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.

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.

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.

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.

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?

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?

“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.

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.

I have a strong feeling this is going to end up as rather sensational case law.

Very depressing.

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 Seats non metropolitan areas POV. On the other hand, Kev might be looking for an opportunity to show some non-partisan magnaminity.