DOOGUE:            ... And the shortage has been highlighted in current debate about medical indemnity insurance.  So this morning we're going to have a crack at that too, with the help of the Vice President of the Australian Medical Association, Dr Mukesh Haikerwal.

My guest now joining us is the Vice President of the Australian Medical Association, Dr Mukesh Haikerwal.

Dr Haikerwal, these are not new issues for you, are they?

HAIKERWAL:      No, Geraldine, good morning, thanks for the opportunity. 

No, obviously the issue of workforce shortage has been something that we've been highlighting, firstly during the more recent Medicare - [inaudible] Medicare package debate - but prior to that. 

In fact, we are very pleased with the progress of AMWAC now, and obviously the concerns that were expressed earlier we expressed a few years ago regarding the GP part of the AMWAC brief.  And [inaudible] the benchmark that was used came out with the conventional wisdom of the time that we had an oversupply of doctors and the more doctors there were the greater the impost on the Medicare budget and therefore the idea was to reduce them. 

Allowing doctors to come from overseas not only was restricted by the exams that you've got to pass, which of course we agree with, but also the fact that people used to get negative points for coming across.

And if people came across to Australia as a spouse - they actually didn't declare the fact that they were medical for fear of having problems getting into the country.  So there are a variety of different sort of people in the community that can be accessed to work, and we have a problem where the people work in the workforce - the participation rate of our doctors is down to 64 per cent.

And this is ...

DOOGUE:            Say that again, please?

HAIKERWAL:      The participation rates - the number of doctors working equivalent [inaudible] think that there's about 64 per cent of time available.  Of, say 100 per cent of doctors are working, 64 per cent of their time is available.

DOOGUE:          At any one time?

HAIKERWAL:      At any one time, because of the change in demographics, the change in working patterns.  People talk about the feminisation of medicine with more than 50 per cent of graduates being women and more than 50 per cent going into GP training be women.  But of course it's not just the feminisation, it's also what I'd call the socialisation where the guys are looking to work more reasonable hours as well.

And the really scary one is that one in six people are actually leaving the medical workforce, and ...

DOOGUE:            Why?

HAIKERWAL:      Well, there are a variety of reasons.  You mentioned one earlier - indemnity - and people's exposure.  Costs of compliance with multiple levels of government, the actual administrative time and [inaudible] that's involved people just getting fed up of not actually having time to do the medicine because they're too busy doing the paperwork.

DOOGUE:            Mmm.  But look, can I just interrupt you both, in a way.  Because I think a lot of listeners will be hearing this and, remembering the statistics, for instance, that Senator Helen Coonan brought out, I think just last week, talking about the real income levels of specialists and the average GP, that I think listeners will say, look, is this special pleading by the medical world to get more people into training courses, to get more concessions for doctors, should we genuinely be worried?  Or are we being manipulated?

HAIKERWAL:      Well, could I answer that first, Geraldine?  I mean, if you're looking at a business model and you're trying to talk about supply and demand, if that was the reality we'd say no, we don't want any more people, we don't want to train any more, because the fewer there are the better it is for us, we can drive the prices up.

But we're simply not saying that.  What we're saying is across the nation, in every speciality - and it's not just rural and remote, it's also [inaudible] suburban and some metro areas - we're crying out for more medical personnel.  Because the degree of expectation with the community for the quality and number of medical services is increasing.

DOOGUE:            So, is patient care being compromised, do you believe?

HAIKERWAL:      I believe if we let things continue the way they are patient care will definitely be compromised.  Currently we're struggling on and doing a pretty good job, not only in general practice but in our public hospitals.  We've seen across the nation the public hospitals struggling under the load that they're encountering - carrying through.  But there's no fat left in the system and there's no fat left in the training areas either.

DOOGUE:            ...  Mmm.  So isn't that an obvious answer?  Mukesh Haikerwal, does the AMA seriously want to tackle that?

HAIKERWAL:      Yeah, look absolutely, Geraldine.  I mean it was again an interesting experience on the weekend, there was a GP summit where the four major GP groups got together with members of the community who are basically involved in general practice.  So not just the medicos but also the nursing staff, the allied people, the practice managers and so on.

And one theme that came through quite clearly throughout that whole summit process was the need for the primary healthcare team.  In other words a team - not just the doctors but also supported by allied health workers and of course nursing people as well.

And, look, that model is fine.  We're very support of the collaborative work model with all the professionals, especially nursing staff, because it's a very good way to go.  And certainly that's worked.

What we do have a concern about, and certainly have talked about previously, is where it's complete substitution and independent workers in these areas.  Because we believe that doesn't bring the same level and access of care as we'd expect across a country.

DOOGUE:            And look I couldn't go - I've just got to have another minute, or cadge another minute.  Our Monday economist, Peter Martin, quoted Geoff Richardson, a very prominent and well respected health economist, I think, two weeks ago on our program talking about death rates and the proportion of GPs and specialists serving a population, that the ideal, as it were, was six per 10,000 of population for GPs - whereas the range in Australia was one to thirteen - and specialists two per 10,000 - and the range was nought to 28.  Suggesting, Mukesh, that we need a lot more useful debate, possibly, about the ideal supply and demand ratio between doctors and the population.

HAIKERWAL:      Look, there's no doubt about that and we're very deeply engaged in this process supportive of the AMWAC process - our own Secretary-General of our organisation sits on the AMWAC committee and is actually currently in Europe at an international workforce discussion on medical issues.  And they'll talk about things like, you know, sucking in the doctors from countries where they need more like - and the WONKA* world.  WONKA is an international GP organisation - national - international GP organisation that passed the Resolution of Melbourne, deploring the taking in of people from countries where they're needed more.

And all these issues, some of them were very keen to progress with AMWAC and certainly with the government.  And it's not just a matter of wringing hands and shouting about it, it's actually getting solutions - real solutions - proper training opportunities for our students, not duding* our students by getting them into medical school and charging them and then making them go to places they don't want to go to, and areas like that.

DOOGUE:            Okay, this is a debate that will go on.  I notice every weekend there seems to be another meeting of doctors.  I don't know what it says about the issues of the time.

Ends