Australian College of Rural and Remote Medicine

Australian College of Rural and Remote Medicine (ACRRM) has a current membership of around 3,500 including fellows, registrars, practitioners and students.

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. Full accreditation was achieved in October 2011 thus making ACRRM the first college of rural medicine in the world.

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.

The Health Insurance Act 1973 that legislated universal health insurance, and The Health Insurance Regulations 1975, gazetted underneath the Health Insurance Act, 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.

Legislated standards for ACRRM Fellowship

Recognition process by the Australian Medical Council

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 submissions for its deliberations. The application was rejected as the Minister for Health and Ageing, Hon Tony Abbott MHR, did "not consider that a case has been made for rural and remote medicine to be a medical speciality."

The Review Group considered that "applying a broad definition of general practice, the practice of rural and remote medicine is largely general practice." Additional comments said that "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."

In light of these comments, on 22 December 2005 Abbott released 1 million dollars to the Australian College of Rural and Remote Medicine to develop an accredited training program for rural general practitioners.

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 as follows:

1. Attainment of fellowship of the ACRRM after the requirement to undergo accredited training. The two groups under this section of the Regulations (section 6DB(1)) are 1) doctors who successfully complete accredited training, and 2) doctors who have been assessed by the ACRRM as having training and experience equivalent to successful completion of accredited training.
2. 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 1) 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, and 2) doctors who are vocationally registered general practitioners.

The inclusion of the latter section 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

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)

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 speciality). 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. Further evolution can be seen in the 16-point scheme 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.'

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.

External links

• Australian College Of Rural And Remote Medicine Official Site