Category: Women in Medicine in Australia

Attention International Medical Graduates in Australia!

Good morning Possums!

This notice is for IMGs/OTDs who have migrated to Australia. I am interested in hearing your experiences, stories and testimonials of your personal and professional transition into a new country and health system. The struggles, challenges, joys and inspirations. Thoughts on AoN/DWS especially would be really interesting – did you feel isolated, supported, depressed or rejuvenated? Was your employer supportive, were you welcomed into the community? Did you experience racism or were your expectations exceeded in how well you and your family settled in Australia?

You can DM me on whichever platform you are reading this or you can email koala@doctorsdownunder.com

All notes to me will be kept in the strictest of confidences.

We are on twitter @Drsdownunder

We are on LinkedIn  and Facebook ! Check us out!

Photo credit:

Ruthie

junior doctors – patience younglings.

Hello Possums! Just a quick one. Had some questions from the younger of the medical fraternity concerned about my focus on the consultant/specialist types that make their lives living hell.

Do not fear. I will be writing about you my little brush tailed possums: how career grade, registrar, junior, middle grade etc. etc. jobs are structured, paid, recruited, how muchand if OTDs are eligible for such jobs.

Happy?

Good… so until then, watch this space, enjoy this picture of a sleepy kangaroo, keep it together and stay safe.

Photo credit:

Ewa Gillen

the aussie healthcare system, is it worth working in?

Everyone knows the Australian healthcare system is extremely well regarded. So much so, its gets embarrassing. Sure the right wing press here love to whinge and moan about it but the reality is it is an excellent health system. Doctors get well paid, well supported and even in some services they can work 4 days a week. After you have wiped whatever it was you were sipping off the screen , please read on.

Feedback from OTDs (overseas trained doctors) who have migrated to Australia tends to be extremely positive of the systems, facilities, workforce planning, funding etc.

In the context of working as an OTD in Australia, critics tend to  focus on the process that directs OTD Consultants/Specialist to areas that are short of medical skills rather than the broader health system or specific practicalities. More of this extremely  controversial topic in a future blog post (area of need, district of workforce shortage).

If you transfer over from the NHS in the UK, working in the Australian public health care system as a doctor does tend to mean less hours worked whilst getting paid more. Salaries tend to be higher at all levels, registrar to consultant ratios are good, most facilities are new and well staffed.

I have heard of no instances of doctors returning to their departure countries because of dissatisfaction with the Australian healthcare system specifically. People tend to return for family reasons.

So, let’s get it into it, the fascinating and dangerous world of the Australian health care system. By the way all of this information can be found on the Australian Bureau of Statistics website but its a pain in the arse to research.

Australian healthcare is a hybrid of private and public sector involvement. Simple as that sounds the reality is more complex. Not as complex as brexit negotiations but complex.

The thought of how Australia’s health services are managed and regulated brings out hives in the best of people. Throw in the endless tiers of local and federal government as well as NGOs and you have a potential bunfight of monumental proportions.

The system demands a lot of money to work. In 2014-2015 Health funding cost governments in Australia was AU$108.2billion with the states and territories contributed AU$42 billion (26%) of this, the Australian Government AU$66.2billion whilst other stakeholders such as NGOs, private health insurance etc. contributed the remaining AU$53.4billion.

Health spending has been increasing like every 1st world country -mainly down to an ageing population, chronic conditions, diseases and risk factors etc. etc. So how is healthcare in Australia actually delivered and managed?.

Understanding this will also help you understand the variances in salary levels between the states and territories, job title terminology and the context in which allegations of protectionism (what! I hear you cry! Impossible! Look out for future posts..) towards international medical graduates are made.

Australia is a federation of states and territories. The Federal government – I will term as the Australian government – is based in Canberra where the national parliament sits and hurls abuse at each other. The states and territories are – in no order – West Australia, Northern Territory, South Australia, Tasmania, Australian Capital Territory (ACT – Canberra basically), Victoria, New South Wales, Queensland. Each State and territory has its own local government which provides services to its citizens that reflects the varied logistical, economic and social requirements of this huge continent. Public health care is devolved to each of these state and territory governments.

Yet, the Australian Government continues to have has important financial and policy responsibility for health services including hospitals, mental and public health. Basically, they fund the crap out of it. Approx. 70%.

State and territory governments, local councils and NGOs are mainly responsible for the delivery of these services. Private, “non-salaried medical practitioners” deliver most of the medical, dental and primary care services. FYI in case you’re wondering, as an OTD Consultant/Specialist you cannot work in private practise from the get go. Please read my upcoming blog about where you can work – and the controversy around this – as an OTD consultant/specialist.

The two national services Medicare and the Pharmaceutical Benefits Scheme (PBS)  are funded by the Australian Government. They cover all Australian citizens and permanent residents.

Medicare is Australia’s universal healthcare system giving people access to subsidised services and prescriptions (pharmaceuticals) and free hospital care as a public patient.

Since 1984, Medicare has been funded by a tax of 1% of an individual’s taxable income – regardless if you have private health insurance or not.

The Australian Government also runs the MBS (Medicare Benefits Schedule) which gives rebates for patients using the services of medical practitioners and allied health professionals. The benefits given are based on a schedule of fees, which are put in place by the Government after they have pow wowed with the medical community.

So we know the system is an intricate and confusing web of public and providers, stakeholders and supporting tools. Great, a recipe for disaster I hear you say. It works pretty well though and is fairly well respected by the general population despite the best efforts of the Murdoch media beat up. Sure, we’ve had the odd medical college bullying scandal, dodgy hires, sex discrimination cases and the odd surgeon misrepresenting their backgrounds.

The providers of healthcare are your standard medical practitioners, nurses, allied health professionals, hospitals, clinics, government and NGOs etc. etc.

Private sector providers include private hospitals, radiology clinics, medical practises and chemists (pharmacies).

Public hospitals are funded by the Australian, state and territory governments. However, the management of these is done only by the state and territory government in which the hospital is in unless they are a private institution. There are number of private hospitals that are contracted to government to deliver public services.

Here are some exciting stats.

In 2014–15, there were 10.2 million hospitalisations (2.5 million involving surgery), including 7.4 million presentations to emergency departments.

Public hospitals provide the vast majority (over 90%) of emergency department and outpatient services. Private hospitals account for more than 2 thirds of hospitalisations involving elective surgery.

All tiers of government  contribute to funding and delivering other niche services such as indigenous Australian health services, mental health services etc. Watch out for a future post on indigenous health by the way, its going to be ripper.

The government tries to incentivise people to take out private health insurance by offering tax rebates. In 2012 57% of the adult population had a form of private health insurance.

Some believe this is the main reason why the public health care system in Oz is as well regarded.

Primary care is delivered through traditional methods but the sheer scale of geography – the famous tyranny of distance –  in regional Australia and Indigenous Australian health care issues can make it even more problematic. Platforms of delivery include GP clinics (including ‘GP Super Clinics’), Indigenous Australian and community controlled health services, allied health clinics and community health centres.

When you look at it spending on primary care is close to spending on hospital services.

For more specific GP information and primary health care look out for an upcoming post!

The parent health services and associate acronyms of each State and Territory are:

ACT Health. Australian Capital Territory (ACT) – basically just Canberra. A paradox of a city in itself. Boring yet still fascinating.

NSW Health. New South Wales (NSW). Under this umbrella, lots of Local Health Districts (LHDs)

Queensland Health (QLD).

WA Health. Western Australian Health (WA). Looks after different  Perth metropolitan services and WACHS – West Australian Country Health Service.

SA Health. South Australia (SA).

Vic Health. Victoria (VIC).

Tasmanian Health Service. Tasmania (TAS).

NT Health. Northern Territory. (NT).

Our next post will be about job title terminology in each state.Hopefully.

Picture Credit:

Piron Guillaume

a primer for doctors thinking about living and working in australia.

Australia has a world class health system.

It’s major metropolitan centres are repeatedly listed near the top of global liveable city lists (house prices aside) and the United Nations ranked Australia second in its liveability index in 2011.

It’s economy has been growing since 2005. It shrugged off the GFC, posting sustained levels of record growth.

Arguably it is the most successfully multi-cultural society in the world. It is a country whose wealth, liberal democracy and success is down to its migrants. It is a truly great country in which to live, watch your children develop, take a sabbatical or to retire.

It’s natural environment is sensational and conducive to enjoying an active and outdoor lifestyle. If you love the natural world or the feel of the sun on the back, if you want your children playing outdoors or swimming in your own pool then the country offers all of this, wherever you end up living.

Over the years, popular culture and a powerful public relations industry has represented Australia to temporary workers and permanent migrants as the land of milk of honey, endless beaches, a sun kissed people, a land of egalitarianism – “the lucky country”.

The truth is – like everything – far more complex. Scratch a little under the surface and some paradoxes and contradictions emerge. Some of which are more specific to Doctors.

For example, there are shortages of medical specialists in rural areas. However, it is rumoured that there is collusion amongst members of certain medical colleges to prevent the employment of OTDs (Overseas trained doctors) consultant/specialists to avoid the prospects of any competition to their private practices.

Another example – Australians are perceived to be laid back and easygoing. However, this stereotype is contradicted by the lengthy, complex and procedurally driven recruitment, college assessment and medical registration processes which frustrate, confuse and often ultimately deter the most qualified and patient of doctors.

Australia’s shortage of medical specialists in rural and remote areas demands the continual supply of OTD GPs and consultant/specialists. Yet these procedures and processes are onerous, fraught with risk (levels of which vary depending on specialisation), can deter – and sometimes reject – the most sincere, honest, caring and professional doctors in providing essential healthcare in skill short areas.

In broader terms, contradictions emerge which are important to consider if you have been bombarded by the standard presentations of Australia as an easygoing, beach obsessed, sports mad country. For example, Australia has arguably the richest economy on the planet, yet the socio-economic plight and health outcomes of indigenous Australians should shame every Australian. It is a nation built by those who travelled to it seekng a better life yet it jails asylum seekers in offshore prison camps.

Australia is rightly regarded as fanatical about its sport, has more than 600 50m olympic sized swimming pools, and has 4 competing codes of a game that involves chasing a ball around a field.Yet, adult rates of obesity are at record levels.

Australia is a huge land of wilderness yet most of its population live in its major cities.

Australia has a world class health system. It’s education outcomes for its children are excellent.

It’s major metropolitan centres are repeatedly listed near the top of global liveable city lists (house prices aside) and the United Nations ranked Australia second in its liveability index in 2011.

It’s economy has been growing since 2005. It shrugged off the GFC, posting sustained levels of record growth.

Arguably it is the most successfully multi-cultural society in the world. It is a country whose wealth, liberal democracy and success is down to its migrants. It is a truly great country in which to live, watch your children develop, take a sabbatical or to retire.

It’s natural environment is sensational and conducive to enjoying an active and outdoor lifestyle. If you love the natural world or the feel of the sun on the back, if you want your children playing outdoors or swimming in your own pool then the country offers all of this, wherever you end up living.

Over the years, popular culture and a powerful public relations industry has represented Australia to temporary workers and permanent migrants as the land of milk of honey, endless beaches, a sun kissed people, a land of egalitarianism – “the lucky country”.  

The truth is – like everything – far more complex. Scratch a little under the surface and some paradoxes and contradictions emerge. Some of which are more specific to Doctors.

For example, there are shortages of medical specialists in rural areas. However, it is rumoured that there is collusion amongst members of certain medical colleges to prevent the employment of OTDs (Overseas trained doctors) consultant/specialists to avoid the prospects of any competition to their private practices.

Another example – Australians are perceived to be laid back and easygoing. However, this stereotype is contradicted by the lengthy, complex and procedurally driven recruitment, college assessment and medical registration processes which frustrate, confuse and often ultimately deter the most qualified and patient of doctors.

Australia’s shortage of medical specialists in rural and remote areas demands the continual supply of OTD GPs and consultant/specialists. Yet these procedures and processes are onerous, fraught with risk (levels of which vary depending on specialisation), can deter – and sometimes reject – the most sincere, honest, caring and professional doctors in providing essential healthcare in skill short areas.

In broader terms, contradictions emerge which are important to consider if you have been bombarded by the standard presentations of Australia as an easygoing, beach obsessed, sports mad country. For example, Australia has arguably the richest economy on the planet, yet the socio-economic plight and health outcomes of indigenous Australians should shame every Australian. It is a nation built by those who travelled to it seekng a better life yet it jails asylum seekers in offshore prison camps.

Australia is rightly regarded as fanatical about its sport, has more than 600 50m olympic sized swimming pools, and has 4 competing codes of a game that involves chasing a ball around a field.Yet, adult rates of obesity are at record levels.

Australia is a huge land of wilderness yet most of its population live in its major cities.

Everyone thinks most Australians go to the beach. Most actually don’t go to the beach.

Because of the nation’s fascination with sport, most people assume Australian’s lead healthy lifestyles and are fit. They’re not. Check out these stats, from the Australian Institute of Health & Welfare (AIHW):

45 per cent of Australians are not active enough for a healthy lifestyle;

95 per cent of Australians don’t eat the recommended portions per day of fruit and vegetables;

63 per cent of Australians are overweight or obese;

27 per cent of Australians have a chronic disease;

21 per cent of Australians have two or more chronic diseases; and

20 per cent of Australians have had a mental disorder in the past 12 months.

What else?

Australia is known to be hot, but it also snows in some parts.

The Head of State (Queen Betty) is British but federal MPs are not allowed to hold dual citizenship.

Australia is both a representative democracy and a constitutional monarchy.

Darwin is closer to the capital of Indonesia then it is to the capital of Australia.

You get the picture.

DDU’s aim is to be a “Primer” for you, a web-based information hub used for instruction in the subject of working as a doctor.

We will guide you away from misleading stereotypes, prepare you for the bureaucratic jungle by presenting a real picture of Australia and its healthcare system to give you the confidence to deal with the services, recruiters, colleges and the statutory bodies – for a beneficial outcome for all.

However, the aim is for your, the doctor’s, comments and experiences to populate the site as much as anything else so please leave comments and observations.

 

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