I didn’t get that impression myself but if you did then any momentary confusion by you on that point is perfectly understandable.

By the way, I’m not opposed to specialists’ organizations as such. I’m all for any body that preserves and enlarges a body of specific knowledge, that pushes the boundaries of our understanding, that transmits particular valuable skills, that encourages and protects its members, that ensures that nobody can make false claims of having high-level skills in that specialty …. all wonderful stuff.

The objection is to such an organization degenerating into an exclusive racket that hinders new entrants, that only pretends to encourage research, that is obsessed with making the racket as profitable as the public will bear.

A massive, radical and fearless review of our entire health system is long overdue - if that means that some hitherto prominent players in this game are upset and peeved over it then so much the better; [my own preference is to see them jailed but there’s fat chance of that ever happening].

No need to be confused about the closed shop aspect . A racket is a racket whether it it run by mafia, triads or by specialists’ “colleges”.

Where my confusion arose was that the original post started: “The last remaining closed shop union, the AMA,…”

To me, this implied that the author thinks that doctors need to be AMA members in order to find work and training opportunities. Nothing could be further from the truth, in my experience.

Thanks for mentioning that great hero, Dr Semmelweiss.
Dr S [13 and 16]:

Thanks a lot for your own insights.

There’s an interesting parallel between medical practitioners and war veterans: The news media always focusses on the Australian Medical Association and very very rarely on the Doctors’ Reform Society just as they always focus on the R&SL and vary rarely on any other exservice organizations – the result of this skewed focus is that, in the public’s mind, there is only one authorative organization speaking for the whole class ….even though that well-publicized group might be as useless as an ashtray on a motorbike and though the unpublicized groups might have been the ones that gotthe results. Worse yet, bad behaviour by the highly-publicized organization then reflects badly on everyone in the whole class.

Everyone;

There was one issue in the last federal election that went way below the radar of the parties and the pundits but was on everyone’s lips whenever industrial relations was mentioned …. that the Howard government was bashing trade unions at the same time it was mollycoddling the worst union of all - the union of rich doctors.

Even dyed-in-the-wool, union-hating Coalition supporters detested the hypocrisy of that and hoped Howard would put an end to the practice when he got re-elected. [Of course, they said, The Milky-Bar Kid would give the **** doctors heaps more of our money if we were stupid enough to vote him in].

“what is the point to this post? That the AMA is slack about the standard of practitioner it allows into the country? Or that a closed shop should not be allowed?”

Well, actually, both. Oh yes, and there’s also the matter of so many good people being killed, maimed and impoverished by organized gangs of greedy plundering rats pretending to be doctors.

“Doctor Bashing”? You bet!! Should have happened years ago …. then a lot of good people would still be alive today …. and a lot of decent caring young Australians would now be looking after our health.

Lauredhel [7 and 17]:

No need to be confused about the closed shop aspect . A racket is a racket whether it it run by mafia, triads or by specialists’ “colleges”. No doubt you are already aware of exactly what happens when a bright, hard-working, enthusiastic young doctor wants to become a specialist in a particular field of medicine.

The sooner the specialist “colleges” racket is made illegal, the sooner we will have an efficient health care system.

Debbieanne [19] and Mark [20]:

Registration and Malpractice are two very different – though related - issues. It is bloody annoying when the news media mix up the two.

It is such a common problem in all professions and all occupations that it deserves the widest exposure and it it amazing how easy it is to do a proper reference check if you are not too lazy to get around to doing it.

I didn’t mean complaints by the querulous, I meant very serious transgressions such as (say) doing an unnecessary clitorectomy that had not been requested by the patient, while carrying out a separate procedure the patient HAD consented to. Malcious malpractice, not routine and minor errors, or irritating a patient.

Yes: it’s a very difficult task, to check on professional work without becoming very onerous or using “trivial indicators”. Ask some University researchers about the flaws in the 2007 trial audit of research performance - since then dropped by Senator Kim Carr. Sounds as if parts of the medical sorority are already much more closely monitored… and with some success.

Aren’t registration and problems with malpractice two separate issues.

Not exactly. Malpractice claims can of course be pursued through the legal system, but at the same time, complaints about impaired and dangerous doctors are also dealt with through the State Medical Boards, who decide whether a doctor should be deregistered (permanently or for a time period), and/or whether conditions should be placed on their practice. The State Medical Board system, doctor-controlled, is what would be thrown out if a National Medical Board system were imposed.

Currently, at least two state medical boards have places reserved for AMA appointees. It’s not too surprising that the AMA is opposed to any erosion of that aspect of their power.

The main explicit objections I’ve been reading within the medical community against the proposed national registration system are objections to being registered in the same system with inferior beings like nurses, optometrists, physiotherapists, and so on. But I haven’t caught up with this week’s mednews reading yet.

From a unionisation point of view, however, they’re nowhere near a ‘closed shop’, if you consider the AMA the union. I’ve been employed by a variety of hospitals and private practices, and been through a formal training programme, and no one has so much as asked whether I was an AMA member, let alone altered my employment or training chances because of it. I don’t know of anyone, not on the rumour mill or anyone else, who has been denied work opportunities due to lack of AMA membership.

I dont’ have numbers to hand, but I’d be surprised if more than half of the docs in Australia are AMA members, and would be at all surprised if it’s significantly less.

I think your comment about the dipped lid brings up a particular issue. Complaining about your doctor, or more frequently your mum’s doctor, is a fairly confrontational process. Although there are lots of avenues, they are all adversarial. This means that people need a great sense of being personally wronged, as opposed to merely unlucky, to get involved in such a thing. Consequently there is quite a degree of selection of the querulous inherent in the process. Bottom line, most people complain because you irritate them rather than because you failed to heal them. Some people are easily irritated and some doctors are particularly irritating.

For instance. There is a man of my professional acquaintance who spends his life deluged in a waterfall of complaints. He is actually a highly skilled surgeon who I would be pleased to have operate on me. He is also, quite frankly, a prick. Consequently the Health Services Commission has him on speed dial.

This is similar to expecting the civil courts to develop consumer protections rather than having a government supported standard. The punished actions are those most complained of rather than most damaging overall.

So. How do you oversee medicine in such a way that it is not so onerous that no-one can get anything done nor so invasive that we all de-camp to New Zealand in a collective huff? I am not entirely sure, actually. Some branches you can simply count things. The vascular surgeons have run a program for a decade monitoring complication rates in routine surgery and mandating re-training if they go off. Auditing and protocol are very successful in anaesthetics. Radiology would perhaps benefit from one in a thousand films being double-read.

How one monitors the performance of the diagnostic sub-specialties without adopting trivial indicators I do not know. Oh, and anyone who suggests a neurologist should have clinical pathways and diagnostic protocols foisted upon them has never been to a decent neurologist. Some kind of oversight not based upon resolution of complaint appears inevitable and, indeed, desirable but exactly what that should be is one of the many things I am glad is not my problem.

At least national registration could give pause for thought to a chap who had been struck off (in Victoria, say) and was contemplating hanging out his shingle in Merimbula (say).

There have been plenty of well-publicised recent cases of malpractice other than the Patel imbroglio, bad as that was.

I dips me lid to patient/victims who find the strength to speak out.

it was only nurses complaining after all, and/or a few whiny patients/families, not anyone worthy of proper attention like another doctor.

I think the main beef from the AMA was getting lumped in with people they view as beneath their status under the same registration body. The idea of sharing a professional body with those oiks the physios brought them out in a bout of fake aristocratic cold sweat.

Word, both.

I am reminded of the tragic tale of Ignaz Semmelweis, whose 19thC campaign to get Viennese doctors to wash their hands in between the dissection table and the labour ward foundered on their disdain for the fact that he was a mere Hungarian peasant. Numberless women died of puerperal fever as a result, their begging to be allowed to give birth in the gutter rather than in the hospital having fallen on deaf fake aristocratic ears.

The AMA itself denies being a union. This means that if I have an industrial dispute with my employer they are more than happy to advise but not willing to represent, certainly not collectively. This makes the awards for junior doctors something of an optional document. The NSW junior doctors are represented by the single most effective union in the country, the ANF, hence get paid and treated infinitely better than their Victorian counter-parts. The AMA obviously is a union but they can get quite huffy about it if anyone mentions the word.

Also thought it worth mentioning, there are closed shops in medicine but it is the specialist colleges who run them rather than the AMA. Can’t hang out my shingle unless the Physicians say I am an upright and decent chap. Although, no-one is quite sure what happens if I then fail to keep up my membership.

As to disciplinary procedures in medicine I can only comment on the Victorian situation. In a public hospital my practice is subject to investigation by:

1)The Medical Board of Victoria. This polices my fitness to hold ongoing registration.
2)The administration of the hospital in which I work. This would usually involve morbidity and mortality committees, an office of patient advocacy and ad-hoc administrative responses to any medico-legal issues or serious complaints.
3) The office of the Health Services Commissioner
4) The civil and criminal courts

Of these the most important, rapid and flexible is the administration of the Hospital itself. There are inevitably doctors involved in any investigative process as it is otherwise difficult to establish a standard of care. Having said that, my peripheral experience of these processes is that they are primarily driven by administrative concerns and staff. Quite frankly, this Patel character should have been sacked and charged. In most hospitals, he would have been. Is leaving this to hospital administration as the first tier of response appropriate? No, but leaving service provision decisions to local administration is equally flawed.

As to the national registration issue, I think the main beef from the AMA was getting lumped in with people they view as beneath their status under the same registration body. The idea of sharing a professional body with those oiks the physios brought them out in a bout of fake aristocratic cold sweat.

National registration is a perfectly sensible idea. Having said that, the chances of it stopping a repeat of Patel are Buckley’s. The main advantage is going to be inter-state travel, particularly on a locum basis.

Their fight to oppose a national system of registration for doctors, a move supported by many GPs, nurses and midwives and patients rights group is a case in point. It’s a no brainer that a national registration system would help streamline mobility of doctors to tackle skills crisis and could help protect patients from rogue surgeons.

So, if the Rudd government wants to prove it will not be bullied by the nation’s unions into policies that are not in the interests of working families, the cashed-up Australian Medical Association would be lovely place to start.

The Australian Nursing Federation, that represents thousands of nurses that work side by side with these doctors was quite right to point out today that the doctors reasons for opposing a national register was “absolute garbage”. They warn of a culture of silence among doctors over malpracticing colleagues who “close ranks” to protect their own.

As for the reason for opposing a national accreditation system, the AMA has argued it cannot accept any reforms that undermines their independence from government on standard setting and accreditation within the medical profession.

But this is really just another way of saying doctors run a closed shop and want to keep it that way.

http://blogs.theaustralian.news.com.au/samanthamaiden/index.php/theaustralian/comments/ama_aim_is_to_ensure_nothing_changes/