Issue 21 / 22 November 2010

MANY doctors have expressed their dismay at the annoying inefficiency of the Australian Health Practitioner Regulation Agency, based on recent posts in MJA InSight.

Many might generously accept that the new system is overwhelmed by its obligation to take over the registration of hundreds of thousands of health professionals.

But how many appreciate the philosophy underlying this new initiative by Labor governments in Australia?

Or that this new bureaucracy emanates from the workforce considerations of the Productivity Commission?

Productivity and medical practice are not familiar bedfellows.

Does medical practice even lend itself to the notion of productivity?

How can the concept be applied to the management of patients and their illnesses and concerns?

If this is, indeed, a nonsense, then what is the new Authority all about?

For some decades now, Australian governments have been focused on “competition”, whether in banking, manufacturing, wholesaling or retailing of commodities.

“Competition is king” because competition lowers prices.

Competition can also lower prices in health care.

Permitting lesser paid, underqualified people to perform the work presently done by more highly paid, properly qualified people will lower prices.

Even when those people advocate unproven remedies, their services will be cheaper — at least in the short run.

Up until this year, Australia’s eight medical boards, largely independent of government control, were concerned exclusively with standards of medical practice.

They, rightly, had no interest in workforce or in “productivity”.

They have been committed to establishing and maintaining the highest standards of health care.

Now they have been replaced by a government body which has already shown the colour of its cloth by registering chiropractors and which is about to register Chinese medical practitioners, without evidence of the efficacy of these systems of healing the sick.

At the same time, the federal government has established Medicare rebates for services given by nurses, who will be able to prescribe pharmaceuticals and order pathology tests.

Can politicians be so stupid that they do not realise that diagnosis precedes therapy?

How can individuals untrained in diagnosis treat sick people with any degree of professionalism?

The combination of the national recognition of practitioners of unproven remedies and the extension of therapeutic potential to people untrained in diagnosis expose the true motivation behind the establishment of the AHPRA — price-cutting at the cost of high-quality professional health care.

This should not only alarm all doctors, but all Australians.

Dr Peter Arnold is a former Deputy President of the NSW Medical Board, former chairman of the Professional Standards Committee and a former member of the Medical Tribunal of NSW.


Posted 22 November 2010

18 thoughts on “Peter Arnold: The real cost of national registration

  1. Geriatrics Registrar says:

    Associating medical practitioners and allied health practitioners from professional groups with evidence-based practices with chiropracters, Chinese medicine practitioners and, I am sure, faith healers and witch doctors soon to come, by virtue of registration under the same government body, may in fact validate these unproven and often harmfully ineffective avenues of “treatment” in the eyes of the general public. Be afraid – be very afraid.

  2. Donald McDowall says:

    I enjoyed reading Peter’s defensive comment but could find no references for his statements. Did I miss something? Is there evidence for this statement “The combination of the national recognition of practitioners of unproven remedies and the extension of therapeutic potential to people untrained in diagnosis expose the true motivation behind the establishment of the AHPRA — price-cutting at the cost of high-quality professional health care.” ?
    Maybe AHPRA are right, Peter, and you could be better informed given this latest study regarding outcomes and savings with chiropractic care. I will include the extract. “Results show that paid costs for episodes of care initiated by a DC were almost 40% less than care initiated through an MD. After risk-adjusting each patient’s costs, researchers still found significant savings in the chiropractic group. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. ”
    Maybe a similar Australian study will show just as effective results? Maybe the results will be better given the quality of the current Master’s degree university programs for chiropractors?
    Why not work as a team and save money at the same time?

  3. Dr Klaus Stelter says:

    We know who Peter Arnold is but who the hell is Donald McDowell?
    At the St George Division we have had a number of complaints from old people being rung up by chiropractors at home offering free spinal checks “to find and cure spinal pathology”.
    I have had two pamphlets in my home letter box one of which was from a chiropractor using the title “Dr” whose motto she stated as “You’ll feel better just walking through our doors”.
    And another stating “chiropractice helps with allergies, asthma, colic, headaches, ear infection, stress and balance problems”.
    The last patient I had that had seen a chiropractor for headache had meningitis!!!
    I concur be afraid of these people.

  4. Tom Ruut says:

    Like the venerable Peter Arnold I too resent being lumped together with these other purveyors of dubious therapeutic benefits.
    What really annoys me is that the registration fee has almost doubled! So much for the efficiencies of scale. One would have thought that the registration fee would be less.

  5. A Medico says:

    It would appear that medical paranoia is alive and well. Many would say that having a national approach to registration is overdue for many good reasons. Furthermore many medicos still seem to think that they exist in a parallel universe and that the government owes them their regal Medicare entitlements (private practice) without question because they are such fine fellows!

  6. Geoffrey Miller says:

    When I qualified in 1954 I would have been struck off the register for professionally associating with unqualified practitioners such as chiropractors! Now they can practice in association with medical clinics!
    I remember, when I was in general practice, seeing a patient with an acute myocardial infarction. He had had prior angina, radiating to his left arm, that had been treated by a chiropractor with manipulation….

  7. Ben says:

    Dr Arnold asks rhetorical questions about productivity in medicine, and calls it a ‘nonsense’. However there are a multitude of ways doctors can be more productive, and given doctors are a finite resource, it is something we should all be concerned with. Whether this is a job of a medical board is an interesting question.
    Then near the end, “so stupid that they do not realise that diagnosis precedes therapy?” and, “How can individuals untrained in diagnosis treat sick people…”.
    Really? Emergency doctors and GPs routinely start treatment long before diagnosis is made or even considered. Analgesia is treatment. And it greatly limits medicine to define ‘treat sick people’ as curing disease, as so much of medicine and health care, practised by doctors and other professionals, is concerned with caring, relieving, alleviating and empowering, not just fixing. Much of which can be done without being trained in diagnosis.
    Although I agree with Dr Arnold’s sentiments about cost-cutting and his concerns about unproven treatments, I don’t think an article that reduces us to unproductive fixers of disease does much to further the standing of medical practitioners.

  8. anon says:

    “The last patient I had that had seen a chiropractor for headache had meningitis!!! I concur be afraid of these people.”

    I saw two patients with a vertebral artery tear following chiropractic treatment. Of course chiropractic treatment can be cheap, the point is whether is works.

    The other problem with national registration – what happened to the publication of decisions? Previous disciplinary action is on the state websites but nothing has been put on for months. This is a significant problem when I am being asked to refer to people who have been through disciplinary processes, the outcomes of which are not available.

  9. Nick Aalders says:

    My registration as a GP is due in 3 weeks. As yet, I have not had a single communication from AHPRA about ANYTHING! This despite repeated communications by me to them. How does this body expect to ensure professional standards across all the helping professions when it has no professional standards of its own?

  10. Peter Arnold says:

    The anonymous ‘A Medico’ writes, “Many would say that having a national approach to registration is overdue for many good reasons.” As both Kerry Breen (former president of the Medical Registration Board of Victoria) and I have written in the MJA, we have not seen a single GOOD reason for introducing national registration. If ‘A Medico’ can think of one which justifies this expensive, unwieldy shlemozzle, please tell us – and also tell us who you are.

  11. Max King says:

    Lots of griping and sour grapes- but no sensible solutions.
    Firstly, are eight medical boards better than one? Or were eight medical boards better than what the one could and should be? The ‘could and should be’ is the challenge for professional bodies (and lobbyists) to address to the government. Negotiate.
    However, I was bemused by the Peter Arnold’s sudden lurch into productivity and competition.
    Productivity – let’s call it “improved efficiency and effectiveness at managing and using resources (human, chemical, physical and whatever)” – a highly commendable goal with better patient outcomes. Overservicing springs to mind. But I am uneasy about the crucial – the critical – role of diagnosis being delegated to non-medically trained persons.
    Competition – don’t we see this already, with bulk-billing versus non-bulk billing practices? I do, however, strongly agree that the introduction of quackery into the competition for patients is obscene and insulting to valid health care professionals.
    Finally, I was disappointed with Peter Arnold’s resentful and bitter tone, exemplified by the comment: “Can politicians be so stupid that they do not realise that diagnosis precedes therapy?” So, no therapy is administered until the diagnosis has been made – sounds a bit off.

  12. Pete Bradley says:

    I have no problem with the statement “no therapy is administered until the diagnosis has been made”, or at least a working concept of what the problem might be, but that has little or nothing to do with state or national registration. However, I do take exception to Peter Arnold’s challenge to state one good thing about national registration. What about the complexity and cost of having to wear and repeat all the bureaucratic paperwork and fees to register with each silly state health department individually if one wants to practise in more than one state? It’s crazy. The states have proven incompetent to deal with it anyway. (Patel et al)

  13. Isaac Brajtman says:

    Now that we are on registration, what can be done about the total deregistration of retired doctors which is apparently being spoken about ?

  14. Richard M says:

    What I would really like somebody to explain to me is who are the people on the board answerable to for THEIR behaviour and performance and why do they not just come right out and state clearly what we all know…
    Any doctor who they “advise” (HAHAHAHAHAAaaa…) is guilty of all and any accusation until they are proven. They hold themselves above Natural Justice and Rules of Evidence.
    Having seen the careers of two excellent anaesthetists destroyed by these functionaries (aided, it has to be said, by blatant misinformation and misrepresentation by so called “exspurt” witnesses) the question has to be asked, Why are they allowed to get away with it??
    It helps no one.
    As to their obsession with intruding between two adults even if in a mutually consenting relationship, well, what does that say about them?

  15. Anonymous says:

    Dr Arnold, why would you demand to know the name of an anonymous commentator? The medical establishment has shown itself many times to be vindictive and ruthless in persecuting those who don’t toe the line. I’ve worked in four states, and had to pay registration and send certified documents each time. In one case, missing the oppurtunity to provide holiday relief for a doctor because the board only met once a month, no exceptions.

  16. Paul d'Arbon says:

    I recently received a letter from Dr Joanna Flynn, Chair of the Medical Board of Australia, welcoming me to the national registration and accreditation scheme and forwarding the application for renewal of my limited registration (public interest-occasional practice).
    My name on the form was “Dr Paul DArbon Oam”
    In order to correct my name I rang 1300 419 495 and, after a wait of 20 minutes, a lady answered.
    I informed her that “Oam” should have read “OAM” to be told that she had never heard of the Order Of Australia and said she would connect me with the person in NSW who dealt with such matters. After a wait of 10 minutes she told me that this person was in a meeting and would contact me. I left my home and mobile numbers but heard nothing.
    I then wrote to Dr Flynn giving her the details of my initial contact and asking for assistance.
    I have had no reply.
    Give me the old system any day.

  17. HJR says:

    There are literally hundreds of nurses waiting on AHPRA for registration and many have been waiting for more than 6 months. Previously the state reg boards would send out applications to nurses at uni to complete and as soon as they graduated they had their registaration within days. They were booked into graduate programs in hospitals. These all had to be cancelled because AHPRA has taken many months to register these much needed members of the hospital workforce. Many from overseas could not afford to wait for their placements and had to return home. A funny story – a nurse from NZ applied for registration and was sent an English exam because she was not from Australia – she completed it and sent it back with the required $300.00 just for that. She received a letter from AHPRA stating they no longer required the English exam from New Zealanders however she had not passed it anyway and so could not be registered. Whatever you do – do not let your registration lapse!!!

  18. Lester Cowell says:

    I received confirmation in December from the National Registration Authority and discovered that I now have 3 new numerical identifiers to keep secure, one of which is 16 digits that replaces the 4 digit state based ID. Possibly this is an extension of the Medicare coding for patients but remembering 16 digit codes and a 10 digit password I cannot do and indeed not even the banks ask such of their retail customers. I am comfortable with the current 6 digit prescriber and 8 digit provider code but are these soon to be redundant? Is a very large influx of providers expected? A lot of encoding could go into the 9 surplus digits. Can someone explain a) the need for these identifiers; b) the form of these; and c) when exactly I am to use these codes?
    Am I cynical to think that the bureaucracy is creating work for itself? Perhaps this is where the higher registration fee is used. Although, in school economics we learnt that large operations are more efficient and have lower unit costs.

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