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Doctor shortage woes require national fix: report
The Productivity Commission has recommended an overhaul of Australia's health workforce to help overcome shortages of medical professionals.
In its final report to the Federal Government on the country's medical workforce, the Productivity Commission has recommended health ministers establish a new national agency to increase multi-skilling for medical professionals.
It also wants national registration and accreditation boards.
If the recommendation is accepted, 90 individual boards around Australia would be scrapped and replaced by a single organisation to set standards across the country.
Commissioner Mike Woods says the changes will make the system more efficient.
"Training more of the same is needed in some areas, but it's not the most efficient long term solution," he said.
"For instance, nurse practitioners have been evolving for the last ten years and yet we still only have 100 of them in Australia.
"By having a national accreditation process and a national registration board, innovations that are found to be a national significance can then be quickly rolled out right across the country."
But Dr Choong-Siew Yong from the Australian Medical Association (AMA) is not convinced.
"More committees will not necessarily mean quick solutions down the road," he said.
Dr Yong says registration boards are already being streamlined across state and territory jurisdictions and the Productivity Commission's plan could be difficult to achieve.
"To bring it under the one banner will I think be a long exercise that may be difficult to do," he said.
"More efficiently I think will be for the boards to work together so that we can, when doctors want to move interstate, they can do so easily."
Dr Yong says the plan is too bureaucratic and will not solve the health workforce crisis.
"The Commission's report comes up with a whole lot of very bureaucratic, committee-driven solutions," he said.
"They're proposing a range of new, integrated, over-arching, cross-jurisdictional committees to fix the problem.
"I'm not sure how that will translate to doctors on the ground."
The Commission also recommends state and territory governments be given more say in the number of medical training places offered at universities.
Another report from the ABC: Allied health workers welcome proposed shake-up
Quote:
Nurses, physiotherapists and other health workers could soon be given greater powers and have their services covered by Medicare.
The radical changes are outlined in a Productivity Commission report released today.
It is the biggest shake-up of health services in Australia since the introduction of Medicare.
The report calls for greater use of health workers such as nurse practitioners and physiotherapists.
It says patients should be able to claim visits to those practitioners on Medicare.
"It's very important that we break down the current rigidity that exists, Robert Fitzgerald, from the Productivity Commission, said.
"We need to better utilise the whole of the health work force and part of that is the way in which we fund it."
The current referral system would be scrapped with patients by-passing GPs to go directly from allied health workers to specialists.
"These proposed changes will improve efficiency of the national healthcare system and give better access to all Australians to the healthcare they need," Daniel Finniss, from the Australian Physiotherapy Association, said.
Under the plan, existing registration boards controlled by doctors' groups would be replaced by a central accreditation agency.
"This is not an attack on doctors," Mr Fitzgerald said.
"It's not an attack on the quality of care.
"What it is is saying that demands of the future means we need to do things differently."
But Australian Medical Association (AMA) says the quality of medical care would suffer.
"We have one of the best health care systems in the world and if we take these proposals we may be looking at a much lower standard of care for Australians," Dr Choong-Siew Yong, the vice-president of the federal AMA, said.
The AMA believes the solution is to train more doctors to fill the gaps.
The proposals will be considered at next month's Council of Australian Governments Meeting (CHOGM)
NURSE practitioner Jane O'Connell experiences first-hand the frustrations of Australia's health system every day – not as a patient, but as a professional who works within it.
She is one of a relatively new breed of nurse: trained to see patients independently without them being referred to her by a doctor. She can decide what is wrong with the patient, order diagnostic tests such as X-rays, and assess which specialised doctors it might be appropriate for them to see next – or treat them herself. Such advanced nursing roles have been widely used overseas, particularly the US and UK, but their roll-out has lagged in Australia. There are barely 100 nurse practitioners in this country, two-thirds of them in NSW and all in the public sector.
Like her counterparts overseas, O'Connell can also prescribe drugs; and her right to do so, and her other roles such as referring patients to other doctors, are explicitly recognised in NSW state legislation.
But outside the walls of Hornsby Hospital in Sydney's north where she is based, this recognition doesn't mean much. Her status is unrecognised by Medicare, which is governed by federal and not state laws, nor by the Pharmaceutical Benefits Scheme, another federal program. This sounds abstract, but it's not.
If O'Connell writes a prescription for a patient, it can be dispensed from the hospital's drugs cupboard and the patient pays nothing. Take the same script to a normal High Street pharmacy, however, and it's a different story. No PBS recognition means no PBS subsidy, meaning the patient would have to pay the full cost, even for drugs costing hundreds of dollars. The patient would have to seek another consultation with a GP – costing the patient and the system extra time and money – to get an identical PBS prescription ensuring the patient pays no more than the maximum PBS co-payment of $28.60.
Likewise, O'Connell can write a referral for the patient to see a specialist, and if the specialist is in the public hospital system, that's fine. But if the patient chooses to see a specialist in his rooms or in the private system, O'Connell's referral counts for nothing. The specialist is likely to charge the patient over $100 for the private consultation, and if the referral had come from a GP, Medicare would pay the patient a rebate of $62.95. But if O'Connell writes the referral, Medicare's bean-counters insist the visit to the specialist is a "non-referred attendance" and the rebate is as little as $17.85.
O'Connell – president of the Australian Nurse Practitioner Association – agrees all this means she and her colleagues are "absolutely" hamstrung by existing arrangements and by the attitude of doctors' organisations such as the Australian Medical Association, which has fought independent nursing roles tooth and nail despite there being an acknowledged shortage of doctors.
The AMA this week claimed the report was "a missed opportunity" and substituting other health workers for doctors would merely create "inferior care". "Proposals to replace doctors with lesser-trained and lower-skilled health workers are unacceptable," said AMA vice-president Choong-Siew Yong.
But to O'Connell, the result is wasteful duplication: "The silly thing is there's an expectation by the AMA that if I see a patient in the emergency department that I think needs referral to a specialist, their line is I should refer that patient back to the GP to get the referral. That's just double-handling, and negates the registration that we have and the capability we have to do that (referral)."
The word "silly" doesn't actually appear in this week's Productivity Commission report Australia's Health Workforce, but even so it's clear its authors share O'Connell's view that things need straightening out.
"The operation of the MBS may not always facilitate the provision of health services by the most appropriate health professional," the report more soberly notes. The 450-page volume – commissioned by the federal Government and set to be discussed by the Council of Australian Governments next month – made a number of recommendations, including setting up an independent review committee to assess which services and health workers should be included under Medicare, and what lower level of rebates should apply to non-doctor services.
It should also decide what referral and prescribing rights other health workers should have, and make Medicare rebates payable for a wider range of delegated services – for example, when a GP refers a patient to another health worker such as a speech pathologist or physiotherapist. Such referrals happen already, but there are strict conditions.
The report said it was "widely perceived" that many services now provided by doctors "could equally well be provided by other health professionals without diminishing quality or safety".
"Moreover, the limited coverage of the MBS (Medicare benefits schedule) may potentially discourage the emergence of new models of care."
Physiotherapist Trish Neumann is another poignant illustration of the savings bonanza if the report's recommendations are adopted.
Neumann specialises in pelvic floor problems and the treatment of stress urinary incontinence, a condition that affects one in three Australian women and becomes much more common in middle and old age.
In 1998 the cost of treating the condition overall was $339 million, but that is expected to soar to $1.3 billion over the next 20 years as the population ages – with 88 per cent of those costs going on surgery.
Neumann's study, involving 274 women in 35 centres across the country, found that the surgical treatment for stress urinary incontinence – which involves re-suspending the bladder by tightening ligaments – costs from $4500 to $6000 per patient. When carried out in a public hospital, the patient pays nothing.
But alternative treatment, a course of five physiotherapy sessions costing a total of $300, cures over 80 per cent of affected women. And yet, because physiotherapy has negligible coverage under Medicare and limited coverage under private health insurance, the lack of Medicare coverage means that $300 mostly has comes out of the patient's own pocket – a significant disincentive.
Neumann says the "subliminal message" to patients from only the surgical option being taxpayer-funded is that the "surgery works and the physiotherapy doesn't".
In fact US standards bodies have recommended conservative non-surgical treatment for the past 10 years, she says. As well as the lower cost and high success rate of physiotherapy – 86 per cent of the 274 women in Neumann's study were very satisfied with their treatment, and remained satisfied one year later – surgery also carries risks, including infection and bladder perforation.
While physiotherapy doesn't work for everyone, it's a good example of how current funding arrangements are counter-productive.
Not surprisingly, Neumann is as pleased with the report's recommendations as the Australian Physiotherapy Association, and says the report's stance "makes a lot of sense". "We need to remember that health resources are limited and finite," she says. "If we have a choice between treatments that are equally effective, it makes sense to provide support and fund the treatment that's cheaper. I think it's fantastic, and it's absolutely the direction that society needs to go down."
Doctor shortage woes require national fix: report
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