BREAKING NEWS – “David, should I fire my young GP Registrar?!”

You are fired!

Breaking News – Latest update 1st March 2015

We continue to express concern about the viability of training positions, that the new 2015 national minimum terms and conditions impose on practices. All GP registrars must now be employed. We note the 2015 national minimum terms and conditions wages are on average 30% higher than the Award. Special Fair Work friendly employment contracts need to be signed by all Registrars and contractor arrangements are disallowed.

Practices should speak up on this issue. We understand that this is not part of the Fair Work Act other than, it is being enforced by the training program that all Registrars are employees. It would have been great if Registrars to have the option to consider an alternate non-employee arrangement that are more favourable to both parties. This would ensure more training places were available.

We question why the training program plays an  industrial role given no other education provider in Australia does so for training accreditation purposes. With the disbanding of the General Practice Education Training body and this function now being referred back to the Federal health department, there is a clear opportunity to have this contentious issue resolved as it is not the role of the Department to legislate industrial matters.

More importantly we are receiving many reports training practices are withdrawing their interest in offering 2015/16 places.

Practices are unnecessarily undertaking a higher medico-legal risk. Furthermore they are being financially penalised. They are required to pay on a percentage of gross receipts if it is higher than the prescribed hourly wage rate. Salaries can range from $70,000 (Term1) up to $123,000 p.a. (including employer on costs e.g. employer indemnity, Workcover and payroll tax) for a final year Registrar.

Clearly Registrars that see fewer patients per hour e.g.3 per hour are affected most by this outcome. The impact of the Medicare rebate freeze and any other funding cuts should be carefully taken into consideration. The key is  to have a very efficient program and a careful recruitment and selection process.

Email our office at pa@healthandlife.com.au if you would like to discuss the business case for undertaking registrars.

Breaking News – Latest update 10th January 2015 – Stop Press!!

On the 20th December 2014, we published our concerns about the new registrar rules.

This includes our long held concerns about the nature of the employment and contractor terms.

We feel total vindicated after a Training Organisation had published their response shortly after our press release quote:

Dear Registrars, Supervisors and Practice Managers,

Good news! 

Following our representations to GPSA and GPRA today, we are advised that:

Both GPSA and GPRA are happy to agree that all contracts signed on or before 15 December 2014 are honoured and legally binding, and cannot be overwritten by the new NTCER.  If the practice and registrar wish to renegotiate their contracts then that is up to them, but unless they do that, the existing contracts stand.

With the exception of GPT1 and GPT2 registrars who must be employees: you may continue with contract agreements already entered into prior to 15 December 2014 and for the 2015.1 placement.  However, please be sure to plan for employee agreements thereafter.

IMPORTANT:  We advise that the option provided to continue under contractor agreements is not to be taken as a recommendation or advice by GP Synergy to do so.  If the parties (training practice and trainee) elect to undertake a contractor relationship, it is recommended that each considers their circumstance and obtains professional advice pertaining to taxation and regulatory issues including superannuation liability, indemnities, insurances and other factors that may be material to the contract. This is to ensure that each party is compliant with the regulatory environment and is suitably protected.

Kind regards,  

John Oldfield Chief Executive Officer”

GP Synergy (NSW) On Sat, Dec 20, 2014 at 6:54 PM

We feel this statement only validates our concerns that it is not the role of a training program to interfere on how trainees are employed. So we welcome the above response. Please read the rest of our article below and then check with your adviser and training providers before taking any action.


BREAKING NEWS!  “David, should I fire my young GP Registrar?!”

(published 20th December 2014 2am)

– Four important things to consider

Just when I thought, I could rest my keyboard for the Xmas break a serious problem has surfaced this week affecting all young general practice registrar training positions.

All week the phones and emails had been running super hot at my office from practices enquiring about whether to withdraw their offers to 2015 GP registrar trainees. I have some good news. However, there are also some challenges.

The change may threaten the actual viability of future training positions. This includes a practice’s succession plans. Practices that have invested heavily in new consulting rooms in the hope of securing the “tsunami” of GP registrars, are maybe in for a rude shock.

  1. General practice hit with another big blow!

1.1 The first blow: Significant changes to Medicare

Practices are facing a decline in patient numbers. Please see How to beat the $5 rebate. This is due to the 1st July 2015 proposed $5 Medicare rebate cut. In addition, there is a four year Medicare price freeze on rebates and the new 10 minute rule for item 23 consults starting on 19th January 2015.

punch

1.2 The second blow: 2015 New National Minimum Terms and Conditions (NMTC)

Great practices train our future generation of hardworking young trainee general practitioners. Many in Australia this week would have received an email on Monday. Please see http://bit.ly/1w6Nvz5 from the General Practitioners Supervisors Australia (GPSA)in relation to the new 2015 NMTC’s.

The NMTC’s is just like a collective union agreement except it is not a legally binding at law. It is unenforceable. It is essentially a tripartite document between the Australian Medical Association (as facilitator), General Practice Registrar Association and General Practice Supervisor Australia.

The devil is in the detail. There are some good things and also some challenges.

For example, a new requirement, is that wages to move in line with the Medicare Benefits, schedule which is currently being cut or frozen. The Fair Work Act that does not allow an employee to be worse off as a matter of principle. The Fair Work Act calls this the Better Off Overall Test (“BOOT”).

Like many of the pseudo collective union agreements, they can be negotiated to a point. We understand the NMTC is not a collective agreement. However, it seems to force the same outcome just like a collective agreement. It prevents employers from individually negotiating different arrangements between employers and employees. Under the Fair Work Act, this is called an Individual Flexibility Agreement. These are legal and supported by the Act. They must not violate the Act or their relevant Awards.collective bargaining

Practice’s report that they are conflicted. They fear they will be disadvantaged by training providers if they do not toe the line. Furthermore, that they risk failing accreditation for non-compliance or financial ruin with these industrial terms. The NMTC’s arrangement is unusual and unique to the healthcare industry. Sometimes NMTC’s may do more harm than good. It is a conflicted process.

NMTC’s can become too complex or expensive to implement for a small practice. Inevitably this means fewer training places are on offer. Ultimately this forces our local young doctors overseas.

If a practice does not comply, with the new National Minimum Training Conditions by February 2015, then a trainee’s work experience will not be accredited. All trainees must now be employees. This is a change for Advanced trainees. Significant employment on-costs such as payroll tax, super and hidden worker entitlements, administration and accounting costs will render such arrangements unviable for practice owners.

2. How are practice owners reacting!?

We all need time to digest this news. Overwhelmingly, the initial reaction is the new arrangements for many practices are they are simply unsustainable, especially in light of the new Medicare changes. We have received many reports and calls to advise on whether to cancel offers of training for 2015.

A range of concerns was raised last week:    Angry doctor owner  

  1. “Why only 2 months short notice” – “I cannot afford it. I want to cancel all my 2015 training positions?”
  2. “Why the lack of consultation with practice owners?”;
  3. “Is the Medical Practitioners Award 2010 relevant?” If I do comply with this request will I run the risk of being prosecuted with a fine up to $51,000 per incident under the Fair Work laws? Is it worth all the trouble and expense?”
  4. “Why are now all trainees from Term1 to Advanced Term forced to become employees even though they are happy with their existing employee or contractor arrangements
  5. “Do these training bodies or organisations have the legal authority to unilaterally enforce these arrangements between consenting employees and employers?”; and
  6. “Many conflicting opinions continue to exist surround whether such arrangements comply with the Medical Practitioners Award and Taxation laws, is there a better way”.

With the best of intentions to seek some clarity, I had contacted midday yesterday, the National Chair of the General Practice Supervisors Australia– Dr Bruce Willet.

The key message was…                           

“Practices and registrars who have signed a contract in good faith before the release of the NTCER on 15 December 2015 should not be forced to renegotiate their contracts.”

Chair – December 2014 5 pm eNews for GPSA Member

3. There are 4 simple steps to solve your concerns….

3.1 There is time!

The good news. There appears to be a 12 month moratorium, so you do not have to withdraw any offers. Just make sure all offers are signed and agreed by all parties in writing. Our best advice also get the monitorium in writing from your local training provider;

contract-1024x6823.2 Understand your arrangements – get independent legal advice if you have to.

The following article, should answer concerns about the difference between Employee Registrars v Contractors and the Awards;

http://www.healthandlife.com.au/what-we-do/news-and-archives/employee-v-contractor-and-gp-registrars/

Make sure all your advice is in writing. Don’t rely on opinions from professional bodies. Ask them to identify their legal advisers and opinion’s in writing with appropriate references. Please note we are not lawyers and are simply assisting you in asking better questions from your advisers.

3.3 Do not be afraid to sign a contract!

You should have a signed employment contract or agreement. Do not leave any room for doubt. It is a big risk to leave arrangements based on a “verbal misunderstanding”. It is an accreditation requirement if you want to rely on your existing arrangements and not the new 2015 NMTC. Put everything in writing and sign it;

3.4 Do not re-invent the wheel, “it is cheaper and can be more effective”

At Health and Life you can purchase template Fair Work and Tax Office tested employment for all practice staff and contractor agreements (that we call service or tenant doctor agreements).

For a full list of our templates see

http://www.healthandlife.com.au/what-we-do/services-peace-of-mind-solutions/specialised-services/products-for-medical-practices/templates/Template contract

This should be a simple way to get everyone out of a tight spot. These can be customised to meet where commercially possible the National Minimum Terms and Conditions.

Our research

We had extensive verbal written dialogue at a national level with the Federal Australian Medical Association, General Practice Registrar Association and General Practice Superviser Australia and the Federal Tax Office especially in the last 12 months. These agreements have been also been reviewed by the soon to be defunct the national General Practice Education Training Program (GPET) that oversees the training bodies.

4. Where to from here?

For more information, contact our office at pa@healthandlife.com.au or 1800 077 222 for a no obligation chat,  with David Dahm our CEO and Founder of Health and Life – national Health Practice, Tax and Accounting Advisers since 1992. Alternatively visit our website at http://www.healthandlife.com.au.

Please consult us or your legal adviser before acting on any information. Please note we are not lawyers and are simply assisting you to ask better questions from your advisers.

If you are seriously considering the immediate positive benefits of a practice restructure or changing accountants who better understand your needs, we hope when you click on this link it will help.

Join our discussion on Linked In for further updates or keep watching this space.

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  2 comments for “BREAKING NEWS – “David, should I fire my young GP Registrar?!”

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