Dr Kerryn Phelps, AMA President, with Howard Sattler, Radio 2SM
SATTLER: We have talked a fair bit about it because it affects so many people, about the proposals, and they just sort of float these things before they announce them in the Budget. The Federal Government is planning to try and cut between $1.5 billion and $2 billion from its Pharmaceutical Benefits Scheme and one way they're going to go about that is they're going to have people confined to using generic or cheaper drugs. They're going to increase the cost of medicines by up to $8 for general patients and $1.50 for concession patients, mainly pensioners who can ill-afford the cost of drugs anyway, but there you go, they're the vulnerable victims. All this to try and balance the books.
Now, ingredients of this also include chemists having to ring a bureaucrat to check what kind of drug, whether they're going to offer a cheaper drug instead of one that's been prescribed by the doctor and also the doctors having to get on the phone when they're with their patients and getting approval to prescribe certain drugs.
I want to talk about that with Dr Kerryn Phelps who is the head of the Australian Medical Association about that and also a story that caught my eye today about an alarming shortage of rural doctors. It's only going to get worse in the next 20 years.
Hello, Kerryn, how are you going?
PHELPS: Good morning, Howard.
SATTLER: How do you feel about having to be sitting in your surgery with a patient in front of you and then having to ring a bureaucrat and getting approval to prescribe a drug?
PHELPS: We already have to do that for a number of drugs and I have to say it's an insult to your training and the level of responsibility that you feel to your patients, to have to ring a clerk, tell them what the patient's condition is, which I think has privacy implications, and ask permission to prescribe the drug that you know is in the best interests of the patient.
SATTLER: So you ring a clerk, you don't ring a doctor? You don't ring a doctor?
PHELPS: No, you ring a clerk. It's heavy-handed bureaucracy and it's an insult to doctors.
SATTLER: It looks as though it's only going to spread.
PHELPS: They are looking at it as one of the ways of controlling what they want, they, being the Government, want doctors..
SATTLER: You mean the Treasury?
PHELPS: Yes, a part of government, Treasury, yes.
SATTLER: It's all to save money. Government!
PHELPS: It is and, I mean, it's frustrating because doctors, if they are given independent evidence of what is in the best interests of their patients, will prescribe accordingly. We have ample evidence of that and certainly in the case of the cholesterol-lowering drugs, the statins, we know that if people are properly selected for these medications, in conjunction with exercise, diet, lifestyle modifications, that you can prevent heart disease, decades down the track. So if we're making false savings today, we could be paying for it in the future.
SATTLER: I'll come to that factor in a minute because I've got personal interest in this. I don't use these drugs anymore but I had an involvement with them. Now, the point here too, is that they're insinuating, this is the message I'm getting between the lines, that you doctors have got some sort of deals going with drug companies where you are prescribing drugs that may be the most expensive drugs when you really don't have to.
PHELPS: I think that all sorts of reasons and excuses are being floated to justify heavy-handed bureaucracy and I don't think many doctors or patients would wear an excuse like that because, just think about it, I mean, I'm sitting in my general practice surgery, what I'm thinking about is what's best for the person sitting in the chair next to me, I'm not thinking about, 'Gosh, I can prescribe a really expensive one and that will really get up the nose of Treasury'. That's the last thing on your mind.
We always bear in mind cost-effectiveness, for the patients and for the system, but if a more expensive drug is, in our opinion, better for the patient, then that's the one we'll select and I don't think that it's up to a distant clerk in the Health Department or in HIC to tell us what they think is best for our patients.
SATTLER: I used to take anti-cholesterol drugs and I tried three different ones. The one that worked best was the most expensive. It just turned out that way.
PHELPS: That's often how it happens and I don't think we should have to ring and ask somebody's permission when we've gone through the history-taking process, we've examined the patient, we know them well, we've tried out perhaps a number of different medications and worked out what is in their best interest. I just think that we really should insist on more faith in our doctors.
SATTLER: Onto where you're going tomorrow and that's to Tamworth, I believe.
PHELPS: I am.
SATTLER: This is a conference about the crisis revolving around the shortage of country doctors, is that right?
PHELPS: It is. It's rather extraordinary because a couple of years ago we were being told that restrictions had to be placed on the numbers of doctors, particularly entering general practice being trained for general practice because there was this big oversupply of GPs, big oversupply of doctors, and that all we really needed to do was to provide incentives for doctors who were in the city, who were just waiting to be lured to the bush and the rural medicine crisis would be solved.
The AMA commissioned Access Economics to conduct a very elegant and far-reaching survey of rural workforce numbers and metropolitan workforce numbers and what it showed is that there is not this great hidden workforce in the city that's just waiting to be lured to the bush.
Now, what this means is that people who are in the bush are finding it tougher, they're finding the going is tougher as time goes by. The ACCC, with its scaremongering tactics around the bush, about rosters and doctors being able to cooperate in various sorts of arrangements to take some of the load off them is creating an unnerving situation for many, it's making it less attractive. We are really seeing, I think, a looming crisis in the medical workforce in the bush and many people where I travel around in country Australia come up to me and they say, 'what can be done about getting more doctors to come out into the bush'? We're trying. What we need to do now is use this information that we now have to more successfully plan our medical workforce for the future.
SATTLER: I'm looking at these figures here quoted in 'The Australian' newspaper, today. They're saying there will be a shortage of more than 10,000 doctors in rural areas within 20 years. Is that right?
PHELPS: That's right and what makes that particularly chilling…
SATTLER: That's unsustainable. You can't … terrible.
PHELPS: It is terrible. And what makes that particularly chilling is that it takes 10 years to train a GP or other specialist and so unless we do what is needed to be done right here and now, then we are going to have a drastic shortage of doctors and that will have implications for the health of possibly generations.
One of the things that people have said is, 'Well, we can bring in temporary doctors from overseas', and we have been doing that to plug the gap, for many years, but the reality is that there is a similar workforce shortage in places where we traditionally draw our overseas-trained doctors: the UK, Ireland, Britain and Canada, those countries also are having a severe shortage of doctors, similarly a situation for New Zealand. I was there late last year and they are having similar problems even attracting overseas doctors to come to Australia who have appropriate qualifications.
So we can't look to the rest of the world to train doctors for Australia. We have to look to Australia and what we can do here and what the appropriate numbers are. We've been getting it wrong for a long time. This survey, I believe, at least gets the numbers right and we can start making some more effective planning.
SATTLER: So is tomorrow's meeting based on the survey and who's going to be involved in that?
PHELPS: There are a wide number of medical and community representatives speaking at the meeting tomorrow and I think it's really one of those situations where we do need to have community consultation, we do need to involve governments at all levels, the medical profession and people who have a vested interest in the medical workforce in the bush. And the more good ideas that we can put together, the more cooperative approach that we can take to solving this crisis, the better.
SATTLER: Any health ministers going to be there tomorrow? That would be a good idea, I would have thought.
PHELPS: I'm not sure about that.
SATTLER: Yes, I mean, they need to hear. All right, thanks for your time. Have a safe trip and talk to you later.
PHELPS: Thanks Howard, cheers.
SATTLER: Kerryn Phelps, the National President of the Australian Medical Association. Those figures. 'Chilling' is the word she used. A shortage of more than 10,000 doctors in rural Australia within 20 years. Ten thousand. I mean, when we talk about two or three leave a town, when you add all that up that says to me just about every country town, city or whatever, in Australia, is going to be short a doctor, substantially, say within 20 years. Then where will you go for your health care?
Ends