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Tuesday, 13 June 1989
Page: 3913


Senator COOK (Minister for Resources)(9.58) —Senator Puplick asked two questions and made a number of comments about his version of reality concerning the Government's proposal. Senator Coulter's entreaty was that since these matters are to be canvassed at length by the Committee, we should not dally at this hour of the night, given the legislative program that we have. My heart strings are certainly pulled towards Senator Coulter's position because I would like to see us dispose of this legislation as quickly as possible. We also have a series of questions from Senator Walters.


Senator Walters —Just one.


Senator COOK —Senator Walters has asked one question. While absolutely disposed to Senator Coulter's position-he asked a pertinent question-the debate should not move on until I have at least responded to some of the things Senator Puplick has said. As I have pointed out, he made a number of observations. I should go into some detail about his claim that what we are proposing to do here is far more stringent than what might be done in other comparable countries. On that point, the changes we are proposing are consistent with overseas practice and developments. As I have said constantly throughout this debate, there is no compulsion for general practitioners (GPs) to undergo further training. The minimum requirement remains: undergraduate medical training for five or six years plus an intern year and, currently, the family medicine program is four years-two in a hospital plus two others. There is scope for improved efficiency and discussions are under way with the Royal Australian College of General Practitioners (RACGP) to reduce it to three years, which, after an examination, could in future years lead to fellowship of the Royal Australian College of General Practitioners. The three years voluntary training that we are proposing compares with three years compulsory vocational training in general practice in the United Kingdom for anyone wishing to enter sole practice or partnership. Of course, few GPs are salaried. In Canada there is two years of voluntary training-compulsory only in Quebec, but other provinces are moving that way-with some three-year training places and pressure for general extension to three years. Though training is voluntary, it is increasingly difficult for doctors without such training to establish themselves. For example, hospital accreditation is difficult without postgraduate training. In the United States of America there is three years voluntary training, but most family physicians now undergo such training. Establishing oneself without such training is increasingly difficult.

I conclude this round-up of allegedly less stringent overseas requirements by mentioning New Zealand. In New Zealand, there is one year of voluntary training, but the New Zealand Medical Council has recently introduced an indicative register for GPs who demonstrate competence and training. Current requirements are demonstrated competence and five years experience, three of which must be in general practice. From 1990, doctors will have to be members of the Royal New Zealand College of General Practitioners, which involves passing an examination. So, given that quick circuit of the world, I do not think it can be said that what we are proposing in our legislation is more stringent. Indeed, I think the reverse can be said.

Allegations about discrimination figured in many of the speeches in the second reading debate. Indeed, I remember Senator Knowles making a big play about this in her contribution to the debate. It arises again in this debate. The first allegation is that the package discriminates against women doctors. These claims mainly relate to the alleged difficulties for part time doctors. The Royal Australian College of General Practitioners (RACGP) will accept two sessions in one practice as meeting its requirements for experience in general practice. It already provides training programs based on part time availability for its fellowship. Doctors who are ineligible or who choose not to apply will still have access to existing GP items. The recent South Australian survey conducted jointly by the South Australian Government, the Australian Medical Association and the RACGP found that 67 per cent of female GPs had some family medicine program training, compared with 35 per cent of males, and that female GPs report attending significantly more formal education meetings than their male counterparts. I believe that female doctors may find it easier to meet some of the requirements and do not appear to be unable to do training or continuing medical education. So I do not accept that the package discriminates against women doctors.

It has also been alleged that the legislation discriminates against doctors, mainly women, specialising in family planning, sports medicine, women's health and student health. Doctors will be assessed on training, experience and the type of practice. If their clinical practice is predominantly a general practice, they will be eligibile, provided that they have the necessary experience and training.

I turn to the other question of discrimination-the argument that rural doctors will be disadvantaged. The RACGP will accept certain experience in country hospitals as experience in general practice, thus advantaging rural doctors over their city counterparts. Continuing medical education and quality assessment programs are largely designed around self-directed learning-for example, videos, self-assessment Viatel patient surveys and practice management surveys, which are readily accessible to rural doctors. If there is a shortage of doctors in rural areas, non-enrolled doctors have nothing to fear from competition from those who are enrolled.

To complete the round-up of the discrimination arguments, I turn to the question of whether patients of non-enrolled doctors will be disadvantaged. The answer is: only if their doctors move to the new fees. Public education awareness and competition from vocationally registered doctors is the best countermeasure to this. The Government will launch a substantial education publicity program to ensure that all patients understand these new arrangements. So, on that basis, I do not think it can be argued, as it is in this debate, that the alleged discrimination will exist.

Let me now turn to the questions that Senator Puplick has explicitly put to me and which were also raised by Senator Peter Baume. I regret that I did not hear Senator Peter Baume's speech; I would have liked to. As I took it down, Senator Puplick's first question was: How does the system of differential rebates assist patients? The second question which I took down was: When will the Government respond to the Doherty report-the report of the Committee of Inquiry into Medical Education and Medical Workforce? I take question one first. In the debate over these issues the Government has been at pains to stress that these proposals would promote a better quality of patient care. That is one of the positive advantages. The proposals will provide an opportunity for general practitioners to spend some time with their patients and should result in reduced requirement for the expensive ordering of diagnostic tests and pharmaceuticals and for unnecessary referrals. From that point of view it can be well and truly argued that the proposals before the chamber would assist patients greatly.

As to Senator Puplick's second question, on the Doherty report, the truth is that the Government is responding to the report. Many of the recommendations, as Senator Puplick knows, are properly the province of State governments and/or require State and Federal Government cooperation for their implementation. For those reasons, the Commonwealth has referred the Doherty report to the States. Some of the recommendations have been dealt with at the Australian Conference of Health Ministers. The need for two years vocational training, for example, is one of the issues that have been raised there. The Doherty report did not recommend mandatory training for medical practitioners and what the Government is proposing is along the lines of the report. We are responding in this way to the Doherty report. We are working through the recommendations in that manner.

I trust I have provided adequate answers to the questions that have been raised but I take the point of Senator Coulter that now that the proposals are being sent off to a committee-and that is not the Government's desire; it is the Opposition's desire-it seems a waste of the chamber's time to canvass them.


Senator Walters —You have not answered my question.


Senator COOK —Senator Walters has reminded me that I have to answer a question from her. That question was a direct question, as Senator Walters is given to asking. As I have taken it down, the question was: Where are the eligibility criteria in the Bill? The Bill provides that doctors will be registered if the Royal Australian College of General Practitioners certifies that they have appropriate training and experience in general practice. The criteria to be used by the RACGP are in the agreement with the Government. The agreement provides flexibility so that criteria can reflect changing undergraduate courses and the needs of general practices in the future.


Senator Walters —Where is it in the Bill?


Senator COOK —It is in the agreement between the Government and the Royal Australian College of General Practitioners. As I said, it needs to be flexible so that it can reflect the changing needs of the industry.