The successful action last week by the Australian Competition & Consumer Commission (ACCC) in prosecuting two surgeons in the Federal Court for “market fixing” might herald a new step in breaking some of the stranglehold the medical profession has over new entrants.

Then again it might not. The ACCC has made several attempts over the past decade to open up medical practice to more competition.

Attempts some years ago to prosecute the Royal Australasian College of Surgeons (RACS) over its control of surgical training and hence the number of surgeons entering practice resulted in an elaborate “Mexican stand-off”. The outcome was that the ACCC set out some rules for the College to follow and nothing much changed. This arrangement became the model for other specialist colleges to follow to ensure that their anti-competitive training arrangements remained within the “public interest” and would not be subject to prosecution.

More recently, efforts by state health ministers to break the College’s restrictive control over the number of surgical trainees amounted to little. A fig-leaf of consultation between health officials and the College around training numbers seems to have saved embarrassment all round but not a lot else has changed.

The College for its part in the last year has revamped its training program, but effectively the previous controls over numbers, selection and where training can occur remain.

Specialist training is certainly a difficult area. Governments and, presumably, the ACCC have to walk a perilous tightrope between the public interest in terms of quality and safety standards and a more open and competitive market in the provision of training and services.

It is open for training providers other than RACS to establish alternative surgical training programs under the accreditation arrangements managed by the Australian Medical Council. In 1994, Peter Baume undertook a review of surgical training for the Federal government and recommended that the universities be encouraged to establish surgical training programs. That report went nowhere.

The problem for the universities is that to establish surgical training programs they would need to engage the services of surgeons currently teaching under the RACS program. The College has not supported any sharing of this valuable resource.

After a decade of occasional flurry and excitement, we are probably no closer to a more open, competitive market in surgical training and the country remains seriously short of qualified surgeons.

Amazingly, despite a decade of debate and litigation, it appears that the two surgeons fined by the Federal Court were not aware that they had been engaged in an illegal activity.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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