Medical Profession Context and Impact on Patients
The reforms in this document are designed to improve the operation of the health system for patient and practitioner alike.
They respond to the experiences of our members, the insights offered by our patients, and the lessons learned from our rapid reform to respond to COVID-19. They embody the principles of building a sustainable, inter-connected, high-quality health system that provides access for all, with leadership and independence of the medical profession, while empowering our patients. It is not only possible, but absolutely necessary, to ensure that any reforms to the health system support our doctors – for otherwise we will fail to improve the health of Australia’s patients.
Australia’s medical practitioners have shown themselves to be adaptable, knowledgeable and resilient in times of need within the healthcare system. But Australia’s doctors face some significant challenges resulting from COVID-19, which are compounded by our current policy and funding settings. Public hospitals are already operating at dangerously high capacity, and this could be made worse by people presenting with late-stage disease following a reluctance to attend hospital (e.g. to partake in cancer screening) at the height of the pandemic.
COVID-19 has also had significant impacts on trainee progression and therefore the workforce pipeline into the future. Beyond COVID-19, we have medical training shortfalls in key areas, and significant areas of workforce maldistribution. At the same time, we have a projected oversupply of medical students in some specialty disciplines, creating significant training pressures and negatively impacting our ability to train the right number of doctors in the right specialties who want to work in the right areas to meet community healthcare needs.
GPs increasingly feel disconnected from the rest of the health system and curtailed in their ability to efficiently manage a patient’s care through the life cycle. Despite being at the centre of the medical system, expansions in the scope of practice in allied health, an increasingly fractured model of health service delivery, and extreme financial pressures mean the next generation of GPs face significant challenges. Meanwhile the current generation feel beleaguered and under-appreciated, lamenting the lack of focus on prevention and innovation.
Our hospital doctors deal with the most complex life-saving treatments, 24 hours a day, seven days a week. Yet the AMA’s research has shown many doctors are working dangerously unsafe hours, putting them at a higher risk of fatigue to the extent that it could impact on performance, and affect the health of the doctor and the safety of the patient. Patients continue to wait longer for treatment. Aboriginal and Torres Strait Islander doctors continually experience instances of racism and discrimination from patients and peers, which impacts the cultural safety of hospitals and clinics18. Funding agreements continue to drive quantity and haste, not quality and training.
The prolonged COVID-19 shutdown, financial pressures stemming from insurer changes, and reduced private health coverage threaten access to the critical private health pillar of the system. Complicated, variable insurance policies often leave patients confused and unknowingly underinsured, or significantly out of pocket. Practitioners often bear the brunt of a system in need of urgent further reform. In addition, the private system has not been funded to adapt to the ongoing changes needed to deal with COVID-19.
18 Australian Indigenous Doctors’ Association (2017). Report on the findings of the 2016 AIDA member survey on bullying, racism and lateral violence in the workplace. Retrieved 23/11/2020 from: https://www.aida.org.au/wp-content/uploads/2017/08/Report-on-AIDA-Member-Survey_Final.pdf