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HEALTH workforce policy, health funding policy and university education policy are fascinating ingredients in a 2014 political melting pot. Yet the resultant amalgam remains a mystery.
In the 2009‒10 federal Budget, the Labor government removed the cap on funded university places (except in medicine) and moved to a “demand driven” model, which created an increase in the number of students.
The Budget papers reveal that there are now more than 720 000 full-time equivalent domestic student enrolments in Australian universities. As well, about 1.5 million Higher Education Loan Program (HELP) borrowers owe $25.2 billion.
Medicine may have been spared from the uncapped intake but most of us are au fait with the predicament of our interns following a steep rise in the number of medical graduates in the past few years.
There is an important lesson for us from the experience of our seriously displeased professional cousins: dentists; vets; nurses; and speech pathologists. They’ve all voiced concerns about the flood of health neophytes.
This oversupply of health workers should be leading to greater access and lower prices for the public. Yet, at best, this effect has been patchy, which may explain why both sides of politics have persisted with area-of-need positions and the controversial 457 visas.
Regrettably, governments fail to appreciate that prices can only go so low before practice becomes unviable. They also fail to appreciate that setting up in small and remote communities can not only be professionally and personally scary, but also economically unsound, as the set-up costs are not justified by the scarcity of patients.
From my experience in rural practice, it’s hard to justify setting up a stand-alone private practice in a town with population of less than 1500.
The tsunami of health graduates is also bringing out the worst in some employers. I have been told by dentists that young dentists are earning as little as $40 an hour. A number of Sydney pharmacists have also told me that pharmacists can be employed for under $20 an hour, especially in the discount warehouse-style shops.
I see this as a chilling warning for us as corporates and private health funds seek closer relations with government.
Health funding influences employment too.
If the proposed copayment goes ahead, we are likely to see lower volumes of patients. This could lead to unemployment for young doctors, and a dearth of GP registrar positions.
When the previous government abolished Enhanced Primary Care dental referrals, many dentists had an immediate fall in patient volume.
The abolition of practice nurse Medicare item numbers by the previous government made practices think harder before employing nurses.
To this confusing workforce salad we now add the Abbott government’s policy of university fee deregulation, which, on the surface, appears to indicate fees will skyrocket.
Doctors and vets have initiated media campaigns whingeing about new students paying a possible $250 000 for a degree (it hasn’t happened yet) .
However, the public sees these two professions as having potential annual incomes of more than $250 000. Over a 30‒40-year career, we are talking a minimum income of $7 million, so spending a small percentage of that amount on a low-interest loan for education seems more than reasonable.
Imagine how our complaining looks to someone training as a boilermaker or hairdresser. They certainly don’t enjoy the government largesse poured on medical students’ education … and they are the taxpayers too.
Once upon a time, choosing a university course in health meant a secure and rewarding career.
In 2014, school leavers and others considering careers in health need to recognise that Australian society has handed over their fates and futures to the machinations of the politicians.
Caveat emptor!
Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.
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The AMA has stood up for doctors in objecting to the proposed Medicare co-payment.
I agree with the author of the above article that the proposed co-payment may result in lower numbers of patients seeing the GP. Does anyone think that this will balance the budget?
Already, we struggle to get the growing number of chronic disease patients to attend the GP to access the basic recommended preventive health care, including to access recommended immmunisations such as Influenza, Pneumovax, and to accept referrals to the dietician, podiatrist, opthalmologist, physician, to have the recommended pathology tests such as HBAIC, lipids, urinary albumin, etc , even when they are bulk-billed.
The basis for preventive health care has been to reduce morbidity, reduce vaccine-preventable infections, to reduce preventable public hospital admissions,reduce preventable renal dialysis, amputations, blindness, and reduce preventable nursing home placements.
To introduce a co-payment for recommended preventive health measures is a completely unetihcal illogical contradiction , which can only result in increased morbidity and cost to the public health system, while giving patients the message that preventive health care is a luxury only available to those who can pay for it.
In contrast, the untouchable golden cow Centrelink continues unchecked, as Gough Whitlam intended, while Australia is giving overseas aid to countries now wealthier than Australia.
As healthcare has become a political football, let the politicians donate $7 for each patient in their electorate from their own salary, and see whether that balances the budget.
It would be nice if the AMA stood up for doctors the way the ADA does for dentists. Instead, we have the absurd situation where thousands of young doctors struggle to find training positions while the AMA leadership (all comfortably employed as senior consultants) insists that actually there is a massive doctor shortage and therefore we have to keep pumping 3000 new graduates each year into the system no matter what.