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Wednesday, 13 May 1970


Dr CASS (Maribyrnong) - The amendment proposed by the Minister for Health encompassed practically everything that the Opposition foreshadowed in its amendment. I would like to persist with a couple of points that the Minister omitted. Before I do that, I express agreement with he basic reason behind the amendment.

I think it has something to do with the brawl that is going on over the schedule. The basic problem is one of standards. For this reason it is necessary to recognise that the Australian Medical Association is not basically concerned with standards. It is a political organisation representing the doctors as a whole. For the purpose of the Bill and the proposed committees it is quite clear that what is aimed for is some measure of the standards of the various practitioners in their various specialities. For that reason the amendment is perfectly logical. I am glad that even the AMA woke up. 1 would like to persist with Labor's suggestion that perhaps there could be a clause (f) in proposed new section 298A to include someone nominated by the State Health Departments. The committees will be established in each State and they ought to work in collaboration with and not be separate from the State health authorities. I hope that that is not a partisan point of view. The State Health Departments will be responsible for or should play a large part in keeping an eye on the registers of various specialists. We must not forget that the State Health Departments are responsible for the employment of most of these specialists, because they are working in the large public hospitals which are the responsibility of the State Health Departments as well as of the Commonwealth. Therefore [ feel that it is reasonable to include on the committees someone nominated by the State Health Departments. The Minister has also conceded the possibility of appointing specialists outside the specific precincts mentioned in the 5 groups. I would mention the anaesthetists who form part of one of the other colleges. Their interests are so different that it would be worth inviting an anaesthetist to join the committee if one is considering the problem of anaesthetists. They are encompassed in the overall umbrella of the Royal Australasian College of Surgeons. The Minister has conceded this in his last section where he states that a consultant medical practitioner with the appropriate qualifications and experience can be brought on to the committee. The Opposition certainly agrees with that.

The group that he has omitted - although he may concede that they would be covered by the wording of the last couple of amendments - are the oral surgeons.

I am at a bit of a loss to know what an oral surgeon really is. I think that the Minister is in the same position at this stage. Regrettably, this is a sphere that has not been defined properly by anybody. At the moment it seems that we have 2 groups of oral surgeons; we have oral surgeons who are trained dentists and also trained medical practitioners. They are in essence a specialised branch of surgeons who would be encompassed partly by the Royal Australasian College of Surgeons. What concerns me is the misty area of oral surgeons who are qualified dental practitioners and not qualified medical practitioners. I am a bit worried about how far they can extend themselves into the sphere of oral surgery. That is a necessary part of the definition, lt harks back to the point that I started out by mentioning - the whole question of standards.

The same problem exists in the brawl relating to the 2 levels of fees depending on whether a service is provided by a general practitioner or a specialist. We have an overlapping area with general practitioners doing some things and surgeons also doing the same things. I ask: Are general practitioners properly qualified to do all those things? If they are, why should surgeons be entitled to charge more for doing the same th:ng? if general practitioners are not properly qualified to do those things, why are they doing them anyway? They should not receive any fee for doing it. They should not be allowed to do it. lt should be the prerogative of surgeons only or of people properly qualified. This is an unsatisfactory situation. Quite frankly, I do not blame the Government for it; I blame the medical profession itself. 1 think the med:ca profession has been too concerned about politicians on both sides of the House intruding into its affairs and has not been concerned enough to worry about its own affairs in terms of standards of medical practice.

I cannot give a ready answer to the problem. I am simply indicating the doubts and sowing the suggestion that the Minister might consider including in Hie committees someone representing the oral surgeons. I must confess that I cannot give a clear definition of who they might be. The Labor Party had proposed members of the Australian Dental Association. ] think that we should all think about it a bit more, mainly because the professional groups need to think about it a bit more. In summary, the Opposition is not unhappy with the Minister's suggestions. For the sake of completeness I would suggest that the State Health Departments ought to be incorporated and that the Minister, in his further deliberations, ought to think about the oral surgeons and who they really are.







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