I am a so-called “Non-Vocationally Registered” ("Non-VR") GP who has been endeavouring, for many years, to be recognised as fully equivalent to my “Vocationally Registered” ("VR") colleagues, and thus access appropriate Medicare payments for my work. (I say appropriate, given I do the exact same work, take the exact same patient responsibility - and have to pay the same indemnity insurance, as my "VR" peers.)
I am in despair as to my career and am considering leaving the practice of medicine entirely. I have also suffered depression as a result of this protracted injustice.
I became classified as a so-called “Non-VR” GP because in 1996 I had to take a few years out of the full-time medical workforce to care for my wife, who had become injured, and for our 3 infant children. I worked as a GP part-time during this period, with my family relying for support on the disability and carer’s pensions. When I returned to full-time medical practice, because of our changed family circumstances and the fact that my wife was unfortunately still injured, and my children needed substantial ongoing support, I was unable to enrol in my chosen specialist training program.
Like all other Australian GPs before me, I had been able to obtain a Medicare “Provider Number” in recognition of my medical qualification and experience. However, while I had been caring for my wife and kids, there had been created - out of thin air - a critical difference between GPs like me, and my colleagues who graduated just a couple of years before: due to the new political regime, we were known as "Non-VR" GPs.
For, after 1996, pathways to becoming a "GP" were now limited by the government to the completion of an additional 4-year training program - meaning a GP had to have a newly-created title of "Vocationally Registered" to be paid the usual GP Medicare payments. All doctors who had 5 years experience as a GP were automatically offered "grandfathering" onto the newly-created "VR register".
This new "training program" effectively enabled the federal government
to cap the numbers of GPs
and thus conscript doctors
to areas and localities of the government's choosing.
In 2004, under a program of the federal government of that time, so-called “Non-VR” GPs were given access to normal GP payments (i.e.: the normal payments were now called “VR” payments) if they worked in non-Metropolitan “areas of need” for 5 years.
After completing this program, working as a GP in the Blue Mountains, I understood that I would be finally be paid “VR” GP Medicare payments after March 2009. Unfortunately however, Medicare subsequently informed me there had “been a mistake”: I was advised I was not – and never would be – eligible for "VR" GP payments in Sydney... or anywhere outside a designated "geographical area of need".
Despite my 20 years of General Practice service to the community, if I choose to live and work in Sydney, or another city anywhere in Australia, I still am only eligible for half the Medicare payments of “VR” GPs.
Throughout these past 8 years I have constantly endeavoured to have my qualifications - and all my previous years of General Practice - properly recognized: to enable me to bill for my time as a so-called “VR” GP under Medicare, and so be paid the same Medicare payments as all the other GPs who work in the same surgeries I do, performing identical work, with identical qualifications to my own.
The final indignity: on the 1st of July 2012, the outer-metro surgery where I worked was informed that the Labor Government had taken away my “eligibility” for “VR” Medicare payments even from there.
To sit in that same surgery during the first two weeks of July 2012 and work in identically the same way, in the exact same room, seeing the exact same patients that I had for the previous 8 years, but now suddenly for half the Medicare of my peers, brought the injustice and inequity of this issue home in a massive way. As you might imagine, it was quite surreal.
Most of my GP colleagues who work in the surgeries I do - graduating as they did only a couple of years before myself
- were all “grandfathered” into “VR” GP status and thus automatically receive twice my remuneration, no matter where they work in Australia. Their qualifications are
identical to mine in every respect, yet they are paid double by Medicare for identical work. (NB: The term
"grandfathering" is a bureaucratic one, it mean the names of some GPs were simply entered onto a list! If a GP's name is on the list they get the usual Medicare payments. If their name is off the list they now get only
After several weeks in July 2012, during which I was forced to actually beg the federal health department to reconsider, my “eligibility” for “VR” GP Medicare payments - only for that locality - was extended, and only to 30th June 2013.
For the past year I have agitated again, writing to all Federal politicians I could think of, to try to fix this gross pay inequity, before my time being paid the usual GP Medicare payments expired. However it was to no avail. I was informed recently by a government bureaucrat that my ineligibility to “VR” GP Medicare payments is because I am “not qualified” (!!) (which is absolutely untrue, given I have exactly the same qualifications and experience as all my so-called "VR" peers who I work with! So that means they're "unqualified" too!!)
I am now on the verge of despair. Since this gross pay inequity, created purely by a bureaucratic pen stroke, cannot be resolved under the current government I have to reconsider my commitment to practicing as a GP altogether. What an appalling waste of talent and effort, and what a deplorable outcome for all my patients.
The lives of all my family have been put on hold, for over 20 years, as a result of a bureaucratic decree – one which should, in fact, be judged unlawful if it could be tested in an industrial relations court. (No well-known human rights legal firm wants to take this case on and go up against the federal government - despite the lawyers agreeing this discrimination is clearly against the law!) The so called “VR/Non-VR” categorization of General Practitioners unashamedly discriminates against so-called “Non-VR” GPs, who perform identical work to their “VR” colleagues - for half their Medicare payments.
I have ceaselessly contacted all relevant politicians of the incumbent government, and government department bureaucrats, but all to no avail. The former Federal Minister for Health, Nicola Roxon, and the current Minister Tanya Plibersek, have not even responded to my entreaties. I am now tired of the constant frustration, and of fighting political bureaucracy, and am thus reconsidering my future as a GP.
I realize that this is a deplorable outcome for my many patients, and I would like to assure you that this decision has certainly not been taken lightly.
To have to abandon a career that took 7 years of undergraduate university study, at Honours level, years of working in hospitals and the subsequent and continual effort - including working in many and varied disadvantaged practices around the country - and to abandon the personal relationships with patients and their families that I have formed through years of dedicated and genuine care, is not what I ever envisaged, or even considered I would one day have to do.
However my family responsibilities are significant. I therefore cannot possibly continue working in exactly the same way to so-called “VR” GPs, bearing exactly the same responsibilities, the same costs for indemnity insurance, the same costs for staff and equipment, and the same requirements for continuing medical education, but for half their payments from Medicare.
The "VR/Non-VR" categorisation of General Practitioners unashamedly discriminates against so-called "Non-VR" GPs, who perform identical work to their "VR" colleagues for half their pay.
Under Australian law this discrimination is ILLEGAL.
The time is way overdue
for this blatant discrimination and inequity to be struck down,
so-called "Non-VR" GPs granted equal status under the law
to that of their so-called "VR" colleagues,
and be paid equal Medicare payments for the exact same work and responsibility.
Thank you for your support for a Fair Go for Doctors
MB.BS. (Hons) UNSW BSc.