Author: Dr Greg Brogan
Peer reviewers: Dr Brooke Riley and Dr Nat Appelbaum
One of the biggest problems with medical training is that we are trained only in medicine, not finance and business – no one tells us about all the forms we have to fill and approvals we need to get. This was an annoying struggle for me and I didn’t really find any useful guidance online for it, so I’ve written down the major steps I did in the hope it may help a few people to navigate this confusing pile of paperwork. The information below applies to my navigation of the process as a fellow of the College of Intensive Care Medicine (CICM), though I imagine there are some themes in common for new specialists of any discipline. I’d also like to remind you that ultimately, the responsibility for your registration, paperwork, criminal checks, finances, and so forth lies with you. Think of this not written as an exhaustive guide nor checklist, it is simply a reflection of my experience and it is provided in the hope that it may add reassurance or a general bearing rather than directions. Do not be afraid to check or ask others (friends/coworkers/hotlines) for help.
As you’ll find below, I’ve separated out the major hurdles I had to go through – this is mostly from memory and so I may have missed a detail or two. I’ve also put these steps in the specific order in which I did them. I think this is also the order that they need to be done (College before AHPRA before Medicare) as each successive step needs a letter or registration of the former.
“Get in early” was the best tip I was given and I give it to you too. This process navigates several government/bureaucratic organistations which have a turn around time of weeks and variable levels of intercommunication. Unless you get this going early you may actually not be able to work (read: “bill and get paid”) as a consultant for some time – so be prepared! You’re also about to generate a million forms so make sure you build a system for these where you know you can go back and get them.
College Approval and Fees – The “Admission to Fellowship”.
About ~3 months before finishing my transition to fellow year I emailed the CICM to ask about the process. I was told that the earliest you could start it was 3 weeks before the end of term – so that’s the exact day I scheduled my FITER (Final In-Training Evaluation Report). That said, they let me complete the “MPI form” (Medical Practitioner Information form) and pay a fee a bit early so it was handy speaking with them when I did.
- I’d suggest contacting the college early on, just in case things change. 3 months was a generous amount of time.
- Complete your FITER, meet with your supervisor and have them submit it online.
- There might even be a paper version to do as well – this was at least a thing with the pre 2014 process. I did one of these too and saved a copy, but I’ve never needed it.
- After this I was then directed by the college to fill out 2 forms (I was actually able to do these before the FITER was completed). They’re both fairly self explanatory and they were sent to me by the college. The college has a page dedicated to this part of the process.
- Pay the fee for Admission to Fellowship Fee
- This is AUD$1375 in 2022 according to the CICM Fees breakdown
- I was sent an invoice upon initially writing to the college
- Wait for the letter of admission
- This is the step that takes up to 6 weeks .
- Why so long? It goes to the “fellowship admissions committee” for review before being approved and then I think the college president needs to sign it
- The letter
- Congrats – you have your letter! You can now sign any form you like with “Dr _______ , FCICM”.
- I received mine via an email.
- This usually suffices for proof of fellowship, which the next few steps will need and so will your new employer – so SAVE IT – Don’t just leave it in the inbox.
- You’ll eventually get your official certificate posted to you or at graduation – this form is the formal recognition of being a Fellow which you’ll need to have in the future. When you get that make sure you save a digital copy.
- Fellow’s Subscription fee
- In addition to the “Admission to Fellowship fee” you need to pay the “Fellow’s Subscription”. I couldn’t find this listed in the CICM Fees breakdown but it was was approximately AUD$2000 for me in 2022.
The college sent a copy of my letter to AHPRA (Australian Health Practitioner Regulation Agency) – I suspect this is the official channel by which AHPRA receives the recognition but you might need to make sure they’ve received it at any rate.
- The big form you need to submit to AHPRA is the “ASPC 30” – the “Application for specialist registration. For medical practitioners currently holding general and/or specialist registration”. The form is available via AHPRA
- This can be submitted online. I got a confirmatory email after doing this. I also called the helpline for some advice during this part of the process and they were very helpful, so I’d recommend doing this if you have any issues.
- The AHPRA fee – This cost was AUD$209 in 2022 (according to the ASPC 30)
- You’ll also get access to a downloadable certificate which shows you’re registered as a specialist – make a copy of this and set it aside!
- If you ever need help (like I did), feel free to call up either AHPRA or Medicare helplines – this worked for me and they were able to run me through the process.
Congrats! You’re making headway. You now need 2 things from Medicare: (1) Medicare to recognise you as a specialist and (2) a provider number for each location at which you’ll work
- The recognition
- Download and fill out the form: “HW077 – Application for recognition as a Specialist or Consultant Physician”
- You then email this to the address on the form itself.
- The turn-around time for me was about a month.
- After this, medicare will recognise you as a specialist – congrats!
- The provider number.
- Medicare has an online system called “HPOS” (Health Professional Online Services, through “Services Australia”) – you access it through “PRODA” (Provider Digital Access). You’re able to do a lot through here but I suspect not everyone is able to. If you have PRODA already set up then that’s great, the next step is easy, but it may take time to organise if you don’t have it already – you need to submit forms and identity documents etc so get this going early.
- Assuming you have full access to your PRODA account, it’s simple – Log into PRODA and select HPOS
- In HPOS in the top left hand corner there’s a menu – select that and go down to ‘my details’ and then select ‘provider numbers’. From here you can apply for a new provider number – and the process is instant!
- Before this will work you need to be recognised as a specialist however. I had a fair bit of trouble initially but that was before I had the specialist recognition (it wouldn’t let me make changes with HPOS and so I spent some time on the medicare hotline – don’t be afraid to do this if it happens to you)
Medical insurance is vital and surprisingly a bit cheaper than I expected (quotes for a first year ICU consultant ranged from $1000-2000 for the year). That said, I expect this to increase over the next few years. There are some considerations you need to make depending on your specific job and so the best advice would come from your chosen Medical Defence Organisation (MDO). I won’t go into too much detail as this is a conversation you need to have with them.
- Which MDO to pick? There is no right or wrong choice of MDO, just pick the one that fits best for you and you can always change it if you don’t like it. I spoke to some medical colleagues and found out who they were with.
- If you’re taking a public hospital job your hospital will often indemnify you to some extent. This will alter your premium for your MDO (as they won’t have to cover you as much). Don’t be mistaken, even if the hospital indemnifies you to some extent, get an MDO. The MDO will look after YOU, as opposed to the hospital insurance looking after the hospital.
- If you’re doing private work away from the hospital (i.e. locum, private hospital) then that’s when your MDO will step up and cover you (often stratified by how much you’ll expect to charge per year). This means that if you have more private work your policy will likely cost more.
Hospital Specific Forms, Finances and Miscellaneous
Congrats, you’re almost at the end of the paperwork trial… and the start of actually working. But now’s the time for more forms! This process is variable based on your hospital and state. That said, you’ll often have an administration person who will help guide you through all the forms you need so don’t be afraid to contact them! Though these are ordered they can usually be completed simultaneously
- Working with Childrens check (WWCC)
- Each state has different requirements for WWCC and the forms/information are often sent to you by the hospital.
- Police Check
- Again, each state has a different method – some require you to go to a police station to have documents witnessed, some you just fill out things online. Your hospital will supply you with the information to get this done.
- The staff health department at your last hospital is a great place to try to get your record. Sometimes this will suffice for the next hospital.
- Some hospitals will accept this record straight up, others will require you to undergo further testing by your GP or staff vaccination service.
- This is a fact of employment – find a comfy chair, put on some tunes and get ready to spend an hour learning how to wash your hands!
- Private Billing Rights
- Another important consideration and something I knew nothing about before this process. This is one of the reasons why your provider number is so important.
- You need to figure out how your unit deals with private billings. From what I can see, there is a spectrum. For this I found speaking with other intensivists at my unit very helpful.
- Some units have built a financial trust and all the private billing gets pulled into a trust. Then it’s distributed amongst the consultants who participate in that trust.
- The other end of the spectrum is that in some hospitals (especially with low private billing rates) consultants lend their rights to bill privately over to the hospital in exchange for an increase in base salary. Depending on the award this can be something like an extra 50%.
- There’s also provisions where you can split – you can bill up to x amount yourself and let the hospital take over.
- Because it’s a spectrum there’s an in between, some get a boost in salary up to x dollars and… I really don’t understand it at all. The point of this all is to recognise that there’s variability and so local knowledge is key!
- Read your enterprise agreement for your hospital/state. This may help clarify how billings work and how you’re reimbursed. In fact, do this anyway. Again, you’re a consultant, in depth paperwork is something you need to do.
- There is no overall ‘best way to do this’ from what I understand – it depends on you and your unit – so speak with your director or another consultant who understands how finances and billing works. This is when you need to be asking questions and don’t be afraid to or think it’s impolite.
- It’s not over. In fact, it’s just begun! Once you’ve picked out how to distribute it you need to start billing for it. Again, different units have different ways. I’m most familiar with a paper system built like a spreadsheet where you tick off each day from a list of options of what you’ve done for each private patient (don’t forget – road traffic traumas are usually covered under the Compulsory Third Party ‘green slip’ insurance program as private!). Some units even use an app!
- Finances, CME funds and salary packaging
- The first thing I have to say (legally, actually) is that this is not financial advice, instead consult with your own separate financial advisor… which is the crux of what I say below.
- Being medical specialists we’re mostly intelligent, high functioning people… However, unless you have a degree in commerce or financial planning I will simply recommend considering finding an accountant, financial planner, lawyer for your wills and someone to help with life/income insurance. Often they can pay at least part of their worth in terms of opportunity cost and the time you’d otherwise spend managing your own finances. After saying all that, you can’t completely outsource all your business and financial thinking. Think of it more along the lines of “getting a consult from the financial planner” – you have to retain responsibility and take charge of your own finances. It’s your money in the end and by working together with a financial planner and building your own savvy you can make the best decisions for yourself.
- With your financial helpers get your head around continuing medical education (CME) allowances and taxes. Different jobs have different systems – some will pay you an extra loading on your wage for CME while some will have a separate fund for you to claim reimbursements for your CME. As registrars we’ve been used to paying out of our own pocket but by optimally using your CME funds you can make use of a fair chunk of money that may actually return to the hospital if not used in time. It takes a lot of time and paperwork to correctly leverage your CME so start early, be patient and don’t be afraid to ask for help.
- Salary packaging is quite complex and how you leverage it really depends upon your individual circumstances. It may offer a tax-savvy way of paying for things you’re going to use anyway like cars, rent, gym fees etc. However, it really depends on your individual circumstances so chatting with your financial helpers and learning about it yourself is a wise way forward. Beware that sometimes it actually may not help you and things like leases may potentially reduce your borrowing capacity.
Keeping tabs on your forms
I have a bit of a confession to make – throughout uni and med-school I was horrendously disorganised. It was only after I participated in HETI’s LEAP program did I realise that this was actually a bit of an improvable weakness for me… And then I became, in relative terms, a planning and organisation monster. My personal organisation system is a very uninteresting topic I can save for when you’re suffering insomnia, but I have included a few tips that I’ve found helpful in becoming more organised in terms of forms and paperwork
- Develop your own system
- Sorry, not really helpful, but if you don’t have one, now’s the time to get organised
- Organise in (your own) logical blocks
- As long as it makes sense to you, you can figure it out and find things
- I’ve separated out life and work and then subcatagorised my work into specific folders (and subfolders +++) for each project. At the start of the year I’ll start a yearly folder for the projects and carry over any continuing ones into the new folder.
- All the forms I generate for a project are scanned and deposited directly into the folder
- It’s so much easier than rifling through paper forms – there are a few apps available where you can scan PDFs from your phone.
- Upload and save them as soon as you get them, otherwise you never will.
- Keep your paper safe!
- Paper forms are sometimes required (i.e. for your will, contracts, ID documents like Working With Childrens Check cards). So get a filing cabinet or equivalent shelf to keep these in a safe and known location
- Back-up your computer
- Buy a large hard drive to save your work onto. You never know when your computer will break, get lost/stolen or even hacked.
- You can either back up your folders or even your whole computer
- Start doing this every so often. It doesn’t have to be daily, just at sensible intervals – e.g. every week when you head out to do your shopping.