Government needs to do more to lure specialists into public practice


14 Sep 2016

State Governments need to abandon “policy by anecdote” in favour of “policy based on data” if they are to have any hope of attracting more specialists to work in the public health system, says a leading University of Melbourne researcher.

And Professor Gary Freed, of the university’s Centre for Health Policy, Melbourne School of Population and Global Health, said there was not sufficient data to do more than ‘guess’ whether there were even enough specialists in Australia.

“I believe the problem is that so many people in positions of authority (public and private and professional) are willing to guess without any data to support their beliefs,” he said.

“We need to get away from policy by anecdote and personal experience and move toward policy based on data.  But, first we have to have the investment to get the data.”

Speaking to the limbic from the US this week, Professor Freed was unable to speculate on whether patients on long public hospital waiting lists were dying unnecessarily because they could not access timely care.

“I have no data on this issue,” he said. “Anything anyone will tell you on this is speculation based on anecdote.”

However he said there was some wide disparities between hospitals when it came to waiting lists.

“The lack of transparency is very disempowering for patients and may lead to poor health outcomes,” he said.

Professor Freed was the co-author of a paper published in the journal, Australian Health Review, which compared the amount of time specialists spend on private versus public care.

“The problem of long waiting times is not necessarily one of doctor shortages,” he said.

“Governments can spend a lot of money on funding training for more specialists, but that will have no impact on public waiting times if they mostly go to work in private practice.

“State governments need to open more positions for doctors in public hospitals to meet patient needs.”

The paper revealed significant variations across different disciplines, with specialists such as orthopaedic surgeons and rheumatologists spending more than 70% of their time in private practice, while neurologists were close to a 50:50 split between public and private practice.

Professor Freed said there were no clear, consistent guidelines from governments/ hospitals on the amount of time doctors employed in the public system should spend on public patients versus how much time they spend in their private clinics.

“Some doctors may only spend one-half day a week in public clinics,” he said.

“This can result in inefficiencies and in patients seeing a different doctor every time they return to the clinic.”

For all medical specialists combined, working hours have been reported to be similar in the public and private sectors. In aggregate, 48% of specialists work across both sectors, 33% work only in public practice and 19% work only in private practice.

But he said this did not mean the government should spend less money on training and more on making public practice more lucrative or appealing than it currently is.

“I do not believe this is an “either/or” decision,” he said.

“It is entirely possible that more funds are needed in both arenas or that more is needed in one area but that does not translate into less in others.”

Professor Freed said private practice was often more attractive because it offered higher remuneration and better conditions, such as fewer after-hours or weekend callouts. He urged governments to look at offering more effective incentives to public practice. And, if a doctor works in the public system, they should be encouraged to spend as much time there as possible.

He also said states needed to be more transparent about specialist waiting list data.

“The focus should not only be on waiting times for surgery, but also how long it takes to see a specialist for a consultation.

“Most governments don’t make information on wait times for outpatients publicly available — as a result, patients have no idea where they should go for timely care.”

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