Interest group politics following a change of government is always interesting. It’s not always quite as simple as rewarding your friends and locking out your enemies (though maybe it was with Paul Keating and John Dawkins), but some repositioning always goes on – for a smart lobby, in advance of the election. That occurred last year with business groups – some were prepared to cut the Howard government loose and go public with concerns about lack of infrastructure investment, population policy, climate change, productivity and federalism. From early 2007, blind Freddy could have seen the defeat of the Howard government coming, even if the national news media couldn’t, and the agenda of groups like the BCA was well articulated to the policy direction of the Labor party, thus guarenteeing influence both before and after the election itself. Even on the touchy issue of IR, it became fairly clear that ideologues such as Peter Hendy aside, most business interests had reasonably happily accommodated themselves to the end of WorkChoices well before November, and in fact that they extracted significant concessions in their favour. Those who really kept their head down when urged to put it above the parapets by the Howard government – such as the AIG – have had their reward in spades under Kevin Rudd.
The Australian Medical Association seems to be an exception to this rule. As Tim Dunlop writes:
The Australian Medical Association (AMA) has obviously decided they don’t like the Rudd Government and seem to be doing everything in their power to criticise, annoy and/or embarrass them. Since before the election, the doctor’s union has made clear that they don’t like the approach the Labor Party takes to health and were, for instance, critical of Labor’s plan to—potentially—shift control of hospitals to the Federal Government.
Since then, they have taken every opportunity to attack the Government’s plans to change the criteria for the health care rebate, and have been particularly upset about moves to allow nurses to increase their role in the provision of general practices services.
The degree of self interest in the positions they’re adopting is a bit too blatant for comfort, I’d have thought. Their withdrawal from recruitment services for the Northern Territory intervention comes in the wake of allegations that they’d been profiteering from their involvement, and as Gary Sauer-Thompson points out, their opposition to changes which would allow a bigger role for nurses and allied health proposals also looks a lot like an old-fashioned “demarcation dispute” and not much like a disinterested concern for public health. Even if those at the top of the AMA are philosophically closer to the Liberals’ approach, surely it should be obvious that their ability to represent their members and advocate effectively needs to take into account the change of government?
I thought it was all about Rosanna Capolingua, AMA president, and her political ambitions. That union is the way forward for a budding conservative politician.
Unions protect their turf, and their opposition to changes which would allow a bigger role for nurses and allied health professionals could be categorised under typical union behaviour.
Also, the Australian Medical Association has a similar attitude to public health policy as the American Medical Association, in as much as their policy goals with regard to the public/private balance.
The AMA think that the public image of doctors as altruistic guardians of the public interest against evil nasty bureaucrats is so ingrained that they can get away with any amount of behaviour that, from other trade unions, would be regarded as old-style industrial thuggery.
To be fair, there’s a fair degree of historical precedent to back up that judgement.
I should add that I think doctors are mostly very smart, dedicated people who work hard to give their patients long, healthy lives. But they have interests of their own that don’t always perfectly align with their patients, let alone wider society, and I wish that the tabloid media occasionally kept this in mind.
Can we get one more link to Tim Dunlop’s News Corporation (TM) blog please? I make that only about seven this week, and I have a bet with my friend (yes, I only have one) that the Murdoch-dominated corporate media has successfully co-opted the blogosphere in Australian politics. One more LP link to Tim and my friend is willing to concede defeat.
Oh, sorry! OFF TOPIC! Naughty, naughty Gandhi.
Go on, delete this comment just like my last three.
Robert, I think that you are right on the money there.
I am listening to Capolingua now at the National Press Club, and the journalists are ripping her to shreds over her allegiance to the Liberal Party. Everything she says is sugar-coated BS.
Anyone seen anything from
the goodDoctor C. by way of helping with the South Australian doctor’s crisis? Solving it I mean, not stirring it up.The top ER dogs there were offered an an inrease from $310k to $356k, but it wasn’t enough, they want $425k, and so their fellow professionals ( anaesthetists, general surgeons) are resigning, 2 weeks notice, in support.
As one of the resignees, Colorectal surgeon David Rodda, said: “.. working in a public health system where doctors’ concerns were ignored was no longer worth the angst. It is just impossible to work there anymore and I just can’t be bothered”.
Can’t be bothered!!??… must be a new clause in the hippocratic oath.
Gee, maybe Tim Dunlop is worth reading despite having sold his soul to THE GREAT SATAN MURDOCH? Get over yourself, gandhi. Not everyone is obliged to join your campaign.
Howard C [2]:
You are right, of course.
But the issue goes much deeper than a mere demarcation dispute. How many good people have died well before their time or suffered lasting harm just so as to preserve that grossly inefficient system of featherbedding and of plundering the public treasure.
One of the reasons the Howard regime was so loathed was that it used all its power to attack the Maritime Union of Australia – at a time when the MUA was actually boosting productivity and was modernizing itself – and yet this same regime flung blank cheques at any rorters who trotted up with “Doctor” in front of their name. Like it or not, the AMA and its kindred bodies are the most powerful unions in Australia – and a hell of a lot nastier than were the old Communist-dominated Wharfies.
danny,
Why would a specialist physician or a surgeon accept crap conditions and mediocre pay (by industry standards) when they can get a better deal elsewhere? Specialists and surgeons aren’t indentured labour!
Gandhi, it’s a shame that you can’t judge the quality of people’s posts on their merits. Tim Dunlop writes many posts well worth reading in my opinion. Good on the LP bloggers that link to interesting posts that he writes. I think just about everyone is sick of you making unjustified guilt by association remarks about him and his work.
On the topic, I find the behaviour of the AMA rather curious and it does seem to be influenced by self-interest and politics.
Graham Bell,
“…and yet this same regime flung blank cheques at any rorters who trotted up with “Doctor” in front of their name.”
Wow, Graham Bell. Any evidence to back that intense statement up? And what are these “blank cheques” of which you speak?
Why would a specialist physician or a surgeon accept crap conditions and mediocre pay (by industry standards) when they can get a better deal elsewhere? Specialists and surgeons aren’t indentured labour.
I’d like to be in a position where 330K / annum is considered “crap pay”.
This is not new. The AMA were not keen on Whitlam’s Medibank. And way back in the 1940s the BMA (before there was an AMA) mounted a vociferous and successful campaign to stop Chifley introducing a national health scheme. I suspect ALP pollies have learned to live with it.
If this is going to be the MSM’s new sacrificial lamb we’ll have a country of dentists and no doctors. A nation dead but with pearly whites.
The AMA has long term form on this. They’ve resisted every nasty ’socialist’ reform from nasty ’socialist’ governments. I wonder how well they actually reflect the views of doctors.
My brother is a an experienced Emergency Nurse Practioner, I bet he would haved loved to have seen even a quarter of 425k p.a. when he was working in the RAH Emerg!
Down and Out of Sài Gòn:
“I’d like to be in a position where 330K / annum is considered “crap pay”.”
No problem. Just sit the GAMSAT, do really well, then enrol in Med. Rack up 100K in HECS then become a resident working 70 hour weeks for around 70K p/a. Then work your way up the hospital ranks, all the while with your eye on becoming a surgeon or developing a speciality. Then after about another 5 years, fork out 10K or so to sit the surgeon/physician exams. After all that, then tell me that you want to have people’s lives in your hands while getting paid less than your mates in the private hospitals.
Yeah, I can’t understand at all why these surgeons and specialists working the public system bitch so much either! NOTE: sarcasm.
So, what your saying is that the AMA is completely useless for creating humane working conditions. Got that.
There’s no doubt that doctors, particularly specialists are a protected species in Australia. Other countries where this is not the case, such as Japan and Taiwan have health systems that are in many ways superior to ours.
Nope. Not saying that at all. What I am talking about is the ability of a worker to withdraw labour either temporarily (strike action) or permanently (resignation) in order to leverage better working conditions. It just so happens that Doctors tend to be far more fed up with the public hospital system rather than the private system.
The AMA doesn’t speak for all doctors on all issues. It’s often positioned on ground far way from the views of individual doctors. However, as it’s effective at ramping up the conditions of medics it still serves them some purpose.
Antonio: if medicine such a bad deal, why are there far more students who wish to study medicine than are permitted to enrol?
Antonio [12]
Well, for a start …. the Medicare zip-zip money spinning machine.
Second-best racket in Australia!
Like any representative group, the AMA is to a large extent interested in the position of its members at the expense of the public good.
Unlike private sector unions, corporations, etc., all of whom battle with each other to see who can do their job best, the only people the AMA and other public sector unions have to enter into conflict with is government, who ideally represent the public interest.
Competition means you can be self-interested and still ultimately serve the public interest. But self interest in groups that don’t compete will always appear selfish.
The worst policy example of this is the cap on medical graduates. Justification? Doctors don’t want to flood the hospital system/lower standards/etc. etc. etc. Funnily though, nobody complains about training surplus law students who don’t end up employed in that profession.
Mr Merkel @ 23:
People study Medicine for all different kinds of reasons. Not everyone who studies medicine wants to be a specialist or a surgeon, save even a practitioner.
However, people whose aim is physician specialisation or surgery know that the road will long and hard to get there. Once they get there, I ask again – Why would you accept working conditions in the public system inferior to those that your mates enjoy in the private system?! Altruism can only get you so far before being understaffed and overworked just becomes too much.
NOTE: I’m not saying that every public hospital pays Doctors relatively poorly.
“The worst policy example of this is the cap on medical graduates. Justification? Doctors don’t want to flood the hospital system/lower standards/etc. etc. etc. Funnily though, nobody complains about training surplus law students who don’t end up employed in that profession.”
Leon, while there’s no doubt some truth in this, the number of places at unis can’t just be increased without giving thought as to whether there is enough training programs for new interns and residents. The number of medical places has been increased a fair bit over the last couple of years, at least in Qld where I am, and there are genuine concerns about whether we’ll all have somewhere to go when we finish. I think a large part of the reason for the cap is the fact that it is so expensive to train a doctor.
Perhaps a bigger issue is the way the specialist colleges control their intakes.
Graham Bell (9)(24)
“MUA boosting productivity and modernising itself”. A rather ingenuous remark!
Much as I opposed the Government’s action on the waterfront at the time, I try not to let those sentiments twist the facts. Suggest you do the same.
Medicare – Howard government innovation??
I would have to agree with Graham Bell’s thoughts in response to my initial thoughts.
Why are the AMA any different to any other public sector union that governments of both levels and both parties have decided to play hardball with over the years?
The AMA acts as a lobby group. In all likelihood it wishes to do good for its own members. Is the main point of this post that lobbyists should be very, very polite? Or hide their true views in order to curry favour??
Some dissemble, some don’t. I reckon the pollies are onto their tricks.
dj, as with your brother, my daughters are highly skilled registered nurses with six degrees and many certificates between them and each with over 25 years of service, and they would give their eye teeth to earn 100k p.a. But unfortunately they continue to be hog-tied to the doctors’ handmaiden tag; males just as much as females. Though it has improved since I was a registered nurse, but that’s not saying much.
Notwithstanding, the Labor govt in SA – who like every other govt in Australia, are still mesmerised by the so-called logic of free markets (economic rationalism), and thus hoist on their own petard – must know that when demand exceeds supply, those who supply (doctors in this instance) hold the whip hand.
Further, Labor prior to the 2006 state election gave in to the demands of visiting specialists to government hospitals and upped their hourly rate from around $150 to well over $200 – leaving long experienced and highly skilled hospital employed doctors – whose hourly rate was already a good deal less, and who were/are really doing the hard yards, extraordinarily p****d off. Now these doctors are getting theirs. As they say, they can get a job anywhere; for instance, an Adelaide Uni medical degree still has considerable cache, as has medical student/intern/RMO practical training in the RAH and QEH, which, by the way, are being required to undergo another tranche of funding cuts. I’m not sure where Rudd’s $billion or so to state hospitals’ waiting lists stands at present
So, if Premier Rann and Health Minister Hill will just see past their overweening sense of self importance and wounded pride and get down to the negotiating table – they might just prevent a catastrophe. ATM they are threatening to spend unspecified millions on trying to poach the few available retired, interstate and overseas doctors (extra-specially difficult I would say if you want the best, when the pay and conditions on offer are below parity), in order to be seen as tough. Oh pity our poor medicare system.
And BTW, who will mentor these new doctors induction and practice? Also, will the RAH and QEH be able to maintain their ‘teaching hospital’ status? Long waiting lists for procedures and incoming patients on trolleys in corriders will seem the least of our problems.
GW: fair point, but you realize that heaps of people do degrees in areas like psychology and law without being guaranteed the equivalent of an internship at the end of it?
As far as the specialist colleges go, interesting to note that the College of Surgeons loses its exemption from competition law on surgical training at the end of the month.
“Why are the AMA any different to any other public sector union that governments of both levels and both parties have decided to play hardball with over the years?”
Because they almost always get their way.
While of course they are a highly powerful and conservative union ( along with lawyers) that amount practically to a monopoly, I did briefly warm to them when I heard they were pulling out of the Northern re-invasion/ intervention. This heavily militarized, bad faithed and barge-arseing effort was always doomed to fail imho.
And the quicker the better.
Whats with all this shielding of the Kruddy regime Mark?
Can’t they stand up for themselves with their massive approval ratings and come up with a better idea than sending in the army to confiscate peoples pot and porn?
Where the hell has all the democratic-socialist native intelligence, street smarts and self-confidence gone?
If you’ve lost it then just pass the baton on to libertarian socialism now and go toddle off to the high security twighlight home you appear to be longing for.
We’ll ne-er forget ye.
Following on from Leon @ 25:
While this has certainly been true, the issues with Medicare coverage for allied health services are changing the competitive landscape for the AMA. This is going to bring the lobbying capacity of the AMA into competition with the peak bodies for other allied health professions. It’s an indirect form of competition, but it does provide a source of alternative arguments.
An example of this is when the Howard Government introduced Medicare coverage for mental health services – the AMA got a system where GPs are responsible for referral and ongoing assessment, but the Australian Psychological Society got its members in private practice the capacity for patients to claim Medicare rebates. I think it’s fair to say that would have been a pleasing outcome for the psychologists, given the historical influence of the AMA. But it looks like the ground has shifted with a change of Government. The AMA is trying to retain its position as the most influential union in the health sector, but the other organisations appear to be getting better at putting their cases forward and the AMA’s arguments are sounding flimsy.
Some similar cross-profession disagreements are building in the USA at the moment. In response to the growth of doctoral training in nursing, their AMA is considering a resolution that the titles “Doctor” and “Resident” should only be used in medical settings by doctors, dentists and podiatrists – and the associations for not only nursing but psychology, etc. are voicing their concerns.
GW & Robert Merkel.
Extra medical graduates wouldn’t solve the problem. As GW has pointed out, the factor driving up private procedural specialist incomes is
1. A relative shortage in those specialities
2. The way that private health insurance funds have little power over those specialities in terms of fees.
The relative shortage can’t be fixed by more graduates, because it is more fellows graduating from the specialist colleges is what is needed.
The ACCC has done a pretty good job of scaring the colleges about limiting the number passing the exams, the real choke-point is that there are insufficient specialists in public hospitals to supervise the registrars (trainee specialists).
Those numbers are low because the pay in private practice is so much better than that available in public.
(as an aside, hospital staff specialists are represented by ASMOF, and the AMA has only tangential interest in their situation, it is much more focussed on being the union for doctors in private practice)
The AMA is not nearly as powerful as it once was, so the government might well treat them with the disdain they deserve. The AMA possibly thinks that since one of their former presidents is the leader of the opposition, this gives them a seat at the Table of the Powerful and Influential.
The problem is that the Nelson has no power himself and is no position to deliver anything to anybody.
Robert in Newy: is the shortage of specialist supervisors essentially solvable with the application of money?
And, furthermore, is there any way that the workload of these specialists could be further streamlined, so that they can spend more time supervising registrars and performing surgery?
Oh, I dunno. I was in Domino’s the other night and they were advertising for drivers.
Robert @ 38:
Reduction of bureaucratic reporting requirements would be good. It would also be good if there wasn’t a fight over hospital beds every time someone came in for a CABG or whatever.
In effect, the aspect of private hospitals that medical practitioners admire over the public system is the extent to which the bureaucrats get out of their way and just let them practice medicine.
“I was in Domino’s the other night and they were advertising for drivers.”
He’d be good for the 3am shift I suppose. How to stop him giving it to streetkids for free though, the big emo heart-on-legs?
The AMA despite its claims doesn’t really represent GPs. Ask any GP – it represents medicos other than GPs.
Like a lot of unions the AMA is a stepping stone to bigger things – media and politics.
A new President has to establish herself quickly. That is traditionally done by stoushing with the Fed Gov (never state) – of any colour – and then sitting down and negotiating.
I’m opposed to extending Medicare Fee-For-Service (time based) to other professionals. I’m in favour of reducing fee-for-service (time based) to GPs as has been happening over the last 20 years – why sabotage a hard won trend.
I would like to see a DRG or procedure based service fee for Gps, dentists and other health professionals.
The extending of Medicare Fee-for service to psychologist did nothing to improve access to services in disadvantged areas. The biggest usage was in Hawthorn Victoria – where most Psychologists live.
I’m not convinced that $150,000 to AMA was a rip off. I once calculated a $5,000 Fed grant cost an organisation $7,500 in reporting and compliance costs
GJ [28]:
Alas, I got my information from exporters and from people in the shipping industry who were pleased at the improvements that were already happening before the unnecessary Waterfront Dispute was inflicted on us. I beg your forgiveness; henceforth I shall get all my information from the daily papers and from TV mini-series.
Of course the Howard regime could have stamped out most of the Medicare fiddles – they certainly had ample time – but they had a severe lack of willingness to do so.
Antonio [38]:
Now that is an issue that affects the daily work of many many medical practitioners. Now wouldn’t be better if the AMA concentrated on that important issue than on ways to maintain their closed shop and other political shenanegans?
The AMA is Australia’s greediest union, hands down. We need a taxpayer revolt to finally stare them down. Enough is enough.
Well yes I’m sure the nurses and other allied professions see this as an opportunity to justify further pay rises too. If we’re short on doctors why not fund more HECS places? We’re not short on people willing and capable of doing the courses.
As we’re told we’re also very short on nurses – how is giving them more work to do help that shortage?
The AMA live in a very narrow world. Their only real concern is the maximisation of returns and conditions for specialists in private, inpatient practice. This has always seemed an odd focus to me. They are minimally interested in the negotiation of junior doctors conditions and utterly uninterested in the enforcement of these. The last Victorian junior doctors agreement lost conditions on balance and delivered a real wage cut(The representative of the AMA actually didn’t know what CPI was, although I should mention I trained with him so finance was merely his hobby). Similarly their interest in keeping the medicare rebate in step with inflation for outpatient consultations, something your health fund is not allowed to help with, has been insufficient.
The AMA stance on local hospital board control makes no sense to me except as part of a blanket disapproval of all things centrally controlled. I would have thought regionalised services and rational planning of capacity was a good thing. Apparently not.
As to the SA guys, there are many conditions of employment that would make one take a pay cut to walk away. I really don’t think we are seeing all the details here, especially as $450K is a vast salary for a full time consultant. A little over half that would be usual in Victoria.
The AMA is not a union in the traditional sense. They are best thought of as a club for the expression of my colleagues’ baser urges. A stage where the otherwise unacceptable voice of Mammon can sing from every private practitioner unwilling to admit they believe they just plain deserve to be rich.
Which is a pity. Because it doesn’t leave anyone to actually lobby for the things most of us actually want most, like well run public hospital services based on such radical principles as measuring demand and people in Cairns not to have to fly to Melbourne to see a specialist.
How long ago was Nelson head of the AMA? I imagine he would still have quite a few influential friends.
What will be interesting from a Rudd p.o.v. is what to do with the newly created ‘nurse practitioner’ that ostensibly lies at the heart of this current demarcation dispute. In the absence of a doctor and a desparate clientele does Rudd allow for the creation of a new medicare category thereby giving these nurse practitioners the capacity to prescribe prescription drugs. This is new and the capacity for remote area professionals to get on with the job of medicine rather than wait for a medico to ‘fly’ in and countersign a prescription will be interesting.
As far as GPs volunteering to go to NT:
The AMA are not really central to the issue of recruitment – the Divisions of General Practice and the Rural Workforce Agencies in each state would be more important and closer to GPs and in the case of RWA have infrastructure to facilitate volunteers.
In any case any health service in NT that relies on volunteers is doomed. With all the good intentions and volunteers in the world I’d say the volunteers would have reached their limit by now anyway. Volunteers have other jobs and family and such in other places.
Whilst it is true that in the past many medical/surgical Colleges have acted like Guilds to limit the workforce it is not so much a universal factor these days. The biggest impediment to increased medico numbers is the ability of the health system to offer enough hands on training places. This is only partially due to available $$.
The SA kerfuffle is not all that clear from media reports but a look back at history shows that the common negotiating tactic from proceduralists is to “hand in their resignations” – often these can be dated months in advance and withdrawn when the barney is over.
The public seems to think that hospitals employ doctors like full time public servants – 5 days with 9 – 5. Some do but many of those “resigning” will be VMOs with only a few sessions (3 – 4 hours) a month. Even if they resign they will be rehired back (and most will gladly return) whenever they are needed.
pablo – this current scrap is a scrap that every new AMA Pres has to have – any excuse will do and the current beat ups are as good as any excuse.
The nurse practitioner issue(s) is only one of many structural and demarcation reforms that are needed but it will be no panacea. There is also a worldwide shortage of skilled nurses around and higher skilled “independent” nurse practitioners won’t (don’t) come much cheaper than a newly minted GP. And if you think the AMA is bolshie – just wait and watch the Nurses unions go troppo when anyone proposes some lesser beings taking over “nursing duties” to free nurses up.
I don’t have much sympathy for the AMA, which as others have already said, does not represent the interests of most doctors. Having said that I think the AMA was right to bail out of the NT intervention. Not just because it is a poorly organised shambles, but because the AMA was damned if it did and damned if it didn’t. Who exactly leaked this document purporting to show the AMA was profiting from the recruitment of doctors? Not Roxon’s office, surely?
And who would be the first to jump up and squeal when a Graham Reeves or Dr Death Patel turned up working in the NT because nobody did the basic checks on their skills and qualifications?
I also wonder how much of the vitriol directed against Rosanna Capolingua stems from her being a high profile female leader. She is right to be asking why doctors are expected to work for free while 800 plus Federal public servants are being sent to administer the NT intervention on full pay plus allowances.
I disagree with this. Again, consider the law example. Science degrees are also vastly oversupplied, if one considers the jobs available (in the sciences of course — graduates don’t actually end up unemployed most of the time!). Arts degrees too.
That’s true. I forgot that the new government has abolished full-fee places, effectively meaning the numbers for every course in every uni are set directly by the federal government. In which case, if full fee places don’t come back, I’d suggest the govt. decrease funding per student and increase the number of places available. The strong demand suggests that currently high HECS costs don’t deter too many potential students.
Dr S [26] and Dave [44]:
Thank you! Thank you!
What is really needed for a start is for a public revolt against the ignorant lazy journalists who give so much prominence to the AMA and its views – views that are sometimes hostile to the interests of many health professionals and patients alike.
Everyone:
Three things need to be done.
First: Take the authority to qualify candidates for the specialities right out of the hands of the racketeers. There is a completely artificial and very dangerous shortage of specialists in most of Australia and a thoroughly artificial glut of specialists in a few geographically-tiny localities.
Second: Abolish faculties of medicine and transfer their functions to other faculties of universities. Now that a degree in Medicine has degenerated into an showpiece of conspicuous consumption – can you think of any other way of getting an effective health care system in future?
Third: Abolish the AMA. Get rid of it. It is only a rebadged BMA and it has hindered the development of a world-leading healthcare system in Australia.
This will work really well. Anatomy in the Law faculty. Endocrinology in the Architecture faculty. Obstetrics in the Engineering faculty. Neurology in the Science faculty. Surgery in the Economics Faculty. Gastro-intestinal medicine in the Arts faculty. It makes such perfect good sense.
Graham, I agree with you on taking the qualification system out of the hands of the colleges but racketeers is a little on the harsh side. These organisations are mostly run by slightly incompetent volunteers rather than Tony Soprano. The majority of their failings are unintentional blundering rather than deliberate malevolence. Still,it should all be run by the Universities, although I have fears about the stringency of the resultant assessment process.
Strongly disagree on the Faculties of Medicine comment. My profession is applied biology of a particularly specialised kind. Without those Faculties we are highly unlikely to see ongoing scientific advance. Secondly, the major issue with recent medical education is the lack of practitioners in the course. I cannot see that improving with the destruction of University institutions.
I realise your point is actually that Medicine as a profession is so corrupt that it should be destroyed and it’s roles and responsibilities defused to new system. I just don’t agree, sorry. I admit bias but claim a significant balancing knowledge base.
As to abolishing the AMA, much as it may be desired, I am sure you are well aware it is not really possible. The AMA is a voluntary organisation funded by subscriptions, it can no more be removed by fiat than the Dandenong Historical Re-enactment Society or The Communist Party of Australia.
Sorry, first patient is here, ironically enough
Greg M,
Most universities will have a Faculty of Health where they train other health professionals – nurses, for example. It would be a good idea to take doctors out of their hallowed halls and make them train beside the other professionals that they will have to work with. In additional to taking the ‘holier than thou’ attitude from the doctors, it might help raise the standard of training for other professionals, and increase mutual respect all round.
Polyquats – Better ask the other faculties first. I suspect the nurses would be less than impressed by being invaded. Difficult enough to assert one’s professional credentials without the whole faculty being infested by senior medical researchers.
Thanks Dr S at 8.33pm last night!
One thing puzzles me: “The representative of the AMA actually didn’t know what CPI was, although I should mention I trained with him so finance was merely his hobby). Similarly their interest in keeping the medicare rebate in step with inflation …….”
Ummmm how does one argue that the medicare rebate must be raised in line with inflationary rises, if one doesn’t know what the CPI is? I mean, truly-ruly, even some JOURNALISTS understand the main idea of the CPI.
“a club for the expression of my colleagues’ baser urges” LOL, that will keep me going all day
, thanks doctor, you’ve been a great help. Yes, I promise to keep taking the placebos.
On cue:
http://www.news.com.au/dailytelegraph/story/0,22049,23885975-5005941,00.html
I wonder how many doctors loath the AMA palaver, under Capolingua, but continue membership just because they do not feel they have much choice. I am a member of RACV , for instance, but cannot stand some of the lobby work they do on behalf of unreconstructed motor heads.
Does anyone remember the Doctors Reform Society?
http://www.drs.org.au/
They still have a site up, but have been pretty quiet in recent times. They provided a bit of balance and did more for the medical community, on the greedy bastard front, than they probably realised.
Who was that Indian chap that was the AMA President recently? He seemed quite inoffensive.
Mukesh Haikerwal, Spiros.
http://www.theage.com.au/news/General/Politics-and-the-medicine-man/2005/06/03/1117568371123.html?from=moreStories
Mark @59 I am obviously not surprised.
Just as Howard damaged the Liberal brand another self interested, overly ambitious, individual has badly hurt the image of what should be an important organisation.
Mukesh Haikerwal, wasn’t it?
[... I wanted to voice my ongoing displeasure with the Australian Medical Association (AMA) and their seeming inability to separate self-interest with the interests of Australians more broadly... there is some interesting back and forth at Gary Sauer-Thompson's Weblog...]
Re RM @ 32 and Leon @ 52:
Of course I realise that other degrees don’t have guaranteed jobs at the end, but I don’t think anyone is complaining about a shortage of lawyers. At a time when we have a very real shortage of doctors, I think most people would find it absurd to have medical graduates sitting on their hands when nearly everyone would rather see them in the workforce.
Re joe2 @ 60:
I’m a first year med student at UQ. At the morning tea they had on the first day they had tables where you could sign up for various medical indemnity companies (free for students!) that sponsor the UQ medical society and another table for the AMAQ. I rolled my eyes as I walked past it, but if the DRS had had something there I might’ve signed up.
Mark @ 12:04 pm, certainly my assessment of the President now changes but not the organisation. Is that remembered in this debate?
Re (43) Graham Bell
“I got most of my information from exporters and people in the shipping industry”
Gossip and anecdotes – a solid research foundation!!
FYI there were incremental improvements in the late 80s/early 90s associated with the WIRA processes – but very little after that until the dispute.In fact during the decade prior to the dispute the crane rate inched up from 16 to 18. Perhaps, however, the real villains in the sorry saga were the anti-competitive actions of the MUA combining with Patricks and P&O to force OOCL to withdraw from the Port of Melbourne project. Those actions cut out a third player which may, through the force of competition, have averted the subsequent dispute. But that, of course, is speculation – another view suggests they may actually have deserved each other!!
I would suggest, if you seriously wish to understand the dispute and its background, you should examine some of the Productivity Commission papers on benchmarking the container stevedoring industry and Parliamentary Library Notes about that time.
Perhaps you will find that more illuminating than anecdotes etc from vested interests!!
Dr Jayant Patel?
(Have to say the question sounds like it should have been asked by a well-meaning Nanna.)
*Practises croaky voice*
Doctors are overrated monopolists, exploiting the ludicrous bias of the media in their favor to win higher and higher incomes at taxpayer and patient expense. Specialist taxable incomes are now approaching the 1m plus mark (as the recent Kossmann controversy in Melbourne showed).
The self imposed shortages of surgeons are now a national disagrace, and a toxic health hazard. All Australians have to stand up against this union – fast.
“I rolled my eyes as I walked past it, but if the DRS had had something there I might’ve signed up.”
GW@ 66. Contact Doctors Reform Society through their website or phone.
I am sure they would be thrilled to here from an obviously progressive medical student.
There was an interesting program on SBS the other week involving a journalist (no not Michael Moore) visiting various countries, including Japan, Taiwan and Germany, and comparing them with the US. It was fascinating because all the countries had different approaches, but none seemed to treat medical practitioners with the veneration that we seem to here.
Taiwan was particularly interesting because they were basically starting from scratch, and tried to get the best ideas from around the world. One point that was made very strongly was that the idea of having to get a referral from a GP to see a specialist was inefficient and to be avoided at all costs.
The Return of Herindoors. Worth taking on board.
As for the Australian Mememememememe Association, I reckon they should dump the mean-spirited one & get w/ the scene. Surely their BMW elite can find time to look into their hearts & do a good deed w/out requiring another yacht & 20 course meal to fill the empty void?
Still, I know they represent plenty of good guys & gals too. Hopefully they’ll work this mess out.
Upgrade the nurses I say…& train more, more, more.
Domination of a sector is not healthy, particularly in a country w/ a small population…remembering a certain music host/God/bore who brought us all the great medical hits like this at the expense of our sanity, blood pressure & alternative artsist?:
http://www.youtube.com/watch?v=5xRAQgrNNDM
(Doctor, Doctor)
Good points Mark. Considering you must be exhausted.
Pardon me but I don’t think doctors should double as cops. And thats what the re-invasion boils down to imo. Trialling out police state tactics for later use in the ‘burbs.
Like Macquarie Fields.
Having the army crack down on the black( no pun intended) economy is a disaster.
Lets call a spade a bloody shovel.
How would youse like yr pad being turned over for mull and popular art!
I didn’t think so.
‘ First they came for the first Australians…’
Just a little, nasking! I’ll probably end up at a gp’s soon myself!
“I’ll probably end up at a gp’s soon myself!”
Can relate to that Mark. There’s been a cough thingy going around Sth East Qld the past month & yours truly has picked it up…managed at a birthday outing to sit next to the only family member of my wife’s who had the bleedin’ virus, who kindly managed to blast spittle into my mouth. That’s what I get for pontificating in public at a rapid rate, when i shoulda just kept my mouth closed unless tucking in. Sigh.
My Grandpop knew better. He masticated 20+ times every morsel…in order not to choke or be forced to respond to dumb questions or say anything he’d get a clip around the earole for by his wife, my grandma. Wisdom of the elders…;)
Dr S [55]:
Thank you for your thoughtful response.
“Racketeers” may be harsh term but the effects of intentional predatory behavior – rather than malevolence as such – on patients is harsh too.
Make no mistake, I am all for giving handsome, well-deserved rewards to those who have devoted much effort over many years to develop exceptionally high levels of skill…. but that is a world away from some of the closed-shop, plundering rackets that have been allowed to develop in the health industry here. Having universities or academic-dominated control the specialities is not the answer either – what happened to the specialized subject areas of Education should be a stark warning to everyone. I do not know what the answer is – perhaps broadly-based authorities which include astute members from right outside the specialty? Whatever replaces the present system must preserve and advance the great body of knowlege of that specialty; it must ensure that practitioners within that speciality maintain a high level of skill yet not hinder innovation and deviation from common practice; and …. it must not allow mangy stale old dogs, using every dirty trick in the book, to keep as many aspirants as possible out of their territory!!
Alright, if you don’t like the idea of abolishing faculties of Medicine, what can be done to make them more open to those with the ability to become effective doctors [sorry about that old-fashioned term] and less of exclusive social clubs for favoured rote-learners? There’s also the matter of entrenched racism in faculties of Medicine – to paraphrase the notorious early-20th-century door-sign in Shanghai “Dogs and Bogans Keep Out!”. I am delighted that after decades of exclusion, Aborigines are now allowed to become doctors – but somehow I just can’t see the AMA suddenly encouraging a broader range of native-born non-Aboriginal Australians from all parts of society to become doctors.
Well, since you put it like that ….yes.
Now, how swiftly can we get the new vastly-better system up and running??
I too admit bias but claim a significant balancing knowledge base …. a rather different knowledge base perhaps – but no less significant.
GJ [68]:
Larvatus Prodeo is a blog; it is not a doctoral thesis. Different standards of proof apply. I passed an honest opinion based on what I knew; you did likewise. b.t.w., anectdotes from vested interests are, IMHO, rather more reliable than are news[?] stories, propaganda and TV dramas.
(77) Graham Bell
“LP is a blog. It is not a doctoral thesis.Different standards of proof apply.”
I agree – but it is also not a shelter for opinionated drivel disguised as commentary. Sure such posts are frequently made on blogs, but in doing so you can’t expect not to be corrected if that opinion is patently wrong or subject to broad debate.
Rather than be defensive, might I suggest you resist being guided by anecdotes, mass media, gossip, etc and be prepared to do a little research of the evidence that may(or may not) support the opinion you offer.
Graham – Simple answer to the “plundering rackets” is to abandon Medicare and adopt the model of the NHS except funded at a little over 10% rather than just under 8% of GDP. There is absolutely no chance of this happening, of course, but it solves the problems created by the Medicare system of public funding for private medicine.
There, colours on the mast.
As to the Faculties of Medicine, I don’t really share much of your animus. As scientific institutions they are really quite effective. As to teaching they have recently been hijacked by a particularly inappropriate use of problem-based learning but are starting to recover.
As to the ethnic status of their intake, certainly in Melbourne it is heavily skewed. Just not, I suspect, how you think. At Monash, where I trained a number of years ago I do not care to discuss, a first year lecturer surveyed religion. He left off Jewish and ended up with 30% “other”. At Melbourne, where I currently encounter medical students, the vast majority are from south east Asia. Most medical schools have a majority intake of women, largely around the 60% mark. The more the intake is based on marks rather than interview, the fewer wealthy Anglo blokes. Three of my current tutorial group of seven keep their stethoscope tucked rather neatly in in their hijab.
I would also, as I have on other threads, warn against excessive belief in the relevance of the AMA. They have precisely nothing to do with specialist training and minimal role in decisions about medical school numbers. There are a number of specialist colleges who engage in restrictive practices, for instance you do not get into opthalmology without the death certificate of a current member, but otherwise the training numbers are decided by the relevant state government. The recent issue has been that due to nerfing the medical courses no-one wants to do internal medicine (as it is seen as too difficult) and training positions are going begging.
The ideal behind the current practice of medicine is, without a doubt, anachronistic in a 19th century kind of way. The model is of the learned practitioner, trained over decades and infused with perfected wisdom, translating base symptoms into revelatory diagnosis and perfect cure. Which is silly and ignores the messiness of reality and the rather pleasantly collegial nature of actual practice but there we go.
Despite my and my colleagues pomposity it is difficult to think of exactly how you would diffuse our purpose and knowledge into a system rather than individual based mode of care. System based approaches are the basis of nursing practice and are extremely successful at providing quality care. Nurses do far less silly things in a week than most doctors because they have such clear, algorithmic, rational processes to rely upon. The problem is that for the accuracy of their diagnostic input and agility in dealing with the unexpected these systems rely on the intervention of the “wise man” medical role.
Feel free to hand it to someone else but I am not sure how to make a system work without someone in that role. Disease is too damn messy to be solved solely by algorithms. Or, at least, I am far from wise enough to write them.
“I would also, as I have on other threads, warn against excessive belief in the relevance of the AMA.”
Yet another example of a lazy and inept media giving prominence to an organisation that doesn’t deserve it.
This was yesterdays Courier Mail http://www.news.com.au/couriermail/story/0,23739,23885804-3102,00.html
It is really a worry if surgeons have this much control over our health system. It seems top be a case of how much wealth and power are enough? (sorry if link doesn’t work)
DrS – people here might mistake your hyperbole for accurracy.
Mr Holden – Only the mildest of exaggeration. The last person need not die, merely retire. No increase shall be permitted.
What DrS said: Just because the AMA makes a lot of noise, or more correctly its leaders do, doesn’t mean it is always influencial or even always even relevant. on many health issues the AMA doesn’t even have a seat at the table.
“plundering rackets” are not the exclusive preserve of medicos. Lets not get onto the claims of chiropractors, naturopaths, nurses doing “colonic irrigation”, chemists who sell “weight loss treatments” and assorted woo woo shonks.
GPs and specialist consults are (in general) re-imbursed from the public purse on a fee-for-a-time-based-service plus any co-payment (known by gypsies as crossing the palm with gold)[let me point out I am not totally against co-payments depending].
Procedures (operations, surgery etc) are in general funded on a DRG (Diagnostic Related Grouping) fixed fee for work completed basis.
In my view any move away from fee for time service toward fee for work performed is a good move – in general. There are always many exceptions, but we seem to be talking in big picture generalities here.
The australian health system is generally acknowledged to be amongst the top 3 or 4 in the world for access, equity, safety, patient satisfaction, cost / benefit, outcomes X % GDP etc.
[Cuba is always useful to bring up here to derail discussion (similar to Godwins Law) but in the absence of any real evidence about all aspects of the Cuban system it is wise to put it aside as an "interesting case - worthy of further study"]
The rigid trade/guild demarcations in health care are a cause of many problems and inefficiencies. These demarcations and their disputes and flow on effects are tradition in australia fostered by our silo like education systems, industrial relations and professional payment systems.
I’d like to see more articulation of education, experience and credentialing systems. This would also lead to the breakdown of rigid role demarcation inside health and permit more horizontal and vertical multi-skilling. It wasn’t that long ago that a nurse (usually female) with 3 years university training plus 4 years A&E experience who wanted to become a paramedic /ambulance officer could not get any credits at all to enter into a 2 year part time TAFE ambulance training course.
On the other hand an experienced paramedic with 6 years experience cannot walk into any role in a busy A&E department.
A person should be able to start as cleaner in a hospital and get some recognition of experience and studies to be able to qualify as a technician /porter, and then move to say a Theatre Technician then to Nurse similarly then to say Aneasthesia and say surgery or beyond god to being an Orthopod.
Meanwhile, Cuba is providing 300 doctors to East Timor – completely free of charge. As it happens, I was in Havana recently discussing these matters with their Ministry of Foreign Affairs and Cooperation. I can reveal that similar programs are underway in Vanuatu, and in advanced planning for PNG and Solomon Islands.
“Meanwhile, Cuba is providing 300 doctors to East Timor – completely free of charge.”
Excellent point Lefty E. So much to be learnt from the Cuban experience. And not all negative like some politicians & media would have us believe. Glad to see the EU is constructing some BRIDGES.
Lefty E – I’d be keen to hear a bit about all the elements of the Cuban system – education – experience, degree of replicability (is that a word?), things like comparasion of nurses and medicos skills and payment in the Cuban system, do Cuban trained doctors emmigrate ? Are they in demand in a market or are they only conscripts? Could the Cuban System do efficient low cost training for the rest of the world?
All pretty interesting FXH and Nasking. Im writing up a piece (or will soon when brain returns from holiday).
There are 1000s of foreign students learning medicine in Cuba including 800 Timorese, several hundred from Kiribati and (wait for it) – 100 US citizens (mostly Blacks & Latinos).
Its a proper “degree” style medical course, though they spend more time in actual clinics than they seem to here.
All scandalously ignored in our press – despite a growing regional presence. How they fund it is beyond me, but mostly they do themselves (some countries that can pay for the doctors do, eg Venezuala, some african oil states). I agther its an imprtnat part of the systems legitimation in their eyes, so they prioritise it
Separate to that, and more inovative is the Dili Medical college, which is a new program involving following graduated doctors on daily routines and learning on the job, with night courses to supplement. Whether they graduate as MDs Im not sure – but they’ll be useful.
There’s doco by Tim Anderson doing the capital city rounds right now if you want to learn more, called “Doctors of Tomorrow”.
As for low cost training – yes, clearly. I like the way they seek to replace their own doctors with local graduates as soon as they can.
Intersting sidenote: downer tried to ehavy Somare not to take Cuan doctors in PNG. Somare told him to either cough up 25 free doctors, or alternatively , to go to buggery. Ha!
As for earnings – no, they earn nothing special in the Cuban context. Normal (low) wages. 30% work overseas.
I don’t have figures but I thought the number of East Timorese in post secondary education was somewhat less than 4,000. If thats true then 800 doing medicine in Cuba seems like a lot. Do you have any figures on numbers of ET in tertiary eduation (also medicine) in Australia and say Portugal?
Can you point me to any source documents with comparasions of Cuban tertiary sector and others?
Dr S [79]:
Sorry about my delay responding. A pleasure to read your comments …. though we disagree enough that we might come to fisticuffs if we ever met face-to-face.
My distrust of the AMA might have started by seeing decent DP/migrant doctors working on the pick-and-shovel, back in the ‘fifties, because of the BMA’s closed-shop racket.
“ “Disease is too damn messy to be solved solely by algorithms.” “ Yea verily!
We have both identified a few of the problems in the current system – so where do we go from here? What practical things can we ourselves, as individuals, do to inprove the current health mess? There is no point in waiting around for a magical Royal Commission to set things right, neither of us is likely to live that long.
You mentioned spending under 8% of GDP – if that is so, what would be wrong with the frugal well-directed spending of a bolus 12% of GDP over a 3 or 4 year period to fix a lot of the problems in the current health system and then reverting to a maintainence and development level of say, perhaps, 6% or less for the following two decades? Not quite a Snowy Mountains Project but still a worthwhile national project. After all, we Australians are quite happy to pay half a million dollars and more for our “muck-mansions” and to donate our wealth to the Saudi royal family each time we refuel our cars and to squander our national treasure on mythical war-toys which might, if we are good kiddies and eat our crusts, be delivered at the end of the war after next. Visionary political leadership would make spending on such a project not only acceptable to the electorate but welcomed with open arms.
Back to the AMA: When the Doctors’ Reform Society got going several years back, it shook the AMA out of its torpor. Why didn’t that effect continue?
GJ [78]:
Do you expect me to be so paranoid that I question every word spoken to me by people with first-hand experience and whom I have found to be truthful in most other respects? Come off it!! Besides, I’ve seen enough dodginess in formal research [usually by omission or by misinterpretation of data] to be suspicious of any latter-day bibliolatry – calling something research doesn’t always mean it is incontrovertibly true.
But the point is that most people don’t find it absurd that lawyers are “sitting on their hands” — at least in part because they aren’t; they go and get jobs in related fields. Having a graduate surplus would put pressure on the monopolizers at the tail end of the medical education system, and perhaps develop some competition. (Oh, and for what it’s worth I’m also a medical student, sort of.)
Heres a small bunch of information I found about Cuban Medical Education and Health System on a quick google:
http://www.medicc.org/ns/index.php?s=11&p=0
http://student.bmj.com/issues/07/11/news/386.php
http://www.washingtonpost.com/wp-dyn/content/article/2006/07/19/AR2006071901380.html
http://en.wikipedia.org/wiki/Education_in_Cuba
http://mondediplo.com/2006/08/11cuba
http://en.wikipedia.org/wiki/Healthcare_of_Cuba
Hi FXH – no, there’s some 15,000+ tertiary students in Dili alone, not counting those in Indonesia (several 1000s), Portugal (several 100s) Australia (maybe 50)and elsewhere. Demographic pyramid is steep. 75% under 30.
150 are doing the Dili medical school course, and 850 are actually in Cuba doing medicine and associated (some radiogrpahy, some nursing etc). Not all are training to be doctors, but most are.
Oh, and by contrast, Australia is training 8 Timorese doctors, and one surgeon.
Rosanna Capolinga may be a would-be Liberal politician. But the Rural Doctors Association are already hand in hand with the Liberal Party. They had a rally in Adelaide last week to protest downgrading of 43 rural hospitals. A worthy cause but they lost much of their moral high ground when it was revealed the rally was actually organised by the Liberals:
http://www.theaustralian.news.com.au/story/0,25197,23892766-23289,00.html
Thanks Lefty
I recommend WE think things thru…soon
how many babies…? OK NURSE…CARRY ON
get me a STIFF ONE out of the morgue…for the PHARMA…exper..i…men…tation:
http://www.youtube.com/watch?v=aC1OVsJ8u2g&feature=related
(Cubanismo – Mambo UK – Live)
N’…now
FXH [84]:
I don’t think you could call two outstanding 20th-Century Queenslanders, Sister Kenny and Chemist Roush “assorted woo woo shonks”. And what about the old-fashioned German and Chinese Herbalists [the real ones] who did so much for the health of the community in years gone by? They each found beneficial ways of bypassing a very rigid system …. and the efficacy of their treatments speak for themselves. b.t.w., sometimes they were the ones who detected unnoticed serious conditions and urged the patients to seek attention by conventional licenced specialist practitioners.
and FXH again [82]
What hyperbole? Be happy with your fantasy if you believe that any and every graduate can, after a couple of years of clinical experience and by diligent study alone, become a fellow of one of the better-PAYING specialty closed-shops.
L=O=L
Everyone:
IMHO, the AMA is just like the RSL or the Country/National/Pineapple Party or any other organization whose primary functions are to maintain the status quo, to keep entrenched power- [and/or money-] holders in place, to prevent criticism and challenges especially from upstarts …. and who achieve this even when, in doing so, they inflict serious harm on the people they are supposed to be supporting.
Why not just replace it?
Maybe then we would see an end to both the doctor shortage and to the woefully misdirected health funding.
Would that be the Sister Kenny who had a cure for polio?