[ExI] Australian state public health system update

[Damien Broderick]

The Age newspaper of Melbourne reports:


Surgeons walk out of public system

Nick Miller
March 17, 2008


SURGEONS are quitting Victoria's public health 
system in alarming numbers, dismayed at their 
working conditions and pay, a ministerial review says.

Morale is low, frustration is rising and senior 
and junior surgeons are joining the exodus, the independent review says.

The Australian Medical Association says this is 
evidence that Victoria is on the precipice of a crisis in public health.

"Public hospitals are at a crossroads: what 
happens now will determine whether we plunge into 
crisis or not," AMA Victoria president Doug 
Travis said. "Fewer surgeons will mean fewer operations. It's that simple."

 From 2000 to 2006, the number of full-time 
equivalent (FTE) surgeons operating only in the 
public sector dropped by almost 40%, from 139 to 
84. At the same time, the number of FTE surgeons 
operating publicly and privately fell by almost 
10%, from 914 to 826. FTE numbers in the private 
sector stayed steady. FTEs do not directly 
correspond to surgeon numbers, but show that 
surgeons are doing less work in public hospitals.

Tim Woodruff, of the Doctors Reform Society of 
Australia, said this was a worrying trend that 
would hurt those with serious, complicated 
illnesses who could not afford private health cover.

The Ministerial Review of Victorian Public Health 
Medical Staff was completed in November but has 
not been released by the Government.

The Age has seen the part of the review that 
looks at problems with retaining senior staff in 
the public system. It says the problem is not confined to surgeons.

"Both general working conditions and remuneration 
are driving Victorian doctors from the public 
sector both into the private sector and 
interstate," the review says. "Reasons that 
attracted clinicians to public hospitals in the past are rapidly disappearing."

Procedural specialists are a particularly 
endangered species, the review was told.

"There is considerable disquiet particularly 
amongst orthopedic surgeons within the public 
health sector, with many surgeons having resigned 
their public appointments within the past 12 
months," the review panel heard. "These 
resignations not only include many senior 
surgeons but also a number of junior surgeons."

Low pay in the public sector is a key determinant 
in the problem, the review says. But surgeons in 
the public systems are also affected by a loss of 
goodwill and job satisfaction.

"There were many reports of poor morale, a 
feeling that medical practitioners were devalued 
by the system and by management," the review says.

Medical practitioners told the review panel there 
was a proliferation of hospital bureaucracy, 
setting key performance indicators that did not 
relate to quality of care but increasingly emphasised patient throughput.

One submission says staff morale at Victorian 
hospitals is at an all-time low. "Attendance at 
medical staff meetings, once dynamic, frequently 
fails to make a quorum," it says.

Another complained about the increasing 
separation of hospital management from medical, 
nursing and paramedical staff. "This 
 has led to 
such a high degree of frustration that many who 
were previously committed to the public hospital 
system have often decided to spend the minimum 
time possible (if any) in the public health system."

Dr Travis said the report's findings matched his 
own observations. Younger surgeons were more 
likely to go interstate, where they could earn up 
to $100,000 more a year, he said. Older surgeons 
were more likely to cut the amount of work in 
public hospitals. "We are on the precipice," he said.

He called for the immediate release of the report 
so work could start on addressing its recommendations.

Last week Nationals leader Peter Ryan quoted in 
Parliament a leaked section of the report's 
findings that said reduction in bed numbers and 
high occupancy rates were causing stress in the health system.

"It puts the lie to the position the Government 
consistently portrays: that the system is running well," he said.

Health Minister Daniel Andrews told Parliament 
the review was entering its final stages. "There 
will be a Government response," he said.

Yesterday a spokeswoman for Mr Andrews said the 
report would be released shortly.

"The Brumby Government has recruited an 
additional 1800 doctors to the system since 
coming to government," she said. "We currently 
invest around $40 million each year to recruit 
and retain our health workforce. "We are working 
with the Rudd Government to address this issue."