a gp who is also qualified as a public health physician or palliative care physician). the royal australian college of general practitioners (racgp) and australian college of rural and remote medicine (acrrm) are responsible for the accredtiation, education and training of gps in australia; medical practitioners who complete the registrar training program are awarded a fellowship of racgp (fracgp) and/or acrrm (facrrm) and recognised as specialists in the field of general practice. registrarship and specialist/vocational training in general practice is typically 3 years or 4 years if additionally completing extended skills training to develop additional competencies to practice in rural and remote locations. rural generalists are upskilled gps that are capable of delivering emergency and hospitalist medical care in rural and remote locations where non-gp specialist care and health resources are limited. rural generalist medical practice is in the process of becoming formally recognised as a subspecialty within general practice by the amc and ahpra. nevertheless, historically and coloquially the term 'specialists' refers to medical practitioners qualified in a specialised field of medicine beyond the scope of general practice (or family medicine). medicare also makes this delineation for the purposes of appropriately allocating referrals, rebates and billings amongst gps versus non-gp 'specialist' consultants. medicare requires patients to see their gp first for a referral to see a consultant (that is, if the patient intends to have medicare subsidise costs associated with seeing the consultant). in australia, the healthcare system is predilected upon patients seeing their gp for an initial health assessment, prior to been referred to consult with a consultant of a relevant specialty for further medical advice and treatment that may be beyond the scope of the gp, and then the consultant returning the patient back to the gp for ongoing primary and shared care. medical pracitioners (that is namely interns, residents, registrars and hospitalists) who have not attained specialist fellowship qualification or registration with ahpra are issued a restricted medicare provider number that allows them to initiate referrals and request diagnostic pathology and radiology investigative services, however not access medicare billing benefits. medical practitioners who could demonstrate that they practiced for at least 5 years in general practice prior to 1995 were not required to complete a specialty training program nor required to be awarded a fellowship by racgp or acrrm in order to be recognised as specialist gps by ahpra and medicare; these gps were effectively 'grandfathered' onto the vocational/specialist register. historically, medical practitioners who practiced in general practice without specialist registration and who were not formally enrolled as registrars in were known as non-vocationally registered (non-vr) gps, and typically only practiced in areas-of-need with restricted access to medicare billings. as of 2018, the non-vr gps ceased to be recognised by medicare and are no longer be able to invoice for medicare billings unless they formally enrol in a formal registrar training program to attain fellowship and be recognised as a specialist gp. non-vr gps essentially now fit into the category of 'other non-specialist medical practitioners'. in order to practice in the specialty field of general practice, similar to other non-gp specialties, medical practitioners must formally register as a registrar to complete a specialty trianing program with racgp or acrrm and attain fellowship status. continuing professional development (cpd) continuing professional development (cpd) ensures clinicians remain up-to-date and evidence-based in their medical practice as mandated and audited by the medical board of australia: medical practitioners with specialist registration (that is, specialist medical practitioners; general practitioners and consultants) must continue to meet the cpd requirements set out and logged by their relevant speciality college. medical practitioners with general registration only and not enrolled (nor have intentions to enrol) in a specialty-vocational training program (that is, other non-specialist medical practitioners; hospitalists) must continue to complete a minimum of 50 hours cpd per year to be facilitated at their own discretion and a logbook to be kept; notwithstanding, these clinicians may elect to enrol into a relevant specialty college cpd program as a non-fellow affiliate member and have their educational activities logged through that college. medical practitioners with general registration only and enrolled in specialty-vocational training program (that is, registrars) must attend relevant educational activities and complete assessment requirements as part of their training obligations as monitored and facilitated by their specialty college and clinical supervisors at their teaching hospital or clinic. medical practitioners with general registration only and working in a pre-vocational training capacity (that is, residents) must attend relevant educational activities and complete performance reviews as facilitated by clinical supervisors at their teaching hospital or clinic. medical practitioners with provisional or limited registration (that is, interns or international medical graduates), must complete a term of supervised practice, meet the educational standards set and successfully complete any assessments during that probational period as set by the medical board and/or specialty college and/or teaching hospital or clinic, prior to been eligible for general or specialist registration. education of junior doctors (that is, interns to residents to registrars) is typically arranged on a regular basis by the hospital at which these clinicians work at and are facilitated by the senior staff specialist clinicians, as well as a proportion of self-directed learning in their own time. the forms of education can include but not limited to: formal lectures and teaching sessions case presentations informal bedside teaching research and clinical trials morbidity and mortality ("m&m") meetings grand rounds clinical skill workshops and courses journal club simulations committees audits education of fellowship qualified general practitioners and consultants, is typically facilitated by the relevant specialty medical college; with each college having its own cpd program. similarly, hospitalists and registrars financially enrolled in the college as non-fellow or trainee members may also partake in the cpd program and educational activities, some of which are highly recommended or mandatory. most specialty colleges use a points-based system to keep track of the clinician's cpd obligations for each year, with each specific activity attracting a certain number of points (for instance, attending a conference or workshop may be worth 3 cpd points, whereas reading a journal article and completing the online quiz may be worth 1 cpd point). there are certain education modules that are mandatory for specialists and their trainee-registrars, and others which are optionally recommended to be completed at the preference of the clinician. mandatory education activities typically require the clinician to participate in activities that ensures ongoing up-to-date competency and receive feedback on core skills and clinical knowledge related to their scope of practice. these typically include: ensuring up-to-date first aid and resuscitation skills certification; such as, cpr, als, apls, emst (atls), et cetera ensuring an up-to-date logbook of core skills and procedures; such as, performing at least 3 endotracheal intubations annually participating in a clinical audit of patients seen by the clinician or colleagues within their department participating in a performance review and receiving feedback from a senior colleague in addition to the above hospital-based education already mentioned, additional forms of self-directed education include such activities as: participating as an attendee or instructor at workshops and courses subscription to journals including online educational resources conferences or seminars academic appointment recency of practice to meet the standard, medical practitioners must practise within their scope of practice at any time for a minimum total of: 4 weeks full-time equivalent in one registration period, which is a total of 152 hours, or 12 weeks full-time equivalent over three consecutive registration periods, which is a total of 456 hours. full-time equivalent is 38 hours per week. the maximum number of hours that can be counted per week is 38 hours. medical practitioners who work part-time must complete the same minimum number of hours of practice – this can be completed part-time.