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A cure for our chronic lack of healthcare choice

Any health practitioner can be the first port of call for a patient. AAP

“When people get sick or injured or want advice about their health, they want to see a doctor,” Dr Andrew Pesce, AMA President.

Patients may want to see a doctor but they don’t necessarily want to join a waiting list.

Medical graduate numbers have almost doubled over the past decade and yet we still have difficulty attracting doctors to rural areas.

So what’s going wrong?

It’s likely that our renumeration system, which pays specialist doctors far more than general practitioners, is partly to blame.

Graduate doctors who opt for higher-paid, specialist career paths as surgeons, physicians or anaesthetists are more likely to live in metropolitan areas. While general practice tends to be lower down on young doctors’ list of career aspirations.

If we can’t get doctors to relocate to rural and remote areas to provide health services for those communities, we need a rethink of our current system which allows only doctors to treat, prescribe and advise.

Perhaps the biggest problem with a doctor-centred health system is its lack of economic sustainability. Health is expected to consume around 20% of Australia’s GDP by 2020-2025. If we don’t want medical costs to skyrocket we need to look at solutions.

We need to examine the role of the doctor and work out what elements of healthcare need to be managed by doctors, and what can be done by other, appropriately trained professionals.

Medicine is the last profession on the planet to be restructured. Banks, construction, manufacturing even the legal profession did it long ago.

Imagine if banks resisted the development of ATMs because they wanted to maintain the teller’s role of dispensing money.

Hospital-based doctors still spend significant time chasing up results, collecting blood and completing a raft of taks that could be done by others.

There is no reason why pharmacists shouldn’t be involved in repeat prescription writing, why physiotherapists can’t manage orthopaedic waiting lists and patients’ exercise prescriptions, and why more nurse practitioners can’t manage more chronic diseases like diabetes.

Yet the AMA continues to resist the move from other health professionals to gain access to the Medicare Benefits Schedule, which would allow their patients to receive government rebates for seeing these non-doctors.

The AMA has worked actively against the introduction of other health professionals such as physician assistants, who work closely with doctors on delegated tasks. The University of Queensland announced the closure of its physician assistant program on Wednesday.

These health professionals complete a two-year graduate program and study alongside medical students. There are 75,000 physician assistants in the US alone, and Israel, Germany, Holland, Canada and the UK have set up or are expanding their programs.

The help of physician assistants allows doctors to spend time doing the things they are trained for: dealing with medical uncertainly and managing the care of complex patients.

Many studies from around the world show patients are very satisfied with the care they receive from nurse practitioners and physician assistants or other middle-level health professionals.

In fact, these health professionals often rated better than doctors because they could spend more time with the patients.

The key element with all middle-level providers is that they work as a team, they understand their competencies and they know when to ask other members of that team for advice when out of their comfort zone.

It is unethical for any health practitioner to say they act as a totally independent person within health care. We all work as part of a team – and any member of that team may be able to be the “first line” of call for a patient enquiry.

When patients are sick or injured they want choice. For too many Australians in rural and remote areas there just aren’t any options.

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