The clinical school at Woden Valley Hospital is not out of the woods yet. At the end of the Health Ministers’ conference in Alice Springs in the middle of last month, the clear impression was the Federal Government would put on hold for a year its plan to cut the number of medical graduates from 1200 a year to 1000. It meant that Sydney University would therefore be able to continue servicing the 30 places at Woden. It now appears that that is not the case. The Federal Government is to press ahead with its plans while a committee looks at doctor supply. The political fall-out has been a spat between the Federal Health Minister Carmen Lawrence and her ACT counterpart Kate Carnell. They have traded accusations about who said what to whom and when and what were the precise terms of the agreement between the state and federal ministers. The head of the ACT’s Department of the Health, Greg Fraser, and the South Australian Minister, Michael Armitage, say they got the impression that the plan to cut back graduates was on hold for a year. Dr Lawrence says to the contrary. Dr Lawrence allowed the impression that the cuts were off for a year to remain with the public for two weeks before putting her interpretation.
The spat aside, it seems pointless and silly to review an issue when the Federal Government is pushing ahead with its conclusion anyway. The real issues are whether cutting back medical graduates will benefit health care in Australia or even achieve its stated aim of cutting Medicare costs and what effect will cutting back medical schools have on smaller schools, in particular the ACT clinical school.
The Federal Government has a serious difficulty with the cost and effectiveness of Medicare. More people are deserting private health care. More people are seeking more health care, some of which may be put down to over-servicing. The Government refuses on mainly ideological grounds to have a co-payment for Medicare _ like pharmaceuticals, which help cut over-servicing. The Government refuses, again on ideological grounds, to abandon community rating for private health insurance. True, it has allowed health funds to negotiate directly with providers which may help cut costs, but by cutting off major workable options, it is left with fanciful ideas, such as cutting the number of doctors. The theory is that with fewer doctors, over-servicing will drop because doctors will not need to generate business. However, it may be that over-servicing will continue as the over-supply in the cities continues and fewer doctors are forced go to the already doctor-starved bush. Also, fewer doctors will mean less competition and therefore higher prices _ fewer may bulk-bill.
Of more import to the ACT, is the effect on the clinical school. It is not enough for Dr Lawrence to say no school will close as a result of the graduate cut-back. The schools have to have long-term viability and short-term functioning strength. Any reduction on the current 30 places would impair those things. The dean of Sydney’s Faculty of Medicine, Professor John Young, says negotiations to cut the number of graduates would affect the number at Canberra because he would try to spread the pain. The head of the Canberra school, Professor Paul Gatenby, says it is appalling that Dr Lawrence has reneged on her promise to put the cull on hold.
Woden Valley Hospital serves 600,000 people in the ACT and surrounding NSW. Ultimately, perhaps when the 10-year contract with Sydney University ends, the ACT should have a full medical school functioning out of the two main universities here. The number of people being serviced and the catchment for people seeking educational opportunities warrants that objective.
Whatever happened at Alice Springs, Dr Lawrence should abandon the cuts at least for a year. They are misguided both nationally and for their local fall-out.