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Health system held to ransom by a doctors' racket

By Ian Hickie - posted Monday, 19 October 2009

Every day I'm in contact with some of the brightest minds in my specialised area of science and medicine around the world. Some are Australians working abroad while others are citizens of other countries who have developed very successful professional careers. Very often I am trying to persuade them to move to Sydney and contribute their considerable talents to our collective scientific pursuits, our economy and our society.

For the Australians, the process is simple enough. For others, we can usually demonstrate to immigration authorities that we lack people with these specific skills. For the scientists, we immediately recognise their skills and achievements. But we have to explain one rather small-minded, nasty problem to medical graduates. Australian doctor groups still use a variation of the British qualification system to keep foreign expertise offshore. (Interestingly, the system is now illegal in Britain due to its participation in the European Community.)

If these highly skilled doctors move here, it is highly likely that our royal colleges will not recognise their specialist qualifications and will require them to complete months or years of additional training and then sit a range of further examinations. We do let overseas doctors into work temporarily in many of our most at-risk and isolated communities, but we are very unhappy about the idea that they may actually move in and compete in full-time practice.


Combined with other health and higher education policy failures, the net result is a shortage of both general and highly specialised doctors in this country, high costs for particular types of care, and perpetuation of one of the most pernicious protection rackets ever set up by any professional group. As illustrated by the current case of a Canadian doctor, Sue Douglas (Herald, October 13), who is a highly experienced family practitioner with additional academic expertise, our system can make great use of you one minute and then withdraw your practising privileges the next. Guess who is really worse off - the patients she treats!

Of course, when our doctors travel overseas we expect other countries to recognise our training credentials. We are rather insulted when they apply the same protection racket against us. Of course, they use the same ''protection of quality'' argument that Australian medical groups drag out in defence of our system. To add insult to injury, when our home-grown specialists then threaten to withdraw their services from the public sector, as some surgeons did in the 1980s and as the ophthalmologists are doing now, we have no alternatives. In 2009 we are all still paying the economic and social price for the failure of previous governments to take on these vested interests.

Throughout the 1980s most other Australian industries were forced to abandon old restrictive work practices and compete on the world market. While this was very traumatic for many businesses and some communities, it was generally agreed that it was a necessary process to ensure our long-term national wealth and quality of life. Sadly, as a consequence of doctors flexing their industrial muscle, the health sector escaped microeconomic reform.

Even though the Rudd Government is now talking tough about substantial changes to the health system, its recent skirmishes with the medical establishment do not suggest that it has yet come to terms with the scale of the problem. Although the Productivity Commission has repeatedly drawn attention to this highly distorted market and the Australian Competition and Consumer Commission has challenged the ways in which our royal colleges (and other professional associations) control both training and specialist qualifications, essentially we remain a closed shop.

Over the last two decades, instead of opening Australian medicine to competition we have, in effect, turned our back on the globalisation of health care services. In the 1980s Australia not only had great medical schools but also the potential for further expansion of its postgraduate and specialist training programs. We could have used those resources not only to train sufficient doctors for work in Australia but also served as a hub for training international students.

Instead, in the early 1990s Australia's health bureaucrats, in partnership with our medical training institutions, decided to cut the number of doctors in training. This rather bizarre decision had the stated aim of reducing long-term health care costs. The only trouble was that Australians were ageing, we were in need of more, not less, medical care and that, collectively, we expected to receive health care when we were sick.


Unfortunately, this myopic policy also coincided with the rapid economic development of China and India and a sharp rise in the demand for trained health professionals throughout the developed and developing world. At home, our own doctors also decided to work fewer hours and, consequently, provide fewer overall services. The net effect of these global and local changes was not only the shortage of general and specialist doctors that has become evident in the last five years, but also Australian doctors tightening their monopoly over the supply of services.

This monopoly operates across the whole medical sector but is particularly fierce in the areas of specialist services. Rather than be held to ransom once again, the Federal Government should act on behalf of all Australians and welcome well-qualified doctors from throughout the world. Australian doctors may then prove a little less willing to threaten walk-outs on the public system and the current round of health reforms may stand a more robust chance of real success.

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First published in The Sydney Morning Herald on October 14, 2009.

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About the Author

Ian Hickie is a board member of the Mental Health Council of Australia and executive director of the Brain and Mind Research Institute at the University of Sydney.

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