Billing, hops. Admit rigts	N/A	38-40 hrs	$90	$3,630	$188,777

So overall, GP remuneration is now reasonable with recent changes to Medicare. It is important to note that working in rural areas, doing procedural work and working as a hospital VMO tend to attract significantly higher incomes. However even in urban areas, once established in their practices, GP Registrars often earn more than what is stipulated in the NMT&C document. All this with flexible hours and choice of practice style too!

Incentives

When working as a GP Registrar, there are a few financial incentives and reimbursements to be aware of. They are linked to working in areas of unmet need i.e. outer metropolitan and rural practice (RRMA 4-7).

HECS REIMBURSEMENT SCHEME
The scheme is for Australian graduates who have graduated in 2000 or later only. Participants in the scheme will have only one fifth of their HECS fees reimbursed for each year of medical training undertaken or service provided in areas with RRMA classifications 3-7.

GENERAL PRACTICE REGISTRARS RURAL INCENTIVES PAYMENT SCHEME
This is available to registrars enrolled in the Rural Training Pathway who must do their training in RRMA areas 4-7. Up to $60,000 is available over 3 years. It does no include the hospital year.

The payments for full time registrars are as follows:

GP Year 1: $10,000
GP Year 2: $20,000
GP Year 3: $30,000

ACCOMDATION
Each RTP will have different accommodation and relocation subsidies for GPRs undertaking rural training.
This can include free accommodation, mortgage/rent subsidy and a variable degree of furnishings. Subsequent GPRs may not be eligible for the same subsidies as basic and advanced GPRs.

EDUCATION EXPENSES
AGPT has dedicated funding for Rural Pathway GPR training. (The Enhanced Rural Training Fund) this money can be used to pay additional emergency skills training courses such as ALS, ACLS, APLS, EMST, REST,ELS and probably a few others. There seems to be variable knowledge and uptake by RTPs of this pool of funding.
Enrol early for these courses (as some may have waiting lists as long as your training!) and contact your RTP about accessing this funding. If unsuccessful, contact AGPT directly

MEDICARE PLUS
Rural and remote registrars (and Tasmanians and those in areas of medical need) can use item number 10994 instead of 10990 for every item bulk-billed for pensioners, concession card holders and children under 16. This gives you a rebate of $7.65 instead of $5.10 for each consult.
Doesn’t sound much, but it’s probably enough to get you over the hurdle from being salaried to receiving 45% of your billing much earlier than you otherwise would.

MORE DOCTORS FOR OUTER METROPOLITAN AREAS PROGRAM
This is a Commonwealth Department of Health & Ageing (DoHA) program. Form 2003 onwards, GPRs enrolled in the General pathway must complete a compulsory 6 months outer metropolitan placement. Incentive payments of $3,000 +/- $1,000 to GPRs who have to do these outer metro terms is available

RURAL RETENTION PROGRAMME
This 1999 Government initiative is a financial incentive program which aims to recognize and retain GPs for their longstanding service to rural and remote communities. This payments are for continuous service and are location specific with five categories of location. Different qualifying time periods apply for each location category; A-E (one to six years active service). The payments are calculated retrospectively every quarter and are based on the value of Medicare claims (with different maximum payments for each category). Pro rata calculations are made where doctors have been active in different categories. Due to location of GP Registrars and the relatively short duration of training it is not common for GP Registrars to be eligible for his program

This scheme currently has continued allocated funding till 2007

For more information about the scheme and which doctors are eligible visit the department of health and ageing website:
www.health.gov.au/internet/wcms/publishing.nsf/content/health-pcd-programs-ruralgp-rurrnet-index.htm