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Registrar Remuneration FAQs

Unsurprisingly, calculation and payment of wages is one of the most frequent reasons for disputes between practices and registrars.  Different interpretations and methodologies can lead to different results.  

In drafting the most recent version of the NTCER, GPSA and GPRA worked hard to make the calculation of pays as straightforward as possible.  In case you still have some queries, we have provided responses to what we think will be the most Frequently Asked Questions.

Yes – subject to 9.2(a) of the NTCER, which refers to educational release after hours, mandatory educational release forms part of the registrar’s ordinary hours. 

Yes – in-practice teaching and administration time are part of a registrar’s ordinary hours and must be paid at the base rate of pay. 

Orientation at the commencement of a semester should be undertaken during the registrar’s normal working hours. If orientation takes place on a day that is not part of the registrar’s normal roster, they must be paid at their base hourly rate AND receive a day off in lieu.  Whenever possible, orientation should be undertaken on the first day of employment.

Whilst some Fellowed GPs are paid a salary, they are by far, the minority.  The income of most GPs is determined by the patient revenue they generate.

The NTCER provides a base wage for registrars at the different stages of their training.  The base wage is lowest for a GPT1/CGT1 and increases for GPT2/CGT2.  The base wage for a registrar increases again at GPT3/CGT3 and then remains the same for the remainder of the training period.

The NTCER allows for registrars to earn above the base rate of pay IF the agreed percentage of in-hours, after hours and on-call gross billings or receipts (‘the percentage’) is greater than the base rate of pay.

By building this into the NTCER, registrars earn a guaranteed minimum, but like their Fellowed colleagues, they have the opportunity to positively influence their income.  This is an important part of the registrar’s training.  Our health system is currently built on a ‘fee for service’ model.  Having potential income reliant upon good time management, a willingness to ‘squeeze in’ an extra when there is time, and having a working understanding of the MBS and billing rules assists the registrar in becoming an efficient and financially viable independent GP in the future.

Clause 11 of the NTCER relates to Remuneration and requires a decision regarding whether payment will be calculated with reference to billings made or receipts received. 

This decision needs to be made and recorded in the employment contract PRIOR to the registrar commencing at the practice. 

For the purposes of calculating the gross billings amount to be used for wage calculations, practices should refer to the definition of gross billings in the NTCER.  

Gross billings:  all fees generated by the registrar’s clinical work at the practice in which they are training minus adjustments for reversals, rejections and write-offs

Therefore, if the practice is required to reverse an account and rebill it to Medicare, both the reversal and the re-billed amount are included in the calculation of gross billings.  The net effect of this is that the incorrect billing is excluded completely from the figure on which remuneration is calculated.

Write-offs that are due to practice billing policies – eg. Billing at the practice rate regardless of what the insurer will pay, are also used to reduce the billings figures as it is known that these amounts will never be paid.

Write-offs:  any portion of the fees that have been billed by the registrar for which the practice will never receive payment – the reduction of the registrar’s gross billings by write-offs only applies where this is the result of relevant state/ Commonwealth legislation; write-offs for bad debt are to be borne by the practice.

The reasons for this are varied:  

  • The patient may depart the practice without paying, resulting in a potential bad debt.
  • The practice policy may be to raise an invoice to the insurer for the full practice fee.  In many cases, this is greater than the legislated amount the insurer will pay.  The difference between these 2 amounts is generally written off at the time payment is made.
  • Medicare or the Department of Veterans Affairs may reject a payment.  There are many reasons for this to occur, but the most common is that an item number is charged outside of the time period allowed.  E.g. a 75+ Health Assessment (Item 707) is charged less than 1 year since the last 707 was last charged.

If a patient leaves without paying, and despite every effort being made by the practice to collect the money, the account is never paid, a decision may be made to write this amount off.  Whilst it would be unusual to make this decision within 12 months of the account being raised, if this course of action is followed, the registrar’s billings MUST NOT be reduced by this amount. They are entitled to be paid for this work. The write off is the result of a breakdown in practice procedures, and has nothing to do with the provision of service by the registrar.

By including a definition of gross billings in the NTCER, ambiguity regarding billings has been removed. As the only difference between billings and receipts is bad debts written off – and these are not deducted from the registrar’s billings for the purposes of pay calculation -, billings and receipts will be the same figure. The only difference is when the income is recognised.  

For practices with cash flow concerns, calculating top up payments on receipts ensures that the cash is available to pay wages and superannuation.  However, as the receipts method requires additional calculations to be performed at 3- and 6-month intervals after the end of the semester, practices may determine that billings is an easier and cleaner option – from both a calculation perspective and a payroll processing perspective. Whichever method you choose, make sure it is clearly communicated to the registrar and defined in the employment contract.

We cannot answer this question for your business. 

We can, however, confirm that you cannot pay any less than the % in the NTCER which is currently 44.79%.

Whatever % you negotiate with the registrar, it is essential to note that superannuation is paid ON TOP of this; i.e. whatever % you negotiate, it is ‘plus super’. Failing to recognise and communicate this clearly in your contract can be costly.

  • The minimum percentage of billings/receipts is 44.79% before superannuation. 
  • Superannuation is currently 11.5%.
  • 11.5% of 44.79% = 5.15%.  

So… the total remuneration package inclusive of superannuation is 44.79% of billings/receipts + 5.15% (superannuation contribution) = 49.94%.

 

Some practices have, for consistency, offered the registrar the same net percentage as independent GPs earn.  Paying this amount, without adjusting for superannuation, will cost you money and perhaps the goodwill of the other GPs in the practice.

For transparency and full compliance with employment laws, agreed percentages in a modern employment contract should be ‘plus superannuation’.  For the employment of registrars, this makes it very clear to everyone that there is another cost component on top of the base % negotiated.

Example: If you would like to offer the registrar a total of 60% of billings, you would use 60/1.115 = 53.81% plus superannuation of 11.5%.  

Failing to perform this calculation and including the amount of 60% in your contract would see you pay the registrar 60 x 1.115 = 66.9% of billings/receipts.  As annual leave, personal leave and public holidays are also paid entitlements, you may find that the registrar is the highest paid GP in the practice.

Schedule A of the NTCER relates to remuneration for AGPT registrars.

Registrars must be paid their base rate of pay no less regularly than fortnightly.  You may pay weekly if you prefer.

Any top up required to bring the base rate of pay up to the agreed % must be paid no less frequently than monthly.  This is a change from the 13 weeks that was previously in the NTCER.

‘Monthly’ means a calendar month. This makes a neat 6 billing cycles across a 6-month contract, but is likely to be a stand-alone calculation you need to perform outside the normal pay cycle. Before you choose a 4-weekly calculation as the ‘easier’ option, bear in mind that this has its own inherent issues.

For the mathematicians among us, dividing a 26 week Semester into 4 weekly periods begs the question “what do you do with the 2 weeks left over?”!  As long as you perform the calculation no less frequently than monthly, you may decide which 2 weeks will be ‘stand alone’. Of course, you may choose 2 weekly or 3 weekly calculations… 2-weekly will be easily divided over the semester – 13 calculations per semester -, but 3-weekly will still leave you with 2 weeks left over.  Payment cycles must be decided in advance and agreed in the contract signed by the registrar. There can be no ‘picking and choosing’ according to the registrar’s pattern of work throughout the contract term.

GPSA creates a spreadsheet calculator to assist with this process, however it is always important to have an understanding of the process behind the calculations.  This will help you to double check that the wages you are paying are correct.

Scenario 1

Jo is a GPT1 registrar working 38 hours/week.  Jo and their practice have negotiated 45% + super, to be calculated on a 4-weekly cycle, using billings.  Jo is paid the base rate of pay on weekly intervals.

Week 1 – Jo had 2 days education release this week, plus a full day of orientation

Gross Wages paid for weekly hours: $1,705.82

Gross Billings: $1,000.00  

Week 2

Gross Wages paid for weekly hours: $1,705.82

Gross Billings: $4,000.00

Week 3 – Jo had 1 day of mandatory education

Gross Wages paid for weekly hours: $1,705.82

Gross Billings: $3,200.00 

Week 4

Gross Wages paid for weekly hours: $1,705.82

Gross Billings: $4,000.00

(A) Total Gross Wages for period: $6,823.28 

(B) Total Gross billings: $12,200.00

(C) % of billings for top up calculation $12,200 x 45% = $5,490.00

(C) – (A) = -$1,333.28 = no top up payment

i.e. as Jo’s gross wages for 4 weeks is greater than their % of billings for the same time period, there is no top up payment due.

 

Scenario 2

Louis is a GPT4 registrar working 38 hours/week.  Louis and his practice have agreed upon the NTCER base % of 44.79% + super, to be calculated on a fortnightly cycle, using billings. Louis is paid the base rate of pay fortnightly.

Week 1

Gross Wages payable for weekly hours: $2,190.32

Gross Wages paid for fortnight: $0.00

Gross Billings: $5,500.00

Week 2

Gross Wages payable for weekly hours: $2,190.32

Gross Wages paid for fortnight: $4,380.64

Gross Billings: $5,000.00

  • (A) Total Gross Wages for period: $4,380.64
  • (B) Total Gross billings: $10,500.00
  • (C) % of billings for top up calculation $10,500 x 44.79% = $4,702.95

(C) – (A) = a top up payment of  $322.31

 

Scenario 3

Jane is a GPT3 registrar working 4 hours a day across a 5-day week (20 hours in total).  Jane and her practice have agreed upon the NTCER base % of 44.79% + super, to be calculated on a monthly cycle, using receipts.  Jane is paid the base rate of pay fortnightly.

As the pay cycle is fortnightly, but the calculation period is monthly, there is a little more work to be done to determine whether or not a top up payment is due.

We will assume that both the pay cycle and the current 31-day month commence on a Monday.

1st – 7th

Gross Wages payable for weekly hours: $1,152.80

Gross Wages paid for fortnight: $0.00

Gross Billings: $3,100.00

8th – 14th

Gross Wages payable for weekly hours: $1,152.80

Gross Wages paid for fortnight: $2,305.60

Gross Billings: $2,800.00

15th – 21st

Gross Wages payable for weekly hours: $1,152.80

Gross Wages paid for fortnight: $0.00

Gross Billings: $2,400.00

22nd – 28th

Gross Wages payable for weekly hours: $1,152.80

Gross Wages paid for fortnight: $2,305.60

Gross Billings: $3,000.00

29th – 31st

Gross Wages payable for part-week: $691.68

Gross Wages paid for fortnight: $0.00

Gross Billings: $1,900.00

  • (A) Total Gross Wages for period: $5,302.88
  • (B) Total Gross Billings: $13,200.00
  • (C) % of Billings for top up calculation $13,200.00 x 44.79%: $5,912.28

(C) – (A) = a top up payment of $609.40

Note:

The billings on which the % has been calculated include all 31 days in the month; the wages earned in the same period will not be paid in full until the next pay cycle but are included for the purpose of determining the registrar’s ‘top up’.

Clause 11.1 of the NTCER refers to Indexation. 

Any increase due to indexation of the MBS will take effect in the next full pay period immediately following 1 July. 

The ‘old’ pay rate would be paid for the 1st pay run in July and then the new rate would apply from 10 July onwards.

Registrars are employed on either a full-time or part-time basis for fixed term contract periods.  If they are part-time, their hours will represent a fraction of the full-time hours (38).

If a registrar is 0.5FTE, they are working 50% of a 38 hour/week – 19 hours/week.

If the registrar is 0.75FTE, they are employed for 75% of a 38 hour/week – 28.5 hours/week.

Schedule A of the NTCER contains a table which breaks down the rate of pay for each registrar level into annual, fortnightly, weekly and hourly rates. We suggest you determine the number of hours per week the registrar is employed (based on their fraction of FTE) and multiply this by the appropriate hourly rate.

Example: 

Alex is a part-time GPT2 registrar training at 0.5FTE which equates to 19 hours/week.  Alex is paid fortnightly on the inimum terms set out in the NTCER.

To calculate Alex’s wage, we would look at the GPT2 base hourly rate in Schedule A of the NTCER for the current training semester, which is $53.97/hour.

19 hours/week x $53.97/hour = $1,025.43/week.  As Alex is paid fortnightly, his base rate of pay excluding superannuation is $2,050.86/fortnight.

Date reviewed: 20 September 2024

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