Issue 10 / 6 September 2010

I have never seen myself as the stereotypical arrogant and paternalistic doctor. I do, however, believe that professionalism comes with both rights and responsibilities.

So I was surprised at the response I received when I decided to post a comment on the ABC’s website on the topic of midwives’ access to Medicare.

I’d been listening to a fairly typical pre-election interview on ABC Radio National’s Life Matters with AMA President Dr Andrew Pesce (an obstetrician).

Dr Pesce was asked about the AMA’s stance on the pre-election health strategies of the two major political parties.

At the very end of the interview he was asked about recent federal legislative changes that will give private midwives access to Medicare.

Under the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, which will be effective from November 1 this year, private midwives must enter into a written agreement with a specific obstetrician.

A midwife’s patient management plan must be approved by the obstetrician before he or she is allowed access to Medicare payments.

Although Dr Pesce spent most of the interview discussing issues such as e-health and rural health, all ten responses posted on the program’s feedback page after the interview related to his comments on the amended law.

Midwifery Anger, a previous discussion on the topic broadcast on Life Matters on August 12, likewise drew 56 responses.

Most were strongly worded complaints about the imposed control of obstetricians over private midwives’ access to Medicare and the alleged loss of a birthing mother’s right to choose.

“Human rights” and “unconstitutional” were among the strong phrases being used.

In my view, the issue comes down to this: any independent practitioner who has access to the public purse must practise according to principles approved by the expert community.

So my own comment was this: if the obstetrician is expected to provide support for complexities and complications, shouldn’t they be involved in the care plan?

I was met with vitriol.

Some might say I am blinded by the medical model which places me in a position of clinical authority.

But perhaps proponents of the other view are also equally blinded by their own ideology.

I guess we’ll have to see which ideology prevails.

Dr Ieraci is a specialist Emergency Physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. In addition to her emergency department work, Sue runs the health system consultancy SI-napse.


Posted 6 September 2010

6 thoughts on “Dr Sue Ieraci: New midwife laws draw vitriol

  1. Nurse says:

    Any other nurse with access to medicare e.g mental health nurses and diabetes educators, must be part of the GP’s patient management plan to claim reimbursement. Why do midwives think they are different?

  2. Anonymous says:

    As well stated in the introduction to this article, you have dared to comment on something to do with nursing…

    “Paying nurses to play doctor will make system sick
    Jeremy Sammut | The Australian | 22 March 2010
    Criticising the nursing profession is like killing Bambi. Nurses who devote their lives to the care of the sick rightly deserve our honour and respect. But the problems with the Rudd government’s changes to Medicare, which fundamentally change the role of nurses in the health system, cannot pass without comment.”

  3. alarmed says:

    The SA data shows what happens when midwives run things out of hospital. Babies die and are born hypoxic at a much greater rate. Midwives get free idemnity from the Fed govt, and can not possibly interpret pathology tests (as they have no training in this). Doctors don’t claim to work in isolation, most welcome the team approach. I fail to see why midwives feel they don’t need a team approach!!!

  4. The Saint from Elsewhere says:

    Its fascinated me for years that the only people completely unrestricted are those whose actions generate the spending – ie the general public.
    Before the introduction of Medicare it was generally regarded as unprofessional behaviour to see and treat a patient currently being seen by another practitioner, except in an emergency. The patient would be informed that they must advise their current doctor that they wished to change before another doctor would see them – and breaches were not infrequently reported to medical boards as unprofessional conduct. The same, incidentally, applied to vets!
    There is now some imaginary “right” of patients to see 10 doctors simultaneously if they so wish, often generating repeat investigations paid for by the public purse. We need the SENSIBLE bits of the British system – that is, a patient may CHANGE doctors as often as they wish – surely that should preserve every right the patient has to choose? But they may NOT choose to have several doctors seeing them at the same time, in ignorance of each other’s existence, at public expense. Patients should be registered with one practice, and other than in an emergency or travel (both accomodated in the UK system) they should pay themselves for additional consultations.

  5. woolly says:

    if midwives want to run the whole show then let them deal with the complications and lawsuits themselves.

  6. Nan says:

    If the midwives want to use public money via medicare they need to be regulated and supervised like everyone else.

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