Health Minister Nicola Roxon’s latest proposal that patients be allocated to doctors on a list basis is straight out of the playbook of Britain’s National Health Service.

　　Let’s think about this from the patient’s point of view. Some doctors are better than others, the same as some plumbers are better than others. The reason may be a better bedside manner; it may be they are more competent; it may be just that there is a simple personality clash—it may just be that, at times, the patient wants a second opinion. Or it might be that the patient has a potentially embarrassing problem that he or she does not want to discuss with his or her regular general practitioner.

　　Some people who are ill-suited to their career choice are always going to slip through the system. In other words, if you are allocated a doctor you don’t like or who is a dud, you are likely to be stuck with him. Of course, the government will make some noises about “freedom of choice"; but in the end, a doctor who hangs up his shingle and succeeds or fails according to the quality of service he offers is going to provide a better quality of service than a public employee.

　　Now, all doctors, including general practitioners, must be members of the appropriate professional body, which accredits them as qualifi ed practitioners. This means they must first finish medical school and then qualify as surgeons, physicians, ophthalmologists or psychiatrists.

　　This postgraduate training is arduous and expensive, and practitioners naturally expect a return on their investment of time, energy and money—the average medical graduate is left with tens of thousands of dollars in university fees.

　　Much is made of the top professionals who make millions, but the average GP is running a practice that gives him a barely adequate return on his investment in professional development. Indeed, many GPs complain they are virtually government employees relying on Medicare to pay their bills, but the “virtually” is important. They remain independent professionals who succeed or fail according to the service they provide.

　　The recent moves to widen the scope of nurse practitioners concern many GPs. While nurse practitioners may have a role in isolated areas, a nurse is not a substitute for a general practitioner, who has years of undergraduate and postgraduate training in family medicine. Expanding the role of nurse practitioners may simply be an axe to wield again the ancient enemy, the family GP. Many nurses have specialist training, which makes them indispensable in the medical system; but a nurse is not a substitute for professionally-trained general practitioners with years’ more education behind them.

　　Minister Roxon’s move to cut Medicare payments for cataract surgery again fl ies in the face of reality. On the face of it, it may seem plausible—better technology equals cheaper prices. If the Fred Hollows Foundation can do cataract surgery for $25, why can’t an Australian ophthalmologist? The reason is that an Australian eye-doctor is running a practice. He has to pay a receptionist, an accountant, rent for his rooms and so on—in other words, he has fixed costs, which means the money goes into a lot of pockets apart from his own. In fact, he can’t absorb the cost cuts that the government is asking him to accept. From News Weekly, November 28, 2009

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