Tristar could start charging patients amid rural doctor shortage

Geir O’Rourke | 14th November 2018

One of Australia’s biggest corporates says it may have to privately bill patients to keep its small-town clinics above water and prevent doctor burnout.

Tristar Medical Group operates 54 clinics across Australia and is known for bringing easy-access, bulk-billing medicine to the bush — with a heavy reliance on IMG doctors.  But the business has struggled to recruit in the past year, according to CEO Dr
Khaled El Sheikh (pictured), who likens the search for a GP willing to work in the bush to finding a unicorn.

He blames restrictions that were imposed by the Medical Board of Australia in 2016 in an attempt to improve the supervision of IMGs on limited registration working in isolated communities.  Under the changes, the most inexperienced IMG doctors must be supervised in their practice by a vocationally registered GP with at least three years’ post-fellowship experience.

“They are asking us to find a unicorn,” said Dr El Sheikh, who practises as a GP in Mildura, Victoria.

“A town like Wentworth [in south-west NSW] with 1000 people can only afford one
full-time equivalent GP.

“So, for this woop-woop town, it is extremely difficult to find the unicorn, by which I mean a fellow with no restrictions and can work anywhere, to go and sit and work there. It can’t be done.”

Coupled with Federal Government restrictions on workforce visas for IMGs, the changes are hurting everyone — not just Tristar, he said.

“You just randomly pick any rural town with one or two doctors or the operators of those clinics and ask them how they are going with doctor recruitment. They will tell you it is a disaster.”

“We are going with lightning speed back to that horrible era of the rural workforce crisis, which nobody wants to return to, and the challenge is this is disadvantaging the smallest communities the most.”

The corporate has a workforce of just under 200 GPs, but right now more than 30 of those positions are vacant, Dr El Sheikh said. In June, Tristar lost its contract to provide GP services to the small community of Keith, SA, after the clinic was left for four days without a doctor because the resident GP took personal leave.

It has also been forced to scale back services in the Victorian town of Traralgon — as well as Wentworth — because of the number of GPs who have left in the past six months. Dr El Sheikh said the corporate would now start looking at privately billing
patients in similar communities as a possible way to keep their practices going.

“Otherwise our doctors will burn out in no time,”  he said.

He welcomed supported fellowship pathways for IMGs and other non-VR doctors but said the early intakes were too low to address the problem. “It is fantastic but these programs from the RACGP and ACRRM, with 50 or 60 candidates per year, will not even block one small recruitment hole in one small state.

The four supervision levels of IMGs working with limited registration

Level 1 supervision:

  •  The supervisor takes direct and principal responsibility for each individual patient.
  •  The supervisor must be physically present at the workplace at all times when the IMG is providing clinical care.
  • The IMG must consult their supervisor about the management of all patients at the time of the consultation and before the patient leaves the
    practice
  • Supervision via telephone contact or other telecommunications is not permitted.

Level 2 supervision:

  •  The supervisor shares with the IMG responsibility for each individual patient.
  • The supervisor must ensure that the level of responsibility that the IMG is allowed to take for patient management is based on the supervisor’s assessment of the IMG’s knowledge and competence.
  •  Supervision must be primarily in person — the supervisor must be physically present at the workplace a minimum of 80% of the time that the IMG is practising.
  • Where the supervisor is not physically present, they must always be accessible by telephone or video link.
  • The IMG must inform their supervisor on a daily basis about the management of individual patients.

Level 3 supervision:

  • The IMG takes primary responsibility for each individual patient.
  • The supervisor must ensure that there are mechanisms in place for monitoring whether the IMG is practising safely.
  • The IMG is permitted to work alone, provided that the supervisor is contactable by telephone or video link.

Level 4 supervision:

  •  The IMG takes full responsibility for each individual patient.
  • The supervisor must oversee the IMG’s practice.
  • The supervisor must be available for consultation if the IMG requires assistance.
  • The supervisor must periodically conduct a review of the IMG’s practice.

Source: Supervised practice for international medical graduates

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