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Health care falling victim to turf wars

By Kym Durance - posted Wednesday, 1 March 2006

The Productivity Commission Health Workforce Study (pdf file 1.52MB) released in January recommends a standing committee advise the relevant minister on the feasibility and appropriateness of changing services covered under the Medicare Benefits Schedule (MBS).

Recommendation 8.1 addresses the question of whether any areas currently the exclusive domain of medical practitioners can be undertaken reasonably and safely by non-medical practitioners - and funded under the MBS scheme.

Not surprisingly, groups like the Australian Medical Association (AMA) and the Australian Doctors Fund (ADF) have come out against the notion.


Even more recently, Stephen Leeder published an article in The Australian (8 February), and subsequently reprinted in On Line Opinion, calling for general practice psychologists to be funded through Medicare. It would be safe to assume Dr Leeder will come under attack for floating the idea as well.

After the Commission handed down its report, the AMA protested the idea of role substitution. In a media release in January, the AMA’s vice-president, Dr Choong-Siew Yong, said “proposals to replace doctors with lower trained and lesser trained health workers is totally unacceptable”.

Also, late last year - and aware of draft proposals coming from the report - the ADF published a response to the draft proposals, commenting on the notion of task substitution.

In particular reference to nurses, the ADF said the imposition of university education for them was responsible for a fall in nursing numbers, together with unrealistic expectations that they may engage, or yearn to engage, in quasi-medical activities.

The ADF called for a return to the hospital-based apprenticeship form of training - clearly the nurses were thinking well above their station!

Sharp debate over role delineation is commonplace in the health industry, occurring for instance between the various nursing divisions where one historically, lesser trained group aspires to a role or task traditionally the turf of the higher trained group.


When health professionals in many disciplines are thin on the ground, the public become unwitting victims of these internecine struggles, irrespective of the profession involved. And, in this instance, the Productivity Commission report’s recommendations appear to have given rise to just such an unproductive tussle.

Arguments against role and task, and role substitution, are littered with the notions of quality, expertise and accountability.

In the AMA’s August 2005 media release leading up to the report’s release, its current president, Dr Haikerwal, is quoted as saying, in clear objection to the concept of role or task substitution, “We must put an end to any moves towards sudden or forced role substitution”.

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About the Author

Kym Durance is a health professional and has worked both as a nurse and in hospital management. He has managed both public and private health services in three states as well as aged care facilities; and continues to work in aged care.

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