Judith Adams (WA, Liberal Party) Share this | Hansard source

I rise today to speak on the Health Insurance Amendment (Medical Specialists) Bill 2005. This bill represents a minor procedural change to the Health Insurance Act 1973. The reason for this amendment lies in the current cumbersome and time-consuming process by which some medical practitioners are recognised as specialists or consultant physicians for the purposes of Medicare. It will streamline the procedures for the recognition of some medical specialists and consultant physicians so that their patients can access Medicare rebates at the specialist or consultant physician rates. With Australia experiencing shortages in the medical workforce, this amendment will ensure that specialists and consultant physicians can enter the workforce as quickly as possible without compromising safety and quality standards.

This legislative amendment does not bestow specialist or consultant physician status on medical practitioners. Medical practitioners are identified as specialists or consultant physicians by medical boards when they are registered and by specialist medical colleges. Currently, a medical practitioner is recognised as a specialist for Medicare purposes via one of three pathways. The first pathway is automatic recognition. Applicants can seek automatic recognition if they are living in Australia, have a fellowship with a specialist medical college and have the relevant qualifications from a specialist medical college. Recognition is then provided by the managing director of the Health Insurance Commission, following advice from a relevant specialist medical college that the criteria have been met.

The second pathway is alternative recognition. For those Australian trained medical practitioners who are unable to meet the criteria for automatic recognition an alternative pathway is available. In the alternative pathway the minister’s delegate must refer the medical practitioner to an appropriate state or territory specialist recognition advisory board. State and territory specialist boards are administered by the Health Insurance Commission and meet every two months. The Minister for Health and Ageing appoints committee members from panels of nominees put forward by the relevant professional bodies and colleges. For those medical practitioners who are seeking recognition as consultant physicians, which are a subgroup of specialists with qualifications as physicians, rehabilitation specialists and psychiatrists, this is the only pathway for recognition.

The third pathway is for non-domiciled medical practitioners. Medical practitioners not domiciled in Australia at the time of application may seek recognition through a determination of the Minister for Health and Ageing. Applications for temporary residence were previously considered by an overseas specialist advisory committee. These committees were abolished in July 2004. The government was able to do this administratively because there was no mention of the overseas specialist advisory committees in the act. The government is abolishing the specialist recognition advisory committees for much the same reason that the overseas specialist advisory committees were abolished: these committees have become redundant. Since the committees were first established, specialist medical colleges and medical registration boards have been developed and they have implemented assessment processes which are used by the specialist recognition committees in making their determinations.

That the specialist recognition committees have relied on the assessment advice of specialist medical colleges and medical registration boards in making their decisions means that the specialist recognition committees have become a redundant administrative layer in the processing of applications. This unnecessarily extends the time between the registration of specialists and when they provide services under Medicare. According to an official at the Department of Health and Ageing, the Health Insurance Commission is reporting that since the abolition of the overseas specialist advisory committees it has been processing applications within a shorter time frame than was previously the case. Applications are now usually processed within 28 days, as opposed to the previous time frame of two to three months.

It is intended that the decision-making powers of the disbanded specialist recognition advisory committees will pass to the delegate for the Minister for Health and Ageing in the Health Insurance Commission. This will streamline the application processes for special recognition by avoiding the necessity to meet cut-off dates for applications to the specialist recognition advisory committees and then wait for up to two months for the committees to meet.

The amendments proposed in the bill include the recognition of the consultant physicians domiciled in Australia in the alternative method of recognition. Because the specialist recognition advisory committees have been the only means by which medical practitioners could be recognised as consultant physicians, disbanding these committees will remove the provision for them to become recognised. To correct this, consultant physicians will be included along with specialists in the alternative method of recognition. Transitional arrangements have been provided to ensure that specialists and consultant physicians previously recognised by the specialist recognition advisory committees will continue to be recognised under Medicare. Arrangements have also been made to allow the delegate to immediately consider existing applications with the specialist recognition advisory committees at the time of abolition.

This bill involves minor changes to existing procedures. The objective of these minor changes is to reduce the complexity and time currently involved in the recognition under Medicare of medical specialists and consultant physicians seeking to enter the Australian medical workforce. According to Dr Felicity Jefferies of the Western Australian Centre for Remote and Rural Medicine, commonly known as WACRRM, anything that streamlines the process of recognition of specialists is an excellent idea. As Director of WACRRM, Dr Jefferies has an intimate understanding of the medical needs of rural Western Australians and is at present greatly concerned about the lack of general physicians practising in rural and regional Western Australia.

According to Dr Jefferies, there is currently only one general physician practising in each of the three major population centres in rural Western Australia. There is one general physician in Albany, a city that services the specialist medical needs of towns as far afield as Katanning, Narrogin and my own hometown of Kojonup. There is one general physician in Geraldton, a city that services a huge area of the northern wheat belt in Western Australia. There is one general physician in Kalgoorlie, which is one of the most remote cities in the whole of Australia. These general physicians need support and, more importantly, they need to be able to pass on their knowledge to the next generation of country medical specialists.

General physicians are an interesting class of medical practitioner. They have undergone an enormous amount of training, including some of the hardest exams faced by any medical student. They are not surgeons and they are not specialists such as the cardiothoracic or ENT specialists that we are used to finding in our capital cities; rather, they are a highly trained general medical consulting physician with a detailed understanding and knowledge of most human symptoms, complaints, ailments and diseases. They are exactly the sort of medical practitioner that country regions need, and we are running out of them very fast.

Rural and regional Australia cannot generally support highly trained and specialised surgeons, as small populations generally mean practices such as these are not profitable. However, the practice of a general physician who can advise patients on a wide variety of medical problems can be supported in regional areas. Any change in legislation, whether technical in nature or not, any removal of barriers to entry and any scheme that facilitates more doctors and general physicians moving into rural and remote Australia is a positive step.

The Rural Doctors Association of Australia, RDAA, has supported calls for better measures to encourage specialist physicians to practise in rural Australia, adding that there is a desperate need for all types of medical specialists in the bush. The Internal Medicine Society of Australia and New Zealand and the Royal Australasian College of Physicians launched a position statement in September last year which recommended that Australia’s governments implement various strategies to attract general physicians to rural and remote areas, including improved financial arrangements, better access to training and continuing professional development.

I cannot overstate just how important that is. Continuing professional development is absolutely essential for people who go to work in rural and remote areas, and they must have improved conditions of work. Dr Sue Page, President of the Rural Doctors Association of Australia, said:

Medical specialists, including general physicians, are a critical part of the multi-disciplinary rural healthcare team ... But as with the rural GP procedural workforce, many rural specialists are now nearing retirement, with few younger specialists moving to rural areas to replace them.

Coming from rural Western Australia and having been very involved with health and health service provision over a number of years, I cannot overstate how strongly people out in rural areas feel about being unable to access medical specialist services. Another thing I feel very strongly about is that, if the specialists cannot move to the rural areas, at least we should have a better system throughout Australia for the Patient Assisted Travel Scheme. Every state in Australia is having problems with this scheme. I think we have to do something about rural people being second-class citizens in not being able to access specialist medical services, and I intend to move in that direction when I can. Dr Page went on to say:

Urgent recruitment and retention strategies are required to reverse this trend, before specialists become all but extinct in the bush and rural patients are subjected to the very serious consequences of this decline. In its recent submission to the Productivity Commission’s Health Workforce Study, RDAA’s Rural Specialists Group highlighted key actions for increasing the number of specialists in rural Australia, including:

• improving rosters and locum arrangements, so that rural specialists are not required to be on-call for after-hours duties more than 1 in 4 days and can take much-needed recreation or education leave. In cases where a 1 in 4 roster is impossible to achieve, doctors must be supported by triage back-up, special locum relief and additional recreation leave;
• increasing the infrastructure available to support specialists in rural areas, including information and communication technology, medical infrastructure, and additional healthcare and administrative staffing support;
• strengthening connections between regional specialists, metropolitan hospitals and metropolitan specialists. Rural specialists rely on these connections for clinical CPD, ready access for second opinions on clinical cases, access for the referral of patients requiring higher level services, and an avenue for locum support;
• encouraging and supporting the specialist colleges to provide enhanced rural training; and
• resolving rural specialist dissatisfaction with inadequate payments and unresolved financial anomalies between metropolitan and rural practice. For example, recent Medicare changes that allow obstetricians in private practice to charge a significant ‘booking-in fee’ do not benefit their rural colleagues who practise overwhelmingly in the public sector. Additionally, there is currently very poor remuneration available for rural doctors (whether GPs, GP proceduralists or specialists) who make a significant commitment to provide after-hours care in the bush, and a rural after-hours loading should be provided in this regard.

Importantly, the more complex caseload undertaken by all rural doctors—GPs, GP proceduralists and rural specialists (including non-procedural specialists)—must be recognised through higher remuneration structures such as rural complexity loadings. The increased complexity of rural patients’ healthcare needs, coupled with less access to additional medical support locally, often means longer consultations for rural doctors and hence reduced incomes compared with their metropolitan colleagues.

Our governments must work together urgently with the medical profession and its colleges to widen measures to support general physicians and other medical specialists currently working in the bush, and to entice more of these specialists to the bush, before there are no specialists left in rural Australia at all.

I would like to continue with some of the National Rural Health Alliance policy statements. For seven years, I was a member of the National Rural Health Alliance representing the Australian Healthcare Association. I have followed and worked very closely with the National Rural Health Alliance. This general statement really fits in with this bill:

The Alliance ... has a particular interest in:

the enhanced infrastructure, and broader system, for placement and postgraduate training of the extra medical and nursing students;

increased rural exposure in the training of medical specialists;

the references to special incentives for the training of dentists (the Alliance wants to see the Commonwealth involved in this as well as the States);

the promise of “better consultation” between the States and Commonwealth on health-related university places;

a single national registration scheme for health professionals …

I must say, having been involved with nursing and also at the moment working for Navy nurses on this issue, for the Defence Force this is one of the most difficult things as far as registration goes for nurses. Each state has its own registration scheme. As you can imagine, when Defence people are so mobile and shifted at short notice, this is causing huge problems for them. The statement continues:

a single national registration scheme for—

all—

health professionals and the fact that “other professional groups (including Aboriginal Health Workers) may be added over time”;

a single national accreditation scheme for health education and training;

a national process for the assessment of overseas-trained doctors …

Once again, this is very difficult with each state doing their own assessment through their medical boards. The statement continues:

the Commonwealth’s intention to provide rural medicine with formal recognition under Medicare as a generalist discipline; and, most importantly,

the initiatives relating directly to improving the health and wellbeing of Indigenous people, such as governments’ “long-term, generational commitment” to overcome Indigenous disadvantage, the commitment to closing the health, education and learning gaps between Indigenous and non-Indigenous children, and further measures to address alcohol and substance misuse, including through additional resources for treatment and rehabilitation services in regional and remote areas.

Having been involved in the petrol-sniffing inquiry with the Senate Community Affairs References Committee, I cannot stress enough just how important it is to have rehabilitation services in regional and remote areas—they are very important services. Once again, we need a very different sort of specialist to be able to handle and cope with these areas.

In conclusion, I commend this bill to the Senate. It is very important that the legislation is put into practice as soon as possible so that specialists are not waiting for two to three months before being recognised to practise. We cannot afford this time.