Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Roxon outlines plans for health care reform

Discussion in 'Australia' started by LuckyLisfranc, Jun 11, 2008.

Tags:
  1. LuckyLisfranc

    LuckyLisfranc Well-Known Member

  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Can I take it from the lack of views and comments that no-one is particularly interested in what could be the greatest quantum leap forward in podiatry/primary care professional practice that this country has ever seen?

    Referral to specialists? PBS drugs? Medicare rebates? Decreased medical dominance?

    Perhaps it isn't that exciting...maybe I should find some toenails to paint.:rolleyes:

    LL
     
  3. Kent

    Kent Active Member

    We'll see. Can you really see any of that happening in the next 5 - 10 years?

    Is the profession/association getting involved in these talks or putting forward a submission to the federal government???
     
  4. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Maybe you should be writing to your local Association and the APodC to ensure they do. I certainly will be.

    The politics of this siutation is that the AMA, Divisions and RACGP will go crazy at the thought of a dilutation of medical dominance over other profession. The government will seek a middle ground.

    The reference committee is to report by mid 2009. This is the same time the NHHRC is providing its report. So there will be many professions, like ours, arguing for the same reforms to occur.

    If there are 10 professions arguing against one (powerful) profession - the government will seek a balance. Remember the nurses make up more than 50% of the entire health workforce and are heavily unionised. Podiatry is not, but its about time we were.

    If YOU want to see reform, write to your Association, the APodC, your federal MP and blow the podiatry trumpet. This opportunity is a once in a generation opportunity to advance non-medical professions in Australia out of socio-political obscurity.

    I know I would love at least to just be able to write a bloody prescription for Keflex for an ingrown toenail, have it covered under PBSS, and refer someone with knee OA to an orthopod without subjecting myself and the patient to an economically pointless GP consultation.

    LL
     
  5. Two Shoes

    Two Shoes Member

    LL

    I agree - this is huge. However, I wonder if the debate will be dictated by the association wielding the biggest stick (ie influence).

    The AMA's influence is huge in Canberra, but I would like to think the APodC and state associations will be in there fighting.

    I will be writing to to the APodC/state association.

    Who knows, maybe a few pea-shooters will distract the big bully enough for a knockout blow to be landed and sway the debate.
     
  6. RStone

    RStone Active Member

    I agree - it would be nice to be able to directly refer to some of the specialists directly - particularly the orthopods.

    I am very interested in this new direction & whether we're sceptical or not we should become involved and at least try - the other professions will and if we don't we'll miss out (again). Cynicism is not always productive in achieving our goals.

    Lucky - just wondering if you could give some of us who are not so confident in political activity some ideas of what to include in our "letters" to the various groups you mentioned. Are there certain points we should cover in particular? It might encourage a few more podiatrists to write if they have some sort of outline and it would give us some sort of consistent message to present.

    Look forward to hearing your ideas
    Cheers
    RStone
     
  7. Kate Walter

    Kate Walter Member

    Take another step back - not only could a move in this direction be good for the allied health professional, but also for the users of the health care system.

    Is the stage being set for a rise in self management of chronic conditions?

    Nicola presented the management of incontinence as an example. Soon we could be presenting patients with a range of health care options to suit their particular circumstances. Not just surgery. How often are patients forced into surgical interventions because they are the cheapest (for the patient) at point of use?

    PA posters have mentioned the foreseeable reluctance of the medical profession in letting go of the central role in patient management. I don't see this happening. It shouldn't happen. What is a GP if not the primary health care co-ordinator? (Or am I wrong? Could we really trust consumers to manage their own health?) We should talk about the shift towards self-management. Not taking power away from one profession and distributing it to others. To pull this off we are going to have to take a good long look at our information systems. Crikey. Can we have another rise in alcohol tax please? And another review while we are at it.

    The confusing thing for me here, is hearing a politician make sense. It makes me nervous.

    Kate
     
  8. ely

    ely Member

    SARRAH has released a statement endorsing the review, available at http://www.sarrah.org.au/site/index.cfm?PageMode=indiv&module=MEDIA&page_id=110903&leca=2 and quoted below...

     
  9. Two Shoes

    Two Shoes Member

    There is an article in yesterday's Weekend Australian "Wider role for allied health staff backed" in Weekend Health pp16-15 that may be worth a look.
     
  10. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Two Shoes

    Yes, I read this too. Dissapointingly, there was no mention of the APodC:

    If we as a profession are going to have our say in things, we need to be more sophisticated in our approach to the politics of the situation.

    LL
     
  11. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    RStone wrote:

    I think the mere act of putting pen to paper, or fingertip to keyboard, to write to MPs and your professional bodies puts people on notice, regardless of content.

    For instance, whenever I have written to my local MP on a health issue that affects podiatrists, my MP then writes to the health minister seeking clarification to the issue. MPs ignore their constituents at their peril, and this is politics 101. They desparately need your vote to be re-elected, and we endeavour to support any sensible arguments you raise.

    Hopefully if you were to write separately to your state association, and 'cc' this to the APodC you would achieve a comparable result - though these are volunteer organisations.

    In terms of content, many people have eloquently described how podiatrists can be more productive in the health system, and use their skills to full potential. But to summarise, I would be including comments about;

    * limited prescribing for common podiatric conditions (infections, pain relief, acute inflammatory conditions)
    * triage of foot/ankle pathology by podiatrists in public hospitals (like the UK)
    * podiatric surgery services in the public system (like the UK, US)
    * direct referral to relevant specialists (including pathology) to reduce waiting times for GPs and decrease Medicare costs (like the argument used to get ultrasound referral rights under Medicare)
    * Extending the availability of Medicare rebates for podiatric services (eg acute diabetic foot, non-chronic conditions)

    It is the role of your professional body to supply governments with the evidence to support these requests, but much exists in the literature (mostly for other non-medical professions) to justify these approaches.

    Just my thoughts,

    LL
     
  12. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Form today's Australian. Should be required reading for all new graduates on the realities of the Australian health system...


     
  13. Tuckersm

    Tuckersm Well-Known Member

    Let's just hpoe that this initiative isn't derailed.
     
  14. Tuckersm

    Tuckersm Well-Known Member

    From
    Sydney Morning Herald , Page 4 (Tue 24 Jun 2008)
     
  15. Paul Bowles

    Paul Bowles Well-Known Member

    QUOTE from ARTICLE above:

    "Of course, the doctors have a justification for such restrictions. As AMA president Rosanna Capolingua argued at the National Press Club yesterday, "GPs are the pivotal gatekeepers: the people who select the services that each patient requires to get the best health outcome possible, in the most efficient and cost-effective way.

    "Without appropriate medical diagnoses and supervision, patients' problems won't be dealt with properly in the first instance. Missed diagnosis, false reassurance, misdiagnosis, delay in care, all cost dollars and time and human expense."

    That made me laugh uncontrollably for several minutes. Most of the patients I see have been battling with their GP for years on management plans/treatments for the wrong diagnosis - maybe a case of the pot calling the kettle black?

    Stephen this wont get de-railed, but it will be a prolonged fight you can bet on that. It is blatantly obvious that the days of the GP as we know them are limited. Even the medical profession has indoctrinated the GP as a sub specialty now in its own right! I'll let you all put one and one together to work out what that means.

    If Roxon can pull this off it will be the single greatest political achievement in years. The problem is - can we as a profession keep up? Are we educated enough to be doing these advanced things? Do the majority of Podiatrists/Physio's want S4 drug rights? There is no doubt they could use it, but some just do not want the hassle. Has anyone asked them? What do we do with those who don't want the right? How do we segregate that part of the profession without offending anyone?

    It would seem that whilst we are supposedly "dumbing down" the podiatry profession in some educational areas, we are trying to bolster it in others? Is this merely internal, self propogated, professional self destruction?

    Undergraduate education? Foot Carers? Demise of undergraduate Podiatry programs? Changes in undergraduate program structures? Anyone want to throw their two cents worth in? Am I being too harsh here?

    So many questions - so little answers.

    I will step back and put my FLAME SUIT on, because I am sure the comments above will attract plenty of nasty posts!!

    :butcher:
     
  16. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Paul

    There is little doubt that the potential reforms that are on the horizon will leave some (many?) in the non-medical professions feeling a little worried about their current skillsets.

    However, as an isolated profession, we are not use to the massive resources in postgraduate training and education (outside of the university system) that medical practitioners have had almost the exclusive freedom to enjoy. Think of the National Prescribing Service, the Divisions of GPs, and the dozens of other organisations that exist to purely encourage life-long learning and skills development for medical practitioners. Once we are able to access these resources, and they are filling up our in-trays with new weekend courses and educational material - osmosis will start to kick in. Those old undergraduate subjects in pharmacology and pathology will start to clatter around in the brain and take on new meaning as one begins to actually USE this knowledge. Daily. No just once in a while...

    A change of the magnitude that is being considered will require a least a generation or two to really come into its own. As new graduates enter the system, hopefully with the necessary background to get straight into enhanced scope activities (think professional development year anyone?), and the older providers drop off the perch, there will be a gradual phasing in of these capabilities.

    More exisiting practitioners may be sufficiently motivated then to enter postgraduate university programs (or alternative arrangements!) now that there could be a useful benefit to these courses in service delivery, as opposed to the past - where really it was just another piece of paper without any meaning.

    LL
     
  17. Paul Bowles

    Paul Bowles Well-Known Member

    Agreed entirely Tony - but you know that we are always on the same page. :)

    I was more interested in comments on the current undergraduate climate around the country (being as diverse as it is) and the way in which everyone thinks this is being managed? Universal Undergraduate training anyone? Board examinations anyone?

    Lots to think about and lots more to do!!!
     
  18. EMadden

    EMadden Member

    This sounds outstanding to me! I don't know how many of you have had patients say to you that they didn't know if they should be seeing you or their GP, to then have to refer back for AB's or MRI etc.

    If we ever hope to get anywhere as a profession we really need to be seen as the experts in our field and from what I've seen at some of the most recent conferences we have a long way to go. It's disappointing that CE has had to be made compulsory to get so many people to attend.

    I suppose my point is this....Ms Roxon can give us all the power in the world, but if the majority of Pods out there are happy to just cut toenails then an increase in scope of practice will not get us very far, considering our numbers.

    We need to continue to evolve and maybe this will be a major first step (no pun intended), so bring it on. I'm with you LL, structured and recognised post grad education is the way to go to make sure that we make the most of these opportunities when they arise. I'll be writing to my local member.

    No more calls for an increase in alcohol tax, please. Is there an assessment tool available for that??
     
  19. Spur

    Spur Active Member

    Hi everyone,

    Very keen on podiatric surgery, would like to hear your thoughts on the future of pod surgery in Australia, in regards to sx training/practicing and how it will fit into the proposed health reform????:confused::bash::empathy:
    Cheers.
     
  20. PowerPodiatry

    PowerPodiatry Active Member

    Its good to live in interesting times.
    Paul you are right that non-orthotic advanced skills that will be required will find most podiatrists falling short of the mark. I went down the path of surgical registrar, masters, 4 yrs surgical assisting to come up against the very big GP wall. I was politely told off the record if I finished my qualifications to become a surgical Pod that I would be black listed by all the GP's and would have no access to any surgical facilities. Yes this will be a hard long and dirty fight that many fat dumb and happy orthotic pods are poorly armed to fight.
     
  21. Spur

    Spur Active Member

    Hi Colin,

    Did this political bullying :boxing:result in you ceasing your surgical career? Very unfortunate if so.
     
  22. Paul Bowles

    Paul Bowles Well-Known Member

    Good to hear from you Colin!!! Long time no see - I think you partly answered the posters question above about Podiatric Surgery and the state of play witin Australia.

    I won't comment on Pod Surg training and rights in Aus as others know my opinions - suffice to say - its a tough and dirty game to be in and in all honesty, one must consider their priorities in life before undertaking such a thing!
     
  23. PowerPodiatry

    PowerPodiatry Active Member

    Surgical career ended for many reasons, open-heart surgery being one and a sore head from hitting walls but I am a very staunch supporter of the advancement of podiatry.

    We are the only allied health professions in Australia that dare pick up a scalpel as opposed to orthotics. The physio's are yet to slice and dice but they do assure me that if and when they decide too that we will be there poor cousins and we can go back to cutting toenails. I transgress. Why we wish to reduce the sub speciality of the lower limb down to putting plastic into shoes is beyond me. We need to have excellent generalists that do everything including minor procedures (soft tissue) and physical therapy (which orthotics is just one of the tools). The average Pod that I come across these days has a very rudimentary understanding of the benefit of appropriate surgery. If we argue to the minister that we are the lower limb specialist then I hope we step up to the mark and shoulder a bit more of the burden that this really means.
     
  24. ClintonAbel

    ClintonAbel Active Member

    Education at the level of the division of GP's, requires "co-operation". Something that local podiatrists do not have. An undercurrent of animosity and competition exists between private podiatrists (and this appears to be the world over- not just in Australia).

    Not until we make a concerted effort to break down these professional barriers, will post graduate education become more appealing. I would love to able to refer a patient to a colleague who sub specialises in a certain field. This, with today's culture cannot happen.

    All of the GP's in my division get together regularly at social events. I work in the vicinity of podiatrists I was good friends with at uni, and we no longer speak. This to me is absurd.
     
  25. EMadden

    EMadden Member

    Unfortunately I've heard that before. It seems that their are people out there that will put personal ambition above integrity. People do what they deem necessary to get ahead. Whether it's right or not. That makes it difficult to work together.

    The problem we face is that as a profession, we seem divided by those that are happy with things as they are and those that believe that to continue and survive as a profession we need to utilise our specific skill set, to make sure that we are the best health care professionals in dealing with the lower limb. I think that postgraduate qualifications are the only way we can do that.

    One of the advantages that Dr's seemed to have over many other professions for a long time was the sheer length of their degree. I have a very good friend who is a GP and was asked by a pt what was the difference between Dr's and nurses, to which she replied "about 3 years". And to specialise they need to do around 6 more years in their chosen specialty.

    That's where the 4 yr degree course did give us some leverage. But I do understand that the uni's are looking at a postgraduate Masters as a qualification in the future, so a 3 yr degree is a stepping stone to that.

    Can anyone tell me where our interstate brothers and sisters stand with prescription rights? Last I'd heard Queensland had just given pod surgeons that right. NSW was just about to resubmit after the election, I think. Any ideas what sort of qualification we would need for that ie graduate certificate/diploma? Are any of the undergraduate degrees submitting proposals re pharmacology, anticipating a possible breakthrough regarding prescription rights?
     
  26. Paul Bowles

    Paul Bowles Well-Known Member

    Liz I am sure Stephen Tucker will come in and tell you about the Vic experience as he has played a large roll in it. I am also sure Tony will tell you about the Qld experience for similar reason.

    In NSW however we are really no closer. We have submitted the document, however it has not had an extremely good airing. I know that APodA(NSW) is now chasing this at regular intervals, but as you can appreciate in the political world time moves extremely slowly.

    My personal opinion is that we need to focus about this on a National Board level as we are about to all become one big melting pot. When the Boards amalgamate the real interesting question will not be "when will NSW Podiatrists get prescribing rights?" It will be "what will happen to the states that currently already do?" I.E. Vic.

    As for qualifications/courses - its anyones guess really until the National Registration takes place. This could take any number of forms and is dependant on many peoples input.

    Intersting times ahead. Its a numbers game - have the numbers and you will win the battle. Maybe its time we started sharing resources with Physio's, Chiro's, Nurses etc.. who are all in the same boat as us. Take nurse practitioners in NSW for example - they have similar restrictions to Podiatrists in terms of drug use, and their situation is not much different. Maybe make them allies and use group power to push forward. I know the Health Minister in NSW was keen prior to the election at getting all allied health limited S4 rights - Roxon migh just be on the right path.
     
  27. EMadden

    EMadden Member

    Thanks Pauly B. I know that in SA that nurse practioners have had a breakthrough with the AMA and that is what the uni has based it's Pod Master's pharmacology course on so that the same battle doesn't have to be waged again.

    So in around about way I guess we can see how if we combine forces against the dark side we may get better results.

    I agree that we will have to wait and see what happens with national registration. I expect the difference between undergraduate programs may be an issue then.
     
  28. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    I'm afraid the same battle will have to always be fought whilst we still have individual state legislation covering drugs and poisons. It would be wonderful not to have to fight the same thing over and over with a Commonwealth act that covers nationwide drugs and poisons rights...but I think we are a long way off the States relinquishing these controls too.

    All the non-medical professions are fighting the same arguments against extended scope activities, including prescribing. It makes good sense to follow their successes and failures and learn from this, particularly nursing - especially as Rudd has commissioned a Chief Nursing Officer for Australia who is keen to see reform.

    Very little me thinks. But long term benefits may flow.

    It needs to be an issue now. The UG courses need to all "beef up" pharmacology and advanced scope acitivities immediately, so the government can see action occuring at this level. We cannot be reactive. The LaTrobe pharmacology units are a good example.

    LL
     
  29. EMadden

    EMadden Member

    I agree. But speaking specifically of SA, they have used the Nurse practitioners course to prevent having to go up against the AMA again and then seek individual course approval. As individual states we will most definately have to start again.

    Would it be better for us to combine forces? Most definately!

    I do know that UoN undergrad program has made a major effort to account for the pressumed future approval of prescription rights. Which is great to see and they should be commended for. This will make it easier when the time comes for the powers that be to see new grads ready and waiting.

    It's only through dynamic and progressive development of these and post grad programs, that we will be ready for any increase in scope of treatments WHEN they arrive.
    :drinks
     
    Last edited: Jul 1, 2008
  30. Tuckersm

    Tuckersm Well-Known Member

    EMadden,

    In Victoria, the legislation was enacted 12 months ago (July 1st 2007) and since then the registration board has been in dialog with the DHS bureaucrats ironing out what drugs pods will be allowed and what both the educational and experiential requirements will be. We are almost there!! Drug list almost finalised with a split between generalists and specialist pods (currently this group will only include ACPS fellows, but has the potential to grow as the Advanced Practicing High Risk Foot Podiatrists formalise things over the next 6-12 months). Education: Approved Pharmacology units, that are standard in most 4yr courses now, plus a 30 hr update, plus Advanced Life Support training. Experience: either recognition of prior experience (having worked in a hospital environment) or a mentoring approach.
    Still not finalised, but soon!
     
    Last edited: Jul 2, 2008
  31. Sarah B

    Sarah B Active Member

    Hi All

    I have been reading this thread with interest, as a I'm a UK pod seeking to migrate to your lovely country!

    Over here (as no doubt most of you realise) there has been a massive increase in non-medical prescribing/issuing of drugs in recent years. But has there been a corresponding increase in medication errors? I think not! (I can honestly say that when I issue POMs I check & double-check because I don't want to lose my bits of paperwork that give me the right to provide the drugs for my patients!) There must be evidence from this neck of the woods that could be used as a comparator.

    Of course, the way the UK health system is set up (i.e. mostly public) was the biggest driver for change; with Blair and his 'labour' friends keen to reduce prescribing costs...

    I really hope that this opportunity to provide Australian citizens with appropriate care delivered by AHPs is taken by the current government. As far as I'm concerned, the fact that I am now able to provide my patients with appropriate ABs has increased their confidence in me & reduced the burden on their GP. (Of course, over here GPs don't just hold the keys, they get paid to put them on a keyring, then paid again to prove they've put them on a keyring!)

    Sarah
     
  32. Paul Bowles

    Paul Bowles Well-Known Member

    Doctors do not have monopoly on care: Roxon

    From Sydneys paper - SMH.

    [link]http://www.smh.com.au/news/national/doctors-do-not-have-monopoly-on-care-roxon/2008/09/19/1221331206981.html[/link]

    "DOCTORS face pay cuts if they insist on doing work that nurses could perform just as easily. The message, to be delivered tonight in a speech by the Health Minister, Nicola Roxon, is likely to anger the medical profession."

    ""Doctors must and will remain central to our health system. But to date, professional resistance and government funding have prevented the development of a health sector in which services are delivered not only by doctors, but by other health professionals who are safe, potentially cheaper and, most importantly, available," Ms Roxon says in notes for the speech."

    Finally some politician see's the light in this country!!! Well done Roxon!
     
  33. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Paul

    Yes I read this in the Australian today.

    Very much looking forward to seeing the transcript of the speech after tonight...

    She certainly sounds unrelenting in her attitude to the status quo!

    LL
     
  34. ja99

    ja99 Active Member

    Hey LL,

    I wouldn't normally follow ANY political debate domestically ! However, thanks to you for raising the issues involved here.

    Please post again on the issue....

    Have a great weekend...:drinks
     
  35. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    If you would like to see a difference in the future of your career, then understanding what is occuring between the ears of the decision makers is critical IMHO.

    Unfortunately our profession in this country is essentially apolitical, apathetic and unsophisiticated in relative terms. We have a lot to learn from our American colleagues about being actice participants in the political process (including financial support to political parties - heaven forbid!).

    I know, for example, the APMA has spent considerable sums on supporting the Democratic party in the US in the upcoming election. I am sure if APodC spent a few thousand dollars to attend a politcal fundraiser here and there, we would see a lot more forward progression on all of the issues we have been discussing of late. ;)

    The squeaky (but financially generous) wheel always gets oiled....:rolleyes:


    LL
     
  36. Sal

    Sal Active Member

    Can we get the link of the transcript here, LL. Would be much appreciated.
    Perhaps there are some numbers we could use from our UK collegues??? They seem to have started using S4 drugs without any hiccups!!!
    Cheers,
    Dr. Sal (Podiatrist)
     
  37. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Just received the attached PDF today - compulsory reading!

    A couple of interesting extracts:

    and,

    Plenty to chew over

    LL
     

    Attached Files:

  38. Sal

    Sal Active Member

    Thank you, LL. Very much appreciated!!!
     
  39. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Here's the transcript of Roxon's speech.


     
  40. ClintonAbel

    ClintonAbel Active Member

    LL,
    Is there any reason, that you know of, that section 8.1 (Table 2) does not list "Podiatrist" as being a title to be protected?
    Is this merely a result of podiatry being an after thought when being accepted into national registration scheme?
    Your thoughts would be appreciated.
    Clinton
     
Loading...
Similar Threads - Roxon outlines plans
  1. LuckyLisfranc
    Replies:
    1
    Views:
    3,565

Share This Page