COAG Reform Agenda for Health A Blurred Vision

Dr Haikerwal said the agenda is a blurred vision - strong on rhetoric but sadly lacking in detail.

"The AMA welcomes the National Action Plan on Mental Health in the belief that the $4 billion over five years is genuinely new money," Dr Haikerwal said.

"It looks on the surface that the States and Territories have matched the Commonwealth commitment and this is good news for people with a mental illness.

"Our response would be much more effusive if there was more detail attached to the Plan. We are told there is a detailed Plan but we have not yet seen it.

"We need to see how the Plan is to be implemented - especially the role of GPs and private psychiatrists before giving total support.

"However, most of the AMA's concerns are with the Health Workforce initiatives.

"The provision of a significant number of new medical school places over recent years is fantastic, but we are yet to be convinced that all the States are prepared to make the necessary matching financial and resource commitment to provide the clinical training for these new students throughout their course. It is vital that the AMA and the medical Colleges are involved in this process.

"The AMA is concerned that State funding promises already announced may not be enough to cover the number of new students entering their systems.

"It also looks like COAG has agreed only to guarantee intern places for HECS students, with nothing for the full fee paying students, which will leave them high and dry half way through their training.

"We also need to be convinced that the States are serious about their commitment to their medical workforce by ditching any plans they may have for role substitution in the short to medium term.

"If they create a hybrid health system with non-doctors doing the work of doctors then they will have a lot of highly trained graduates in a decade confronting a dramatically changed health landscape - a poorer quality system.

"The AMA supports national accreditation and registration systems for doctors, but we are opposed to systems that bundle doctors in with everybody else under the heading of 'health professionals', but that's what COAG has done.

"It would be a world first in health to have a brand new huge bureaucracy that has a positive impact in delivering quality health care.

"This is dumbing down and de-medicalising the health system and it erodes quality.

"We are disappointed that COAG did not consider the AMA's plan to get young doctors to country areas, with the Federal Government sticking with its unpopular and draconian unfunded bonded scheme.

"There is some good news on the medical training front, however, with a commitment to expand specialist medical training into a wider range of clinical settings - including the private sector."

This is a quick analysis of some of the COAG Health Workforce announcements:

Medical School Places

• On top of the extra 1700 medical school places already announced in the last few years, 205 more places will place even more strains on the limited resources available to provide medical students and doctors with an adequate medical education
• The COAG announcement is short on detail about how the States will guarantee enough clinical placements. For example, by the end of the decade there will be a shortage of 210 interns places in Queensland, and a shortage of 170 in Victoria alone
• The COAG guarantee of intern places is restricted to Commonwealth-funded medical school places - are full paying students being left to fend for themselves despite paying $200k plus for a medical degree?
• We need more than empty rhetoric from State Governments. They will need to invest considerable resources to ensure that students/doctors will be able to spend time in hospitals learning their trade by seeing patients with a wide range of conditions
• If doctors don't get this experience then they will have significant gaps in their skills and knowledge. Once these are lost in one generation of doctors, it is very difficult to bridge this gap for future generations
• States don't have a good record on taking the training of doctors seriously in recent years. They have run down teaching hospitals, and protected training time for junior doctors is becoming a privilege, rather than a right, and specialist trainees no longer see many conditions that should be a fundamental component of their training. The States must therefore build trust by working with the profession to develop concrete strategies to address the looming shortage of clinical placements
• The Commonwealth must also contribute by making sure future health care agreements provide more funding for training

Bonding

• The Federal Government is expanding the bonded medical school places scheme, even though overseas evidence shows it won't work
• The Government has ignored the call to scrap bonding and introduce an incentives based program to get more young doctors into rural areas
• Rural doctors do not support unfunded bonding
• The Government is sending a message that if you can afford it, you can buy a full fee paying place and can eventually practice wherever you wish. If you are poor, you may find yourself locked into a bonded place
• Bonding suggests that certain areas are to be avoided
• AMA believes a scheme allowing medical students and graduates to commit to a period or rural service in return for relief from HECS debts combined with an incentive based rural retention payment would draw on a broader pool of potential doctors, get doctors into rural areas much earlier than current bonding arrangements, and would encourage participants to ultimately make a long term commitment to rural medicine.

Overseas Trained Doctors

• The AMA welcomes the commitment to a national assessment system for overseas trained doctors, but is very cynical about this promise. Current efforts by the Commonwealth and the States to look at standardised assessment systems are being frustrated by patch protection to the extent that even agreeing on a simple form is proving tortuous
• OTDs deserve much better, and unless nationally consistent rigorous assessment processes are introduced patient safety will be at risk.

Specialist Training

• The AMA welcomes the commitment to expand specialist medical training into a wider range of clinical settings - including the private sector. This will allow specialist trainees to improve the breadth and depth of their training and is a very positive move
• This move is essential if we are to cope with massive increase in output from medical schools.

Comments on other issues:

Indigenous Issues

• The AMA welcomes the approach outlined to address violence and child abuse as it appears a balanced and broad-ranging approach. However it lacks concrete indicators for which states and territories and the commonwealth should publicly report against in order to measure progress
• The generational commitment remains vague and states and territories need to identify specific actions that they will take in this area.

Climate Change

• It is encouraging to see the seriousness of climate change recognised through its presence on the COAG agenda
• Any plan to reduce greenhouse gas emissions needs to include significant renewable energy targets.