Issue 47 / 5 December 2011

SPORTS physicians are frustrated that there is no specific funding for registrars wishing to train in the discipline, even though it was recognised as a medical specialty last year.

The Australasian College of Sports Physicians, the only accredited training provider in sport and exercise medicine (SEM), was invited to apply for funding for training posts in 2011 under the Department of Health’s Specialist Training Program.

Although 27 SEM practices made an application, none received funding. Instead, private practices continue to subsidise the cost of training junior doctors in their field within private employment agreements.

A college spokeswoman said although this was a workable arrangement that could provide adequate income for registrars, income levels could not be guaranteed.

Dr John Orchard, a sports physician and associate professor in public health at the University of Sydney, said the lack of guaranteed income made it difficult for registrars who needed a predictable income, for instance, to apply for or repay a mortgage.

“We are in the bizarre situation where there are regulations regarding the quality of our training (through the Australian Medical Council) in order for the specialty to continue to be recognised, but there is no funding to provide quality training”, Dr Orchard said.

He questioned the funding decision, particularly as sports physicians helped people with medical conditions or injuries to resume exercise, which would contribute to many of the government’s public health objectives.

“Is it better value to fund one sports physician to prevent chronic disease or 10 specialists who deal with end-stage chronic diseases like diabetes?”

Dr Orchard emphasised that registrars who completed training could look forward to a busy and rewarding career with long-term employment prospects.

“There is good demand for sports medicine services and it is a fun specialty to work in”, he said.

A Department of Health spokesperson confirmed sports physicians were eligible to apply for funding for training posts, but did not address concerns about why no places were funded this year.

In addition to the training concerns, patients of SEM physicians now receive lower Medicare rebates than before the discipline was granted access to Medicare as a recognised discipline.

Patients of SEM physicians can access rebates under the A3 item numbers, which are more commonly used by procedural specialists such as surgeons.

The college spokeswoman told MJA InSight the item numbers did not reflect the consultant style of practice, and they were in intense discussions with the department to rectify the situation for patients.

“SEM is a non-procedural specialty … we never expected that our patients would be worse off as a result of gaining specialist recognition. [However] the college does not believe the decision was made with malicious intent”, the spokeswoman said.

The department spokesperson said the A3 item numbers were the same items accessed by other equivalently trained medical specialists.

The situation has similarities to issues facing addiction medicine specialists, as reported recently by MJA InSight. (1)

However, unlike addiction specialists who can access higher Medicare rebates through their base specialty, most sports physicians are not registered in any other specialty, Dr Orchard said.

“Sports physicians had no option [but to] swallow a rebate cut. Most patients referred from GPs now get a lower rebate to see a sports physician than they would for the same length of consult with a GP”, he said.

– Sophie McNamara

1. MJA InSight 31 October 2011

Posted 5 December 2011

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