Dr Capolingua discusses OTDs and Indigenous health issues - 2UE Breakfast, Mike Carlton and Peter Fitzsimons

PETER FITZSIMONS: Some new issues emerging. Why do we have all these foreign-trained doctors in Australia? Why do we need them? Are they any good? Are we not training up our own?

MIKE CARLTON: Are they a security risk? And too, also in this area, the big push in the Northern Territory on Aboriginal health. We're going to look at all that this morning. The new president of the Australian Medical Association, she's a GP from Perth, but she's over here in the east at the moment, her name is Dr Rosanna Capolingua. Good morning.

ROSANNA CAPOLINGUA: Good morning.

MIKE CARLTON: Where do we start? Let's start with the Aboriginal health thing because you're meeting Tony Abbott today, the Federal Health Minister, right?

ROSANNA CAPOLINGUA: Yes.

MIKE CARLTON: Where are you going to find the doctors and the scientists and the pathologists and the nurses to do this thing?

ROSANNA CAPOLINGUA: Would you believe that about five to six hundred doctors have actually put their hands up already wanting to contribute to the program, to be involved and go out into the Northern Territory and work in the communities?

PETER FITZSIMONS: Really, and live in the communities and be there for six months, or is it a two-week stint?

ROSANNA CAPOLINGUA: No, we don't have doctors sitting around in Australia who've got six months up their sleeve, but we've got lots of doctors who are very keen to do some work in indigenous health, who are able to manoeuvre a couple of weeks off at a time; maybe on a rotational basis, maybe some can give us three months.

We're going to work out how we can make sure that those doctors are the right doctors to go, give them the up-skilling if they need as far as working in indigenous health, then work out the plan to deliver them out, to take the doctors to the communities.

MIKE CARLTON: All right. But you need all that medical backup, too, you need pathologists who can perform tests, medical technologists who can interpret, you know do the tests, and all that sort of stuff.

ROSANNA CAPOLINGUA: That's not an issue.

MIKE CARLTON: Not a problem.

ROSANNA CAPOLINGUA: The capacity is there for that particular part of the work. It's the doctors out there at the coalface, they're the ones that we need to resource.

MIKE CARLTON: Right. Now, the first proposal was the compulsory testing and a compulsory sexual abuse examination for every Aboriginal child under the age of, I think, 16. Is that going to work? That can't work, surely.

ROSANNA CAPOLINGUA: It wasn't going to be a compulsory sexual abuse examination. There was talk about it being a mandatory child health check, but that's not the case. What we want is for the indigenous families to want to bring their kids to the doctor. This is good for them to do that. So it's got to be something they desire to do.

MIKE CARLTON: All right. But do you think that can be done, that it is going to work?

ROSANNA CAPOLINGUA: I think we need to get away from all the negativity about it. This is something that it's a once in a lifetime opportunity maybe to get us, get the doctors out there into communities. Let's let them know that this is a good thing, that we're going to intervene, we're going to help with the kids, going to find out what's going on and put in some long-term management, as well. It's not a flash in the pan fly-in, fly-out episode.

MIKE CARLTON: Yeah. Well, it looks a little like that at the moment, they don't seem to have funding set aside for a long-term thing. Does that worry you?

ROSANNA CAPOLINGUA: We are very determined as doctors. If my doctors are going out there, they're going to be seeing kids and if they find things wrong with the kids, it's going to need management. If there's sickness or deformity or disability, they're going to want to make sure that management plans are put into place, and I've told the health department that. And if those plans aren't put in place, then the doctors will feel clinically compromised and they won't want to be there.

MIKE CARLTON: And you'll kick up a stink?

ROSANNA CAPOLINGUA: I certainly will.

MIKE CARLTON: Good. Are you a good stink kicker-upper? You good at that?

ROSANNA CAPOLINGUA: I'm pretty good at it when it needs to come.

PETER FITZSIMONS: Are we training enough doctors in this country?

ROSANNA CAPOLINGUA: We haven't been, and hence, we've got the problems that we have today with the workforce and the need for overseas graduates. There's been a couple of decades of philosophy of not increasing medical school student numbers.

PETER FITZSIMONS: Why not? What's driving that?

ROSANNA CAPOLINGUA: In the past it's been about money. I think there's been a belief that firstly, we didn't need them, and secondly, that if you have more doctors it'll cost the Government more money. It's like if you provide more food, Australians will eat more. It's ridiculous.

It's about cost containment. Now in the last couple of years, we've seen an increase in the number of medical schools and the increase in kids, and by 2012, we'll have doubled our graduate completion for doctors.

MIKE CARLTON: But at the moment, isn't it right that I think almost a third of doctors in Australia now are foreign trained? Is that right, about 33 per cent?

ROSANNA CAPOLINGUA: Are foreign trained, yes, and there are about three to five thousand on temporary visas and about 50 per cent of the rural workforce in Queensland are overseas-trained doctors.

PETER FITZSIMONS: Really?

ROSANNA CAPOLINGUA: It's a big thing.

PETER FITZSIMONS: It is a very big thing to become a doctor. My niece has just become a doctor and it was three years undergraduate, then five years now registrar, the whole thing. I mean, it's I think eight or nine years before she got a stethoscope and a wage.

ROSANNA CAPOLINGUA: It is indeed, it's a big commitment. So the people that choose to do medicine are really generally pretty committed people over time, and it's still competitive to get in. We need them and when they get out there now, we're going to have to train all of those new people. We haven't got the positions to do that yet.

MIKE CARLTON: Are we sure that these foreign-trained doctors are indeed trained, that they have the skills necessary? I mean, look at this fellow, Jayant Patel, the man they call Dr Death in Queensland. That is a worry.

ROSANNA CAPOLINGUA: The medical board registration checks are primarily to determine the clinical competency of the doctor. In other words, firstly the university, their medical school or their primary degree is even credible or real; that sometimes is presented to us and it's not real.

That their training, specialist training is again credible and real. That their positions and work that they have in the past is verifiable. That we've got reports on that. That their reputation is checked. That there are police checks. There are a whole number of processes in place.

Patel was an example of someone who got in, was registered to do a particular role, and then when he got employed in the hospital, he was elevated to a position above what he was registered for.

MIKE CARLTON: Yeah, but he's not the only one. There was that woman doctor, Dr Soo there in the western suburbs who was performing these appallingly botched abortions and so on. How does she get through?

ROSANNA CAPOLINGUA: Yeah, the registration processes do their very best and they've certainly been improved over the last few years. There's been a lot of review and scrutiny and auditing, self-auditing by the boards of their processes to get it right.

MIKE CARLTON: The fact is that we couldn't exist in this country without foreign-trained doctors now, right?

ROSANNA CAPOLINGUA: We wouldn't have been able to over the last 10 years or so, definitely.

MIKE CARLTON: Is that a failing of politicians?

ROSANNA CAPOLINGUA: I think it's been a failing of the lack of investment in medical school places the decade prior.

MIKE CARLTON: Yeah, okay.

PETER FITZSIMONS: What about other issues you're facing? One that tends to bubble up constantly is the lack of doctors in rural, regional areas. I think it was Tumut or Temora…

ROSANNA CAPOLINGUA: Temora, yeah.

PETER FITZSIMONS: … not long ago advertised and said, half a million dollars if you'll come and live here and be our doctor.

ROSANNA CAPOLINGUA: Yeah, that's also a very real problem. People living in rural communities engage in that issue every day. Is our doctor here, is he going to be staying, have we lost one recently? Rural Australia has its innate difficulties and its innate beauties, as well. Being able to live in a rural town and be a doctor in a rural town is an all-encompassing role; you're really it 24-7, there's no doubt about that, and you have to provide a variety of skills.

So I think we need to think about marketing rural Australia medicine as a unique experience in your clinical career. Put the positives there, make doctors want to go there, but make sure that we look after them when they get there, as well.

MIKE CARLTON: The health system generally always seems to be getting by on a wing and a prayer, doesn't it? Shortage of beds, shortage of nurses, hospitals are simply unable to cope, ambulances being diverted. Are we still in trouble here?

ROSANNA CAPOLINGUA: Yeah, we are still in trouble here. Okay, it's pretty good, it's better than some other countries, but we're very prosperous here. There's no need to be falling short when it comes to our health system. The public sector, all those things you've described, we need to be investing money in health now for the long term and the future, not trying to strip it out.

MIKE CARLTON: The Government has a massive budget surplus of billions, why aren't we tipping that money into really decent hospital services for ordinary Australians?

ROSANNA CAPOLINGUA: That is the question, why aren't we? We should be.

MIKE CARLTON: Well, do you say that to Peter Costello when you meet him at wherever you meet?

ROSANNA CAPOLINGUA: I say it everywhere I go, at State level and at Federal level.

PETER FITZSIMONS: To become the president of the AMA, did you stand against somebody, put out a platform, these are the issues that I think are important?

ROSANNA CAPOLINGUA: I did have to do that, yes.

PETER FITZSIMONS: What were the issues that you were beating the drum on, particularly?

ROSANNA CAPOLINGUA: There are a number. Indigenous health was one of the big things. The life expectancy of Aboriginals, of indigenous people is 17 years shorter than non-indigenous people, and that's just a ridiculous statistic, and we can see there's some action trying to happen there. There are issues around COAG reforms, the national registration and accreditation. The public hospitals is a huge thing and affects many of us every day.

MIKE CARLTON: Are we still tied up in this battle, this blame game of the states blaming Canberra and Canberra blaming the states in the system?

ROSANNA CAPOLINGUA: I reckon that's an excuse for not getting a good accountability in the states as well. The states are right there on the ground delivering the services. We have to point the finger at them.

MIKE CARLTON: You got to point to finger at both. Every time there's a problem, you do an interview and you talk to the State Health Minister, Canberra's done this, they haven't given us the money and they've gone back on their commitments. You talk to the Federal Health Minister, he says, the states have got to do more, they haven't got the money and we've been giving them money, they're doing nothing with it.

PETER FITZSIMONS: And going into every election each government says, there'll be doctors reigning from the skies. There'll be money flooding in.

MIKE CARLTON: We've got to solve this problem of the state/federal…

ROSANNA CAPOLINGUA: If you look at state health systems, there's a lot of money invested in reviews and bureaucracy and plans, and not enough put at service delivery, at those nurses that we desperately need, at doctors, at the allied health professionals, at the infrastructure in the hospitals. So let's get rid of all the layers of officialdom and put the money where the patients are.

MIKE CARLTON: Absolutely. Good to talk to you.

PETER FITZSIMONS: Just one more question. I've just got a very sore elbow there.

ROSANNA CAPOLINGUA: I'll see you later.

MIKE CARLTON: Because he's overweight, and he's overweight, if he'd lose a few…

ROSANNA CAPOLINGUA: Elbow doesn't look overweight.

MIKE CARLTON: Nice to talk to you. Thank you.

ROSANNA CAPOLINGUA: Thank you.

MIKE CARLTON: Dr Rosanna Capolingua, the new president of the Australian Medical Association.

Ends