Australian College of Rural and Remote Medicine

Australian College of Rural and Remote Medicine (ACRRM) has a current membership of around 2,500 including fellows, registrars, practitioners and students. [cite web| title = Australian College of Rural and Remote Medicine| publisher = ACRRM| url = http://www.acrrm.org.au| accessdate = 2007-09-22 ]

History

ACRRM was established in 1997.

ACRRM received initial accreditation from the Australian Medical Council (AMC) in February 2007, and was included in the Australian Medicare legislation in April 2007. [cite web| title = Australian College of Rural and Remote Medicine| publisher = ACRRM| url = http://www.acrrm.org.au| accessdate = 2007-09-22 ]

Initial Accreditation by the AMC

Initial accreditation enables ACRRM to now work towards a full assessment by an AMC accreditation team in the future. The AMC assesses and accredits training programs in the recognised medical specialties. Rural and remote medicine is not a recognised medical specialty. The initial accreditation relates to ACRRM as a standards body and provider of specific training and professional development programs for the specialty of general practice. [http://www.amc.org.au/news50.asp| accessdate = 2007-09-26 ]

Australian Legislation and Regulations governing Medicare and the recognition of General Practitioners

This was a Regulatory change rather than Legislative change that enables practitioners who 'meet ACRRM's fellowship standards' to gain Vocational Recognition as a General Practitioner in Australia. Medical practitioners who 'meet the ACRRM's fellowship standards' can be vocationally recognised General Practitioners in Australia and deliver services that attract a Medicare rebate.

Australia has a socialised health care system offering Australians and designated other foreign nationals access to subsidised health care through universal health insurance. A portion of the charge (in many instances the complete charge) for medical services is rebated through the Australian Government via Medicare.

The Federal Government enacted Legislation in 1973 - "The Health Insurance Act 1973" - legislating the universal health insurance. [cite web| title = Health Insurance Act 1973| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/comlaw/Legislation/ActCompilation1.nsf/0/4738F0AB8076B4C0CA25730D001CE3A0?OpenDocument| accessdate = 2007-09-26 ]

Gazetted underneath this Act is "The Health Insurance Regulations 1975". [cite web| title = Health Insurance Regulations 1975| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/ComLaw/Legislation/LegislativeInstrumentCompilation1.nsf/0/2539EC6775B78DA6CA25730D001B68C2?OpenDocument| accessdate = 2007-09-26 ]

Australian Acts require passage through the Parliament. Australian Regulations can be changed by authority of the Minister of the relevant Department and the Governor-General of Australia. The distinction is significant as parliamentary review is the more robust mechanism.

The Act and Regulations define how a doctor can be recognised as a General Practitioner in Australia and, therefore, deliver services that attract Medicare rebates. This is Vocational Recognition of General Practitioners. There are three current pathways.

1/ Section 3EA of "The Health Insurance Act 1973" allows doctors to gain a 'determination' as a General Practitioner if they are General Practitioners if they are 'Fellows of the Royal Australian College of General Practitioners'.

2/ Section 3F of "The Health Insurance act 1973" allows doctors to gain a determination as a General Practitioner if they meet the requirements set out by Medicare Australia. This is the Vocational Register. This list is held by the CEO of Medicare Australia.

3/ The third pathway relevant to ACRRM is not held in the Legislation but in the Regulations. Section 6DA of "The Health Insurance Regulations 1975". This section of the Regulations allows doctors to seek a determination that they are a General Practitioner if they 'meet ACRRM fellowship standards'.

This regulation was added in April 2007 by the authority of the Governor General. [cite web| title = Health Insurance Amendment Regulation 2007 (No. 1)| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/ComLaw/legislation/legislativeinstrument1.nsf/asmade%5Cbytitle/056DF0BA9C02A149CA257294008001EA?OpenDocument| accessdate = 2007-09-26 ]

Legislated standards for ACRRM Fellowship

Recognition process by the Australian Medical Council

The Australian Medical Council has two distinct processes regarding medical specialties in Australia. The first is the Recognition of Medical Specialties. [cite web| title = Recognition of Medical Specialties| publisher = Australian Medical Council |url = http://www.amc.org.au/nsqac.asp| accessdate = 2007-09-27] The second is Accreditation of Medical Specialist Education and Training and Professional Development Programs. [cite web| title = Accreditation of Medical Specialist Education and Training and Professional Development Programs: Standards and Processes| publisher = Australian Medical Council |url = http://www.amc.org.au/specguide.asp| accessdate = 2007-09-27] .

The Australian College of Rural and Remote Medicine initially sought recognition of Rural and Remote Medicine as a unique medical specialty in Australia through the Australian Medical Council (AMC).

This application was hotly debated with the AMC receiving 326 submission for it's deliberations. The application was rejected and the Hon Tony Abbott MHR did 'not consider that a case has been made for rural and remote medicine to be a medical specialty.' [cite web| title = Status of Current Applications for Recognition| publisher = Australian Medical Council |url = http://www.amc.org.au/submissions.asp| accessdate = 2007-09-27]

The Review Group considers that:

'applying a broad definition of general practice, the practice of rural and remote medicine is largely general practice' [cite web| title = Final Report. Assessemnt of rural and remote medicine as a medical specialty| publisher = Australian Medical Council |url = http://www.amc.org.au/forms/Recognition/Final%20Rural%20%26%20Remote%20Report%20pdf.pdf| accessdate = 2007-09-27pg 72]

In addition:

'There is as yet no other instance in Australia of two organisations defining the standards of medical practice and the standards for training and assessment in one medical specialty.....the AMC had agreed this should be possible.' [cite web| title = Final Report. Assessemnt of rural and remote medicine as a medical specialty |publisher = Australian Medical Council |url = http://www.amc.org.au/forms/Recognition/Final%20Rural%20%26%20Remote%20Report%20pdf.pdf| accessdate = 2007-09-27pg 72]

With this in mind, the Minister for Health and Ageing Tony Abbott MHR released 1 million dollars to the Australian College of Rural and Remote Medicine to develop an accredited training program for rural general practitioners on the 22nd of December 2005. [cite web| title = More support for rural and remote medicine| publisher = Minister for Health and Ageing Tony Abbott MHR |url = http://www.health.gov.au/internet/ministers/publishing.nsf/Content/783F5D663A576F82CA2570DF000984FB/$File/abb175.pdf22nd December 2005]

Regulations governing ACRRM

The regulations under the "Health Insurance Regulation 1975", cited above, describe four criteria for eligibility for a determination to be recognised as a general practitioner in Australia via ACRRM. They are split into two subgroupings.

Attainment fellowship of the ACRRM after the requirement to undergo accredited training

The two groups under this section of the "Regulations" (section 6DB(1)) are:
# doctors who successfully complete accredited training.
# doctors who have been assessed by the ACRRM as having training and experience equivalent to successful completion of accredited training.

It is important to note that the Australian Medical council only offers advice to the Minister for Health and Ageing.

In this context, the advice received was for "initial accreditation". [cite web| title = Australian Medical Council Gives ACRRM Initial Accreditation 1st February 2007 | publisher = Australian Medical Council |url = http://www.amc.org.au/news50.asp | accessdate = 2007-11-01] The press release lists a series of specified areas that need to be addressed to achieve full accreditation - mostly regarding an assessment that ACRRM is yet to deliver.

The true impetus for ACRRM's inclusion came from adept and effective lobbying by ACRRM of the state Health Ministers who released the following: [cite web| title = Council of Australian Governments - Communique - 14 July 2006 | publisher = Council of Australian Government |url = http://www.coag.gov.au/meetings/140706/index.htm#health |accessdate = 2007-11-01]

COAG noted that, in order to attract more general practitioners with procedural skills to rural areas, and subject to the Australian College of Rural and Remote Medicine’s training programme being accredited by the Australian Medical Council, the Commonwealth will provide rural medicine with formal recognition under Medicare as a generalist discipline by April 2007.

While clearly confused about rural medicine, what awards offer procedural training and how the Medicare Legislation and Regulations work, this is powerful and insurmountable political pressure for the Federal Government to have acted rapidly on any positive advice from the AMC.

Attainment fellowship of the ACRRM before the requirement to undergo accredited training

The two groups under this section of the "Regulations" (section 6DB(2)) are:
# doctors who have been assessed by the ACRRM, using an assessment model approved by the Department, as having training and experience equivalent to successful completion of accredited training.
# doctors who are vocationally registered general practitioners. [cite web| title = Health Insurance Regulations 1975| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/ComLaw/Legislation/LegislativeInstrumentCompilation1.nsf/0/2539EC6775B78DA6CA25730D001B68C2?OpenDocument| accessdate = 2007-09-27 ]

The inclusion of this section is notable as it fell outside of the AMC's brief and advice. This inclusion was a decision of the Department of Health and Ageing.

There is precedent for the Government to pass into law recognition of doctors in certain medical specialties outside of the professional College structures and professional advice from the regulatory bodies. The inclusion of section 3F of the Health Insurance Act is an example [cite web| title = Health Insurance Act 1973| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/comlaw/Legislation/ActCompilation1.nsf/0/4738F0AB8076B4C0CA25730D001CE3A0?OpenDocument| accessdate = 2007-09-26 Section 3F]

However, at that time a distinction was made between this group of doctors under 3F and Fellows of the RACGP under section 3EA, such that the RACGP current holds a position that Vocational Registration does not lead directly to their Fellowship (FRACGP) [cite web| title = Health Insurance Act 1973| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/comlaw/Legislation/ActCompilation1.nsf/0/4738F0AB8076B4C0CA25730D001CE3A0?OpenDocument| accessdate = 2007-09-26 Section 3EA]

Pre-determination FACRRM, delivered under various Grandfather and Pioneer Clauses, was a peer recognition document that sought doctors to document their contribution to Rural and Remote Medicine (noting that most were awarded at a time when ACRRM was seeking recognition for Rural and Remote Medicine as a medical specialty). This was a reasonable effort to bolster membership and representative input into this organisation. ACRRM approached the new Directors of Rural Medical Schools and University Departments of Rural Health. There is evidence that advocacy groups within the ACRRM sought to increase numbers of females who were under represented at that stage at a Rural Female Doctors weekend in Western Victoria in 2003.

An argument suggests that the criteria for pre-determination FACRRMs is an evolved version of the criteria set down for the Vocational Register. [cite web| title = Vocatoinal Registration of General Practitioners| publisher = Medicare Australia| url = http://www.medicareaustralia.gov.au/resources/medicare/ma_0851_vocational_registration_of_general_practitioners.pdf| accessdate = 2007-10-21 ] Further evolution can be seen in the 16 point scheme [cite web| title = Advanced Standing Assessment Process for Non-VR Fellows of ACRRM| publisher = Australian College of Rural and Remote Medicine| url = http://www.acrrm.org.au/downloads%5CApplication%20-%20Advanced%20Standing%20Assessment%20Process.pdf| accessdate = 2007-10-22 ] laid down by ACRRM as a means to fulfill the government's request to allow recognition for:

'doctors who have been assessed by the ACRRM, using an assessment model approved by the Department, as having training and experience equivalent to successful completion of accredited training.' [cite web| title = Health Insurance Regulations 1975| publisher = ComLaw. Attorney General's Department| url = http://www.comlaw.gov.au/ComLaw/Legislation/LegislativeInstrumentCompilation1.nsf/0/2539EC6775B78DA6CA25730D001B68C2?OpenDocument| accessdate = 2007-09-26 Section 6DB]

The professional risk, however, is the linking of the government driven additions and the professional driven inclusions. The intimate linking of the two within the "Health Insurance Regulation 1975", may mean that ACRRM will not be able to develop a set of standard beyond the Government and enshrines Vocational Registration as an equivalent standard to ACRRM's standard.The trainee organisation, the General Practice Registrars Australia, have commented on the problem but failed to see that the recognition of non-VR GPs under the new "Regulations" is a modified additional round of grandfathering into recognition but denying this path to anyone who does not wish to be a member or Fellow of ACRRM. [cite web| title = Registrars express VR fears 27 September 2007| publisher = Australian Doctors| url = http://www.australiandoctor.com.au/news/fa/0c0505fa.asp| accessdate = 2007-10-26 ]

References