SICK PRIORITIES -- BUT PREDICTABLE FOR A BUREAUCRACY

The number of hospital administrators skyrocketed 58 per cent in the five years between 1997 and 2002, making it the fastest growing health specialty in Australia. In comparison, the number of surgical specialists increased by nine per cent and the number of public health physicians fell by 25 per cent. Doctors told The Australian the figures confirmed hospitals were increasingly focusing on money rather than patients. "We are replacing clinicians with administrators and beds with clipboards," said the Australian Medical Association's Queensland president, David Molloy. "It's the wrong way for the health system to be going. The emphasis is on managing a budget, rather than looking after a patient. It's a very worrying trend." Dr Molloy said that, while administrators played an important role in the running of hospitals, supply had exceeded demand. "The number of doctors and nurses in the past 20 years has remained reasonably static and the biggest increase in the health system has been in administration, not in people who clinically care for other people," Dr Molloy said.

Royal Australasian College of Surgeons standards board chairman Russell Stitz said key medical positions were being filled by administrators rather than doctors. In 2001-2002 hospitals spent $992 million on administration - the third-biggest expenditure item behind wages and medical-surgical supplies. "Important directorships - such as the role of executive director of surgical services at Royal Brisbane Hospital, for example - are being filled by administrators rather than doctors," he said. "That means we have people in these administrative positions who are not fundamentally orientated towards clinical care."

The issue of over-administration is becoming an increasing bug-bear of surgeons, who warn they are being restricted in their practices and efforts to train new surgeons by bureaucratic cuts to theatre times to contain costs. A crisis meeting was held yesterday with about 30 surgeons - covering a range of specialties - voicing their concern that debate this month about insufficient surgical training places did not give a true picture of the challenges facing doctors trying to educate even the existing trainees.

Chairman of the Royal Australasian College of Surgeons surgical training board, Stephen Dean, told the Sydney meeting the college had planned to increase positions from 200 to 240 next year. Professor Dean said the college could ensure adequate teaching for 240 trainees next year, but would be stretched to cope with the 260 it will now enrol after talks with the New South Wales, Victoria and South Australia governments.

Council of Procedural Specialists chairman Don Sheldon, who organised yesterday's meeting, said quality surgeons could not be produced in a "sausage factory environment... Our trainees need real operating time," he said. "It is disturbing the public hospital system is constantly reducing available operating time through rationing and periodic closures. This disruption and reduction is causing loss of quality training time."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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