Scaling Moratorium Provides Rural Incentives for International Medical Graduates

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​The scaling moratorium reduces the amount of time International Medical Graduates (IMGs) and Foreign Graduates of an Accredited Medical School (FGAMS) are required to work in certain areas before they get access to Medicare benefits.

Section 19AB of the Health Insurance Act 1973 (the Act) states that there are restrictions on access to Medicare benefits for IMGs and FGAMS, and that they must work in either a Distribution Priority Area (DPA) or a District of Workforce Shortage (DWS) area for at least ten years prior to gaining access to Medicare benefits.

Moratorium scaling allows IMGs and FGAMS to reduce the amount of time they must work in an area classified as DPA or DWS to provide services under the Medicare Benefits Schedule. Working in eligible locations grants you ‘scaling credits’ and access to rural incentives which may reduce the specific duration of work depending on the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) rating of their place of work. The higher the area rating, the shorter the period these doctors are restricted under the section 19AB and IMGs and FGAMS can reduce the mandated period of work from ten years.

For example, doctors serving in an ASGC-RA area of 5 could serve five years instead of ten. That’s opposed to the IMGs and FGAMS in ASGC-RA areas of 2 who could be restricted for 9 years.

Eligibility for the Scaling Moratorium

Eligibility for scaling is worked out each month. You’re eligible if:

  • your moratorium period has started

  • you have a section 19AB exemption for your practice location

  • your total value of your Medicare billing is or above the $5,000 monthly threshold

  • you work in an eligible Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) 2-5 category.

The ASGC-RA is a geographic classification system to allow measureable comparisons between city and country Australia.

You can find out more about the Australian Statistical Geographical Classification - Remoteness Area | Australian Government Department of Health on the DoctorConnect website.

The 5 Year Overseas Trained Doctor Scheme

An international medical graduate can reduce the time they must work in a DPA or DWS to as little as 3 years. The 5 Year Overseas Trained Doctor Scheme lets international medical graduates do this by working in an eligible rural or remote location. This is an initiative that is administered by the Rural Workforce Agencies in each state.

Eligibility for the 5 Year Overseas Trained Doctor Scheme

  • Complete the required terms of service in a location deemed eligible for the Scheme;

  • Recognised general practice training and qualifications falling within Category 1 or Category 2 of the Specialist Pathway; or

  • Provide evidence they are eligible to be assessed for FRACGP or FACRRM within two years of commencing on the Scheme;

  • Hold or obtain appropriate registration with the Medical Board of Australia;

  • Intend to seek or currently possess permanent residency and/or Australian Citizenship;

  • Will be providing at least 7 sessions a week as part of their placement.

Exemptions from Section 19AB

There are numerous exemptions to the section 19AB, and specific conditions must be met in each of these scenarios.

Exemptions in areas classified as DPA

IMGs may receive their Medicare provider number if:

●      They work in a DPA for their medical specialty

●      Are on an approved workforce or training program

●      Work at any location during after-hours periods

The Health Workforce Locator has a complete list of locations classified as DPA

Exemptions for areas not classified as DPA

Aboriginal and Torres Strait Islander Primary Health Services exemption

You can work at an Aboriginal and Torres Strait Islander Primary Health Service that holds an exemption under s19(2) of the Health Insurance Act 1973. Your local Rural Workforce Agency can help identify eligible locations.

Academic exemption

You may be eligible for an academic exemption if you satisfy 19AA, work in an Australian medical school and perform clinical services as part of your academic appointment.

Specialties in acute shortage exemption

Some medical practitioners may be eligible for an exemption based on their specialty of medicine that is in high demand in Australia.

Locum Exemption

You can work up to 6 months in an area that is not DPA or DWS. This cannot be extended or repeated. A letter of support needs to be submitted with your Medicare provider number application stating that you are seeking a locum exemption.

Spousal exemption

Your spouse will either need to be a medical practitioner who is not prevented by 19AB of the Act from rendering, or from having rendered on his or her behalf, a professional service for which Medicare benefits is payable and who ordinarily resides in Australia, or another skilled migrant recognised by the department of immigration. You are then able to apply to practice near your spouse’s primary place of employment by providing evidence of your proposed place of employment and your spouse’s primary employment location. There is no formal application form and assessment is on an individual basis.

Replacement exemption

Replacing a doctor who held an unrestricted 19AB exemption may qualify you for an exemption, however, the replaced doctor must have ceased working at the practice and in the local area.

Read: What keeps IMGs in rural areas after their 10-year moratorium?

All of the information relating to 19AB can be found here:

For a confidential discussion on your personal circumstances contact Alex Bellingham on 1300 137 142 or