AMA Rejects Role Substitution and Task Substitution Proposals To Address Medical Workforce Shortages, Australia
In its submission, the AMA cites the dramatic advances in medicine over the last twenty years as a compelling argument that it would be dangerous to even contemplate replacing doctors with nurses, allied health workers or hybrids as team leaders in primary care settings.
AMA President, Dr Mukesh Haikerwal, said today the AMA recognises and supports the vital roles played by nurses and allied health workers in providing care to patients, but they cannot be used as substitutes for doctors in the health system.
"The skills, experience, education, training and commitment required to become a medical practitioner have to be worked at and developed over many years, usually more than a decade," Dr Haikerwal said.
"Highly skilled medical professionals cannot be found and deployed overnight by Ministerial decree.
"We need to continue to provide a complete medical education for our doctors if we are to do the right thing by patients and communities, and ensure their expert medical care.
"Governments must provide the funding and resources and policies to maintain an environment in which medical teaching, training and research are properly supported and encouraged.
"We need to encourage new technology, new ideas and new enthusiasm for medicine to provide quality care today and predict the most appropriate care for the future."
Dr Haikerwal said medical advances over the last 25 years have been to a large degree the result of a positive medical workforce environment.
"Between 1991 and 1999, the rate of preoperative death from anaesthesia has reduced to one per 79,500 operations from one per 68,000 operations.
"Between 1980 and 2000 in the United States the rate of death from heart attack has declined from around 345 per 100,000 to around 187 per 100,000 population - and Australia will have experienced a similar improvement," Dr Haikerwal said.
"For stroke over the same period in the US, the death rate has declined from around 96 per 100,000 to around 61 per 100,000 population - a decline of 30 per cent, which would be a similar rate of success in Australia.
"But perhaps the most startling figures come from changes in Obstetric and Paediatric practice.
"Between 1980 and 2003, perinatal deaths in Australia have reduced from around 14 deaths per 1000 births to 8 per 1000 - a 42 per cent improvement. Australia has recorded a steady but impressive reduction in maternal mortality rates over the last 35 years. It has fallen from 12.7 deaths per 100,000 confinements in 1973-75 to 8.2 per 100,000 in 1997-99 - a reduction of more than 35 per cent. These are important indicators of the health of the nation.
"A clear warning about role substitution is contained in the influential Cochrane Review of November 2004, which presented evidence comparing perinatal deaths in birth centres and conventional hospital care.
"The review found an 83 per cent higher risk of perinatal death in birth centres in a sample of 8677 women, and warned that caregivers and patients using birth centres should be 'vigilant for signs of complications'.
"The review stated that there is now good quality evidence that the substitution of obstetricians in birthing is associated with higher perinatal deaths."
Dr Haikerwal said that medicine is a team game.
"Doctors, with their full and rounded training, cannot and do not work alone in saving lives," Dr Haikerwal said.
"Doctors work with other highly skilled and motivated people, and each member of the team has different training and a different scope of practice.
"None of them is dispensable, and none of them is substitutable. The work of one group may be helped by a different group, but you cannot and must not substitute one profession with another.
"If we are serious about providing the best quality care for all Australians no matter where they live, we must put an immediate end to any moves towards sudden or forced role substitution or task substitution.
"We must also put an end to the recent dangerous pursuit by some groups and individuals for a new breed of 'hybrid' doctor-nurse medical professionals. This is an insult to both professions and an insult to patients and communities.
"Every patient has the right to a proper medical diagnosis and medical treatment.
"Australia has a world class health system. To keep it world class, we need world's best solutions, not second best.
"The AMA's Submission to the Productivity Commission is full of world class ideas," Dr Haikerwal said.
The AMA Submission to the Productivity Commission Review of the Health Workforce is available on the AMA website at http://http://www.ama.com.au
Australian Medical Association
AMA Rolul respinge de substituþie ºi de activitãþi de substituþie propuneri pentru a rezolva deficitul forþei de muncã medicale, australia - AMA Rejects Role Substitution and Task Substitution Proposals To Address Medical Workforce Shortages, Australia - articole medicale engleza - startsanatate