Comments on: Time to take on Australia’s toughest closed shop: specialist medicine

By: Tim Woodruff

Tim Woodruff — Wed, 07 Oct 2009 20:15:16 +0000

An excellent analysis of the problem. The basis for the problem however is not a shortage of specialists but the fee for service remuneration which sets the scene for specialists to stay in the private system and charge what they feel they deserve. In private hospitals in major cities there is seldom any evidence of a shortage of specialists. In the public hospital next door and in more remote settings there is a shortage. Combining a fee for service remuneration system with publicly funded private hospitals (through the PHI rebate), and continued underfunding of the public system at a Federal level, means there is little attraction for specialists in public hospitals so they make their lives in the private system and will naturally defend their position.
The alternative not even considered by either major political party is to fund public hospitals properly to make them more attractive for specialist to work in, stop funding private hospitals (gradually), and employ more specialists in the public system at a salary which many would accept. Whilst some specialists will never be satisfied with a salary, many who work in the private system would be keen to work in the public system if it and they were adequately funded. It would still be cheaper for taxpayers than getting the work done privately where mutliple taxpayer subsidies make the cost to government of a procedure is at least as much as in the public system. This would tap into the professionalism of many doctors who drift to the private system because that’s where they can get things done and be rewarded.
tim woodruff
doctors reform society

By: Mal

Mal — Wed, 07 Oct 2009 02:30:17 +0000

There is no doubt the system is flawed but to blame the Specialists is an easy avenue for blame.
To train as a specialist you need to get into a training programme, which yes is capped.
Why? Well you could let another 100 orthopaedic surgeons into the scheme each year, for example. The problem is they won’t get hands on experience as you need as close to 1:1 access to a senior colleague to get real experience and training. They will be fighting for operating and the poor patient will have more faces than a footy team looking at them.
I would love more trainees to teach. The States won’t pay for positions in public hospitals.
Stop worrying about the specialists they are such a small cog in the system. Look at the administrators who waste your tax money cost cutting the small stuff and allowing the enormous waste to proliferate. The big picture is so obvious when you work in the system.
And Bakerboy, can I have the names of the private hospitals who provide free of charge the computers and free rooms etc not in my area! They charge fees in my neck of the woods.
And I can’t leave without a comment on OTD’s. Some are good and some are unbelievably bad. I once watched a specialist anaesthetist from the sub continent intubate a patient. She handled the laryngoscope like the kiosk lady-ie she had never used one before. She was considered to be competent from her CV. Beware what you wish for.

By: jossy

jossy — Tue, 06 Oct 2009 11:49:31 +0000

Sean Cornell, of course all those trades and professions you mention don’t actually have caps on the number of people who can be trained in them by industry bodies. So they are actually more market based. Doctors on the other hand have fought tooth and nail against new university medical faculties (ANU anyone) for decades and then strictly limit the number of specialists trained each year.

By: bakerboy

bakerboy — Tue, 06 Oct 2009 10:19:49 +0000

About 10 years ago I worked in the Health Services branch of the Dept of Vet Affairs. I recall my boss there telling me once that the whole health care system in Australia was controlled by the medical specialists and I now know how true that is. Remember a few years back when every man and his bank were building private hospitals, hopefully a licence to print money. The problem was/is that if a hospital can’t get specialists to operate/consult there, they might as well shut the doors which happened to many. When Specialists do deign to engage with a private hospital, the hospital is required to provide, free of charge, offices, staff, computers, parking, coffee machines etc etc. If we only had a government with the guts to enforce the trade practices act, things could change. Alex

By: Lorraine Bochsler

Lorraine Bochsler — Tue, 06 Oct 2009 05:14:29 +0000

Strange to read the comment “only Australian-recognised doctors….” as if it is excessive and unnecessary to require overseas trained doctors to be assessed in Australia - and that from a doctor. A builder / an architect / a dental hygienist all have to have their training (if done overseas) assessed to be allowed to provide services, if your driving licence was issued overseas you have to be examined - and people presenting as having a degree from an overseas university where the standard might or might not be satisfactory, should be allowed to practise freely! Extraordinary. Does Dr. Patel ring bells?

By: stephen martin

stephen martin — Tue, 06 Oct 2009 04:12:09 +0000

“perhaps the Govt can step in and legislate that restaurant can only charge $30?” - If the government was picking up part of the tab for your sea food meal Sean Cornell they would indeed and so they should!

By: stephen martin

stephen martin — Tue, 06 Oct 2009 04:08:04 +0000

(In 2009, it is still the case that only Australian-recognised doctors can provide safe health care.).
And as long as the general public remember the problems at Bundaberg Hospital they will; believe this.

By: Spectator

Spectator — Tue, 06 Oct 2009 04:01:55 +0000

Ian Hickie is right. There are none in the Federal Health Minister’s office who have a historical perspective whether it was Labour & Bob Hawke (& don’t forget the unforgettable Sir Peter Abeles) with airline pilots or the likes of Bruce Shepherd, Woollard, Glasson (how long will he last at Cancer Australia?) and more recently Capolingua who tried so hard to be as tough as the men but failed so miserably.Over the years who tried the hardest and who knew exactly what the problems were? Take a bow Dr Blewitt (who was ritually insulted by Bruce Shepherd), Carmen Lawrence and in the latter part of his tenure Alan Fels. None of them received sufficient political support to take on the Colleges and Alan Fels was ultimately dragged away from using the Trade Practices Act as a convenient weapon to open up and throw some light on the dark, in-house processes of selecting those who might ultimately become qualified consultants. And as for using the threat of specialists removing their labour from the public system - it is used regularly in so-called negotiations and sometimes occurs until the relevant state or territory health authority gives in. Here we are in 2009 and a ‘Closed Shop’ process is still allowed to flourish with all the resulting problems described by Ian Hickie. This systemic issue lies at the heart of health reform but no-one has the courage to deal with it.

By: Sean Cornell

Sean Cornell — Tue, 06 Oct 2009 03:17:47 +0000

Professor Hickie,

Name me one other profession where the Government gets involved in setting the fees that the professional can charge? I just heard a lawyer on ABC radio saying that he would charge “$40,000 plus GST” for 1 weeks work at a Coronial inquiry!

Why doesn’t the Govt start setting caps for what lawyers can charge, accountants, plumbers etc. In fact, i think it is down right ridiculous that a restaurant here in Perth can charge me $45 for a seafood meal, perhaps the Govt can step in and legislate that restaurant can only charge $30?

By: Victoria Collins

Victoria Collins — Tue, 06 Oct 2009 03:17:29 +0000

I think it also apposite to point out that the Drs group that the Rudd government has decided to take on, the Opthalmologists, is headed by the former President of the AMA and scion of the National Party in Queensland, Dr Bill Glasson. If ever there was a perfect synthesis of latter-day Wooldridgean political Doctor’s representative, then Glasson is it.
You’re right, the government should have developed a water-tight strategy for coping with the likes of Glasson before they took him and the other emotional string pullers on.