Update July 3rd: the Medical Board has now approved the registration of the recruited doctor. Now they just have to get him sorted with a Medicare provider number and he can start providing care to Dorrigo.
* * * * *
From today the two doctors who service the population of Dorrigo are on strike, and at least one of them has resigned from the local hospital as part of their protest: they will continue to attend life or death emergencies and to provide palliative care for the dying, but anyone else in need of medical attention who can make it down the mountain alive to the hospital in Coffs Harbour will be sent there.
Their reason? After finally successfully recruiting a third doctor to alleviate their horrendous workload and provide better services for the Dorrigo community, their overseas-trained recruit (now an Australian citizen) has not been able to gain approval for his registration as a General Practitioner, without which he cannot come and practise in Dorrigo. This final piece of paper was originally supposed to be issued in April when he passed his Board assessment with flying colours, but there has been bureaucratic delay after delay, based on a (ETA) compulsory and arguably inappropriately rigorous assessment of his English competency when he has been working in hospitals here effectively for the last 6 years.
Dr Herb and his colleague just heard that the approval of the registration application has been further delayed until at least the 2nd of July. Unsure of whether this will merely be delayed again, they have declined to renew the lease on the accommodation they had secured for their recruit and his family, as they have been paying hundreds of dollars a week on an empty house since March while waiting for the paperwork to be sorted out, and are unwilling to keep on doing so with no promise of a timely resolution. Suitable accommodation is difficult to find in Dorrigo, and they now don’t know whether, when their recruit is finally approved for registration to practise, they will be able to secure him appropriate accomodation at that time.
In utter frustration, they have decided to go on strike.
Below is the press release from Dr Horst Herb, which was forwarded to me privately by a third party. (I have contacted Dr Herb to ensure that this is definitely from him and that I have his permission to publish it.)
Dorrigo is a small rural community, semi-isolated from the nearest urban centre Coffs Harbour because of a steep mountain road in appalling condition. I am the only full time doctor there, looking after some 3,800 patients together with a female part time colleague.
When I took over the practice 6 years ago, the town had been without a doctor for 6 months. Because of the tyrrany of the distance, people all too often did not attend medical services far away but rather accepted neglect of their chronic and sometimes acute illness. As a consequence, the state of health of diabetics, asthmatics, chronic kidney disease, or people with cardiovascular disease etc was catastrophic and we were swamped with the consequences in the emergency department and with emergency admissions.
I believe we managed to restore the public health situation to a state comparable with the average urban population if not better. Emergency admissions or consultations for derailed chronic disease are now very rare, and even progress of such disease has become uncommon. However, this was achieved at the cost of the doctor’s private lifes and health. Last month alone for example, I logged 378 hours on call, and rarely a night I get home before 8 p.m., often only much later. Many days we don’t get a lunch break before 2 p.m. The few moments that may appear as time off to outsiders are in reality spent with tackling the tons of paperwork we are burdened with. This cannot continue like that forever. I should have realized when I could not attend my mother’s funeral overseas because I could not find a locum in time. Our marriages suffer, we neglect our children, and worrying about this distracts us from our medical work where any distraction or lack of mental focus could result in loss of life or limb.
In February we managed to recruit a most competent doctor prepared to move to our town with his family - after trying for nearly 6 years. Doctors having the right mix of skills as well as the willingness to move to a small country town are extremely rare. It took two months until this rare gem could be assessed by the Medical Board which confirmed that his knowlegde and skills including communication skills were adequate for the position. This came as no surprise since he had been working in the Australian hospital system for more than 6 years, and performed very well according to his supervisors. So why is he not working yet?
He was trained overseas. No matter that he has been Australian citizen for 6 years, no matter that he performed well for 6 years in major Australian hospitals (he became “registrar of the year” in a major Sydney teaching hospital!), no matter that the medical board assessed his professional and communication skills as satisfactory - the bureaucracy responsible for registration insists he has to pass an English test first with marks that many Australian HSC students would not be able to achieve (A minimum of band 7 (out of 9) in each of all four subtests). These bureaucrats basically state that if this most competent doctors commits a few spelling errors in an English test he cannot practice in our community (but can continue practising in the hospital system in critical care where he works now). They deem it more important to stick to poorly thought through rules to the letter than putting my whole community at risk of losing medical services - and this they will.
When we appealed that requirement we were told that they will discuss an exemption on the 18th of June, so we waited some more, all of us getting desperate. So what was the decision? To procrastinate some more, and wait again until the 2nd of July. And no guarantees that a decision will be made then. And even if he got the exemption, the insane bureaucratic process of getting a Medicare provider number for an overseas trained doctor would have barely started - we would be looking at at least another 2 months of piles of paperwork and procrastinating bureaucrats who seem to have no other purpose in life than to delay progress and make our lives difficult.
Both my part time colleague and I have decided that we cannot sustain our current pace without help any more. Six years of working far beyond our duty and possibly beyond human capability are enough. Sacrificing our personal life for the need of the community at large is only fair enough as long as there is genuine need - but if this situation is created artificially by a cruel, inefficient, and inflexible bureaucracy we can’t see the point any more. We will now do as the bureaucrats do - work 5 days a week, 9 to 5, with regular lunch breaks and even holidays. Emergencies 9 to 5 only, please. However, we still feel like human beings and will not display the same callous disregard for the needs of others as the bureaucracy does - if we happen to be in town we will still attend life threatening emergencies regardless of time of day or personal commitments.
We keep on hearing about the problem of getting doctors to settle in country towns. Why, when this country medical centre has secured a competent recruit, is the final stamping of a piece of paper being so unconscionably delayed? If there is some compelling reason for the delay, why has this not been communicated so that at least payments for unused accommodation didn’t have to be made?
As to the road from Dorrigo to Coffs Harbour? Dr Herb has understated its poor condition. It’s a challenging drive on a fine day, let alone a possible mercy dash at night in the rain. Here’s a photo of a truck attempting to climb the Dorrigo mountain road, and the commentary on the photo from its context on the truck photo website where it appears:
This photo was taken on 28 Dec 2004 as this truck was climbing Dorrigo Mountain to the tablelands. It is a Lindsay Bros Ford HN80 and is trying to get around a very tight corner on a narrow section of the road - parts of which are blocked from landslides and washaways. It was also raining quite heavily when this photo was taken.
I have Dr Herb’s permission to pass on his email contact details to any MSM journalists who’d like to highlight this case.
Image Source: Wikimedia Commons - Cedar Falls in the Dorrigo National Park
Perhaps they are still touchy about foreign doctors in the wake of Dr Death?
And had we trained adequate numbers of doctors here we wouldn’t have to poach doctors away from poor countries desperately in need of them.
Dr Death has nothing to do with it…it’s Haneef that scares the shit out of them :o)
I can understand that there might be some reasons for the delay from the bureaucrat’s point of view. But where is the transparency?
The Dorrigo medical practice is thousands of dollars out of pocket for unused rental accommodation, for a start. If the registration board had been upfront about any substantive reasons for a delay then they wouldn’t have secured the accommodation prematurely, would they?
The recruit has been a citizen working in hospitals here for the last 6 years. That’s not really equivalent to the case of Jayant Patel being hired directly from the USA after he had been suspended from practice there.
As a doctor personally acquainted with both Horst, and the facts of the situation, there is nothing to explain the absence of action on the part of bureaucracy other than stupidity and lack of resolve to assist the citizens of Dorrigo to continue to enjoy excellence of medical care. Horst will be the first to add that his circumstances are reflected in medical practices around the state and nation.
We can only hope that the publicity surrounding his brave stance causes the status quo to be altered for the benefit of all Australians.
Mention of the ‘bureacracy’ and the Medical Board and I am assuming they are one and the same. Readers should be aware that while the State Health Dept acts essentially as a secretariat for the Medical Board, the latter is very much a creature of its own making. I can’t recall the composition of it these days but care needs to be made in assuming the bureacracy is just a bunch of public servants.
Speaking of strikes, when is Larvatus going to get off its fanny and do something on the Qantas situation?
I’m only surprised that Horst Herb has taken so long to do this. Good luck to him. Despite rural Australia having a massive shortage of doctors, the system seems hell bent on making it as difficult as possible to practise medicine anywhere outside a major city. An even bigger scandal is the plan for downgrading 43 rural hospitals in South Australia to little more than bus shelters. In a cruel joke the health minister has labelled them “GP Plus” Hospitals. The only problem is, with that kind of commitment to rural health, there will simply be no GPs interested in working in rural South Australia from now on.
Dr Herb actually makes it very clear that he is talking about two different organisations, or at least separate arms of the overall system. The Medical Board responsible for accreditation have assessed the recruited doctor as competent in both his clinical practise and his English communication skills. The Registration Board is dragging its heels.
If it’s anything like the Physiotherapist’s Registration Board with which I am familiar, it will have an advisory committee which includes members of the profession being registered. However, the actual Registrar has the capacity to delay decisions recommended by the advisory committee. Because of a lack of procedural transparency, the Dorrigo practice has no idea whether the decision to delay granting the recruited doctor’s registration has occurred at the committee level or the Registrar level.
Paul Walter, go take a long walk off a short pier. LP is not a publication of record, we don’t cover everything, and certainly I for one have no intention of covering something that I don’t at least understand a little about. You could always get your own blog and write something worth a linking.
This growing assumption by some that LP has an obligation to cover their particular hobbyhorse is exceedlingly irritating, and is one of the reasons that I spend less time posting here than I used to.
I’d like to remind our commenters of our comments policy [link]
Thanks for giving this issue a wider audience tigtog. I have to compliment the Doctors and other medical staff at Dorrigo, they work tirelessly and do home visits when many other doctors would wait for the patient to come in to them. It really was only a matter of time until they got fed up with these delays and being overworked and took this type of action. The people from Dorrigo will understand their frustration.
Most people who have been to Dorrigo (and Bellingen) fall in love with the place. When it isn’t raining, it is one of the most beautiful places in the country - seriously. The comment about the road is a bit tough though - it was bad for a while but is in pretty good shape at the moment and I can attest to being able to drive from Bello, up the mountain road to Dorrigo in 20 mins (assuming you don’t get stuck behind a truck and have a slightly lax attitude to speed limits). It is also only 1hr (driving normally, not Dave55 style) to Coffs Airport which has 6 or more flights daily to Sydney (only an hrs flight) and Brisbane (a few less flights/ day but less than an hrs flight). It would be a great place for Drs to work and retire working part time and yet amazingly, it and many other places like Dorrigo, find it difficult to get Doctors.
Great post Tigtog
“Because of a lack of procedural transparency, the Dorrigo practice has no idea whether the decision to delay granting the recruited doctor’s registration has occurred at the committee level or the Registrar level.”
Unbelievable. This lack of information should be resolved by a simple phone call to the Minister’s office. Any presser worth his/her salt would get that info in less than an hour.
Has that call been made? If not? Why not?
This is clearly a ‘political’ issue that Morris et al would want to solve immediately.
Censor ship and moral cowardice. All hail the coward who abuses then denies right of reply, then censors. And the gormless worms who support fascism.
I have not censored you. I have told you that you are being exceedingly irritating.
This is not a public square, this is a private piece of cyberspace open to public comment. At times people who refuse to observe a modicum of decorum while participating in discussion here have their comments declined for publication. Cry me a river. No-one is obliged to even listen to anyone who is being a jerk, and certainly no-one is obliged to hand the nearest jerk a loud-hailer.
However, you and everybody else who doesn’t like being told that you are irritating remain as free to set up your own blog as you always were.
P.S. Further comments which are not directly on topic regarding the Dorrigo doctors’ strike will not be approved for publication in this thread.
You can come and argue the Free Speech toss with me on my own blog if you like: try this older post which still has comments open.
Dave55 #11:
It has been quite a few years since I was up there, Dave! Glad to hear that there have been some improvements.
wpd #12:
If you know any pressers you can
nagcoax into taking an interest, go for it.It used to be, and presumably still is, possible for Australian citizens to avail themselves of a free, (cert III from memory), distance mode (curriculum and assessment docs in mail) TAFE course in english as second language tutoring. With that sort of quality assurence framework support, I’d imagine there’d be some folks in dorrigo who could and would help the Doctor with whatever problem s/he is having with the local lingo.
There is also the logical possibility, (suggested and supported by fact s/he has 6 years service delivery at the coalface under the belt), that it’s not the Doctor’s English that’s the problem, but the English test bearing dubious relation to workplace reality, (except maybe the workplace of providing work for IELTS industry vendors.)
Better that the test being used is the (specifically designed for this issue) Occupational English Test( OET). A quick google shows there are 6 week overseas health professionals OET test preparation courses running out of the Migrant English Programme @ UNSWIL, Kensington. The next course starts july 28, ends Sept 5, and the certificate test is the next day.
Now if only Kev’s digital education revolution extended to funding UNSWIL, or someone, to deliver that medical services delivery support program via an online classroom/ tutor service, this particular hurdle to getting rural medical services happening could be practically addressed. I mean you can get dialup in dorrigo can’t you? That’s all it needs.
Quite possibly, although he hasn’t moved to Dorrigo yet, because he has no guarantee of an income there until his registration to practice is approved. He has a family to support, so presumably for the time being he is staying where he can get hospital shifts as he has done for the last 6 years.
Bingo.
Edited to add: ABC Online has picked up the story, with comment from Dorrigo’s
StateFederal MP, Luke Hartsuyker.The whole overseas-trained medical registration caper is a game whose sole object is keeping the wages of doctors in the stratosphere. From the point of view of the AMA and the specialist colleges, the health of the citizens of Dorrigo is a second-order concern. The worst political development in Australian history was the Chifley government’s compromise with the medical profession to amend the constitution to exempt doctors (and only doctors) from ‘civil conscription’. This prevents the government from, for example, bonding medical students to work in regional public hospitals for a specified period after graduation. The taxpayer spends literally hundreds of thousands on training each and every medico, who then gets to tell the public to get stuffed while s/he pockets upwards of 300 grand a year - all the while enjoying juicy tax concessions unavailable to the hoi polloi. Whenever debate touches on the sensitive subject of medicos’ wages, expect to hear a truckload of ordure about the sacred doctor-patient relationship and how it’s all about patient care. In mediaeval times the medical profession was referred to by the name of its main clinical standby - leeches. How appropriate.
This all makes sense as long as you remember the point of the current system. It functions to import doctors and then trap them within the junior posts of the public health system. These posts are only briefly held by local trainees on their way past to specialty-dom but are desperately in need of filling.
The problem is that general practice is specialty, medicare-billed practice. Hence, barriers.
There are three bodies involved in registration of an overseas-trained doctors (OTD). The first, The Australian Medical Council, runs examinations pitched at medical graduate level to ensure basic competency as well as checking qualifications. They have been variably recognised by the state medical boards as a required part of the process but, as of July 1st, all OTD will need to get over the AMC hurdle. The second is Medicare. If you want to practice as a specialist or GP you need a provider number. Medicare has chosen to devolve the responsibility of credentialling to the relative college. If the RACP says I am a physician, Medicare are happy. So, the second stage is to convince the College you are competent. The third body is the medical board. They variable repeat or consider the AMC process, although no board does independent examinations some check original credentials themselves. Most require an English exam.
Now. This is a written and spoken exam. We know that, having reached this point, the OTD has passed oral exams for the college as well as the AMC so their spoken english is usually adequate. The problem is their written english. Given that NO doctor can spell or write legibly (we dictate everything) this is a little unfair.
The nastiest little bind is that you can easily have your medical qualification fast track you for immigration then find yourself without the AMC or board recognising it at all. Plenty of African and Sub-continental doctors driving taxis in Melbourne, unable to even get the basic recognition to work as juniors in supervised positions. Sadly, often due to a reasonable assessment of their training to work under local systems (difficult to think about MRIs if there is not even ultrasound where you trained).
And, for the record, I didn’t dictate this.
This paper work stuff is crap.Figure it out,before I go into my sleepy state completely.What this doctor wants is some sort of respect for his” nerve condition”.Women generally go on about how men etc. cannot seem to look after themselves and go to Doctors etc.Well listen to the man speak,does anyone seriously think this Doctor is going to be able to engage with patients and clients well!?The women say his a good quack,the men are not so bloody sure.And I think I might have some insight that provides evidence of a big fish in a small pond,not recognising others are watching his movements.He goes the full hump of strike,a few days after [snip unsubstantiated insinuations ~tigtog].He has been very abrupt to many patients that I have got to know,in a manner that simply is a power game,rather than what a medical person should do under the circumstances.If this Doctor says the paper and,I thought computer usage is time wasting..is it because he has a problem there medically or otherwise,which would then suggest his health is no better than anyone elses!?.On the pay he gets,if that is the case,simply being overworked means there is also a failure on his part to work sleep diet and Vitamin D. He could redesign the quack surgery so at least patients sit a bit in the sun,if there some time.There were in the last year or two some high school kids who wanted to study medicine,if there was a legal provision,that allowed these type students to work at times,after school and in school holidays as office and nurse assistants,even insuring book work was completed ,or home patients ,or in some special cases hospital patients were basically communicated with..it could be wonderful and timely assistance of the young and inspired.I think there must be a fault in how he organisers the requirements of his practice,time use,or some such like.Local liked high school students could do the errands on finding out what was happening with patients.Seeing the high School and other schools in Dorrigo actually almost cover the Dorrigo area in relationships as Dorrigo area,simply increasing the possible range of Doctor assistance is entirely real to pursue.Finally the house,sure,money wasting,after all if I had of known about it,in my outrage now about this man,I would squat in it,to say this house is payment for services already rendered,beyond the call.
Philip Travers, you appear to be, as usual, confused as well as waging some personal vendetta. At least Dr Herb can write grammatical and properly punctuated sentences, coherently organised into paragraphs, which is more than you appear able to do.
Your laziness in composing your posts makes them virtually unreadable. Alos, in future, if you are going to make insinuations about Dr Herb, at the very least support them with links to the local newspaper articles on line, or your comments will not be published.
In any case, Dr Herb’s English competency is not at issue - it is the English competency of the newly recruited Doctor who is not yet living in Dorrigo that is at issue. (I certainly had no trouble understanding Dr Herb over the phone, German accent and all - he has been accredited and registered to practice in this country for many years.)
If Dr Herb’s bedside manner is sometimes lacking, perhaps the lack of time he has to spend establishing a friendly relationship is at least part of the issue, due to the demands of his daily roster (and the hours he works will be triply redundantly documented in order to support his Medicare funding - they audit doctors suspected of over-servicing regularly and rigorously).
As to your last statement - FFS think. Why would you squat in a property rented by Dr Herb and his colleague but belonging to someone else just because you are outraged at Dr Herb? Your logic is a mess.
The NSW government needs to act ASAP, before these good GPs collapse in a heap…this “inflexible bureaucracy” has been created partially by tight-arsedness & fear…originating from events/incidents/policies promoted & sometimes distorted by the sh*t stirring corporate media. It would be nice to think that the relevant/essential characters required to speed things up in the NSW health department & at a Federal level would heed the words, plees & advice of those w/ their nose to the grindstone in the local area rather than just radio jocks acting like Puppet Masters.
It’s a positive thing yer doin’ here tigtog…thumbs up to you.
I’ve cycled through Dorrigo on three occasions and can attest to the natural beauty of the area. I have also cycled down the Dorrigo Mountain road on two and a half occasions - the half being eight years ago (almost) to the day, when I failed to negotiate a tight bend, lost contact with the narrow and ragged shoulder, got into the loose stuff and fell with sufficient force to dislocate a wrist, gash a knee and generally bruise and scrape myself all over. Fortunately the vehicle which stopped to pick me up was travelling downhill to Bellingen where I was stitched up at the local hospital and conveyed thence to Coffs Harbour to have my left wrist reorganised.
I can sympathise, Paul. I had much the same experience on Black Mountain in Canberra a while back. I never got to thank the tourists who picked me up and conveyed me to the old Canberra hospital, where I remained for some days while they ran tests on my back to see if there was any damage there (there was, but it was minor in the scheme of fractured vertebrae). I bled all over their nice new velour-upholstered car - I hope they weren’t involved in any incidents where my blood turned up as evidence in some criminal investigation!
Tigtog - has anyone picked this up and run with it? I think you’re onto something here.
Top work TT.
It’s unfortunate that so many people seem to need anecdotal accounts like this to comprehend the (to me) obvious results of over-bureaucratisin’. But maybe this will help get folks thinking anyway.
SL, so far there’s only that short piece on ABC online as far as Google News Alerts can find.
FDB, thanks really should go to my private communicator of this matter, who prefers to remain anonymous.
Well then thanks to Guy Incognito.
FDB - Bureaucracy is the Australian Way. We want objective tests of competence as well as explicit, transparent rules without prejudice against those of any nationality. The only way to provide this is to have such Byzantine processes as we now have that fairly and transparently try to translate a simple prejudice into a complex system. It is easy not to recognise medical degrees from certain continents except from a select group of institutions. The problem is that Australian governments and Australians as a whole are not comfortable with that. Instead there is a multi-stage obstacle course designed to do the same job. This process has the advantage of staffing the public hospitals in the mean time.
The other option is for someone well informed to make common sense decisions that bypass due process on occasion. For instance, someone from the department would quietly phone the senior staff and ask if this was “our kind of chap”. This is the English way. Corrupt, opaque, elitist and not plagued by this particular form of nonsense. It has other forms of nonsense instead.
After the fuss around the fall of Prof Thomas Kossman and the various loud denunciations that his fast-track was someone else’s fault, the chance of a little corner-cutting appears unlikely.
Funny, true, depressing in equal measure Dr S. From your earlier comment:
“It functions to import doctors and then trap them within the junior posts of the public health system. These posts are only briefly held by local trainees on their way past to specialty-dom but are desperately in need of filling.”
Couldn’t other areas of Doctordom with similarly desperate needs simply be moved into the same category as public hospital residents? Say, a community that feels it’s underserviced could vote and apply to throw caution to the wind and at least get someone? Those communities who feel safeguards are important, are scared by horror stories or don’t dig brown people could choose to hold out for someone to negotiate the maze.
>>Dr. S “..the point of the current system (is) to import doctors and then trap them within the junior posts of the public health system”.. I just love it when doctors talk dirty…
Can someone clear me up on this further dastardly feature of the system… My preferred GP is an OTD, from some strange corner of the world like Leicester or Bristol or something. He happens to have a Ph. D. as well, which serves me well, cos he’s equipped and willing to talk back to God (aka procedural specialists) about what
and what doesn’t constitute good evidence-based care. My point is I’m getting excellent service, but i picked up a whisper somewhere that the (bulk-billing) clinic that employs OTD’s aren’t allowed to bill as much for their services. IE, there is a financial dis-incentive fo
FDB- Such a scheme does exist. One can get specialist or GP registration tied to a specific area of need. in fact, I would not be surprised if that is exactly the situation here. This IS the easy way. The person in question has no hope at all of getting a provider number to work in Darlinghurst.
I have a passing acquaintance with IELTS as well, through efforts to get postgrad students who hail from foreign lands.
My experience has been that IELTS scores have only a rough correlation with people’s English language competency, still less their competency in the areas most of interest - in my case, primarily, being able to write academic papers on software engineering topics.
Danny - Nah. Medicare pay what medicare pay. There is also a scheme for paying a bit more if you jump through some accreditation hoops but no-one comes round to check if your doctors have coal dust under their finger nails.
>>Dr. S “..the point of the current system (is) to import doctors and then trap them within the junior posts of the public health system”.. I just love it when doctors talk dirty…
Can someone clear me up on a further dastardly feature of the system… My preferred GP is an OTD, from some strange corner of the world like Leicester or Bristol or something. I picked up a whisper somewhere that clinics employing OTD’s such as him aren’t allowed to bill as much for their services. IE, there is a financial dis-incentive for practices to take these guys on. Can that be right, and if so is that across the board or a feature of clinics in areas of non-need?
As a bit of a related story of hope, that there just might be a possibility of getting some traction if you are persistent enough, and go beyond the bureaucracy…
There’s been an interesting (blog and petition-enabled) struggle going on the Kev’s own electorate, involving OTD’s (or International Medical Graduates as we sustainable-solutions-for-the-globalised-future oriented types think of them) not being allowed to take over a suburban bulk billing practice when the current owner retires. It means yet another local practice will soon close, much to everyone concerned’s (with exception of labor’s policy brains trust) alarm and displeasure. needmoregps.blogspot.com
In the latest phase of the campaign, Kev got cornered at his (saturday morning shopping centre) mobile office, and as a result he says he’s bumped the local activist proposal up to senior adviser level in his department
“… to investigate your proposal in detail with a view to a national methodology. I (Kev) have requested that he (senior adviser) obtain input from Department of Health and Aging regarding measurement of GP’s and non-specialists across metropolitan areas throughout australia. I (Kev) have indicated that a response is to be delivered to my office by 30 June”
Prior to that, the letter we got in response to the petition (and blog?) extracted evidence that he (Kev) was getting across some of the detail of restrictions to OTD’s practicing. It’s a start. There he also suggested that we “contact the (NHHRC) with suggestions for health and hospital reform” at talkhealth@nhhrc.org.au.
What’s good for Griffith might be good for Cowper. He’ll have to be worked on a bit more to get the
National Party Seatsnon metropolitan areas POV. On the other hand, Kev might be looking for an opportunity to show some non-partisan magnaminity.I just googled Thomas Kossman, Dr S. I had no idea about the history involved, and have really learned a bunch of stuff from this thread.
Very depressing.
I can’t really comment on Prof Kossman as, although I do not work at The Alfred, I used to and know many who do. However I will say that the reported billing arrangements are not that dissimilar to many around in public hospitals and the nature and scope of the medical report used to dismiss him is going to be contestable.
I have a strong feeling this is going to end up as rather sensational case law.
The Coffs Harbour Advocate has now covered the Dorrigo story.
Thankyou for taking up this Dr’s cry for help TT. I hope the MSM will pick it up and fly withit. Please pass on any news and my best wishes to Dr Horst and his p/t partner.
And Tig Tog whoever you are,and I know who I am,and most often as not,I am usually quite right about anyone that I decide to suggest something about.I also live in the area,listen to what people say.Had something to do,I suggest in the organisation of medical services in Dorrigo,and I will claim rightly and honestly and factually,because I am a local,that there is a lot of disdain about this man.Whatever you say about me,is bound to be wrong.For the simple fact,that I have no reason to have a go at this man,except seeing and hearing the end result of his practice.I dont go to Doctors,and there will be nothing in and of the medical archives that suggest any treatment,from Dorrigo medical practitioners. [snip unsubstantiated assertions] And finally TIG Tog,if you ever accuse me of a vendetta,again,and its certainly my politics,but not my actions,until,I get the evidence.See you in that neck of the woods.I think this Doctor should be investigated for over servicing.[snip unsubstantiated assertion ]Well known investigated fact,that the SMH did an article on. [Moderator note: but that you didn’t provide a link to, therefore until you do this assertion is unsubstantiated] [snip further unsubstantiated assertions] And you defending him,on the basis of a few statements I print,means you need to go to a psychologist,because you are sticking your neck out defending a [abuse snipped].
I have read Mr Travers’ posting with grave concern. I would be most interested to hear what facts his opinion is based on. I don’t know him, unless he published under a pseudonym.
I know that we are all prone to delude ourselves regarding our performance - nobody likes to think he performs below expectations. I actually wanted to know how I myself and my surgery performed, and we participated voluntarily in an external audit performed by the University of Queensland. The audit was based on patients of my practice being questioned randomly about their satisfaction and possible criticism. Neither myself nor my staff had any influence on the process which was completely anonymous and out of our hands. Without bragging I can say that we ranked far above average compared to other practices participating in the survey.
I have been registered as a doctor in Australia for more than ten years, and there are no complaints lodged against me (you can check such things on the Medical Board web site). I have obtained fellowship in the RACGP (that is, I am recognized as “specialist in General Practice”) and hold additional qualifications in Emergency medicine, Trauma management, and Surgery as well as accreditation in Mental Health to the highest level achievable in GP (level 2) after additional training in psychological intervention. I am still registered as a doctor in Germany and Norway, no complaints are lodged there against me either, and all this is verifiable even by yourself.
Over the past two years I extended and refurbished the surgery to a worth of A$200,000 - my taxable income last year from my practce was A$79,000 (because a substantial amount of my pre-tax income went, apart from refurbishments and new medical gadgets, into donations to organizations such as MSF, Greenpeace, Amnesty International) and sponsoring local kids from disadvantaged families. And no, no tax tricks pulled, my super fund has got some $140,000, and my house is still mortaged to 85% of it’s value. Yes, I drive an European car, but it was nearly 5 years old when I originally bought it and cheaper than new Holden. All my four children attend public schools.
We bought equipment that makes absolutely no commercial sense such as ultrasound scanner, 24 Hr blood pressure monitor, a defibrillator, and even mechanic ventilation equipment for emergencies. None of these very expensive gadgets will generate any income - zero. Ask our patients who had 24hr blood pressure investigations done by us - we didn’t charge them a cent because tghis is not a Medicare rebateable service. Neither the extension nor the refurbishment will generate any extra income - we have a monopoly position, people have little choice in coming to us, no need to attract them with extras.
The turnover of a medical practice seems huge, but so are our costs. I employ a total of 8 staff including myself, the total costs of insurances and mandatory fees exceed the average income, and I spend some A$40,000 annually in ongoing education and training (and no, that does not include fancy hotels, and I always go for the cheapest cattle class flight available on the net when I have to fly)
When I started out here, we were 92% private billing. After realizing how many people would not attend because of the costs we decided to “compassionately bulk bill” - that is, we bulk bill whoever states that he or she cannot afford to pay, and we take their word for it. When we decided that move some 4 years ago we were already fully booked, we did not want more patients, but we didn’t want anybody in the community to miss out on essential medical services. Now we are some 76% bulk billing.
And no, I am no saint, and I don’t want to brag with the above. I want to point out realities that I am happy for you to check before you badmouth me. I have no cosy rich background - I worked night shifts in an abattoir at the age of 16 o get me through High School, and worked all my way through university - and that is a checkable fact too.
I am not necessarily a nice or good person - in fact I am quite selfish. I practice medicine because I ENJOY doing it. My income allows me to spend time with my patents and not the other way around. It also allows me to positively make a difference for other people through sponsoring projects where no other funding could be found for them.
The only patients I know that hold a grudge against me are those who come demanding their fix of Opiates or Benzodiazepines, because we prescribe solely with the goal of improving a patient’s long term health and not to satisfy their short term urges. I heard that one of the doctors who practiced in town previously quit because he could not stand the constant cajoling for “quick fixes” any more, but same as I stand up against bureaucratic or authoritarian bullies, I am happy to stand up against all other bullies as well.
Now, feel free to take you time and check on what I stated here. If you still have any genuine criticism after checking the facts before you open your mouth I am all ears to hear it.
In reply to Danny’s post (#32): Medicare distinguishes between “vocationally registered” (VR) and non-VR doctors. VR doctors get a much higher Medicare rebate per item number in most cases.
“Vocationally registered” are those who have passed their fellowship exams with either the Australian College of GP or the Australian College of Rural and Remote Medicine, which usually requires some 5 additional years of training and exams AFTER you qualified as a doctor, unless you have been “grandfathered” into VR, that is you had demonstrable skills and experience before these rules had been introduced a decade or so ago.
In oder to maintain your VR status, you have to accumulate a specified minimum of “education points” in every three year period, otherwise you lose it. Education points can be accumulated by attending accredited educational events, and subjecting yourself and your practice to independent audits etc.
If an OTD (Overseas trained doctor) exceeds a minimum requirement in previous experience AND works in a designated area of need above a certain classification AND commits himself to a program that will lead to him obtaining VR within less than 5 years THEN he can apply under certain circumstances (RROMPS scheme) to get the same Medicare rebates as VR doctors.
Sounds good on paper, but in reality often does great injustice to highly skilled doctors coming from overseas, especially when they don’t understand how this system works.
This is in reply to Mt Traver’s post #41
Philip, I don’t know who you are and I thought I know all locals. I would be most interested to hear on what exactly you base your allegations.
If I have performed poorly or indeed behaved “incompetent” as you say you should make those facts public. I would like to know myself if and where I have done wrong. Nobody is perfect - so if you genuinely believe I have failed a patient I need to know.
If you feel I am “overserviceing” feel free to contact Medicare and tell them about your concerns. Alas, they keep quite sophisticated statistics and usually give doctors several warnings when they fall through the statistical raster before they investigate - and in the 6.5 years I have operated this practice I never received any such warnings or investigations. If in fact somebody analyzes our billing pattern they will find that we “underservice” the lucrative item numbers such as “care plans” that are the real money spinners in GP because we are so bogged down with acute cases that we can’t be bothered unless there is genuine urgent need for the patient in order to access subsidized other services such as psychologists.
However, if you have no facts to back up your allegations, I believe you should shut up now and consider yourself lucky that I do not sue people for “defamation” on principle - I believe in total freedom of information and communication. If you re-read your postings and re-check the facts you have at hand, maybe you should consider getting some psychological help (but maybe I just misinterpreted the drive behind your rantings).
Ah, and if you do that, you might find out from our local psychologist that I have provided her with free rooms in my practice so that the locals have timely and bulk billed access to her badly needed services. And no, I don’t get any financial gains from this whatsoever, up to now I haven’t even mentioned this fact to anybody. And yes, under the Medicare rules, due to u extra qualifications in that field, I would be entitled to provide such services (psychological intervention) myself, but I rather let her do it because I deem her a lot more competent in that aspect. Surprised?
PS: there is an anonymous complaints and suggestion box in our surgery at the reception desk - it is emptied every three months and assessed by an independent third party. This avenue is available to you too.
PPS: You will find that most people prepared to rise a stink against the authorities will only do so if they are very confident to have a squeaky clean personal background, because in such position we anticipate very nasty and under-the-belly retributions from the authorities in charge. Does Dr Haneef ring a bell?
Thanks for clarifying your position here, Dr Herb. I snipped the most egregious usubstantiated claims from Phillip Travers posts so as to leave only his opinions, which are his expressions alone. If it’s any consolation I believe that most readers simply skip over his posts just like I usually do, as they are so incoherent as to be hardly worth reading.
P.S. To Phillip Travers: I apologise for using the term personal vendetta, which I used loosely and did not mean to imply that you had a personal reason for your opinions against Dr Herb. I hereby substitute in its place own agenda.
Doctor H: Philip Travers is a person with mental issues. We usually don’t engage with him because he is clearly ill and we feel a bit sorry for him (until now, in my case). No-one is likely to take him seriously.
I simply do not care,what the Doctor has to say for himself,you Tig Tog or those who decide the Doctor is a reasonable man with too much work on his hands. [abuse deleted by moderator]
>>Dr. Herb (43) (if you are still with us, despite PT’s splenetics,)…
Thanks for clearing that up, it restores my faith in my sources after Dr S (35) suggested (I think, tho’ the coal dust reference throws me, Im not sure. ) medicare payments are an even paying field.
Between you and him we have to be the best medically serviced blog around, with exception of 6minutes, and we’re all in trouble if just having a second medical opinon is considered over-servicing.
Could I just encourage you two to visit, and perhaps comment, a blog started by a local GP in our neck of the woods, also devoted to the OTD/ GP shortage issue? We’re not remote from service supply in the ususal sense, but being in a secure labor seat ( The Prime Minister’s) means we don’t get much attention, that’s reserved for the swingers.
However, squeeky wheels and all that, it appears we have his ear.(latter 36) I think he has someone making sure Griffith doesn’t become the new Bennelong, and needmoregps.blogspot.com is probably being read by his office, which is why I suggest you comment there.
If you do revisit here, could you just clear up what I think TigTog (18) is saying - about an English test standing in the way - ” ..it’s not the Doctor’s English that’s the problem, but the English test bearing dubious relation to workplace reality..Bingo.”
That would be silly beyond words, and suggests Dr S is scarily right when he says (20) ““..the point of the current system (is) to import doctors and then trap them within the junior posts of the public health system”.
When I suggested “some folks in dorrigo could and would help the Doctor with whatever problem s/he is having with the local lingo” and TigTog countered with “he hasn’t moved to Dorrigo yet,”, I neglected to mention that the online classroom/tutoring i was suggesting applies quite easily to simple one-on-one interactions: skype, any number of messengers, and if you’re interested there’s at least a couple of ways that free 3-person voice-enabled, shared-interactive-desktop-whiteboard, and synchronised browsing ( for being on same page with curricular materials) can be accessed, even over dialup. That would mean you could drop in on the coaching sessions to see how things were going. I don’t thing that service would have a medicare item # however.
IE, youse dorrigites can help the potential doctor ( and his family?) with his english/whatever while he is where he is and before he does his test. I imagine there would also be positives from early contact when he eventually physically joins your community. Hells’ bells, if we can do transcontinental telemedicine consults, how hard is a bit of english coaching to organise, if the motivation is there?
Danny, while I can see how these ideas could work in theory, would you uproot your whole family from a city where you can continue to find hospital work (as you have been doing for the last few years) to a new town where you have no guarantee of being given the necessary registration to allow you to do GP work? Where will any income come from?
How is the family to pay its bills? I don’t know whether the doctor’s partner is currently working or not, but if they move then she would also have to give up any current employment with no guarantee of having a job at Dorrigo to take up when she gets there.
If I were the newly recruited doctor I could simply not financially justify moving to a new town with no income guarantee. So I very much doubt whether the methods you describe will ever get a chance to be implemented.
Danny and Dr Herb - Oops. Sorry. I don’t bill as a GP so haven’t looked at that end the voluminous item number register. If you get specialist registration there is only one set of numbers. The “coal dust” comment was a slightly obscure reference to the mining and industrial nature of the central and northern UK. Sorry. Ex-Londoner.
Dr. S: Slightly obscure reference? Rather.
Now I understand the coal dust reference, it reminds me of what we are really dealing with, (that and an aside from my B.Ch., Ph. D., GP about coming here as a Thatcher refugee): breaking the Painters and Doctor’s Unions’ stranglehold on health services provisioning. (local historical reference alert)
But does Nicola, or whoever replaces her, have Maggie’s brains and testicles, and will the Medico’s Unions come up with a Scargill?
Rosanna did a fair bit of lily gilding in her press club speech,( 1 hour consults she does in her practice she told us, so we were assured she had her feet on the ground… puh-lease, i thought 6 minutes was more like the average) and she looked like she almost believed her own rhetoric, but I don’t think she’s really that silly.
Mind you the South Australian fiasco was starting to look a bit likely. Those medicos must have plumber envy.
I reckon we might as well go all the way and just outsource medical (including stomatological) education to china, where they can do it for a quarter of the price. There’s no shortage of clinical material (aka patients) there, it’s the clinical trial capital of the universe, and they can actually develop and manufacture the medical devices (at global supply scale) that make “beds” 6 figure propositions. Medical education paradise really. These Rudd era Asia Union medicos will have to pick up some Trad Ch Med , and mandarin, along the way, but since chinese speaking populations are our second largest after english, that’s no bad thing.
I note 30 chinese universities have recently been licenced to confer MB BS to foreign students, curriculum delivered in English. That’s about 2000 seats, we should snap as many of ‘em up as we can at the bargain prices being asked, a decade of that would make a dent in doctor shortages, maybe just in time for the baby boom dotage.
It’s meant to be an export education earner for them, (no doubt they noticed what a magic pudding it’s been for australian universities) so we don’t have to worry our pointy little heads about poaching a third world medical workforce, this is all about medical workforce provisioning for the west as an industry, part of their 2020 higher education plan.
I’d be surprised if quite a few of the registrars of these newly minted chinese training hospitals hadn’t got their training here. That will be an increasingly common career trajectory for Australian Trained Doctors who come that part of the world.
Maybe Dorrigo should get a medical services proviosioning 10 year plan: $100k will cover course fees and campus accomodation for 3 doctors to be trained in China, $20 k a year.
If we’re going to treat what used to be services of the professions as just another market commodity, it’s the logical extension: get ‘em from whoever provides acceptable quality for the cheapest price.
The AMA and colleges could co-operate in some sort of quality assurence/ education consult role if they wanted to. Or just piss off to play golf with their accountants, and let people who recognise there is a massive global problem to be solved in the next decade or so get on with it.
Oops, that’ll be my spleen playing up.
Updatethe Medical Board has now approved the registration of the recruited doctor. Now they just have to get him sorted with a Medicare provider number and he can start providing care to Dorrigo.
Bravo, a victory for common sense, and persistence. It sounds like working in Dr. Herb’s practice will be very rewarding, at least in terms of professional development: I doubt many metropolitan gp practices give access to “ultrasound scanner, 24 Hr blood pressure monitor, a defibrillator, and even mechanic ventilation equipment for emergencies.”, and quite possibly a chance to use them, eventually.
TT, if you’re still around, and interested in australian medical (dis)service stories generally, you might like to check out this story of where corporatisation ( the evil twin of bureaucritisation) of medicine in Ausralia is rapidly taking us.
Only the 6minutes doctors’ blog seems to have picked up the story, which I would find puzzling ‘cept I’m of the opinion that the MSM is rarely up to the task of going beyond press releases.
I reckon Dr. S., if he revisited, would have some interesting and illuminating things to say, considering these closures are in his home town, I gather. Presumably closures on this scale will result in caseloads at hospitals’ EDs increasing beyond the already ludicrous.
Regarding the English language skills - the whole point was that our prospective doctor had no problems with the English language in the first place as far as everyday English and medical English go; his skills may not be enough to write powerful English poetry or literature or to teach English at an academic level, but anything below that he’ll do just fine, like myself (English was my 5th language to acquire and I learned it only late in life; most people capable of a medical degree should have no problems to pick up a new language in no time; my kids went to school under three different languages (German, Norwegian, English) and were performing well each time after a year or two (always public schools and no private language tuition): the language problem is an artifact only existing in the minds of monolingual bureaucrats
Regarding recruitment - there is little point to force highly educated professionals to work in an area they don’t like. There has to be adequate schooling for their children, adequate work for their spouses etc. I am happy in Dorrigo because it has a High School for my own kids, but I wouldn’t have gone to a place without High School because I don’t want to be separated from my children before they become adults. I am also happy because I want a rural life style by choice, though my wife sometimes misses the cultural options of larger cities badly.
Medicine, done properly, is quite demanding - it needs your full attention and not being distracted by worries about your offspring and partner. You will find doctors perform much better in a work environment they like. As much as I like to portray my investment in my surgery as something I do for the community, I did it at least as much for myself as well as to recruit and retain my colleagues: a wonderful work environment where it is fun to work in.
However, if we increase uptake into studying medicine - enable more people to do it y lowering the entrance bar and the financial burden - the more likely it is that doctors of all kinds will emerge who feel happy to work in environments like mine or even more remote locations. For some time, I enjoyed working in the arctic too!
Long term I firmly believe nothing will improve before we have free university education available for all those who can demonstrate knowledge and skills above a certain threshold - I welcome any short term fixes, but we need to start thinking about a long term solution too.
My home country is a fraction of the size of Australia and has basically no natural resources of value (Australia is incomparably rich in natural resources) - yet Germany has become a super power because under Bismarck free universal education was introduced and the universities opened to all who were prepared to put in the learning effort. It produced a society of engineers and scientists who produced prosperity despite wars and lack of resources, and a rich cultural environment for all to thrive. Finland, Holland, Denmark, Sweden and Norway did the same with similar results.
Would be much easier to to all this here! In Oz we have a better climate, more natural resources, less dense population, less poverty to begin with - it could be paradise if only we got rid of the overgovernance, bureaucratic incompetence and administrative waste, and especially this culture of envy where anybody who prospers and progresses above average seems to automatically turn into the enemy of the rest. We need a culture that rewards effort and enables everybody regardless of background and wealth to reach their full potential. Everything else will fall into place automatically.