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States, ACCC turn focus on College of Surgeon -

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States, ACCC turn focus on College of Surgeons

Reporter: Mary Gearin

KERRY O'BRIEN: It appears, on the surface at least, to be one of the last great monopolies -- one
that can artificially control the law of supply and demand.

The Royal Australasian College of Surgeons has traditionally been the professional body that
decides the number of doctors who join its elite ranks.

But now three State governments, under pressure to cut waiting times for surgery, are threatening
legal action against the college, claiming it is artificially restricting the number of surgeons
being trained.

The complaint has rekindled the interest of the Australian Competition and Consumer Commission,
which is keen to ensure that the college's training practices are not designed to protect the
income level of its members.

The college will be meeting representatives of all Australian health departments on Wednesday.

Mary Gearin reports.

MARY GEARIN: For many, this is the pre-eminent medical career.

Surgeons accept the onerous responsibility of cutting into bodies to save or improve lives.

For that, they earn the gratitude of patients, the respect of society and a pretty good quid.

It was a path in which Paul Paddle looked set to excel very quickly, becoming top surgical
undergraduate from Melbourne University this year.

DR PAUL PADDLE, INTERN, ST VINCENT'S HOSPITAL, MELBOURNE: For me, I've always had a passion for

I've always had a passion for the theatre, obviously, using my hands, having a clinical skill in my
hands as well as the approach to surgery.

The fact that you have a problem, you see a solution, design that solution, play an active part in
that solution and hopefully have good outcomes at the end.

MARY GEARIN: But while the 25-year-old passed the national tests to become a trainee surgeon, Dr
Paddle didn't make the cut to stay in Victoria and was told he'd have to leave to be accredited.

DR PAUL PADDLE: For me and for the college, it seemed there is an emphasis put on staying where you
are most supported, developing a relationship with your teaching hospital, with the rotating
hospitals, and having a good working relationship.

For me, I feel that I am working on that and have developed that here in Victoria.

MARY GEARIN: Dr Paddle has decided not to move, and now will spend the next year doing exactly the
same basic level tasks he would have been doing otherwise.

They just won't count towards his accreditation as a surgeon.


Paul was the top surgical student from the University of Melbourne.

He has expressed a strong desire to do surgery.

He's been given a job here at St Vincent's.

We were looking forward to him being one of our leading trainees.

And the College are saying that he can only become a trainee if he leaves Victoria.

enough funding so that there's enough operations being performed, there's enough supervision, and
that the rosters these trainees are doing are going to actually train them in surgery and not just
train them in a way that provides a service commitment to the hospital but perhaps isn't going to
give them the surgical skills they need to progress through the program.

MARK WESTCOTT: That's simply not true.

We have three trainees at this hospital who we are employing next year in the same positions that
they would be employed in if they were to be accredited.

They've met all the entry requirements that the college have put in place.

They're excellent candidates.

They've got a job here at St Vincent's and they're denying them accreditation.

So the positions are there, the funding is there.

BRONWYN PIKE, VICTORIAN HEALTH MINISTER: This is not a matter of funding.

We have the resources and we've got throughput there.

This is rather about the College of Surgeons making a determination that they will keep a lid on
the number of people who they'll accredit.

MARY GEARIN: St Vincent's is not the only unlucky hospital.

While there was a 20 per cent increase in trainee positions nationally, just 51 places were
allocated for Victoria's 65 successful applicants and New South Wales got 17 fewer places than it

The rest, like Paul Paddle, were told to go interstate.

PROFESSOR GUY MADDERN: This, of course, has been happening for many years.

Doctors in surgery have been trained in country hospitals in Victoria and New South Wales, despite
the fact that they might be Melbourne or Sydney-based.

And that's been considered a perfectly appropriate thing to do.

MARK WESTCOTT: At basic training level, we are given a breadth of exposure, intensive teaching in
the basic sciences, and there's not a need to move interstate to get that.

We have the equal of any other teaching here at St Vincent's.

GRAEME SAMUEL, ACCC CHAIRMAN: We want to know why it is that the college of surgeons is saying you
have proceeded through your training, the hospital which is prepared to employ you who has the
available places for you to do it, obviously has the demand for their services and yet you were
imposing a constraint.

We want to understand why that was so.

On the surface, it would not appear to be acting in the interests of the public.

MARY GEARIN: At the heart of this matter is the Royal Australasian College of Surgeons and its
power to decide which and how many doctors become surgeons.

ACCC Chairman Graeme Samuel is familiar with this issue.

Years ago, with the National Competition Council, he helped instill competition in the college's
training process after some tough negotiations.

And last year the ACCC completed another review which, he says, puts limits on the college's power.

GRAEME SAMUEL: No, it's not a monopoly.

The condition are that they must be transparent in their process, they must be objective, they must
be fair, they should undertake consultation with major stakeholders -- in particular, State
Government health departments -- to ensure that it is the public interest that is paramount in
determining the number of surgeons that are trained for qualified surgery, not artificial
constraints being imposed on the number of places available.

MARY GEARIN: And the college says it's keeping to those conditions, it's just demanding more
funding to maintain standards.

PROFESSOR GUY MADDERN: It's not always understood what is required to develop a surgeon and to
develop the skills you need and there may be some confusion within the hospital about what is

MARY GEARIN: But is the restriction of trainee numbers just an excuse for a well-paid closed shop?

GRAEME SAMUEL: If we detected that there were other influences being brought to bear, such as
restricting the number of surgeons that might be available to provide services which can, in the
end, mean that the existing surgeons are able to charge higher fees for their services, which is
the cost to their health system, then clearly we would have concerns if that was occurring.

PROFESSOR GUY MADDERN: I think that, as I mentioned earlier, the 20 per cent increase in places has
been one of the college responses to this need.

In addition to that, I think the safe working hours has been a factor that neither government nor
the college fully appreciated its impact on staffing requirements.

MARY GEARIN: Privately, some surgeons believe the ACCC did not go far enough to curb the college's

States are now considering legal action if the college doesn't satisfy their requirements and are
pointing to the option of accrediting universities or other bodies to authorise traineeships.

BRONWYN PIKE: People will begin to ask the questions -- if we can't have our training supervised
and sorted out by the College of Surgeons, let's see who can actually offer this kind of

GRAEME SAMUEL: Well, the ultimate remedy, of course, is to revoke the authorisations that we've
given them.

That would then leave RACS open to potential legal action under the Trade Practices Act.

Now, that's a pretty significant remedy.

It's a pretty significant action to take.

MARY GEARIN: Meanwhile, surgeons say something must happen before talented proteges lose too much
valuable time and hospitals miss out on too many surgeons.

MARK WESTCOTT: We have actively promoted surgical education here at St Vincent's.

We see it as an important part of the future of this hospital in attracting and retaining the best
junior doctors and training them as best they can.

We feel we're being penalised for promoting and providing such a good teaching service by having
many of our best candidates taken from this hospital.

KERRY O'BRIEN: I guess we'll follow the ACCC's interest from there.

Mary Gearin with that report.