AMA Response To Productivity Commission Position Paper: Australia's Health Workforce

Dr Haikerwal said the AMA will examine the paper more closely over the next week before responding formally to the Productivity Commission, but the AMA has a few immediate concerns.

"The report has squibbed the issue of Commonwealth/State health relations," Dr Haikerwal said.

"This key obstacle to health service delivery efficiency hardly rates a mention. It beggars belief that the strained relationship between the Commonwealth and the States over health policy and funding is skimmed over. Public hospital funding deserved a whole chapter on its own.

"There has been no attention given to the fact that the total number of doctors who can be trained is dependent upon the resources such as public hospital beds and theatre times provided by the State health systems.

"The report has also squibbed on measures to encourage doctors to stay in the workforce. Certain proposals in the report will actually discourage retention of doctors and will worsen the current medical workforce situation nationally.

"Although the report borrows from the experience of other comparable countries, it does not borrow from their retention experiences. This is a major oversight.

"It is disappointing to say the least that the report seems to favour a committee-led 'red tape' approach to the resolution of medical workforce issues.

"A number of new committees are recommended on top of an existing heavily committee burdened system.

"Some are intended to replace existing committees but experience shows there will be a new layer of committees adorned with countless bureaucratic hurdles to keep doctors away from patients. It is all about top down reform through committees and desk jockeys. It is the AMA view that the best health reform is bottom up from the patients and the doctors and other health professionals working daily delivering their care.

"Another criticism is the lack of emphasis on the quality and safety of care, and the report does not acknowledge the level of excellence achieved so far.

"On a positive note, the report acknowledges that the medical practitioner, the highest trained health professional, must be in control of any task delegation sought by other groups within the MBS framework.

"The most significant change to health delivery in recent times has been the incorporation of practice nurses into General Practice under the supervision of the GP through the introduction of specific practice nurse item numbers, which are accessed by GPs.

"It has been a silent but significant change, which has enabled the GPs to refocus the way their practice works, while still maintaining high standards of care for their patients. More needs to be done to promote this type of model.

"The report's recommendations involve a substantial shift of funding away from States and households to the Federal Government. But the Federal Government already has difficulty in funding the current MBS to adequate levels, so we are sceptical that it will do the job at even higher funding level requirements.

"The proposed new national accreditation body is another new committee with broad powers over the work done by Medical Colleges and others - and it is an area which needs careful consideration before it is endorsed. Taking control away from the profession would almost certainly diminish the quality and standards of medical training.

"A greater coordination of medical undergraduate and postgraduate specialist training, with appropriate recognition of incomplete training, is desirable - but the concept of articulation of all health workforce training is a complex area with loads of potential to move standards, quality and safety in the wrong direction.

"More effective national registration of medical practitioners is to be supported, given our geography and demography, but previous attempts led to bureaucratic impediments that discouraged and disheartened doctors who just wanted to get on with the job of caring for their patients.

"The AMA welcomes the recognition that the provision of improved education and training opportunities in rural areas, along with the recruitment of students from rural backgrounds, is the key to building a sustainable rural workforce.

"Another positive from the report is the recommendation of the need for more rigorous examination of rural workforce programs to ensure that they are effective," Dr Haikerwal said.

The AMA will submit a more detailed response to the report by the 11 November deadline.

Background

Australia has a first class health system that provides a large number of high quality medical services at reasonable cost with good access - 220 million at an average of $49.50 fee charged per service. Our doctor/population ratios are not high when compared to OECD countries, we are experiencing a shortage of doctors at present, and the Government has put in place a strategy to remedy that shortage in the longer term, but there is a lag. Australian patients have confidence in doctors to provide good care and to be effective advocates for them in negotiating their way through the health system.

We judge these reports and their recommendations on the basis of how they will impact on the quality and safety of health care delivery, whether they will encourage greater coordination between health providers on the ground (team based approach with doctors at the centre), how they will lead to better outcomes and encourage innovation and technical advances, and how they will encourage doctors to remain in the health service delivering high quality services to patients.

We also judge them on the extent to which they acknowledge that health generally, and health workforce issues in particular, take place within a very complex Commonwealth/State - health/education environment, which can sometimes be an impediment to progress and efficiency.