By Dr Kamala Emanuel
Doctors in the NSW public hospital system are preparing to take industrial action over changes to Medicare announced in the federal budget.
The changes would deny Medicare provider numbers to about a third of new doctors each year. Outside of public hospitals, patients can claim a Medicare rebate or be bulk-billed only for services provided by doctors with provider numbers.
The new scheme, to be introduced in November, will make provider numbers available only to doctors on recognised training schemes — either specialist training (only 400-600 places each year) or the now mandatory general practice training (only 400 places). With about 1200 graduates from Australian medical schools each year, and 200-450 overseas-trained doctors, the restrictions will mean that 400-600 new doctors will be denied access to Medicare.
This move will make it harder for GPs to be relieved, by reducing the number of locums — a change which will badly affect rural areas where workloads and reliance on locums are high.
While federal health minister Michael Wooldridge told the Bulletin that those who miss out on provider numbers "could become health ministers or television reporters, health administrators or academics", the reality is that most will be forced to remain in the public hospital system, working in appalling conditions of shifts up to 34 hours on low pay.
This is an attack on the weakest, most junior doctors, with the narrow aim of containing Medicare costs.
On September 19, hospital resident medical officer (RMO) associations from across Sydney decided to amalgamate and coordinate industrial action independently of the Australian Medical Association. Newcastle hospital doctors met at John Hunter Hospital on September 20, where there was strong support for the proposal to take industrial action. Doctors in other states are also discussing action.
The form the industrial action should take is still a matter of discussion. Meetings earlier in the week had supported the call for strike action or mass resignations. At the Sydney meeting, it was suggested that doctors retaliate by shifting costs from the state to the federal government. This would be done by referring hospital patients to their GPs, and to private pathologists and radiologists (all covered federally by Medicare), and by giving patients prescriptions to be filled at private pharmacies (covered federally under the Pharmaceutical Benefits Scheme) instead of from the hospitals (state funded).
Opponents of this tactic argue that it is unlikely to have much impact on the government and will undermine community support because of the inconvenience and cost of private referrals.