As with medical decisions, political decisions when wrong can have seriously detrimental consequences.
Australia has largely followed the UK in progressively denying the medical profession the freedom to regulate itself or sustain models of patient care that are in the long-term best interests of patients and society, including that most essential and fundamental service in the form of the family doctor.
Whilst Qantas has recently been found by the High Court to have acted illegally in sacking its front-line ground staff and replacing them with contracted workers, the federal government has a similar agenda with general practice. In essence, this involves political and public pressure to accept bulk-billing remuneration that is incompatible with financial sustainability and good clinical practice, resulting in established practitioners leaving the specialty and new graduates eschewing it.
Like Qantas, government has a stealth strategy to replace general practitioners with contracted workers, with migrant visa conditions ensuring compliance with the demands of corporate and bureaucratic masters. This intrusion of corporates and private equity into the realm of primary care is an exceptionally dangerous policy setting. Corporates are not in the business of maximising the health and well-being of individuals and the nation. They are in the business of maximizing the wealth of their shareholders in the annual business cycle, with CEO profit bonuses that are equally short-term. There is thus no incentive to promote health, but rather to maximise disease derived income. This is achieved by short consultations sufficient to provide a basis for medical imaging, pathology services and pharmaceuticals, often owned by the corporate. This is the proverbial “cash cow” so promoted at business schools and presumably advanced by consultancy firms as they simultaneously advise governments to commercialize disease management, whilst also advising corporates on how to milk Medicare, so earning billions.
The detrimental consequences of failure of primary care are profound, ranging from the negative impact on personal health and well-being, to reduced productivity and increased absenteeism, and unsustainable and growing demand for secondary and tertiary medical services, severely stressing state and territory budgets and being a massive opportunity cost where finite tax-payer dollars could otherwise be invested in nation-building activities such as education.
In addition to involving corporates, a further key element in government policy has been to hand over regulation of the profession to bureaucracy. This further restriction on the freedom to practise in accordance with the obligations of the profession, and instead require obedience to government appointed bureaucrats, has compounded the loss of control, felt most acutely and visibly in general practice, with consequences as already mentioned.
Whilst AHPRA was said to be justified on the basis that it would improve outcomes for patients, it has from its inception lacked a rational basis for the claim. It is instead the medical profession that has always been committed through self-regulation to properly serving patients and society, and been the body charged with maintaining high professional standards, and so earning respect. The recent matter of nurse Letby in the UK, being under the regulatory model followed by AHPRA, illustrates how illusory is any claim that massive and expensive bureaucracy provides better patient outcomes. Instead, autocratic bureaucracy simply provides a mechanism for frightening, threatening, and stifling responsible and knowledgeable medical voices, that if heeded could have saved young lives.
It is in this context that we are being asked to pay ever escalating dues to AHPRA as the government agency that subjugates and instils fear and uncertainty into our practice of our profession, whilst denying us the regulatory wisdom and leadership inherent in our profession. There has been much recent critical media coverage of the unhealthy relationship between big government and big business. Exploitation of the sick by corporates and the associated subjugation of the medical profession is an unfortunate and harmful example.
Unsurprisingly, with accountability to none other than itself, AHPRA is at liberty to grow its bureaucracy and demand ever increasing fees as it desires. It is too late for this year’s deadline to take collective action by refusing to pay AHPRA, and instead promote an alternative model of self-regulation. But if the medical profession is to ever regain its proper and essential role in sustainably advancing the health of our nation, rather than being coerced into enabling commercial profiteering from disease, then bold collective action is essential.
The Australian Doctors Federation
September 2023
