In Australia, we don’t have so much a shortage of doctors as a maldistribution of doctors. Auctioning provider numbers could be an effective way of addressing this problem of maldistribution whereby affluent parts of Australia are generally well-served with medical services, but remote areas are badly served. There is also, of course, a strong case to increase the delivery of health services by nurses, pharmacists and allied health professionals.

International comparisons do not bear out the claim that we have an overall shortage. In 2003, Australia had 2.6 GPs and medical specialists per 100,000 of population. New Zealand had 1.4, Canada 2.1 and the UK 1.3. (AIHW, Australia’s Health 2006, p.330) The major problem is the poor distribution of these GPs and medical specialists, to the disadvantage of patients in outer-suburban, regional and remote areas. No wonder Australians in remote areas are likely to be sicker and die earlier.

The Commonwealth Government provides a 79% subsidy for the income of doctors, but refuses to insist that doctors provide adequate services in areas of greatest patient need. The government should auction provider numbers so that the market can provide incentives to promote the better distribution of doctors. Every doctor needs a provider number from Medicare to attract Medicare subsidies.

How would an auction system work? For example, Medicare could determine that affluent Bellevue Hill should have 20 medical practitioners based in that postcode area. Doctors would bid to work in that particular area for a period of say 5 years. The auction might attract a bid of say $40,000 pa, with successful bidders being able to transfer their provider number to another doctor at a fee within the period of the licence.

Medicare could also determine for example that Bourke, which has many disadvantages for medical practitioners and patients, should have five medical practitioners. Doctors could bid say -$40,000 pa — in effect a subsidy of $40,000 pa from the auction pool — for a provider number to attract Medicare benefits for working in the Bourke postcode area.

With refinement and experience we could use the market to significantly improve the distribution of medical services across the country.

As a supporter of private enterprise and market solutions, the AMA could not legitimately oppose such a scheme.

One reason given for not auctioning provider numbers is that it could be construed as civil conscription which Clause 51.XXIIA of the Constitution forbids in the provision of medical and dental services. But is it civil conscription when doctors receive a 79% government subsidy. Surely the government has the right to influence the distribution of medical services. If doctors don’t want the 79% subsidy, they would of course be quite free to work wherever they liked.

If the government or any employer paid 79% of my salary, I believe they would have a moral case and duty to influence where I work.