Things got spicy at the Special Commission as an LHD board member took aim at the bow-tie wearers. Oh, and workforce issues can be solved on a napkin. In two hours.
NSW Health has a role to play in shifting beliefs and attitudes among “pompous, bow-tie wearing” specialist training committees in metropolitan areas, according to a Western NSW LHD board member.
Testifying before the NSW Special Commission into Healthcare Funding, Dr Colin McClintock, a renal physician based in Dubbo, said the Ministry was far better placed than regional LHDs to force metropolitan-based committees to relinquish their “pompous, bow-tie wearing” attitudes and funnel trainees to rural and regional areas.
“There are very good reasons [to support] the devolution of Ministry responsibilities to LHDs, [but] when we’re tackling workforce issues and training issues for doctors, we don’t have the power to change beliefs and direction within specialist training committees within the College of Physicians and within the College of Surgeons,” Dr McClintock said.
“I’d love [the Ministry] to give the specialist training committee in cardiology a bit of a slap around the chops to get some common sense into them, because they should be coming to me to send advanced trainees in cardiology out to Dubbo hospital, where the ST elevation myocardial infarction rate is three times higher [than in] Sydney LHDs.
“I’m wrangling that committee at the moment as a renal physician and director of medicine to get an accredited trainee.
“It’s the pompous, bowtie-wearing nonsense of metropolitan specialist training committees that says, ‘you’re all a bunch of idiots in the country — how on earth could you possibly train high-quality doctors?’”
According to Dr McClintock, the lack of access to medical specialist trainees in regional areas was also due to the way the state’s accreditation system permitted students to remain in more financially lucrative areas like Sydney rather than mandating, to a degree, their transfer to rural and regional areas experiencing far greater demand for specialist services.
“How do we have a system that’s so maldistributed that you wouldn’t, as a cardiologist, want to come and work where your exposure to the acute part of your subspecialty is at its highest?” he said.
“The reason is because we’ve got a system that allows individuals coming out of specialist training to tread water in Sydney, because there’s so many ways in which you can still earn a living without a public appointment in a major hospital in Sydney.
“If I finished training and there are two vacant jobs in Dubbo as a cardiologist, but it may not suit me personally to leave Sydney, and [its] great restaurants, we have a system that is set up where I can just send to private rooms, bill Medicare and bill the patient directly [through] an out-of-pocket expense, because that’s what will be happening.
“I can take admitting rights to a private hospital, and it may be a very undistinguished private hospital, and I can make a good financial living fairly rapidly, rather than just going and taking up a fulltime position in a regional site to work.
“People talk about you can’t conscript doctors in Australia, well maybe we need to hone that a little bit so that we at least reduce the outlets of other opportunity to ensure that you go where the work is. Because I can assure you doesn’t happen to other healthcare systems.
“You have to go where the work leads, and sometimes that will be whether you like it or not, and we are making progress, but there’s a lot more progress that we can make.”
Despite the complexities posed by specialist workforce shortages and market failures in primary and aged care for rural and regional LHDs, Dr McClintock said coming up with possible solutions was work that could take a matter of hours rather than years.
“Bearing in mind that the workforce delivery starts to look complex, because of the interplay of a staff specialists model of specialist recruitment and the VMO model with private rooms, I actually think that should be work that’s undertaken by the local health district,” he said.
“I think it should be the local health district and ministry that undertake service planning.
“The LHD is an extension of ministry, [and] with the devolution of system and process to LHDs, we’ll simplify that to the local health district [level], so I think it should be us.
“And I think you and I could do it this afternoon with a napkin.
“Because, you know, this is not a year of work. It’s probably two hours and a pen and a piece of paper to write down.”
