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Thursday, 26 November 2009
Page: 13175


Mr SULLIVAN (3:09 PM) —I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Let me say at the outset that, whilst it is not my intention to revisit all of the issues that have been raised in terms of what we on this side of the parliament see as very definite shortcomings in the Health portfolio under the former Howard government, I concur with my colleagues who raised those in detail earlier. The main provision of this bill relates to the current restrictions applicable to doctors who are New Zealand permanent residents and citizens—I will come back to that in a moment—who have obtained primary medical accreditation at an accredited medical school in Australia or New Zealand.

The health professions in Australia and New Zealand are fairly heavily intertwined. All but one of the colleges of surgeons—I think there are 11 or so—are termed ‘Australasian’ or ‘Australia and New Zealand’. Joint Australia-New Zealand organisations provide the same training for higher roles in the medical professions. It makes sense that training for general practitioners should be provided in the same way, but the College of General Practitioners is the one college that is not a joint Australia-New Zealand college—there are separate colleges in Australia and New Zealand.

We have heard a lot about section 19AB of the Health Insurance Act and the 10-year moratorium that restricts foreign trained overseas doctors from providing medical services that attract a Medicare rebate—for example, pathology tests—or referring patients to a specialist. We have heard quite a deal about how doctors in that category are able to go and work in an area of workforce shortage in order to overcome the moratorium and get a Medicare number for rebatable services. Provided that they stay there for 10 years, when they emerge from the bush after their 10-year hiatus—if they ever do emerge; the bush lifestyle really grows on the people who go out there and I imagine medical professionals would get used to living in some of those small towns—they will have full capacity to charge for Medicare rebatable services.

But what we have not heard spoken about much today is the fact that there is a shorter course that can be taken, particularly for harder to fill positions. This bill provides for a gradual diminishing of the 10-year provision for those who remain on it—not the New Zealanders, of course—depending on the remoteness of the area or the difficulty in filling the position that they take up. But already in place is a five-year moratorium—or what I like to think of as a short course—for particularly hard to fill positions, where overseas trained doctors in certain categories are able to get full Medicare accreditation in a shorter time. This process is handled by the Royal Australian College of General Practitioners rather than by the Australian Medical Council.

It is very interesting to look at who is able to access this five-year provision. This scheme has four real requirements. The first requirement is that doctors complete five years in a practice in an agreed rural location—and that can even be reduced to three years if they go to a significantly remote area. The second requirement is that they obtain fellowship of the Royal Australian College of General Practitioners. The third requirement is that they obtain permanent residency in Australia. The fourth requirement is that they meet all the requirements of the state or territory administering the scheme.

Which doctors can access this scheme? Interestingly enough, the Royal Australian College of General Practitioners divides doctors into a number of categories. In category 1, there are GPs who hold a fellowship with the Royal New Zealand College of General Practitioners, along with certain doctors from Canada and the United Kingdom. This group of doctors is immediately eligible for admission into the fellowship of the Royal Australian College of General Practitioners. Doctors in the next group, category 2, are able to get onto this short course, if you like, provided that, within two years, they successfully complete the exam to become fellows of the Royal Australian College of General Practitioners. This group includes certain doctors from the UK, Ireland, South Africa, the USA and Singapore.

The health architecture in this country is, I must say, particularly convoluted. On the one hand, we are creating a group of doctors who are from certain areas and who have a special relationship with us and, on the other hand, we are, through this legislation, bypassing some of those relationships and giving doctors from New Zealand an extra special relationship with Australia. As has been said a number of times, Australians and New Zealanders have an interesting relationship. The suggestion has been made on a number of occasions, but particularly back in the 1890s, that New Zealand should form part of the federation or Commonwealth that has become Australia. That was not to happen. And I suspect that it will not happen until enough New Zealanders have taken out Australian citizenship so that we can regularly beat the All Blacks at rugby!

It is a friendly rivalry that we have between our countries. Nowhere else would you think of getting away with wearing a T-shirt that said ‘I barrack for two teams—New Zealand and anybody who is playing Australia’. But here we are today proposing to make not just New Zealand doctors but doctors who are resident in New Zealand a little more equal than Australian resident doctors. For example, the removal of the 19AB requirements applies to New Zealand trained doctors, whether they are trained at one of the two AMC accredited universities in New Zealand or whether they are trained in Australia, and also to New Zealand resident doctors. Hence, a doctor who is a resident in New Zealand but is a citizen of a third country can come to Australia and not have to work through the 19AB or 10-year moratorium restriction, whereas a doctor who is a resident of Australia but a citizen of another country other than New Zealand and who is working in Australia does not have that restriction lifted from them, despite the fact that they have done their medical training in an Australian university. I think it is an anomaly, and I suspect it is an anomaly that we are going to want to correct in the future.

The bill makes a couple of other minor changes. It puts in place some time limits on applications or appeals against a rejection of the 19AB exemption and puts forward sensible measures in relation to when the clock stops clicking for those people who are subject to the 10-year moratorium.

Having made those few comments, I want to talk about some of the issues that I am discovering in my seat of Longman—and I will be brief. Members who followed the 2007 election campaign and people who live in my area will know that, during that campaign, I gave a very strong indication that, while hospitals were and for the moment will remain the province of the state governments, I believe that in our area of South-East Queensland, which is fast becoming the northern outskirts of Brisbane, we need to make provision for another hospital. There is a lot of talk about expanding the Caboolture Hospital. The nearest estimate of what that would cost is $600 million. It may be much more economical to look for another site than to put a fourth hospital in that part of Brisbane.

I have heard plenty of talk today about doctor shortages. Doctor shortages happen everywhere. They are a consequence of decisions that were made in this country earlier on, in the last 10 years or so—but not just in this country; I have spent a fair bit of time in New Zealand, a fair bit of time in England and a little bit of time in America and let me tell you that the headlines in each of those countries relating to health issues are just the same as the headlines that run in the papers here in Australia. Doctor shortages is a worldwide phenomenon and it is something that is going to be very difficult to overcome even in the longer term, I suggest, as the population rapidly ages and as medical technology enables people to live longer—and I think we all want to do that. I think all of us look at the health profession as what keeps us alive and keeps us from finding out what there is after death.

So those shortages are going to occur, but what I am also noticing is not a rush but a move from small practices to major medical centres in towns, and I have noticed that is part of what is happening in my electorate. In one case doctors from one practice were offered a sign-on fee to close that practice and move to another practice some 18 or 20 kilometres away, which caused great distress for the patients. Those doctors, as I understand it, were given a financial enticement to do so and left. The other clinic closure that happened in my area was a consequence of the global financial crisis where the practice, as I understand it, had overextended itself through borrowings from the American market and was not able to keep running.

Doctor shortages and hospital overcrowding, particularly in emergency centres, are pretty much features of every community. I am not aware of anybody who thinks that they have enough medical services in their electorate. I would like to suggest one thing that might help overcrowding at hospital emergency centres. It is a change to the Medicare act to allow the state governments, who are running hospitals, to employ general practitioners to meet patients at public clinics at a hospital and bulk-bill Medicare for it, because these are indeed the patients who are clogging up the emergency centres and who are making complaints about state hospitals on the basis that they are often waiting enormous lengths of time while people with serious injuries are prioritised above them as they come in.

In talking in favour of this bill, I do want to point out that there is an unintended anomaly that we are going to have to look at in the future. I think that we can extend the scope of overseas doctors to whom this kind of treatment can be given, particularly the Canadian and UK doctors who join with the New Zealand doctors in the short course as to the five-year moratorium for hard to fill positions that I mentioned. I think this bill will go a long way to assisting people in the remote locations, in the bush, to acquire doctors. I know that the Rural Doctors Association has said that the system has not been particularly successful. However, the fact that somewhere in the area of 40 to 45 per cent of doctors practising in rural Australia are overseas trained doctors shows that it has been of some help. Obviously, the rural medical schools, such as the one at James Cook University, will help people who have a fondness for their community and want to help their community and who will train through these schools and will do well.

I want to finish by saying that I did not know until I heard the previous speaker say it that the oncology unit at the Cairns Base Hospital is going to be named for Liz Plummer. Liz and Max were friends of mine in excess of 25 years ago. I remember both Liz and Max as wonderful people and I was very saddened to hear that Liz had passed away. I send to Max and family my and Carryn’s best wishes and look forward to catching up with him sometime later on when I get to Cairns again. With those few words, I commend the bill to the House.