Government would take on the salaries of rheumatology registrars working in private as well as public practices under a radical solution to the workforce shortage being proposed by the ARA.

Other suggestions being pitched include overhauling visa restrictions and Medicare rules to bring in more overseas-trained doctors into the rheumatology workforce and adding more places to the specialist training program.

It comes as health systems around the country increasingly turn to so-called ‘single employer’ models for contracting GP registrars in under-served rural areas, typically involving the trainee receiving a government salary to divide their time between a private GP clinic and the local public hospital.

But the benefits of the model could also extend to registrars in other under-resourced specialties such as rheumatology, according to the ARA.

“ARA discussions with its members have highlighted the financial constraints that rheumatologists in private practice face in trying to train advanced trainees in that setting,” it says in a pre-budget submission shared with the limbic.

“Such difficulties could be lessened by introducing a single-employer model for non-GP specialist registrars. Such a model would see advanced trainees employed by the State or Territory but working across both public and private practices.”

The submission, which argues the reform would have only a ‘moderate’ budgetary impact, stresses that a portion of their salaries could be paid as a contribution by their private practice supervisor, both to ensure fairness and reduce the cost to government.

“Such an approach would be consistent with the aim of broadening training opportunities for medical registrars and thus reduce future healthcare workforce shortages,” it adds.

ARA president Dr Claire Barrett stressed the idea was part of a suite of changes being proposed, the most important of which would remain more funding for rheumatology training and more training places.

“In the end, what we want is to find a sustainable model of training in non-traditional locations, be that private private or non-metropolitan centres,” she said.

Perhaps more controversially, another item in the submission suggests including rheumatologists and other specialists in the health department’s Other Medical Practitioner (OMP) programs, which currently allow access to Medicare items for specialist-registered GPs to doctors with no formal GP training in areas of workforce need.

The programs have been criticised amid a perception that they facilitate situations where doctors with limited postgraduate qualifications – often educated overseas – are able to work in relative professional and geographic isolation to fill workforce gaps.

Nevertheless, there may be a place for such a scheme in rheumatology, with suitably qualified professionals on an RACP-accredited rheumatology training program, given the extent of workforce shortages in some locations, the ARA argues.

Dr Barrett also emphasised the ARA’s total opposition to any model which would see unsupervised or untrained doctors working as rheumatologists in any location.

“The various OMP programs have been very successful in supporting doctors on the path to GP fellowship to train and work in areas of workforce shortages, while the enhanced Medicare rebates make the funding of their positions more feasible for the relevant practice,” the submission states.

“The ARA believes that an extension of these programs to include non-GP specialist registrars could provide better patient care in areas currently suffering workforce shortages and enable new training opportunities for the specialist workforce.”

Full list of ARA recommendations:

1. Increase funding for the Rural Health Outreach Program
2. Conduct an independent review of the Rural Health Outreach Fund and its governance. The review will investigate its value-for-money, performance and its governance arrangements
3. Provide grant funding to enable the ARA regional rheumatology outreach clinics to operate until 2030
4. Amend the Tier-2 Non-Admitted Services Definition Manual to include rheumatology nurses as a line item in the 40-Series, at a level of funding similar to that of gastroenterology nurses
5. Improve the funding of nurse practitioner services in the 20-Series of the Tier-2 Non-Admitted Services Definition Manual
6. Increase funding for specialist nurse education for both clinical nurse consultants and nurse practitioners
7. Supplement the Specialist Training Program so as to reduce the number of applications left in the ‘reserve list’
8. Expand the Other Medical Practitioner Programs to include non-GP specialist registrars
9. Introduce a Single Employer Model for non-GP medical registrars
10. Increase the age limit for permanent resident visa applications from 45 to 50 years for highly skilled occupations such as medical specialists
11. Expedite the streamlining of all b/tsDMARDs medicines for all rheumatic conditions
12. Retain telehealth funding