Mass desertion of public hospitals in Australia

So many operations and other treatments are done in private hospitals, doctor's rooms and private clinics that public hospitals can no longer train junior doctors in the skills they need. Doctors say bone surgery, gynecology, dermatology and psychiatry are areas where specialist trainees -- known as registrars, and currently trained in public hospitals -- can no longer learn the surgical and other procedures they will need to perform later in their careers. The Australasian College of Dermatologists has had to extend its training course by a year because its registrars are no longer getting enough experience in common skin conditions in public hospitals.

Figures from the Australian Institute of Health and Welfare show private hospitals conducted 45 per cent of all same-day operations in 2004-05. The national conference of the Australian Medical Association in Melbourne at the weekend heard that doctors training to be orthopedic surgeons in public hospitals were now more likely to treat complex and urgent cases such as road crash victims.

Geoffrey Metz, clinical dean and director of education at the private Epworth Hospital in Melbourne, told the conference the situation was made urgent by the planned doubling of medical student numbers, expected to soar from about 1500 graduates a year to 2900 by 2011. "If there's no increase in the number of beds in traditional teaching hospitals, trainees will be fighting each other over the same number of patients," Associate Professor Metz said. Epworth Hospital, run by the Uniting Church, already takes trainees, he said. "We need to do part of our training outside the traditional teaching hospitals."

Psychiatry registrars training in public hospitals were mainly exposed to patients with psychoses, whereas doctors in private practice saw a lot more patients with anxiety and depressive disorders, Associate Professor Metz said. In gynecology and pathology, there were also big differences between the types of cases registrars saw and the problems of private patients.

Sending trainee doctors into private hospitals might prove tricky, as one of the vaunted benefits of private hospital treatment is that it allows patients to choose their preferred doctor. Delegates at the AMA conference backed a resolution that a position statement be developed to guide registrar training in the private sector, with a stipulation that the arrangements "must respect patient choice by ensuring that all patients treated by trainees are informed about the role of trainees in their medical care, andfreely consent to this".

The federal Government has committed $60 million through the Council of Australian Governments to expand medical training into the private sector. But Associate Professor Metz said this "can't be seen as anything other than seed funding" because of the large number of extra trainees due to come through the system.

Omar Kharshid , who completed his specialist training to become a qualified orthopedic surgeon last year, told the conference trainees in public hospitals were now more experienced in treating road crash victims than patients with common complaints such as bunions.

Health Minister Tony Abbott said the Government would "do its bit" to expand training into the private sector, but details of how the $60 million would be spent had to be finalised.

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Australia: Kidney disease treatment shame

MORE than 200 kidney patients die needlessly every year because of Queensland's "appalling" public health system, according to a leading kidney specialist. David Johnson has revealed that a "woeful" lack of doctors, equipment and understanding of the disease means patients are not getting the treatment they need to stay alive. He said some patients with chronic kidney disease were receiving dialysis only once a week rather than the recommended three five-hour sessions. Without regular dialysis to remove toxins and excess water from the blood, there is an increased risk of complications developing such as anaemia and high blood pressure. As waste products are allowed to build up, the patients can die sooner than they might have.

The latest figures reveal 224 Queenslanders die every year while on dialysis and nine out of 10 die before they even get that treatment. About 1500 are having dialysis and 139 are waiting for a transplant. Professor Johnson spoke out as chairman of Kidney Check Australia Taskforce, a group set up to lobby governments to provide better services. He is also director of kidney treatment and chairman of medicine at the Princess Alexandra Hospital, which treats a third of the state's kidney patients.

"The situation in Queensland is appalling and far worse than the rest of Australia," he said. "We have one specialist per 150,000 patients and we should have one per 80,000. "The lack of workforce and funding is just woeful." Prof Johnson said the lack of dialysis machines also meant many patients were being sent to hospitals up to 100km away from home for treatment, and others are waiting more than a year to see a consultant.

His comments come on the eve of Kidney Awareness Week, as the charity Kidney Health Australia warns the country is losing the battle against kidney disease. Deaths from kidney failure have doubled in 20 years and Australia's health bill for treating the disease is growing by $1 million a week. In Queensland, the number of patients on dialysis is increasing by 8 per cent every year and doctors believe rising rates of obesity, diabetes and the ageing population are to blame. Kidney disease is the "silent killer" - 16 per cent of the population do not even realise they have it until their condition deteriorates.

Tim Mathew, medical director at Kidney Health Australia, is calling for an early GP screening program, targeting people considered most likely to develop the disease, such as the obese, people with diabetes, or a family history of kidney problems. "We basically need to get the Federal Government's support for some active kidney programs to chase the disease," Dr Mathew said. "We also need to educate GPs. "Generally, they don't know enough about it, or if they do they are not confident to know what to do about it."

A Queensland Health spokesman said the department was working to boost dialysis services to cope with the demand, and will be opening a new 12-chair dialysis unit at Redlands Hospital.

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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