We invite you to join in the Need More GPs Solution Discussion.
We do not need any more data to find out how bad the problem is.
We do not need any more statements about how bad the problem is.
We do not need any more whingeing about whose fault it is.
We need some solutions.
We invite you all to use both halves of your brain, to throw the correctly coloured hat onto the discussion table, to think out of the box, out of left field, out of desperation, and join in the discussion.
Towards this end, and in an attempt to open up the debate, we offer some ideas for discussion. We hope that, with your input, this list will grow.
In no particular order, we propose:
1. To assist the urban crisis: a short moratorium (say, 6-12 months) on the provider number restriction, with some other conditions: only Australian residents or citizens who are fully registered and have a demonstrable urban commitment. This could allow an uptake of OTDs into urban practices at risk of closing, without causing an exodus from the bush
2. A reduction of the time-limit on OTDs obtaining unrestricted provider numbers from ten to three years. Three years seems reasonable to demonstrate a commitment to the country. Three years is short enough to make upskilling not too much of an issue for OTDs who have not found work in
3. To encourage doctors to work in rural and remote areas:
(i) They receive a Medicare rebate of 100% of the scheduled fee.
4. To encourage doctors who have left the workforce prematurely to return to practice: (i) A ‘Welcome Back’ package, along the lines of the ‘Golden Hello’ offered to GPs in the
(ii) An upskilling and mentoring program to assist their return to work.
5. Temporary assistance to female GPs who wish to work part-time while their children are under-school age, in the form of a subsidy of their medical indemnity cost, to be repaid (as is the student HECS bill) when their working hours increase substantially. There is strong anecdotal evidence that the very high cost of medical indemnity in relation to a part-time income is a contributory factor in women leaving the GP workforce for this reason. A short period of time out of the profession increases the likelihood of the practitioner not returning to it at all due to loss of confidence and de-skilling.
Please leave your comments directly, using the comments link below, or email us at brisbanegp@gmail.com
42 comments:
It seems to me that the following changes brought abouty the GP shortage:
1. Introduction of Vocational Registration, which makes GP training almost as lengthy as specialist training. So new graduates think "if I'm going to do all that extra work anyway to bwecome a GP I might as well be a specialist"
2. Ceasing to accept degrees from the UK, Ireland, South Africa etc. Formerly these doctors provided a constant stream of temporary workers and many (such as myself) stayed.
3. The provider number moratorium.
All these problems are solvable with the stroke of a pen - scrap the VR system (we all know it's a joke) start accepting UK, Irish & SA degrees again and scrap the moratorium. Easy - why doesn't it happen then?
Good points dxer. For each and every one of the ideas or suggestions we all make, I would like to challenge the powers-that-wont-make-it-be to respond very specifically. To make it easy for them (you know who you are), perhaps they could respond, for each suggestion:
(a) this is a great suggestion, we will implement this immediately
(b)there is some merit in this idea, we will consider it seriously.
(c) this is a stupid idea, and we are not going to implement it because ..........[please fill in the gap].
I have been watching the OTD issue for some time. I can only conclude that the state governments only want OTDs that they can control, ie bonded to particular areas or the state hospital system, they dont want to encourage OTDs to replace GPs in urban areas. This seems to apply to GPs wishing to settle in other countries as well. Everywhere in the Western world its really hard to be allowed to practice independantly.
It doesnt matter that the doctor went to a world respected university and underwent family practice training. The doors are closed.
I think that the government is still seeking to limit expenditure from Medicare, PBS etc by restricting the number of doctors, they are just doing it on the sly.
I dont believe that the government are going to change the rules for you guys unless for short-term political reasons. Small practices are financially not so viable and maybe a corporate will set up a practice nearby which you can join and service your patients.
Hello Andy: short-term political solutions are OK by me because they may allow some of us to stay viable long enough for the underlying problems to be tackled (and for there to be enough of us left to train and mentor new graduates). I agree about the inefficiency and viability of small practices (such as mine), but the corporate model (and I include the proposed superclinics in this) will be non-issues if the absolute number of GPs does not increase. They will simply suffer from the same workforce problem we already have - they will end up like the Yes, Minister hospital episode - wonderful shiny new premises with plenty of administrators but no medical staff to do the real work.
May I suggest a front page photo in the local paper ( and even a spot on "a current affair" ) taken with a few vocationally registered OTD's who are available but not allowed to work at your practice.
Based on my experience ( and that of numerous OTD colleagues ) there are enough GP's in Brisbane to address the "shortage" but due to the restrictions placed on them there are at least 2-3 OTD's competing for each job that they are allowed to work in whilst practices like yours struggle to find staff.
I have met and befriended doctors who have returned to Canada and the UK with their Australian partners as a consequence of the restrictions.
Perhaps a simple proposal to the government would be that they remove the "location-specific" restrictions on registered OTD's and change the ten-year moratorium to a '10 yr bulk-billing only' moratorium applicable to all urban locations. This way metro area's that need GP's ( and hence have sufficient patient numbers to make bulk-billing worthwhile ) can easily employ OTD's while those OTD GP's working in rural area's would be unlikely to rush back to the urban centres as they may be faced with a potential loss in income if they are forced to bulk bill in urban area's.
Thanks Anonymous - the more ideas we get tossed into the mix the better. Your variations on the moratorium idea are good. We have been trying hard to get OTDs in this situation to go public and be interviewed by the media - we have several media people wanting to do that - but they are actually afraid that they will be penalised in some bureaocratic way if they come forward - which says a lot for the relevant departments and the way that they handle OTDs, does it not? If any of your colleagues would be prepared to talk to us, - or even write about their experiences for a post to this blog - we would be delighted.
Watch out for a bit more national coverage tomorrow (we will post about it here)
I don't understand why the Board don't accept UK, Irish etc. degrees anymore. When I came back from several years overseas, they wouldn't let me re-register in Queensland, saying I had to take the AMC. Luckily I had also registered in WA, and they let me re-register immediately. Why the different rules for two similar states?
AT some point at the peak of the political correctness debate, it was decided by "someone" that it was discriminatory to allow graduates of some universities automatic registration and not others. So if you graduated from the medical schools of Harvard, or London, or similar, the rules were changed so that you had to go through the exact same process as someone with a paper degree from an institution that no-one had heard of.
As for your question about state by state registration, that should be solved by the proposed national registration scheme .... assuming of course that the red tape does not increase as a result. We may just swap one problem for another one.
Thanks for your comments.
Eureka! You have finally said what I have always suspected but have never been brave enough to say. Here's what has happened: in the old days (when there was, so they tell us, a surplus of GPs), doctors from the Anglo-Celtic countries (NZ, UK, Ireland, S Africa) provided a steady flow of good quality GPs, filling many rural or other areas of need either temporarily as locums or long-term as many came out for a working holiday and were attracted to the lifestyle. Since these graduates now have to sit the exam they either stay or go elsewhere because it is not worth the hassle for a holiday. Now the only people who can be bothered to sit the exam are economic migrants - principally from the Subcontinent. There is nothing wrong with that, per se, but I think the system now selects for the more "desperate" doctor, rather than those with a solid track record (who have plenty of options so don't need to consider Australia). I might add that there is presently a great surplus of junior doctors in the UK because of the cock-up they made of the training system there, so this would be an excellent time to rethink the requirement for every OTD to sit the AMC.
The OTD/IMGs have propped up a failing rural health system for too long. Allowing OTD to work anywhere may result in even worse shortages in country area. On the other hand it may trigger a crisis that will finally get action or an emergency response. Pity about the patients that will have to suffer though.
Why shouldn't all doctors sit the AMC. If they are quality doctors it should not be a hurdle. Perhaps the cost and waiting time to sit the AMC could be reviewed.
Any employers should make it clear that employees do not need medical certificates when sick leave is taken. A further step could be with new workplace changes it could be legislated. While it is easy money to write the cetificate in reality it is a waste of time that yes some one does have gastro, flu cold or some other excuse not to go to work. alot of consults will be freed up every year so that doctors can do more beneficial and rewarding work.
The cost and red-tape do need urgently reviewing in respect of OTDs/IMGs. We know that both are obstructing the progress of OTDS/IMGs - which seems ridiculous, given the shortage. As of sometime this year (July I think, but I will check and post) IMGs will have to sit an exasm BEFORE they come to the country: the exam will only be held twice a year, in a few places around the world, making the cost prohibitive for many potential applicants.
The idea of reducing the number of trivial consultations is great: we now have to give certificates to kids in child care - or their parents lose the subsidy. A mildly unwell sniffly or spotty kid whose mother is perfectly capable of looking after him/her has to take up a valuable appointment (and cost Medicare a fee, whichever way the billing goes) to get a certificate. I am sure you can all think of many more silly reasons for consultations. Lets start a list!
P.S. As for patients suffering because of the system - they already are, arent they? And the crisis is underway, we all know that too.
Dear Janet,
I applaud your efforts to try and get a solution for the mess that the politicians, Colleges and academics have put us into. The reasons for a lack of GP’s to work, even in metro practices is complex and multifactorial.
I left my metro practice in the late 90’s because I was struggling to survive. I became a locum GP and have enjoyed working in 3 states in both urban and rural. I have seen the complex mess just get worse and I am glad I do not have to run a Practice. You will not solve this problem. Rather you should just enjoy medicine and look after yourself. If it means leaving your practice without a replacement then so be it. This political mess will have to be corrected politically so do not let anybody make you feel guilty.
Trebor
Dear Janet
I have a spare 15 mins because the patient did not turn up. The fundamental problem you are trying to solve is a mismatch between patient demands/expectations and the workforce necessary to deliver those demands. You have focused on the workforce issues and I doubt that you could ever have enough doctors to meet this demand. To some extent the demand is already modified by a price constraint if you do not bulk bill. Practice nurses are another of re-balancing this mismatch, but we should look more at Practice structures to address the demands eg allowing staff to prepare sickness certificates ready for signing. Fundamentally we should alter demand because the biggest problem in consulting is what do I do next for this patient. I am beginning to explore these issues on my www site locumgp.wordpress.com so I can end up with a different model for the delivery of primary health care.
Trebor
Hello Trebor - thankyou for your insights and your own suggestions towards a better model of primary care.
I do not feel 'guilty'- but I do feel intensely frustrated as I see the profession I love being constantly eroded and under valued. I agree that the problem must be solved politically - but will the politicians do anything unless they fear the voters?
I am over to your site now!
Janet
interesting comments posted on
http://forum.onlineopinion.com.au/thread.asp?article=7238
But we need to focus on the patient usage of medical services
Trebor
Hello Trebor - thanks for your attempts to keep this discussion alive! I am certain that the Powers That Be believe we have given up, but we are a long way from doing that. As an aside, readers may be interested to know that I have not received any response at all to my emails to Mr Rudd's and Minister Roxon's offices - and those emails were sent right at the beginning of the campaign.
Dear Janet
In reply to your comment about erosion, there has been an erosion for many years in order to keep the Medicare costs down. To do this we GP's are constantly downgraded and have now become "service providers". This erosion has resulted in the rapid turnover style common in most bulk-bill practices with a neglect of ongoing chronic disease management.
Now all of a sudden the politicians want the primary health care providers to fix the problem of chronic disease management. (the RACGP has told them that this is the way to reduce future shocks in health care management). The trouble is that the erosion has gone too far and cannot be reversed. So a new approach must be set out. However the politicians do not believe that things have gone too far and they want to put in place mechanisms in general practice to head off the impending tsunami of complex health problems in older patients.
This means that the politicians do not fear the voters, they just selfishly do not want a blow out of health costs. So guess what GP's and Chronic Disease Management are the new flavour. In trying to help your patients this is the approach you should adopt with the Govt. They are not interested in the stories of pensioners not being able to get to see a doctor. The politicians will take notice if you say that if the pensioners cannot access medical services then the expected health care bill will increase as it impinges into the Tertiary health care system and the Emergency Depts.
Just say this will be the expected result if you leave and nobody can take over their chronic disease management.
Trebor
Further note about Chronic Disease Management
Of course you and I know that the current mechanisms to implement these plans and to try and follow through basically do not change anything that we currently do. It just means we get more $ for compiling a Plan which often bears no correlation to actually what happens.
So it will not be long before the Govt will start policing these Plans more. They will start to demand inbuilt goals and targets and then payment will be based on achieving these plans. This means that probably normal consult items will not apply if you are claiming some Management Plan in the future for a patient. So guess what. All of a sudden these Plans will not become popular.
What needs to be done is to explore more how we can manage chronic diseases a little better within the frame work of the current consult schedule. Basically we sort of do it now anyway. A patient presents with many chronic problems and we start treatment / or review treatment and organise ongoing monitoring investigations Then we ask the patient to return.
What we do not usually have is aformalised written plan for these patients, which we can refer to when these patients present. I think we had beter start to do this because this is what the Govt will demand when their nice Item 721 plans collapse. In your situation you can then send your plans in to the Health Minister just before you leave and say "now I am leaving I have asked the closest Super Clinic to continue these management plans"
My main point is that we should codify a bit more what we do for these patients so that when the Govt gets angry about lack of results we can weather the storm.
Trebor
Trebor, you are right about the chronic disease management issues - we have been doing it for years, now we are supposed to 'prove' it by filling in another raft of forms. Like you, I do not believe that these item numbers will live forever, and I do not believe for one second that they have actually improved patient care one whit.
As for the catch-phrase of "Better Outcomes", in these days of evidence-based medicine, I think it borders on fraud to use the phrase - no-one is measuring outcomes, so how does anyone know? It is a touchy-feely phrase, that is all.
Janet
another no attendance by a patient so I wrote....
An Apology
The good thing about blogging is that you do not have to produce fine pieces of text.
I realised that I have been proceeding down a pathway of supply and demand of medical services and trying to steer away from commenting on the lack of numbers in the medical work force. My comments will not help your particular situation and I apologise. I can see why you focussed on "why no doctors" because you went from 8 to 2 doctors in your area. Where did they go and why did they leave. You are concerned for your patients because you eventually want somebody to sit in your chair. So I would like to see if I could come up some ideas.
Contact the Rural Doctors Assoc of NSW as they will put you in touch with being able to get a CD that goes into Succession Planning. Rural doctors have it even worse as the doctor may have to leave and there is no replacement.
Write out a description of your practice. Where is it. numbers of patients per day people employed etc together with photos - why will be exp[lained below
What is your long term plan? It appears you would like another doctor to take over your practice (this is where you and your group appear focussed)
What would attract a doctor to do this? What are the positives
What are the negatives? What can be done to minimise these disincentives.
Make sure you are up to Accreditation Standard even if you do not go for it
This involves clear policies and guidleines
Also put in place clear management guidelines as to Chronic Disease Management. EG how do you manage the complex elderly. Are they being reviewed regularly Case note audit 10 of your diabetic patients according to set criteria
If you do this then any intending doctor should be impressed that they will not have to do a lot of work to bring it all up to standard
Prepare a brochure with photos and information for intending enquiring doctors
Now plan a cycle of adverts in Medical Obserever and Aust Doctor. Change item each month
At the same time prepare another plan where you join a larger practice after 12 months (taking your case notes)
Scan in all case notes and then sell the discs of information when people want them if you not joining another Paractice
in that case keep notes in alock up for 7 years.
Make a date in your mind when you intend to leave your practice eg in 5 years time
It is no good relying on trying to convince a change in govt policy to provide sufficient GP's so that one might take over your Practice. Why would they want to. I am in the process of putting something on my wordpress site about what will happen to the new bigger and brighter centres and the increased number of doctors,
Keep trying to attract a doctor but make sure you have an exit date in mind.
This approach should stabilise your resolve and prevent depression.
Trebor
If you are going to keep going and approaching the Govt then you should formulate in your own mind how you would like to see the GP undersupply problem solved, given that from 1013++ there will be double the number of medical graduates (not GP's)
What will attract to GP Training?
What will attract to Stones Corner?
Perhaps your conclusion might be that nothing will attract. Then patient management becomes the responsibility of the Govt and its policies. They will have to deal with the demand for medical services.
PS Dont retire. Perhaps shift your focus and become a locum. Enjoy life as a locum because this is the best way enjoy medicine at the frustation and expense of the Govt.
Trebor
Why bother??
Really, I do not know why I am bothering to be concerned about this issue, which is more than a local Stones Corner issue.
In light of the Budget I should now not work as hard or try as hard. Why get penalised?
But I cannot seem to do that. I have outlined how I can see metropolitan primary health care moving in the future and it seems that has not been challanged,
What has to be done is to seek some solutions within that framework. Especially for that group of disadvantaged and vulnerable patients that Janet is so concerned about. This blog is in response to your concerns posted elsewhere on "On Line Forum" So.......(next blog).
Trebor
Refrom or Repression
I have just posted a blog on locumgp.wordpress.com questioning the latest deliberations from the National Health and Hospitals Reform commision
trebor
GP Super Clinics
An unfortunate name but typical of this new govts media attention approach
I do not believe that these new Clinics will provide a caring health service as the Brisbane GP would like. see http://locumgp.wordpress.com
I am a non provider numbered doctor. I graduated just a couple of weeks after the moratorium came to life. By now, there are almost 10,000 Doctors (Australian Trained Doctors) out there who, like myself have many years and a good diversity of experience. We could fill some of the gp shortage holes. But we are all desperately now trying to find a way to make a living without medicare. At a meeting with 23 Doctors recently I mentioned I was a non-provider numbered Doctor and everyone looked blankly at me. Not one person in the room knew what it meant. Do you think the general population out there has any idea? Do you think anyone in government including the 20/20 group knows that thousands of Doctors would work as GP's tomorrow if the moratorium was abolished or at least if they had have stuck by their promise and those of us that stuck it out for ten years could by now have earned a provider number for such a dedicated service to the community. Would this have happened to the Dentists, our lawyers, our architects = any other professional groups in Australia. it begs belief that something like this could happen in a democratic society - but it has and those of us affected are really crippled and have no recourse. Need anyone to speak - I have a case!!!! I will speak. I deserve a provider number and am constantly turned down. I have given years and years of my life to our communities remote and rural all to no avail.
Yeah, I sympathise ClinicDoc - 5his was point #3 in my original post. I actually have the opposite problem - unrestricted provider number but non-VR. As you say, most doctors (let alone the public) have no idea of these bureaucratic absurdities. Sometimes I see an interesting a rural locum and apply, but give up when I have to explain to them that I am not restricted. The result is that I stay in inner-city Brisbane! I shouldn't really care since I have a great job, but it doen't make any sense when you hear about all the shortages in the bush. It's like a chapter of Joseph Heller's Catch 22!
Thanks for your comments ClinicDoc. Why not consider making a submission to the National Health and Hospitals Reform Commission? See the post for today (May 31) and the link to one other frustrated doctors submission. The more of these individual stories that are told, the better.
Here's the submission info...
Submissions should be made in writing.
Submissions should include a two page summary.
Supporting documentation and references may be attached to submissions.
Please ensure that you complete a cover sheet and attach it to your submission.
Questions 1800 017 533 (free call).
Lodgment of submissions
Submissions should be received by the Commission no later than Friday 30 May 2008.
Oh... we're too late :-)
The system of medical registration is overly complex and counterproductive - and far too expensive. Abolishing state medical boards alone and replacing them with a single national registration agency could free funds for several dozen new doctors and speed up the registration process by an order of magnitude. Getting rid of state registration would allow doctors from one state to work in another, eg for temporary relief, without filling in tons of forms and paying through the nose for that "privilege".
Then comes the insanity of the current Medicare provider number system - needlessly complex, and always grossly delaying the process. Streamlining it to something sensible (eg a fixed provider number for a location, and a fixed provider number per provider, and the COMBINATION of the two numbers being used instead of the current "one number for each location for each person" nonsense, where some doctors have to juggle several dozen provider numbers around.
These two modifications would not only safe millions of dollars in wasted administrative unproductivity, it also would allow eg a colleague from Victria to work in my practice when I want to go on a holiday without
- paying many hundreds of dollars for registration in NSW for a few weeks only
- filling in a pile of papers several centimetres high for all associated applications
- paying extra indemnity insurance
- waiting several weks for this insane process to be completed.
Next, we could let international graduates sit the AMC exam for free (first attempt only), and offer the written part as a computer based exams at Australian embassies. Those who pass with flying colours and wish to commit themselves to work in an area of need should be sponsored by the government to attend the "viva" part of the AMC exam. The old "Occupational English Test" should be restored as simple language proficiency requirement instead of this new IELTS which bears no relation to real life language needs and needlessly excludes many skilled colleagues. Permanent residency should follow automatically after serving an area of need for two or three years, and the first temporary visum and registration should be valid for that whole period (unless the doctor underperforms).
Last but not least, the government has to create both enough study places as well as postgraduate training places to ensure that each student will reach a productive stage of professional development as soon as possible. The silly restrictions and astronomic costs of study places to students cost the community far more in the end
Now, I believe with such a system in place, the doctor shortage would be over in less than a couple of years. How do I know? I went to work in Norway as a surgeon when it had a similar need as Australia had for the past decades. Their government chose to act - they simplified and streamlined the registration process while at the same time increasing uptake for medicine students, including sponsoring their own students to study in other countries with comparable standards and recognize the qualifications obtained there - some of those Norwegian students are still studying here in Australia, but Norway has no doctor shortage any more.
"clinicdoc",
there is a way for -non-providernumbered" doctors to enter general practice: the rural locum relief program. If you have more than 4 years prostgraduate experience, you can enter that stream and even get VR Medicare rebates if you committ yourself towards obtaining VR status within a specified time frame (usually 5 years). Against rumors, this stream is not just for OTDs (IMGs) but open to Australian graduates too.
To obtain VR in that stream all you have to do is sit the RACGP or ACRRM exams once you feel you are ready
Yes, it is a PITA, and yes, you will be restricted for several years to work in an area of need (but hey, even leafy suburbs qualify nowadays), but it a viable option.
I don't think VR as such is a bad thing - I still believe General Practice is the most challenging and demanding speciality; I trained a surgeon and life was much simpler then. To perform well in GP you need a certain skill and knowledge level, and if you have it, the exams are actually quite trivial - I was surprised how easy it was. Yes, some questions will be irrelevant - but even if you simply ignore all the nonsense and irrelevant ones, you still pass. General Practice should not just be a "catch all" for those who fail specialist training! The nonsense is not VR itself, but the differentiation in rebates. Working while training towards fellowship is every little bit as hard (and often productive) as working past fellowsip, so I believe the differential payment is counterproductive, and restriction to access to training places is criminally insane.
Herb,
I wish it was as easy as you suggest. When I asked the College if I could sit the exam they simply referred me to the flow chart on their website to see if I was eligible. I was not - when I asked them to explain why not, I never got a reply. So I continue as an unrestricted non-VR GP in inner-city Brisbane (18 years and counting). I can't go bush as I would like because nobody understands my status. I gave up trying to explain it.
PS: this is the "eligibility guide" flowchart that I referred to:
http://www.agpt.com.au//view/document.shtml?z80291-evwzewm.pdf
I think they must have changed it in this 2009 version, because I now seem to be eligible - they added a new box (bottom left). It would have been nice if they'd informed me. Here is my last email to them (which was never returned):
To Emily.Pickering
dateTue, Jul 11, 2006 at 12:44 AM
subjectRe: FW: Vocational Registration
Dear Emily,
I had a look at the "self-assessment eligibility self-assessment guide", as you call it, and the problem is that I don't seem to be eligible. So is that the last word, then? I just have to continue as a non-VR practitioner? I don't mind that much because at the moment
there is plenty of work for non-VR GPs, but I would like to be sure
and not miss out. Is there no human being anymore who I can ask?
...
That last question was rhetorical, of course :-)
Chris
I hate to sound cynical, but I also enquired about Practice Based Assessment. This also proved a dead end - take a look at the fiasco that unfolded...
Dr Kirtley
Please note we do not have a current mailing address for you so I am unable to send you PBA or membership information. Please forward your address to me at your earliest convenience.
With thanks
Angela
Angela Nasso to me 10/11/06
My apologies, I have just noted your address located at the end of your initial email to us.
Regards
Angela
Chris Kirtley to Angela 10/31/06
G'day Angela,
Did you say that you were going to send me info on joining the College, and practice-based assessment?
If so, it hasn't arrived!
Chris
Angela Nasso to me 10/31/06
Have followed this up for you.
My apologies.
The PBA material will not be coming out to you till mid to late December.
Once again, apologies.
Angela
...
Of course it never did arrive.
dxer,
information flow is atrocious in this country, and information access something taken right out of a Douglas Adams novel. Never rely on information you get from some bureaucrat but always go straight to the primary source of information - if I hadn't done it several times,I never would have obtained registration as a doctor, permanent residency or VR, because at every single stage I was initially fobbed off with "not possible"
When we recently went on strike in our practice one of the causes was apparently that the medical board doesn't even know it's own rules!
The sad thing is that even those organizations who portray themselves as representing us are just as misinformed as everybody else and do not seem to undertake much effort to remedy the degree of ignorance.
While I believe that there are far too many organizations out there already, maybe time to found one that is genuinely competent and willing to tackle the real issues - the incumbents all suffer from the usual crud of professional committee members who lost their grass roots (though RDA, RDN and ACRRM still do a lot of good work in man aspects, just nothing effective regarding the recruitment and workforce shortage misery nor the red tape swamp).
But then, who should staff such organization? Those who can do are drowning in work, and those who can't do are the wrong people for the job.
Right you are, Herb. It really annoys me that we have to be a member of the college to get VR. They are clearly a self-serving mob who are not interested in real progress. Just look at the scandalous situation where the current president refuses to give up her post. The divisions are also dysfunctional - they have lost millions of dollars and claim it has all been spent on writing government reports. In some ways, I am actually quite proud to be non-VR as at least I have my freedom and self-respect.
I delivered a letter to Mr Rudd's office just before Xmas last year, urging him to review provider number restrictions imposed by Howard government. About 3 months later, I received a letter from Department of Health and Aging, saying that the Rudd's government had no intention to change the restrictions, and the government's only interested in setting up GP super-clinics.
Here's my letter:
The health issue is one of the new government’s top priorities. The Labour government has only 3 years to prove that it can improve Australian healthcare system. The government has to act quickly and do something that was ignored by previous government. To achieve its election promise to Australian, the Labour government must analyse the crippled health system and focus on the causes rather than symptoms.
Soon after Mr Howard won 1996 election, his government changed Section 19AA of the Health Insurance Act 1973, preventing doctors who graduate after 1996 to access the Medicare rebates. As described in the “Discussion Paper on the Provider Number Legislation” written on behalf of the Australian Doctors Fund in 1997, the main purpose of the change was to reduce GP number and therefore to reduce the cost to the Medicare. It’s understood that the Health Department at that time calculated that each new doctor entering the Medicare system would cost the Government $176,000 a year. The immediate effect of the new registration was that about 1200 Australian graduate doctors could no longer automatically work in general practice for themselves, in health clinics or as relief doctors from November 1, 1996. As a result, the GP workforce quickly shrank, resulting in a public health crisis: sharp decrease in bulk billing, difficulty in access to GPs and crowded hospital emergency rooms. Existing GPs also were forced to see more patients. Dr Lalor of Woodville, Adelaide blamed provider number restrictions for the dearth of GPs, describing the legislation as “one of the worst decisions made” (Australian Doctor Aug 31, 2005). There is no doubt the Section 19AA is flawed.
In Federal Budget Submission 2004-2005, Australian Medical Association stated that the supply of GPs had been restricted over the years by the government policies including restriction of access to Medicare provider numbers. This is in consistence with the data contained in General Practice Workplace Plan for Rural and Remote New South Wale 2002-2012 which was prepared by the NSW Rural Doctors Network in July 2003.
In May 2005, Dr Erich Heinzle submitted his study entitled “The Australian Medical Workforce Shortage and Provider Number Restriction Legislation – the Perspective of a Post-1996 Medical Graduate” to the 2005 Biennial Review of the Medicare Provider Number Legislation, calling for urgent “fundamental reform of medical workforce planning, Medicare access, training pathways, and oversight mechanisms”. In October 2005, the independent member for Tamworth, Peter Draper, called for renewed debate on doctor distribution in NSW, urging the federal government to investigate the impact of Medicare provider number distribution. However, these calls were completely ignored by Howard Government.
The Labour government must urgently review and rectify Section 19AA of the Health Insurance Act 1973, allowing new doctors to work under supervision until they pass RACGP fellowship examinations. This is the only way to improve the accessibility of the public healthcare. Funding “Super Clinics” alone by government is not enough because doctors cannot work there without provider numbers.
Yours sincerely,
Encl:
(1) “Discussion Paper on the Provider Number Legislation”
(2) The Australian Medical Workforce Shortage and Provider Number Restriction Legislation – the Perspective of a Post-1996 Medical Graduate”: submission to the 2005 Biennial Review of the Medicare Provider Number Legislation by Dr Erich Heinzle.
It seems as if this site is developing into a forum and has the potential to become an expert resource for medical workforce issues. The focus seems to be on the different aspects of IMG / non-VR etc.
I realise that it grew out of a desire to get someone to work in a Brisbane suburb but it appears to have taken on a life of its own---that is good. It should build on this a develop as a recognised spot where questions can be asked and answers given, rather than just a complaints centre.
In some ways I am a little disappointed because as a locum GP I do not have any workforce problems of my own and I tried in the early days of this blog to direct conversations to look at the “demand” side (patient needs/ desires) side of the equation. To me these demands are an interesting side of medicine that has been largely ignored. We all fill out Care Plans but there is rarely any follow-up for these plans. However, we should pay more attention to the actions of our patients because sooner or later the government will run out of options and then make doctors responsible for the actions of our patients. Witness the P4P discussions now taking place. For example how do we get patients to lose weight???
I shall look at your blog from time to time to see how things are developing and I shall try and explore my ideas on my wordpress blog. Of course the future for us older doctors is that in 10 years continued registration will require all doctors to sit for some type of exam /assessment. This is not fantasy because it will soon happen in the UK.
Trebor
Just a brief explanation of what I meant when I said that the UK have already bitten the bullet about doctor licence renewal
· TESTING TIME FOR DOCTORS RADICAL medical legislation will see UK doctors facing mandatory annual reviews in an attempt to weed out poor performers, The Times reports.
Senior doctors will be appointed to assess GPs' competence, prescribing habits, patient interaction and any alcohol or drug abuse problems.
Proposals from the General Medical Council and the Academy of Medical Royal Colleges will see doctors, hospital consultants and private practitioners having to renew their licences every five years.
Doctors who fail practice standards risk deregistration under the new regime, expected to start within two years.
Trebor
The blog has been fairly quiet lately, so perhaps I could inject some controversial comments. I am doing a locum at the moment in the suburbs, and it has shocked me the difference in the type of patients I am seeing compared to where I normally work in the city. Seems like nearly everyone is obese, with multiple chronic health problems and has virtually no idea what medication they are on. They all tell me to "look at the file". I spend ages chasing up investigations that they have had (but usually cannot recall where they had them or what they had done). Almost all of them expect to be bulk-billed too! It is yet another salient lesson to me that city GPing is much easier (and lucrative). I wonder if this is a big reason why there is such a shortage in suburban and rural areas? I am only a few km from the city centre but I would not swap for anything on my experience so far!
Hi. I have recently been knocked back by the Human Rights & Equality Commission when I attempted to enlist their help in finding the 10 year moratorium to be discriminatory in nature. (This was the - successful - course taken by OTDs in New Zealand in the late 90s).
The grounds for dismissal were that a) the Commission may not challenge federal law - this has to be done through parliament or the courts. b) if a native Australian born doctor obtained their undergraduate degree overseas, they would be subject to the same 10 year moratorium rule......thus the moratorium is not discriminatory on grounds of nationality.
I have never come across an Australian doctor to whom this applies. It's actual effect is only on overseas BORN doctors.
Court challenge is probably not worthwhile as no law is being broken by the moratorium.
The last option is to have federal MP bring this to the chamber for debate. My attempts to interest the Health Minister and Shadow Health Minister have met with failure so far.
Does anybody out there have any suggestions as to a possible next step to change/remove this ridiculous (and society-failing) rule?
so as to focus on patient and use time better.
for
* mental health care plans
reduce paperwork to a referral letter only--no "must includes"
* care plans
reduce paperwork to consultation notes only--no" must includes"
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