By Anne Casey
SYDNEY — The latest talks between the NSW minister for health, Ronald Phillips, and the Australian Medical Association, held on April 27, failed to resolve the dispute which threatens to leave the public health system without visiting specialist doctors. (Salaried doctors employed by public hospitals are not involved in the dispute and will continue to treat patients.)
The conflict concerns the 2700 visiting medical officers (VMOs), who are specialist doctors in private practice and who work in the state's public hospital system as contractors.
The doctor's have threatened to resign following the judgment of Justice Hungerford of the NSW Industrial Commission on March 25. The 544 page ruling calls for a reduction in hourly pay rates of between 16 and 20%, up to $22. In addition, contracts would be imposed which stipulate set working hours for the specialists.
The AMA is trying to force the government to abandon the award system for specialist doctors by dropping its implementation of the Hungerford decision and negotiating a standard service contract with the VMOs instead. Both sides have until July 1, when the Hungerford recommendations are due to take effect, to reach agreement.
The doctors sought a pay increase of up to 70%. Instead the report recommends a decrease. The current hourly pay rate of VMOs was established by an arbitration decision in 1985. Following the chaos created by the VMO walkout from the public hospitals in 1984-1985, Justice Macken granted a jump in the hourly pay rate to $135.50. This decision was agreed by both parties at the time to be very generous.
But it would seem to set a very dangerous industrial relations precedent to renege on this decision now, eight years down the track, and cut this group's wages. This is a very vocal and powerful lobby. What is to stop the reduction of wages of workers who wield
far less influence?
The AMA itself hardly has a praiseworthy record with regard to workers' rights. The draft individual contract it has prepared for doctors hiring receptionist-typists establishes "normal hours of employment" between 9 a.m. and 6 p.m. Monday to Sunday. That is, it wipes out the standard working week: receptionists could work for 63 hours a week before earning overtime.
The second major aspect of the judgment is substantial changes to doctors' work practices. These include setting doctors' work hours in advance rather than having doctors treat patients and bill the hospital later. Further, medical procedures to be carried out will be determined by the hospitals, not, as currently happens, by committees of other doctors.
Doctors claim these judgments undermine their professionalism and are impracticable. The AMA claims the rulings make doctors enforce the rationing of medical services.
The Sydney Morning Herald editorial on April 23 commented, "That there will be rationing is obvious. But of course there already is, and no less obviously, so there should be. It is absurd to suggest that an ever-expanding stream of public money be set aside to pay for the exponential availability of new medical procedures and the costs of running modern hospitals."
Such an argument would seem to accord with the cutting back of the public hospital sector in favour of the private. Some though, such as Dr Alf Liebhold of the Doctors' Reform Society, think the issue is not so simple.
"An attitude of being the first with the latest and having total access to all complex, high technology medical interventions is going to bankrupt the system fairly quickly", he says. "This is at the expense, too, of all the simple things which are not so expensive and which can be done to save people from subsequently having to go into hospital for these costly repair jobs.
"What we should be really trying to do is keep people out of hospital. We don't want them in hospital in order to do expensive and difficult operations on them. We must try to work out ways of delivering preventive care."
Dr Liebhold believes decisions about where to cut back and where to increase must be made on a principled basis.
"I'm not in favour of putting more money into high tech medicine at the moment while the more important, simple and cost-effective preventive things are being done so badly. If you're living in a house and you've got a leaking roof, you would justifiably be very angry if your father or brother came home to say, 'Look, I've just bought a $1000 television set'.
"The public health system is not inadequate because we haven't got enough high tech stuff being done. It's inadequate because we're not keeping people out of hospital sufficiently. The money should go to the preventive services, but they've got no clout."
Another meeting between the parties is scheduled, although Phillips has told the AMA he is not prepared to negotiate a deal outside the arbitration system while the AMA sees the negotiation of standard service contracts as "the only way forward".