Negotiating employment Essential knowledge for general practice registrars
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Negotiating employment Essential knowledge for general practice registrars
Second edition, 2017
Negotiating employment Essential knowledge for general practice registrars Second edition, 2017 Disclaimer All efforts have been made to ensure that material presented in this publication was correct at the time of printing and published in good faith. However, GPRA takes no responsibility for any change to any information provided by or sourced from outside agencies and referred to in this publication. Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001 T 03 9629 8878 E registrarenquiries@gpra.org.au W gpra.org.au ABN 60 108 076 704 ISSN 2204-9045 Š 2017 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the publication. No part of this publication may be reproduced without prior permission and full acknowledgement of the source: Negotiating employment: essential knowledge for general practice registrars, a publication of General Practice Registrars Australia.
Contents Introduction
1
Why should I negotiate an employment agreement?
2
Where do I start?
2
What is the purpose of the NTCER agreement?
2
Who will I be negotiating with?
4
Employee versus contractor
4
Things to consider before negotiating
8
Working hours
8
Number of patients per hour
8
Education and supervision
9
Your areas of interest
9
In-practice teaching
9
Educational release
10
Your supervisor’s obligations
10
Renegotiation 10 Other talking points
10
Remuneration 11 Financial incentives
12
Subsidies and expenses
12
Leave entitlements
13
Annual leave
13
Personal leave
13
Study leave
14
Parental leave
14
Employment terms and conditions in detail Hours of work
15 15
On-call and after-hours
17
Fatigue management
17
Supervision and education
17
Training requirements
17
Your supervisor’s obligations
18
Leave entitlements
18
Annual leave
18
Personal/carer’s leave
18
Study leave
19
Educational release
19
Expenses 20 Travel expenses
20
Relocation expenses
20
Accommodation support
20
Registrar requirements
21
Medical registration and indemnity insurance
21
Personal safety
21
Termination of employment
21
Geographic restrictions on future employment
22
Dispute resolution
22
Remuneration 23 Frequency of billing and payment cycles
23
Payment by billings or receipts
24
Payment for overtime
24
Payment for after-hours and on-call work
25
Service incentive payments
25
A supervisor’s perspective on negotiation
26
Resources 28
Negotiating employment – essential knowledge for general practice registrars
Introduction ‘Make every bargain clear and plain, that none may afterwards complain.’ Greek proverb For many general practice registrars, negotiating an employment agreement can be a challenging process. Negotiating employment: essential knowledge for general practice registrars is designed to help make negotiating an employment agreement easier, both throughout training and post-fellowship. It contains guidelines and general advice that apply to both registrars and general practitioners at any career stage. However, in particular, it discusses the terms and conditions for general practice registrars in all Australian General Practice Training terms. There are many things to consider when making the transition from the hospital system to general practice. Hospitals have highly standardised terms and conditions of employment, whereas private general practice – being a business – has more flexibility. There is scope to negotiate the terms and conditions of your employment agreement based on the value you bring to the practice. At the end of the negotiating process with each practice, you should have a signed written agreement that both parties have agreed to and understood. This will go a long way towards preventing any possible misunderstanding later on. With an agreement in place, you will be free to enjoy your time at the practice as you develop your competency and career as a general practitioner.
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Why should I negotiate an employment agreement? A written employment agreement between you and your practice ensures clarity between you and your employer, and gives both parties recourse against breaches under contract law. It sets out the requirements and expectations you have of your employer, and your employer has of you. A signed, written employment agreement is also important to recognise items unique to your employment, such as educational release. Without a signed, written, employment agreement, your only legal protection is likely to be the Fair Work Act (2009). Conflicts between registrars and employers usually arise because of confusion over what has been agreed to, rather than as a result of deliberate breaches. It is therefore best to be clear about all aspects of your employment agreement from the outset to avoid any future potential problems. Any verbal agreements about your terms and conditions should be confirmed in your employment agreement to avoid potential future disputes. An example might be if you were to make a verbal agreement with your practice manager, who then subsequently left the practice.
Where do I start? Most registrars entering the Australian General Practice Training (AGPT) program have come from hospital-based 2
employment, which largely features a structured human resources system. General practice is significantly different as the majority of employers are small businesses. General Practice Registrars Australia (GPRA) negotiates the National Terms and Conditions for the Employment of Registrars (NTCER) agreement with the General Practice Supervisors Association (GPSA) on behalf of registrars in the AGPT program.
What is the purpose of the NTCER agreement? The NTCER agreement sets out the conditions and remuneration for the majority of registrars in the AGPT program, although registrars are free to negotiate improved remuneration and conditions. Although the NTCER agreement is a goodwill document and does not function as a contract on its own, it’s a great starting point for you to negotiate your terms and conditions and employment agreement. GPRA has developed an employment agreement template based on the NTCER agreement. The employment agreement template is available at gpra.org.au/employment Most registrars should aim to have a signed employment agreement that incorporates at least the terms and conditions stated within the NTCER agreement.
Negotiating employment – essential knowledge for general practice registrars
The negotiation process is important in developing a shared understanding of what has been agreed to. Remember, the NTCER is a statement of basic terms and conditions, and you may be able to negotiate improved terms and conditions. Registrars in later terms often negotiate terms and conditions beyond the NTCER agreement. Refer to the GPRA Benchmarking Report to find out about other registrars’ conditions and remuneration. The benchmarking report is available at gpra.org.au/employment We encourage you to enter the negotiation process with an attitude of goodwill and a willingness to look for a win-win outcome. After all, negotiation is a two-way street.
Limitations of the NTCER agreement There are some environments within the AGPT program that the NTCER agreement should not be applied. These include Community Controlled Health Organisations and Australian Defence Force posts. Employment in an Aboriginal Medical Service or other community controlled health workplace is often significantly different to standard private practice. For example, training and employment in an Aboriginal Medical Service often includes additional release-time to engage with the community, and the standard
appointment length may be different to private practice. Therefore the NTCER agreement should not be applied in these categories of workplace. In community controlled health workplaces you will need to negotiate your own salary and conditions, no matter what term you are in. To help you do this, refer to the latest GPRA Benchmarking Report to see what other registrars in the training program earn. You should negotiate similar arrangements to registrars with similar experience, using a salaried model. Additionally, you may be eligible for income-friendly salary packaging or salary sacrificing while working for a not-for-profit organisation. Ask your employer what benefits, if any, apply to you. Australian Defence Force registrars will most likely be bound by conditions other than those contained in the NTCER, and are therefore also unlikely to be able to utilise the agreement.
The NTCER is not an award or registered agreement. Your signed employment agreement is the legal document under which you are employed. Questions can be directed to the GPRA registrar services team at registrarenquiries@gpra.org.au
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Who will I be negotiating with? It is important that you have some understanding of the business structure of a practice. Increasingly, it is individuals other than your supervisor who have the responsibility over the running of the business and the negotiation of employment agreements. The main point-of-contact in a practice will usually be your supervisor, practice owner or practice manager. Depending on the business structure, you may typically be negotiating with one or more of the following people: • GP supervisor – training issues • Receptionist – rostering and days • Practice manager – rostering and days, and financial matters such as remuneration • Business manager – financial matters • Corporate officer – financial matters.
Employee versus contractor Some general practice registrars and practices believe there are advantages to registrars working as contractors rather than employees of the practice. GPSA and GPRA have considered this matter and strongly recommend that practices should engage registrars as employees, and not as independent contractors. Legal advice obtained by these 4
organisations indicates that under the law, the relationship between a training practice and a general practice registrar is that of an employer and employee. Considering both industrial relations law and taxation law, this relationship would not be recognised as that of a principal and independent contractor. Even if payment arrangements are set up on the basis of contracting, this arrangement may be considered invalid and deemed to be that of an employer and employee if the matter came before a court of law. This applies to all terms undertaken by general practice registrars. GPRA believes that registrars are more likely to be disadvantaged financially by working as a contractor. For example, contractors ordinarily do not receive paid personal or annual leave or superannuation. Practices also run a legal risk if a registrar is a contractor and may not only have to backpay the registrar various entitlements, but may also be liable for payroll tax. For information on the difference between a contractor and an employee, it is recommended that registrars and practices refer to the definitions outlined on the Australian Taxation Office (ATO) website at ato.gov.au Involvement in an apprenticeship or trainee situation has a significant impact on whether an individual is viewed by the ATO as a contractor or an employee.
Negotiating employment – essential knowledge for general practice registrars
In rare cases you may be eligible to work as a contractor. However, we strongly urge that you seek independent legal and taxation advice to ensure you meet all the necessary requirements. We also recommend talking to your medical indemnity insurer and ensuring that you
are adequately covered if you decide to work as a contractor.
View the full NTCER agreement at gpra.org.au/ employment
Tips for a successful negotiation Read, research and prepare
Prior to your employment interview, read this guide, and perhaps GPRA’s latest benchmarking report and the relevant college vocational training standards. You should also become familiar with the NTCER agreement, which can be found at gpra.org.au/employment
Find an employment agreement template
Some training organisations have a standard employment agreement template. GPRA’s Employment Agreement Template is available at gpra.org.au/employment
Think about what you want to negotiate before your interview
Consider what’s really important to you and areas where you may be willing to compromise. Aim high, but know the least you are prepared to walk away with.
Be prepared for your interview
Take copies of the employment agreement template, the ‘Essential negotiating checklist’ on page 28 of this guide, and the NTCER document to your interview. Record the outcomes of the negotiated topics on your agreement template.
Take time before you sign
Taking time before you sign your employment agreement allows you to read and understand the agreement properly. If you are unsure about any item in the agreement, seek clarification before signing. Consult your Registrar Liaison Officer or GPRA if you are unsure about any aspect of your agreement before you sign.
Keep your documents together
Staple a copy of your completed agreement to a copy of your letter of appointment and the NTCER document. Once the paperwork is completed and signed, ensure that both you and the practice keep a copy.
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Things to consider before negotiating The needs of individual registrars are unique. The needs of practices also differ. While reading this guide, think about which elements in the agreement are the most important to you and which ones you could compromise on. Being able to compromise on one or more elements that are not vital to you but helpful to the practice, can put you in a stronger negotiating position overall. (Note: you cannot compromise below the NTCER.) Unless you understand some of the issues that are critical to the practice, you will find it difficult to build a positive, long-term working relationship. It is wise to think about the bigger picture during negotiations. Earning a reasonable income is necessary for most of us, but there are considerations beyond money. Your years as a registrar are, essentially, a learning experience. There are many other aspects that should be kept in mind when negotiating an employment agreement. These may include the availability of training in the areas that interest you, a willingness by the practice to fit in with the days you want to work, and the ethos and values of the practice and its staff. These will differ from registrar to registrar, but finding a practice that suits you is important to your wellbeing. 8
Below are some of the main points you should discuss with the practice when negotiating your employment agreement. These should be considered each time you negotiate an employment agreement.
Working hours The details of the structure of your average working week should include start and finish times, scheduled consulting hours (including home, hospital and nursing home visits), locations, time allocations for administration, in-practice teaching, educational release and any oncall and after-hours duties. This is a very important discussion you need to have with the employer. Ensure the results of this discussion are documented in your employment agreement. Think about your personal life, family, friends and hobbies. Is there anything that will be happening during the term that you need to advise the practice, such as annual leave, a medical procedure, major events or exams? How many hours are you planning to work each week? This will impact on the category of your training and employment (see Employment terms and conditions).
Number of patients per hour GPT1 registrars may start with 2–3 patients per hour and increase up to the maximum average of four patients per
Negotiating employment – essential knowledge for general practice registrars
hour as their skills increase (as outlined in the NTCER document). Sometimes the patient mix can determine the number of patients per hour. For example, if you are the only female doctor in a busy practice, you may get a particular patient mix which impacts on the total number of patients you can see. This is something to keep in mind and to discuss with your practice.
Education and supervision Familiarise yourself with the Australian College of Rural and Remote Medicine and/or The Royal Australian College of General Practitioners training standards that apply to you.
Your areas of interest Your training organisation supports your formal training with an individual learning plan, guidance and monitoring by medical education staff and GP supervisors in a practice environment. Keep in mind your medical areas of interest and those of the practice and your supervisor. It is important to define your areas of interest in your learning plan and determine how the people and skill-sets within the practice can help you meet your personal learning goals. Talk to the practice about your learning plan so that you can identify any potential issues that may arise, and to try and ensure that your learning needs will be met ahead of time.
In-practice teaching It is important to discuss the nature of your in-practice teaching with your supervisor prior to starting work at your practice. Where possible, document this discussion to ensure there is mutual agreement and understanding on how and when your inpractice teaching will occur. In-practice teaching can take many forms, such as tutorials with supervisors or others in the practice, supervised procedures, educational practice meetings or corridor teaching. A useful tip is to schedule dedicated teaching first thing in the morning or immediately after the lunch break to ensure that your time is not compromised by patient consultations running late.
GPRA’s In-practice teaching resource was written by registrars in consultation with GP supervisors and medical educators. It provides clear direction as to how registrars can take ownership of their own learning to ensure that they meet their individual learning needs and in-practice teaching standards. Find the resource at gpra.org.au/training
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Educational release
Renegotiation
Find out what your mandatory and optional educational release commitments are from your training organisation at the beginning of each term. The amount of educational release time tends to reduce each term as you progress through the training program. Your practice is not obligated to fund extra or optional educational release or workshops run by your training organisation beyond the minimum, compulsory requirements, nor educational release in GPT3 or GPT4.
GPRA recommends that you set a date to review your employment agreement, remuneration and pay cycles, perhaps after three months. There may be the opportunity to negotiate a better deal if you have been performing well. It’s also a good chance to revisit any elements of the agreement that may not be working.
Your supervisor’s obligations Your employer must provide supervision that meets Australian General Practice Training guidelines. Mutually agreed supervision must be available at all times including for after-hours and on-call work. The supervisor, or a delegate, should be available to attend in-person to support the registrar in the event of an emergency, except in circumstances approved by the college(s). This may depend on your stage of training, and a risk-assessment conducted by your supervisor.
Consult your training organisation or GPRA if you are unsure about any aspect of your agreement before you sign.
If nothing else, this formal review is an opportunity to receive and give feedback on your employment and training with the practice. If you like the practice, ask about long-term job prospects. Many practices will be looking for registrars to permanently join their team. So if you fit in well, this may be an opportunity to discuss future opportunities.
Other talking points The following points are unlikely to be core issues in your employment agreement, but points you may wish to clarify as part of your discussions. • Orientation: Will the practice conduct an orientation session? • Consulting room: Will I share a room or have my own room? • Bulk-billing versus private billing: What is the bulk billing versus private billing mix? Which patients are bulk-billed? • Appointment booking system: What is the practice appointment booking system?
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Negotiating employment – essential knowledge for general practice registrars
• Booked appointments versus walk-ins and emergencies? What about home, hospital or nursing home visits? • Follow up of test results: What is the normal procedure for following up patients’ test results at the practice? What happens with test results that come in after you have left the practice? • Registrars teaching obligations: Will I be doing in-practice teaching of medical students or others? Is this paid? When will this be required and how often?
Remuneration According to the NTCER, registrars should be paid a base salary, or a percentage of billings/receipts, whichever is greater. A base salary is a wage paid per hour worked. All registrars need to have a base salary in order to be remunerated appropriately for paid leave, and to provide a reasonable base wage in case of low workload. The percentage of billings/ receipts payment is a percentage of what a registrar bills or receives (as recorded in the practice software). Keep in mind that billings can be calculated immediately,
Tips to maximise your income Try to be paid via billings rather than by receipts. Being paid via receipts means that your income can be spread out over a longer period. You may also find that you have some exposure to bad debts. Negotiate a short billing cycle (the amount of time after which your practice calculates your billings/receipts vs your base wage). Shorter billings cycles can be financially advantageous. Annual leave will be paid to you upon termination if you do not use it. According to the NTCER, annual leave is paid at your base rate. If you are earning more than your base rate and have a longer billing cycle, taking annual leave will be financially disadvantageous, as it may be consumed by your payment for billings/receipts (unless specified otherwise in your employment agreement). However, remember your wellbeing is important, so the desire for extra income must be balanced with the need for time-out. If you have a fortnightly billing cycle and want to take two weeks annual leave, align your leave with your billing cycle. If your billing cycle is longer, you may be better off taking leave without pay. In this way your annual leave will be paid out upon termination at your base rate. Note that you do not accrue leave during periods of leave without pay.
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whereas there will be some delay calculating receipts.
unclear about whether they, or the practice, should receive these payments.
These arrangements should be clarified with your employer and documented in your employment agreement. Your base salary increases each term from GPT1 to GPT3, however your percentage does not increase. These factors are all negotiable.
PIP payments are paid to the practice. Apart from the anaesthetic PIP and obstetric PIP, individual GPs and registrars do not receive PIP payments.
Higher incomes become possible when your billings for the practice exceed the NTCER base salary. Typically, the transition point comes when you are seeing an average of three patients per hour in eight or more sessions per week. Other factors also contribute, such as whether the practice bulk bills or charges higher private patient rates. Remember that the NTCER is intended to be the basic terms and conditions of employment. You are free to negotiate improved terms and conditions. To assist you in this process, GPRA produces a benchmarking report detailing the terms, conditions and remuneration of registrars around Australia. Check the report to ensure the remuneration you have in mind is reasonable at gpra.org.au/employment
SIPs are usually paid to the individual GP or registrar performing the service. However, it is common for the payment to be shared between the registrar and the GP or practice if, for example, the GP supported the registrar or specialised equipment was required to deliver the service. Details of PIP payments and SIPs should be written into your employment agreement. The NTCER document states that SIPs are to be included in your gross billings/receipts.
Subsidies and expenses Rural or remote placements may include accommodation or rental subsidies. Discuss with your training organisation what you may be eligible to receive.
Financial incentives
Your employment package may also include travel allowances or reimbursement for certain expenses. These are outside the NTCER and may be negotiated on a case-by-case basis.
The Practice Incentive Program (PIP) and Service Incentive Payments (SIPs) are financial incentives paid by Medicare Australia to achieve specific national health outcomes. Many registrars are
Find out whether you will be expected to provide any of your own equipment, for example, stethoscope, auroscope/ ophthalmoscope, ear thermometer, doctor’s bag or reference books.
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Negotiating employment – essential knowledge for general practice registrars
Leave entitlements As an employee, you are entitled to leave arrangements as set out under the Fair Work Act and the National Employment Standards. This includes annual leave, personal/carer’s leave (including sick leave), compassionate leave, study leave and parental leave. The minimums for some of these types of leave are non-negotiable and the employer must offer the legislated minimum leave, just like any other business. If you would like to take annual leave during your training, it is wise to discuss this with your supervisor or relevant practice staff member as early as possible, especially if the leave you require falls during a busy period for the practice. All employees must receive entitlements as set out under the Fair Work Act including superannuation and annual leave. Note that according to the Fair Work Act, leave is not transferable between employers. Therefore any leave you have accrued at one practice will most often not be recognised by another practice (and in the case of annual leave, any accrued leave should have been paid out at the end of your employment term).
Annual leave The Fair Work Act, Division 6, states: ‘For each year of service with his or her employer, an employee is entitled to 4 weeks of paid annual leave. An
employee’s entitlement to paid annual leave accrues progressively during a year of service according to the employee’s ordinary hours of work, and accumulates from year to year. Paid annual leave may be taken for a period agreed between an employee and his or her employer. The employer must not unreasonably refuse to agree to a request by the employee to take paid annual leave. If... an employee takes a period of paid annual leave, the employer must pay the employee at the employee’s base rate of pay for the employee’s ordinary hours of work in the period. If, when the employment of an employee ends, the employee has a period of untaken paid annual leave, the employer must pay the employee the amount that would have been payable to the employee had the employee taken that period of leave’.
Personal leave For each year of service with his or her employer, an employee is entitled to 10 days of paid personal/carer’s leave. An employee’s entitlement to paid personal/carer’s leave accrues progressively during a year of service according to the employee’s ordinary hours of work, and accumulates from year to year.
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Negotiating employment – essential knowledge for general practice registrars
Study leave There is no automatic entitlement to study leave, however, some practices may allow you to take unpaid leave to prepare for exams or pursue other study. You should negotiate this with your practice as early as possible.
Parental leave Parental leave is handled slightly differently to the Fair Work Act within AGPT. The reason for this is that the Fair Work Act states: ‘An employee… is not entitled to [parental] leave… unless the employee has, or will have, completed at least 12 months of continuous service with the employer...’ This eligibility criterion excludes most general practice registrars. AGPT policies allow for parental leave (without pay). Contact GPRA or your training organisation for more information. Registrars may be eligible for payments via the federally funded parental leave scheme. For more information, visit familyassist.gov.au Generally, you should notify your training organisation and your employer of your parental leave requirements as soon as is reasonable.
Employment terms and conditions in detail This section discusses the specific employment terms and conditions that should be covered in the negotiation process. It allows you to easily follow the order of the GPRA Employment Agreement Template. To get the most out of this section, follow this order in your employment agreement. The GPRA Employment Agreement Template can be found at gpra.org.au/employment The full NTCER document can be found at gpra.org.au/employment
Hours of work Reference: NTCER section 10 The NTCER defines ordinary hours as the time between starting and finishing work each day between 8 am and 8 pm Monday to Friday, and 8 am and 1 pm Saturday. This definition is consistent with the Medicare Benefits Schedule (MBS) definition of attendances after hours. You must work in blocks of between three and 12 hours duration. Ordinary hours include: • normal general practice activities including: – scheduled consulting time (whether seeing patients, or not) 15
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– home, hospital and nursing home visits including travel time
Full-time training is determined by ACRRM and the RACGP.
– administrative time (ie. writing notes, telephone calls, reports)
Part-time training is based on the number of hours less than those specified by the respective college(s) (ACRRM and RACGP) of patient face-to-face time. Check with your college and current AGPT policy regarding any specific requirements for part-time training. For example, whether the patient contact hours must be spread over a minimum number of days per week, and what the educational release and training time is for part-time registrars.
• practice-based teaching time • educational release time. Meal breaks and on-call time are not included in ordinary hours. Ensure your ordinary hours are agreed on prior to the start of the term. Your ordinary hours should be itemised and detailed in your employment agreement. Generally, your roster should be similar to other GPs in your practice. Reference: Full-time versus part-time NTCER section 10.2 and 10.7 Before negotiating your employment agreement be sure that you are clear on your training and employment load. Full-time employment is defined as 38 hours per week, averaged over a fourweek cycle with no less than 27 hours per week averaged over four weeks of patient contact time. A full-time salary is based on a 38-hour week. Full-time equivalent (FTE) is a workforce calculation detailing a working load compared to a 38-hour week. Part-time employment is any number of hours less than 38 hours per week averaged over a four-week cycle. A part-time salary is pro-rata based on a 38-hour week. 16
Training and employment are separate considerations when it comes to full-time and part-time definitions. Registrars should be more concerned with their training status than their employment status. Example: A registrar works a total of 35 hours per week (10 x 3.5 hour sessions) at the practice. They are considered a part-time employee of the practice, however, they may be considered to be training on a full-time basis, depending on their training pathway. Part-time hours and conditions apply on a pro-rata basis. The exception to this is educational release, which is calculated at half that of full-time registrars, irrespective of the hours worked. Additional ordinary hours are not generally listed in your employment agreement, but may arise throughout the year. Additional ordinary hours may be worked by the
Negotiating employment – essential knowledge for general practice registrars
registrar by negotiation with the practice. For example, a part-time registrar may be asked to fill in for a colleague who needs a couple of days off. Where this occurs during regular hours, it is not considered overtime, and no overtime is payable on those hours. However, registrars may decline practice requests to work additional ordinary hours without penalty or disadvantage. According to the NTCER there is no overtime rate payable on additional ordinary hours and so the pay rate for ordinary hours applies.
On-call and after-hours Reference: NTCER section 10.11 and 10.10 The NTCER states that where a practice is normally open outside of ordinary hours, the registrar may be rostered to work. The registrar may also be rostered to be on-call at various times. These hours are considered a normal part of general practice, although registrars’ working arrangements should be no more onerous than those of other GPs at the practice. This means that you should be working similar weekend hours to the other supervisors, GPs and registrars at your practice. If the GPs in your practice usually work after hours, then there may be an expectation that you also contribute. You should ensure that these expectations are explicit in your employment agreement, and that you are comfortable with these expectations.
If working after hours is not something you can commit to due to personal reasons, this should be discussed and must be explicitly included in your employment agreement. Keep in mind commuting requirements between workplaces (including educational releases) during these discussions.
Fatigue management It is important to consider your personal wellbeing and fatigue management. Ask the practice if they have policies on fatigue management and safety (see NTCER section 16.2 and 16.3). These policies should be referred to in your employment agreement. Read the Fatigue Management in Vocational General Practice Training document at gpra.org.au/training
Supervision and education Reference: Australian College of Rural and Remote Medicine and The Royal Australian College of General Practitioners training standards
Training requirements Reference: NTCER section 9 Your employment agreement should include the times, dates and any other details about your in-practice teaching where possible. A useful tip is to schedule dedicated teaching first thing in the morning or immediately after lunch to ensure that your time is not compromised by patient consultations running late. 17
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Depending on the level of training and which college the registrar is training with, the allocation of time dedicated to inpractice teaching will vary. Supervisors have a range of teaching styles and registrars have a range of learning styles. GPRA has produced an in-practice teaching guide to help maximise your inpractice teaching experience. This guide is available at gpra.org.au/training We encourage that in-practice teaching is discussed and mutually agreed, with times agreed in advance. Educational release mandated by the college and training organisation must also be considered.
Your supervisor’s obligations Reference: NTCER section 9.1 Your employment agreement should include details of your supervision and teaching arrangements, including the makeup of your supervision team, their contact details and the supervision and teaching time arrangements.
Leave entitlements Annual leave Reference: NTCER section 6.1 and 6.2 Registrars are entitled to two weeks paid annual leave every six months, or four weeks per year. The exact number of hours of leave accrued is based on your ordinary hours of work. On termination 18
of employment, an employer must pay an employee for any untaken annual leave that has accrued. Example: A full-time registrar working 38 hours per week will accrue 76 hours leave (ie. 10 days) after 26 weeks employment. A part-time registrar working 20 hours per week on average will accrue 40 hours leave after 26 weeks employment. Both registrars have accrued two working weeks of leave. The National Employment Standards state: ‘Annual leave is paid at the employee’s base pay rate for all ordinary hours worked, not including extra payments such as: overtime rates, penalties, allowances, bonuses’. You need to clarify in your employment agreement how annual leave is to be paid. Many practices will simply pay your base rate and include periods of annual leave in your billings/receipts. Another method might be to calculate your billings/receipts during the hours that you have worked, excluding all types of leave that are then paid separately at your base rate. Ensure that your employment agreement is clear on which calculation method is used.
Personal/carer’s leave Reference: NTCER section 6.3 Personal/carer’s leave is leave taken due to personal illness or injury (sick leave) or to provide care to an immediate family or
Negotiating employment – essential knowledge for general practice registrars
household member who requires care or support due to personal illness or injury or an unexpected emergency (carer’s leave). Personal/carer’s leave is accrued at half the rate of annual leave, ie. at one working week per term, or two working weeks per year. Example: A full-time registrar working 38 hours per week will accrue 38 hours personal/carer’s leave (ie. five days) over a 26-week term. A part-time registrar working 20 hours per week will accrue 20 hours personal/carer’s leave (ie. 2.5 days) over a 26-week term. Both registrars will accrue two weeks of personal leave per year. Personal leave is paid at your base rate.
Study leave Reference: NTCER section 6.6 There is no automatic entitlement to study leave. Some practices may allow you to take unpaid leave to prepare for exams or other study. Think about when you intend to sit your exams or might need study time, and negotiate any study leave that you may require prior to starting the term. Include any details of your negotiated study leave arrangements in your employment agreement.
Educational release Reference: NTCER section 9.2 Educational release typically does not occur every week, and depending on your training organisation, you may attend these weekly, fortnightly or monthly. Educational release varies between training organisations, and may be face-to-face or online, and during or after business hours. Overall, educational release time can be averaged over a relevant time period. This is useful for when you are doing more consulting in certain weeks and more formal education at other times. Mandated educational release is paid at your base rate in GPT1 and GPT2 if you are typically rostered to work during release times. After hours or weekend educational release when registrars are typically not rostered to work will not be paid. Some training organisations run extra educational workshops beyond the minimum requirements. Your employer is not obliged to fund this time. Part-time training registrars are paid for educational release at half the rate of fulltime training registrars, regardless of the number of educational release sessions they attend. For full-time training registrars that work 38 hours over four days and attend an educational release on the fifth day in a normal working week, then those 19
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educational release hours may be taken as equivalent time off in lieu on the day immediately preceding or the day immediately following the educational release day in order to comply with clause 16.2 of the NTCER, Fatigue Management. It is important to ensure that both you and your practice are aware of the educational release requirements of your training organisation, and that these have been recorded in your employment agreement.
Expenses Travel expenses Reference: NTCER section 12.1 Travel expenses should be discussed, and usually apply to use of your private motor vehicle for work purposes. Reimbursement rates are paid at the standard rates available from the ATO.
Relocation expenses Reference: NTCER section 12.2 Unless otherwise agreed, the employer is are under no obligation to meet a registrar’s relocation expenses. Registrars should check if they are eligible for relocation subsidies from their training organisation.
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Accommodation support Reference: NTCER section 12.3 GPRA and GPSA agree that neither the employer nor the registrar should be financially disadvantaged in supporting a registrar’s accommodation. Any accommodation subsidy shall be distributed appropriately to either the registrar or the employer, depending on who incurs the cost of provision of accommodation. This should be stipulated in your employment agreement. If a registrar is undertaking a general practice term in a rural area, the employer will support the registrar in accordance with training organisation terms and conditions. This may include assisting the registrar to find accommodation to suit their needs (eg. self-contained, fullyfurnished with kitchen facilities) and is in accordance with the standard approved by AGPT policies. The registrar will be responsible for payment of gas, electricity and private telephone usage. Rural or remote placements may include accommodation or rental subsidies. Talk to your training organisation to see what you might be eligible to receive.
Negotiating employment – essential knowledge for general practice registrars
Registrar requirements Medical registration and indemnity insurance Reference: NTCER section 14.1 and 14.2 As a general practice registrar, you must hold an appropriate level of medical indemnity insurance for the work you carry out. You must also have current registration with the Medical Board of Australia. Your prospective employer is entitled to ask for evidence of these. The employer will ensure it has insurance to cover workers’ compensation for the registrar. You must inform your employer immediately if: • your medical registration is withdrawn or conditions are imposed on it; or • your medical indemnity insurance changes or is terminated for any reason.
Personal safety Reference: NTCER section 16.3 It is the employer’s responsibility to provide a safe working environment. As employers, practices are liable if they fail to provide such an environment, regardless of intent. Similarly, it is the duty of registrars as employees to raise any occupational health and safety issues that they become aware of, and to comply with the existing OH&S policies of the practice and
employer. The employer will ensure it has insurance to cover workers’ compensation for the registrar. GPRA strongly encourages early and transparent discussions on any issues related to personal safety. We also encourage that these discussions should be entered into in good faith and with a genuine regard to safety. Ask the employer for any practice policies that you need to be aware of and make reference to them in your employment agreement. If you experience any threats to your personal safety, raise and discuss these with your employer immediately, and, where possible, put them in writing. You may wish to keep a diary of events. Being able to show a history of behaviour is often far more powerful evidence than a single incident. Depending on the severity of the risk, the registrar may choose not to work until the issue is resolved, or the employer and registrar may agree to an action plan and timeline to resolve any issues.
Termination of employment Reference: NTCER section 19 Employment should not be terminated by the registrar or employer before the completion of the term other than in exceptional circumstances. There should 21
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be extensive discussion between the employer, practice, GP supervisor, registrar and training organisation before such action is taken. Termination notice periods should be discussed and stated in the employment agreement and both parties should adhere to these. Exceptional circumstances where patient safety is at risk or extenuating personal circumstances may allow for termination without any notice by either party. This should be discussed and legal advice sought as appropriate. Any relevant accrued entitlements must be paid to the registrar following termination of employment.
Geographic restrictions on future employment Reference: NTCER section 17 Restrictive covenants that prevent a doctor from practising in the future within a certain geographic range from the employer’s practice are designed to protect the practice’s client base. GPRA has obtained preliminary legal advice to indicate that restrictive covenants are unlikely to stand up to scrutiny for registrars in the training program, as registrars typically don’t control their placements and are often required to move practices to meet their training requirements. However, we are not aware 22
of case law on this issue. To get a firm ruling, this issue would need to be tested in a court of law. GPRA believes that restrictive covenants have no place in a training program and would be very difficult to uphold within the training context. Registrar placements should always be driven by the registrar’s learning plan and training needs. GPRA recommends that registrars in all terms of training should attempt to remove restrictive covenants from their employment agreements. Enforcing a restrictive covenant would be extremely expensive, and the benefits to the practice would be limited. GPRA recommends that registrars with ongoing concerns as to restrictive covenants should seek professional advice on the matter.
Dispute resolution Reference: NTCER section 18 Disputes rarely occur over the terms and conditions of your employment. However, should a dispute arise between you and your employer over the terms and conditions of your employment, you should inform your training organisation immediately, and contact GPRA and/or your RLO for assistance and advice. Each training organisation has its own process for dispute/grievance resolution. The NTCER states that during the dispute resolution process, both parties should
Negotiating employment – essential knowledge for general practice registrars
endeavour to continue working in an appropriate and professional manner. It is a good idea to agree to a dispute resolution process and timeframes as part of your employment agreement. This should include issues such as serving a written notice of dispute by either party, and agreeing to a mediation process by nominating the training organisation or appropriate individual or organisation as a go-to point when there is a dispute. Having a clear process can often hasten the resolution process and provide win-win outcomes.
Remuneration Reference: NTCER Schedule A The annual base salary for full-time registrars is set out in the NTCER agreement in addition to the statutory rate of superannuation. Most practices will use the base rates set out in the NTCER. The statutory rate of superannuation is to be paid at the rate set by the Commonwealth Government. The rates can be found in the NTCER or by visiting the ATO website at ato.gov.au Base salaries are reviewed yearly and indexed in accordance with Medicare rebates (see NTCER section 11.1). These are the agreed base rates for the 2017 training year. Higher rates can be negotiated at an individual level.
Frequency of billing and payment cycles Reference: NTCER Schedule A This is a very important discussion point for general practice registrars. Clarity on when and how often you are paid can minimise any issues that can later cause tension between the employer and registrar. Registrars should be paid at their base rate at least fortnightly. The NTCER states that your billing cycle, ie. the period after which the difference between your billings/receipts and your base rate will be calculated, should be a maximum of 13 weeks. Our recommendation is to attempt to negotiate a billing cycle that matches your pay cycle, ie. fortnightly. This is financially advantageous to you, and, in many cases, perhaps administratively easier for the practice. It is important to clarify the period after which your billings/receipts will be calculated, and record this in your agreement. GPRA’s 2014 Terms and Conditions Benchmarking Report shows that fewer than 20% of registrars were on a 13-week billing cycle. If you are negotiating for a weekly or fortnightly billing cycle and the practice wants to use a 13-week billing cycle, it may be useful to advise them that most registrars are on a billing cycle shorter than 13 weeks. The billing cycle specified in the NTCER is no greater than three months (13 weeks), and 23
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GPSA and GPRA agree that it should never be longer than this period of time. As per section 14.7 of the NTCER, practices should pass on billing information to registrars regularly, and at no less a rate than other doctors in the same practice. Most general practice billing software gives an up-to-date calculation; you may like to request access to this calculation so you can check it at any time. GPRA highly recommends registrars understand and confirm billing and pay cycles in their employment agreement prior to starting employment. You should also be aware of the differences between being paid on billings versus receipts before agreeing to one or other method.
Payment by billings or receipts Reference: NTCER section 11 A higher income becomes possible when a registrar’s billings or receipts for the practice exceed the base wages specified in the NTCER. A higher percentage of billings or receipts rate also makes a substantial difference to income. Although the NTCER specifies a percentage of billings or receipts
plus the statutory rate of superannuation for registrars, some registrars are on higher percentages. This may be negotiable, and having more experience or special skills are good reasons to negotiate a higher rate. Bear in mind that it is unreasonable to be paid a higher percentage of billings than very experienced GPs working in the same practice. Gross billings or receipts include all the fees you will generate working at the practice. SIPs are included in gross billings or receipts. The registrar is not entitled to PIP payments with the exception of the anaesthetic PIP and obstetric PIP. The agreed SIPs and PIP arrangements should be included in your employment agreement. The stated percentage of billings or receipts according to the 2017 NTCER is 44.79%.
Payment for overtime Reference: NTCER section 11.2 Overtime can be taken as time in lieu at your base rate, hour for hour, within one month of accrual. Alternatively, overtime can be paid at 150% of the ordinary rate plus the statutory rate of superannuation.
Annual salary
Weekly salary
Superannuation rate
GPT1/PRRT1
$74,215
$1,427.21
9.50%
GPT2/PRRT2
$89,226
$1,715.88
9.50%
GPT3/PRRT3 and above
$95,295
$1,832.60
9.50%
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Negotiating employment – essential knowledge for general practice registrars
Discuss which arrangement will apply to you and ensure it is specified in your employment agreement.
Payment for after-hours and on-call work Reference: NTCER section 10.10, 10.11 and 11.4 According to the NTCER, after-hours and on-call work is paid at the base rate. This applies whether the work is undertaken at the practice or off-site. If this includes hospital-based work, registrars should also receive the agreed percentage of on-call allowances paid by rural hospitals plus the statutory rate of superannuation.
Service incentive payments Reference: NTCER section 13 The exact portion of SIPs the registrar is to receive should be included in your employment agreement. Usually SIPs are included in the registrar’s gross billings, however, registrars and the practice may wish to negotiate a higher rate.
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A supervisor’s perspective on negotiation There are three key elements that supervisors are looking for during a negotiation with a prospective registrar: enthusiasm, simplicity and fairness.
Enthusiasm The supervisor will want an enthusiastic worker and learner who is prepared to see their fair-share of patients and take on an appropriate workload, which could include after hours work. They will want a registrar who is keen to learn from members of the practice, especially in the areas of interest of the supervision team, which may include practice management, chronic diseases, geriatrics, obstetrics and procedural skills. The registrar will want enthusiastic teachers who have an organised teaching program within the practice, who make themselves available for ‘corridor teaching’ (including after hours) and who have a set of special interests that match the registrar’s interests.
Simplicity Supervisors don’t want complicated pay formulas that are difficult to administer and that can lead to arguments or misunderstandings. Keep in mind the practice’s administrative costs when you are negotiating. Complicated contracts or formulas are not in the best interest 26
of the practice, or the registrar. Try to keep your contract simple and easy to understand, and easy to administer for practice and payroll staff.
Fairness Remember that every time you negotiate a benefit for you, it costs the practice in some way. Look at the financial situation from both sides. Also remember the sole income the practice generates is from patient fees. When you are not seeing patients, the practice is still paying the overheads and is unlikely to want to pay extra for those periods you are not earning a fee for the practice. Expect a lesser percentage if you want to negotiate certain elements into your employment agreement. You should expect to do some after-hours work if the practice provides this service to its patients. Of course, this rostering should be of similar frequency and duration to other doctors in the practice, but recognise that even when you are on-call, your supervisor is also still on-call to back you up. Remember, you are a trainee, and are at the practice to train in an apprenticeship model to experience the breadth of general practice.
Negotiate with a ‘win-win’ attitude – neither party should feel like they are the loser in a successful negotiation.
Negotiating employment – essential knowledge for general practice registrars
Just as it is reasonable for supervisors to check your references, it is reasonable for you to ask for details of registrars who have previously worked in the practice to see how the practice teaches and treats its registrars. Check more than one if you
can. For example, you might only speak to that one registrar who did not fit the practice; the other ten might have had very happy and successful terms. Your RLO may be able to help put you in touch with former registrars.
Top five things a supervisor wants their registrars to know when they negotiate their employment Negotiate in good faith – I want the best possible outcome for both the registrar and the practice. I’d like to think that I try to find what is important for the registrar – and in turn, the registrar empathises with the supervisor and practice and learns what is important for them. Just as a registrar may sometimes feel powerless in negotiations, sometimes this is reversed and the supervisor and/or practice owner can feel powerless. Percentages for an employee need to be calculated differently than for a contractor. An employee’s percentage may appear lower because it does not take into account superannuation, annual leave and other associated on-costs attracted by law for an employee. A contractor (GP, not registrar) might be paid more – but the GP must then take all associated costs from the gross percentage. Be willing to trade or compromise beyond money. For example, if you need to leave at a definite time to get to your daughter’s basketball practice on Wednesday, perhaps offer to work on Thursday until close. As a practice owner, I must also make sure all other staff members are getting a fair and equitable workload. Many practice costs are fixed, therefore the practice continues to generate costs even when no patients are being seen. Practices operate on a profit margin of about 5%, but often this is less. As a result, small increases in percentage payments will result in large decreases in practice profitability and sometimes make the practice unprofitable. Registrars need to be proactive and positive when arranging in-practice teaching requirements. It makes it easier to help with teaching when I know the registrar wants to learn and if they communicate what they would like to learn. It is also good to make sure it is protected teaching time that we both deem important and valuable. Dr Bruce Willett GP, supervisor, practice owner and past GPSA Chair
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Resources Your essential negotiating checklist The following negotiating checklist is a summary of key topics that should be covered and documented in your employment agreement.
Working hours
Payment for each leave type
Hours: sessions and locations, educational release time, administration time
SIP and PIP payments
Training and employment load
Any other allowances and expenses
On-call, after-hours, additional ordinary hours Average number of patients per hour
Education and supervision Protected and non-protected in-practice teaching Educational release time Supervision
Remuneration Base salary or percentage of billings or receipts plus superannuation Payment for ordinary hours Payment for off-site work including hospital VMO, nursing home and home visits Payment for after-hours and on-call work Payment for on-call – on premises and off premises Frequency of billing and payment cycles Payment for working on public holidays 28
Accommodation and relocation subsidies
Leave Annual leave Personal/carer’s leave Compassionate leave Study leave Parental leave
Other matters Medical indemnity insurance Personal safety and occupational health and safety Fatigue management Restrictive covenants Renegotiation date Dispute resolution process Termination of employment
Contract paperwork Written agreement completed, signed and dated by you and your employer BEFORE starting work. A copy retained for your records
Negotiating employment – essential knowledge for general practice registrars
Publications and websites
Common Q&As
The following resources are freely
The GPRA registrar services team receives and answers hundreds of calls from general practice registrars, practice staff and supervisors each year. Here are some of the more common queries we receive.
available to assist you in negotiating your employment agreement. • General Practice Registrars Australia publications: gpra.org.au/resources – In-practice teaching resource – Employment agreement template – Fatigue Management in Vocational General Practice – National Terms and Conditions for the Employment of Registrars – Terms and Conditions Benchmarking Report • Australian College of Rural and Remote Medicine: acrrm.org.au • Australian General Practice Training program policies: agpt.com.au • Department of Health, Doctor Connect: doctorconnect.gov.au • Fair Work Australia Ombudsman leave calculator: fairwork.gov.au • The Royal Australian College of General Practitioners: racgp.org.au
I have no employment agreement to fall back on when problems arise. Make sure an employment agreement is created, discussed and signed before you begin work. If you do not have an employment agreement and have already started work, request one immediately. Your training organisation will usually have an employment agreement template or you can refer to the GPRA Employment Agreement Template. If problems have already arisen, this can be a very challenging situation. Seek advice sooner rather than later. It is always best for both employee and employer to sign an employment agreement prior to commencing work, and not rely on a verbal agreement. I’m not sure what was in my employment agreement. You should retain a copy of the signed employment agreement for your records. Scan and email yourself a copy so you can always access it when you need to. Ask the employer for a copy of your employment agreement if you do not have one. 29
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Do verbal discussions about employment conditions count? No, you must ensure that all discussions are documented in the employment agreement. How is annual leave remunerated? Annual leave is paid at the registrar’s current base rate of pay. See Leave entitlements for more details. I’ve just started at the practice and I need to take annual leave. If a registrar seeks to take a week of annual leave in the two months of their employment, there is not enough annual leave accrued. The practice may agree to provide for leave in advance, or refuse the request. You should try to negotiate and agree on any annual leave you may require as soon as possible. Where possible, details of annual leave agreed to should be included in your employment contract.
Read GPRA’s In-practice teaching guide for more information on how to maximise your in-practice teaching experience. The guide can be found at gpra.org.au/ training My teaching time and educational release time has not been paid. Ensure that your employment agreement clearly states that educational release and teaching time is included in your salary, as in-practice teaching time and educational release time are considered to be components of your ordinary hours (where applicable). Educational release and in-practice teaching time mandated by the respective college(s) or the AGPT program should be paid at the relevant base rate. There are situations where educational release may not be paid time, such as when you are not normally rostered to work. See section 9.2 of the NTCER for more details.
My teaching time was not protected.
I was only paid 44.79% of the Service Incentive Payments.
Request that your teaching time is ‘protected’ as per ACRRM and RACGP teaching standards. Ensure that your employment agreement clearly states that this time is included in your ordinary hours. It is a good idea to discuss how, when and where this teaching will occur, and plan ahead.
According to the NTCER, SIPs (after being received by the practice) will be included in gross billings, and so the percentage that you receive for ordinary hours will apply to the SIPs (plus the statutory rate of superannuation). In other words, according to the NTCER, you should be paid 44.79% of SIPs.
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Negotiating employment – essential knowledge for general practice registrars
Registrars and practices may wish to discuss a higher percentage for SIPs, however, unless it is documented in the employment agreement, the ordinary rate will apply. How are my income and conditions applied as a part-time employee? All conditions including the minimum salaries in the NTCER apply on a pro-rata basis with the exception of educational release. This is delivered at half the rate of a full-time registrar.
Any questions? We hope this GPRA guide has been helpful to you and we wish you well for this next step in your general practice career. Most registrars find negotiating their general practice term employment agreement to be a trouble-free process and their training terms to be an extremely rewarding experience.
Public holidays – what do I get paid, and do I have to work?
Remember, GPRA is here to assist you. If you need more specific, confidential and independent advice on negotiating your employment agreement, get in touch with us or your local RLO.
If the public holiday falls on a day on which you would normally work, and you are not required to work, you are entitled to that public holiday as paid leave at the base rate for your ordinary hours.
If your question is to do with your employment, the legal document which governs that relationship is your employment agreement. Have it handy when you call.
If you work on a public holiday in a practice that is open for normal consultations, you either receive:
The GPRA registrar services team can be contacted via email at registrarenquiries@gpra.org.au or by calling 03 9629 8878.
• your normal pay and equivalent time off in lieu; or • 150% of your usual hourly rate or the agreed percentage of receipts/billings, whichever is greater, and no time off in lieu. If you work on a public holiday in an oncall capacity in a practice that is closed for normal consultations, then you will receive your ordinary hourly rate for your usual rostered hours, but no time off in lieu.
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Notes
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General Practice Registrars Australia 2017