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Mind the pay gaps There was one big money story this year and it wasn’ t the MBS freeze.
More depressing details emerged over the pay gaps between GPs and other specialists.
In August, Australian Doctor revealed that the average GP earned $ 102 an hour in 2015, after practice costs but before tax.
Among the main specialists, this represented the lowest earnings, lower than psychiatrists($ 139) and paediatricians($ 132).
The figures, drawn from the MABEL longitudinal survey, also revealed that 25 % of GPs( or 7000 doctors) were earning less than $ 79 an hour.
Based on the same data, the average female GP under 60 earned $ 41,500 less during the year than the average male GP working the same hours.
Dr Isis Maitland-Scott, a Sydney GP and Australian Doctor columnist, put it simply:“ I cannot imagine how it is reasonable that one gender of doctor doing exactly the same job as the other gender can receive significantly less money for it, yet, here it is— here it still is.”
Drug shortages The year was a frustrating one for clinicians and patients faced with ongoing shortages of widely used drugs, such as metformin, and vaccines, such as Bexsero for meningococcal B disease.
Drugs such as glyceryl trinitrate tablets for angina and many formulations of HRT also remained out of stock for much of the year, with suppliers blaming manufacturing problems. Suppliers and pharmacists also scrambled to find workarounds when lifesaving medications such as EpiPens were in short supply.
Fever pitch It was one of the worst flu seasons in recent memory despite high rates of vaccination with government-funded quadrivalent vaccine. The high numbers of deaths and hospitalisations from flu were blamed on the emergence of a virulent mutated A( H3N2) virus strain which was not covered by the mismatched strains included in the vaccine.
The 2017 winner of the year: Greg Hunt? He’ s made no big policy announcements, splashed very little cash and reformed almost nothing, but there can be little doubt that Greg Hunt has had a successful year.
Nearly 12 months into his term as health minister, no one will say a bad word about him— in public at least.
In April, he signed pre-budget‘ compacts’ with the AMA and the RACGP. In return for an end to the Medicare freeze, the groups pledged support for the My Health Record and the MBS Taskforce Review, much to the consternation of their members.
Former health advisor Dr Bill Coote described the budget compacts as the“ most extraordinary documents” he’ d seen in 30 years
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DR ISIS MAITLAND-SCOTT, A SYDNEY GP, SAID:“ I CANNOT IMAGINE HOW IT IS REASONABLE THAT ONE GENDER OF DOCTOR DOING EXACTLY THE SAME JOB AS THE OTHER GENDER CAN RECEIVED SIGNIFICANTLY LESS MONEY FOR IT. AND YET, HERE IT IS. HERE IT STILL IS.” |
DOCTORS’ INCOME
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Minister for Health Greg Hunt.
in medico-politics.
Mr Hunt also said good things about sorting out mandatory reporting and he’ s been attempting to stop health insurers flogging junk policies in return for their giant taxpayer subsidises.
Other alleged reforms— such as the Medicare Guarantee Fund, which seem to have been created purely to allow the minister to say the words‘ Medicare’ and‘ Guarantee’ in the same sentence— have been less useful.
But he’ s done nothing to actively enrage doctors and, for a health minister, that’ s really saying something.
We are still waiting for a general practice policy that will deliver something good for patients, but there is a long list of minsters before him who have failed to do that.
Cochrane collisions Evidence-based medicine clashed head-on with clinical reality this year with a furious row triggered by the high priests of randomised double blind controlled trials— the Cochrane Collaboration.
It released its review of the new breed of hepatitis C antivirals, seen by many as the one bright hope against a disease ravaging the
lives of millions worldwide.
However, Cochrane concluded that there was“ little evidence they clear the virus from the body, only that they may clear the hepatitis C virus from the blood. Our results presumably overestimate the benefit and underestimate harm. The quality of the evidence was very low”.
Professor Greg Dore, head of the viral hepatitis clinical research program at Sydney’ s Kirby Institute for Infection and Immunity in Society, said the conclusions were bizarre.
Cure rates were above 90 %, he said. The short-term nature of the clinical trials also meant they were never set up to detect whether the virus was being cleared from the body, rather than just the blood.
Australian Doctor interviewed the lead author of the Cochrane review, Dr Janus Jakobsen, who was unapologetic.
“ The drug companies are touting a wonder cure and clinicians’ experience is limited to dealing with small numbers of patients. Cochrane has different, higher standards of evidence when making its proclamations and the evidence is absent,” he said at the time.
Professor Dore responded by pulling up the reviewers for their ignorance of clinical reality, which meant they took a perspective on evidence so pure that it risked“ snow-blindness”.
Green light for voluntary assisted dying After marathon sessions of emotionally wrought debate, MPs in Victoria finally passed voluntary assisted dying reforms in November. Doctors were as divided on the issue as politicians.
The reforms will mean that,
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from 2019, terminally ill adults in the state can request an assisted death following clinical assessment by doctors.
Premier Daniel Andrews, who came to support euthanasia after the death of his father last year, said after the historic vote:“ This is a day of reform, a day of compassion, a day of giving control to those who are terminally ill.”
Bastian’ s stand For RACGP president Dr Bastian Seidel, this year can be read in numerous ways. In terms of raising the college’ s media profile, he’ s been a big winner.
He’ s appeared live on TV for numerous high-profile issues, ranging from free flu vaccination for all to the welfare of Manus Island detainees and out-of-pocket costs for patients.
But he has also embroiled the college in numerous sagas that have angered, even enraged, its membership.
It all started in May with the proposed changes to the college constitution, effectively demoting the college council and replacing it with a new corporate board.
Backed by the college executive, it provoked a heated debate on whether the influence of GPs in the RACGP was being watered down.
The plan— three years in the making— was booted when put to the membership at an extraordinary general meeting in Melbourne.
Only 46 % voted in favour of the shift— short of the 75 % required.
Then came news of the college’ s pre-budget pact with the Minister for Health.
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Dr Bastian Seidel. |
The college offered support for a variety of reforms in return for what looked like a very slow thaw to the hated Medicare freeze.
Australian Doctor reported that the pact wasn’ t formally endorsed by council, with two councillors saying they were unaware of what was going on until the deal was publicly announced. Dr Seidel refused to answer any questions.
Despite his silence, when the story was published, he went on the GPDU Facebook page and accused Australian Doctor of deliberately making the story up.
Then, in October, came the turmoil on marriage equality. The council had voted to stay neutral on the issue at its August meeting— an apparent attempt not to inflame the debate. Dr Seidel defended the decision.
It turned out the stance contradicted the college’ s own curriculum, which says GPs have“ an important role to play in advocating to reduce discrimination” faced by the LGBTIQ community. The row became heated. Members threatened to quit. An emergency council meeting was held, and Dr Seidel offered an apology admitting he had made a mistake. It was warmly accepted.
But in November, voluntary assisted dying passed the Lower House of the Victorian Parliament.
A college media release was issued:“ RACGP welcomes moves to allow terminally ill Victorian patients to die with dignity and respect”. It called for the legislation to be used as a blueprint for other states.
Debate raged again. Should the college declare support for euthanasia in the absence of a consultation with its members on an issue of conscience for so many GPs?
The row is still running. Professor John Murtagh, who has threatened to quit over the affair, says he is still trying to find out if college council endorsed the statement or whether it was what he described as a“ captain’ s call” by Dr Seidel himself.
So far Dr Seidel has refused to say.
Both his supporters and critics would agree on one thing: over the past 12 months he has certainly stirred things up. ●
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