Australia needs more general physicians to address problems with the healthcare system
The Royal Australian college of Physicians
*Physicians are often called medical specialists. They are doctors who have completed an extra eight years or more of training after their initial university medical training. Patients are generally referred to a physician by a general practitioner seeking expert medical advice. Australia needs more general physicians to address the complicated medical problems of an ageing population of patients, according to the new position statement Restoring the Balance. The paper was developed by the Internal Medicine Society of Australia and New Zealand (IMSANZ) and The Royal Australasian College of Physicians (RACP) and will be launched on Friday 2 September at the IMSANZ Annual Conference in Alice Springs. “Many patients no longer have access to care from a general physician. This means they may be treated by a different specialist for each separate health problem and their overall health is at risk as a result of poor coordination of care, oversight of problems that do not fit into specific subspecialty areas, or in some cases overtreatment” A/Prof Ian Scott, IMSANZ Vice President said. “Currently there are over 180 vacancies for general physicians in Australia and New Zealand, with 130 of these in Australia. Of particular concern are the numbers of general physicians available to service the health needs in regional and rural centres which have reached crisis point in some regions. There are shortages in metropolitan and outer urban areas as well,” A/Prof Jill Sewell, RACP President said. “This shortage will continue to rise as the present workforce in Australia retires. The current batch of physician trainees are also choosing, for a variety of professional and personal reasons, to train in subspecialties which for many, may not foster an environment in which to maintain their general medical skills once they graduate.” General physicians have special expertise that could be used to solve many of the problems in Australia’s healthcare system, particularly in the following circumstances: * When patients are admitted to hospital with acute conditions that involve a number of organ systems, admission under a general physician team rather than a single organ-system subspecialty care team is more likely to ensure that all problems relating to their health are fully assessed and managed appropriately. General physicians are trained to liaise and consult with other subspecialists to ensure that patients receive timely and appropriate subspecialty care. * When treating patients in the community with complex chronic and multisystem problems such as a patient who suffers diabetes, vascular disease, and respiratory problems, a general physician can give specialist attention to the ‘whole person’. * Patients in rural and regional areas with complex problems are best served by a general physician who is able to deal with a wide range of medical issues. Referral of most patients to city based specialist physicians is inefficient, expensive and potentially detrimental to optimal health outcomes, and imposes unnecessary cost and inconvenience on patients and their carers. “The position paper makes a number of recommendations for Federal, State and Territory governments including greater equity between procedural and non-procedural physicians in the level of remuneration through salary and Medicare reimbursements, and in conditions of work. State and Territory governments should also adequately compensate general physicians in private practice for time spent in undertaking public hospital duties comprising committee work and teaching roles in addition to clinical work,” A/Prof Scott said. The position paper recommends Australian governments improve outer metropolitan, regional, rural and remote general medical services. This includes implementing schemes for attracting general physicians to practice in these areas such as a more regionalised approach to service delivery, staffing and training, and improved financial incentives and conditions of work. The paper also recommends that all teaching hospitals should have Departments of General Medicine of which a key element should be an Acute Medical Admitting Ward led by general physicians. “Experience in New Zealand suggests that Acute Medical Wards provide more cost-efficient care, decrease hospital admission rates, save hospital bed days and streamline care delivery,” A/Prof Sewell said. Another recommendation is to improve physician training and opportunities for Continuing Professional Development in general medicine. The position paper states that IMSANZ and RACP need to develop a flexible training curriculum, establish mentoring and supervision guidelines, and implement further opportunities for CPD. RACP and IMSANZ have already begun implementing the changes to general physician training through the current RACP Education Strategy.