The Australian April 21, 2008
NSW Premier Morris Iemma has taken on doctors and the medical colleges, spearheading a push at the 2020 Summit to end their monopoly over prescribing, examinations and pathology tests.
The former state health minister lobbied the summit to recommend changes to the commonwealth-funded system of subsidies for out-of-hospital medicines, consultations and procedures so that nurses and other health workers could bill for some of the services that only doctors can now prescribe.
Mr Iemma also lent support to other delegates' proposals for a radical overhaul of healthcare training, which would enrol Australia's future doctors, nurses and allied health professionals in the one degree but issue and extend qualifications by the number and type of units studied.
"It's about what kind of health professional we have in 2020," Mr Iemma said, pointing to the difficulties created by doctors' absence from the bush.
"It may well be a nurse, a nurse practitioner, whose boundaries are expanded where you can't get a doctor."
Nurse practitioners already carry out some prescribing, the ordering of tests and patient referrals in states such as NSW, but have more limited and indirect access to the federally funded Medical Benefits Scheme and Pharmaceutical Benefits Scheme.
Mr Iemma said those restrictions had to be lifted if Australia was to adequately respond both to workforce shortages in rural areas and to the extra demands created by heart disease, diabetes and mental illness.
He envisaged a system in 2020 where a nurse equipped with portable cardio and ultrasound machines could feed readings taken at a patient's home in the bush back to a hospital specialist via a broadband network.
"It's a virtual emergency department in the home," Mr Iemma said.
He said the doctor shortages in the bush were exacerbated by the loss of generalists in the health system, as the medical profession became increasingly regulated in terms of who could do what.
The jack-of-all-trades general surgeons who once served as the backbone of regional health services had "one by one disappeared", the Premier said.
While the trend to specialisation had advanced treatment and survival rates, it also made the system much more reliant on highly qualified people who could work in only one area.
"You not only have the orthopedic surgeon, you have the orthopaedic left foot surgeon andthe left toe surgeon," Mr Iemma said.
By Siobhain Ryan
Article from www.theaustralian.news.com.au