Medicandus

Medicandus

Could Campbell Newman make good on his threat to replace hospital specialists in Queensland?

The dispute about new contracts that senior doctors are being presented with in Queensland is the most serious medico-industrial campaign in recent memory. The details of the negotiations are outside the scope of my interest as far as this column goes, but I do find it fascinating that Premier Newman would go as far as promising to recruit from overseas and interstate to replace anyone who resigns.

To me, it seems he has dramatically overplayed his hand.

Historically, Queensland has always been the most poorly served of the Eastern states as far as its public health system goes. After the debacle of the Jayant Patel case in Bundaberg, then-Premier Beattie vowed to make Queensland hospitals the best in Australia by poaching interstate doctors with generous contracts to reduce Queensland’s reliance on overseas-trained doctors. Years later despite a supposed oversupply of local medical graduates, doctors still represent the fourth largest occupational group on 457 visas nationally. Most work in General Practice or supervised hospital practice at a junior level. Few would be capable or legally allowed to work unsupervised at a senior level in even a medium-sized public hospital.These cannot be the doctors he is referring to.

Let’s imagine for a moment that there was a planeload of disaffected, appropriately trained specialists waiting at an airport overseas for Premier Newman to give them a call. Let’s further imagine that these specialists are so annoyed at their current employer that they were prepared to overlook the AMA’s recommendation that overseas doctors avoid signing the Queensland Health contracts under any circumstances. Could they be landed in Brisbane and put to work as Patrick Corporation-style strike-breakers?

Nup. Not even close.

The recognition process of overseas trained specialists for unsupervised practice in Australia is patchy, and highly variable from specialty to specialty. As a simple example, we will look at anaesthetics.

If you want to come from overseas and work in Australia as an anaesthetist, the first thing you have to do is apply to the Australian Medical Council to work as a doctor at all. You have to dig up your original Uni records and present certified copies of them, plus references and documentation of your recognition to practice as an anaesthetist in your home country. This goes off for perusal and if you have a confirmed job to go to (which requires another process from your prospective employing hospital) your application will go to the Australia and New Zealand College of Anaesthetists (ANZCA) for assessment. ANZCA has a rigorous process for assessing overseas trained specialists, which involves at least 12 months of supervised workplace assessment if your previous qualifications are deemed roughly equivalent to a local specialist, and may involve further periods of supervision or even having to sit the ANZCA Fellowship exam if your previous experience is deemed less than equivalent. For at least 2 of my current colleagues who have gone down this path, the time taken before they could work in a public hospital as a consultant anaesthetist was nearly 2 years after they were first offered the job.

Imagine the logistics involved in trying to process 10 anaesthetists (enough for a medium-sized hospital) if you had just one or two incumbents who could act as their designated supervisor. You you might be down to having one operating list going at a time or you’d be breaking the ANZCA requirements for ‘supervised’ practice. It would take months or even a couple of years before a hospital like Cairns or Townsville could recover from losing even half its anaesthetic staff, let alone all of them. The impact on a bigger metropolitan hospital would be devastating, with elective surgery virtually ceasing if there was only enough appropriately qualified anaesthetists to run emergency theatres. Surgeons would either drift off to the private sector or sit around the hospital playing Scrabble instead of operating. Patients in need of anything other than life-saving treatment would be put on the back burner indefinitely.

Now repeat this process for other craft groups such as emergency physicians, surgeons, and internal medicine subspecialists, all of whom are essential to the standard of care one expects of the Australian system (even in Queensland!). Hospital bureaucrats would be tied up in knots trying to facilitate the migration and credentialing of specialists via maybe a dozen equally labyrinthine processes. It would take literally years to restore the standard of care to its current level, even if that hypothetical planeload of specialists was circling the airport as we speak.

Another reality of Premier Newman’s position is that Queensland has already been hoovering up any available hospital specialists for the last few years, and to try to increase their recruitment of overseas doctors would further enhance Australia’s overseas reputation as a selfish poacher of valuable professionals from countries in the developing world who can ill afford to lose such valuable assets. The only way to get more of them would be to persuade the AMC to relax its standards and try to force the Colleges (who rely heavily on pro bono time from their Fellows for this sort of work) to fast track their processing of applications. Would Queenslanders be happy knowing their care was provided by the cheapest, most easily available overseas-trained doctors who skipped out on the proper credentialing channels because of political convenience?

Me neither.

With an exodus of senior doctors from the public system, training of junior doctors would go backwards and many hospitals would lose their accreditation to train new specialists. I am aware of at least training unit in my own speciality where this has already happened. The next generation of specialists will train elsewhere, and more than likely live and work elsewhere. Queensland hospitals will become second-class academic and training institutions for a generation. Reputations built on years of hard work will be lost and not replaced. Think I’m exaggerating? It’s already started.

For Newman to threaten publicly that he would simply replace this set of troublemaking doctors with another bunch who’ll do as they’re told is either braggadocio or profound naivete. He and his Health Minister will not be able to simply bus in replacements even with 3 months’ notice and they ought to be well aware of this. In medico-industrial disputes in the past, I can’t recall any government taking such a concrete and imminent threat of mass resignations so lightly. I really hope for the sake of Queenslanders that someone is pointing all this out to Premier Newman and Minister Springborg. It’s not clear to me from their public posturing that they understand the emptiness of their threat and the grave consequences if their bluff is called.