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Tuesday, 13 June 1989
Page: 3915


Senator PATTERSON(10.12) —I asked the Minister in my speech-he may have answered but I may have missed it-to provide details of the auditing and monitoring procedures and the structure of what is to be called, I think, the Independent Peer Review Organisation. I do not seem to have received any of those details. I know that Senator Coulter said that this is going to a committee but I may not have the pleasure of being on that committee.

I also have concerns about people's eligibility for programs such as the family medicine program. I wish to give an example of a young medical graduate in Melbourne who wanted to participate in the family medicine program as a trainee. She had a number of years at a hospital and thought that she was interested in doing plastic surgery. She realised that this was going to take an enormous amount of time. She had a priority of having a family so she decided she would go into general practice. On approaching the family medicine program she was told that because of the length of time she had spent in a public hospital she was not, therefore-I am quoting her; I rang her again today just to check-a dedicated general practitioner because she had started off on a surgery program.

If this is the sort of thing that is going to go on and people are not going to be eligible for the family medicine program, we will have a group of people who will not be able to reach the standard required to get the higher rebate because they are deemed by those people in the family medicine program as not being `dedicated general practitioners' because they had a change of heart in their career structure. The Minister may not answer that question at the moment but I am sure it is a question that will be raised by the Committee.

I would like to ask the questions on notice that I gave the Minister for Industry, Technology and Commerce (Senator Button) earlier this afternoon. My first question was: will the Minister advise the average and, if possible, the standard deviation of the number of consultations undertaken by trainees during family medicine program rotations in supervised general practice? It was indicated to me outside by one of the advisers that they may not be able to give me this figure. But I have a figure here which was provided under the freedom of information provisions to a general practitioner in Melbourne on the number of general practitioners who had been in the family medicine program rotation. I think I mentioned in my speech that some of those trainees had on average seen 8.5 patients per week and others had seen 129 patients per week. It seems to me that there is no supervision under the system of looking at a practice when it is selected as a practice for family medicine trainees to see whether it has a sufficient number of patients or a sufficient case load to provide the trainees with an adequate general practice. One of the other questions I asked on notice was, `Does the family medicine program use Health Insurance Commission payments as a tool to monitor and identify those practices whose case load is such that they may not provide training for general practice experience?'.

Again I have another example of another general practitioner in Melbourne who was actually in a family medicine program and complained about the treatment that the person was receiving in the placement. A representative from the family medicine program said, `We have already had complaints about this doctor'-I do not know how the doctors are chosen for these trainee appointments-`but we were short on teaching staff, short on people to take on as trainee practitioners, so we kept using him'. This doctor refused to go out when a trainee was dealing with a patient with cardiac arrest. The trainee rang and said, `I believe this patient is dying. I have rung an ambulance. Will you come?'. The doctor said no. This is a person who is being paid a family medicine program allowance, who is reaping the benefit of the rebate the students bring in, and he refused to come. There was no supervision from the family medicine program of the quality of training being provided. The trainee rang concerned about the level of treatment she would be able to give, and what help did she get? None. Finally, when she rang again the doctor came.

I also ask the Minister whether he can advise as to the average weekly payment and the minimum and maximum weekly payments received by supervising practitioners from the Health Insurance Commission for services rendered by family medicine program trainees. I also ask: What is the direct subsidy payment per week provided directly by the family medicine program to supervising doctors for each trainee? Another question one ought to ask is: How are these doctors who are supervising trainees chosen and selected and what basis do they have for the responsibility they are given for training young practitioners?