Aniello Iannuzzi: College expansion

THE Royal Australian College of General Practitioners has been active in the copayment debate, not least with its #CoPayNoWay campaign.

The Senate inquiry into out-of-pocket medical expenses put the Royal Australasian College of Surgeons (RACS) under the spotlight, particularly when the RACS suggested that GPs should advise patients of surgeons’ fees before referring. It’s fair to say GPs were not impressed.

Over the years there have been other examples of the learned colleges buying into discussions about doctors’ fees — the RACS and RACGP are not alone.

In medicine we enjoy status, privilege and good incomes. To protect and maintain these there are the checks and balances to avoid conflicts of interest, such as scripts being dispensed only by pharmacists, the referral systems, and the colleges providing education that is independent of government.

When we went to university we were never taught about doctors’ fees and how to bill patients. It was also understood that the learned colleges were bastions of standards and knowledge for each craft group. It was then up to individual doctors to decide on the best way to practise and earn.

Until recent times, deliberations about incomes and fees were always left to the associations such as the AMA.

I am quite sure the public and politicians regard specialist college qualifications as defining clinical skill and knowledge. However, in the profession change seems to be under way.

Do we need to ask what the current role of colleges should be?

In my discussions with grassroots and senior members of various colleges there is a mixed response.

Some support the push by colleges to be more active in the political sphere. These doctors feel that colleges should provide members with more services and value for money beyond the traditional role of education, training and standards. They argue that quality and cost are linked and cannot be separated, justifying the colleges’ role in discussions about fees.

One argument put forward by those who believe the colleges’ roles should be expanded is that the Health Practitioner Regulation National Law Act opens the door for government to bypass the colleges in specialist training, thus creating this need for colleges to expand their functions.

A more cynical view is that colleges that do the one-stop-shop of academia, politics and finance mean doctors only need to join a college, making associations redundant (of course, like death and taxes, we will never be able to avoid our registration fees). Let the AMA beware!

The opposite side argues that when money is factored into clinical education and credentialing, clinical judgement is clouded if not sidelined altogether. For example, in some RACGP exams questions are asked about how to write chronic disease management plans. Is this really a key to specialist education, or something you learn on the job?

Perhaps learning how to bill Medicare, charge patients, set up practice and manage a business should be left to the associations, or even other organisations. After all, these are also the domain of practice nurses, allied health practitioners, managers and secretaries.

“Give back to Caesar what is Caesar’s” usually applies to church–state relations, but I think it is also relevant to our colleges.

I prefer colleges to be apolitical and focused on the highest levels of knowledge and practice. They should leave the grubby stuff to others.
 

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.