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    I’ve done a out of work on multidisciplinary teams over the last few years, I was a supporter and I have become a partial skeptic. I’m sure they have a role with a minority of complex patients who need a lot of practical support. However for the majority I think they are inefficient, time saved by moving work to non-medical workers is ‘repaid’ by long meetings, extra paperwork and dealing inefficiently with a large number of patients who you barely get to know.
    The “old-fashioned way” means some consultations are “inefficient” (the doctor is doing something, that yes in isolation could be done by others), but by getting to know the patient and family well it allows more judicious use of investigations and specialists over time (which is were the real costs are in the system)
    Another point is on most teams the lowest wage is going to the HMO/intern, the other doctors already delegate medical stuff to them wherever possible, and so moving tasks from them to an NP would actually cost more in wages.

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    Raymond Bange

    John Menadue’s points are well made and I would like to focus on one area in particular. He mentions that attention must be given to expanding the roles of nurse practitioners, other allied health, pharmacists and ambulance officers – or more properly, professional paramedics.

    Australia already has many thousands of highly skilled paramedics within the workforce working both within and outside the statutory ambulance services as well as many more thousands who are trained but cannot practice because firstly. the government doesn’t even recognise them as belonging to a health or allied health profession and secondly, there is no national system of registration to provide the necessary regulatory framework. That’s a stunning misuse of skilled clinically competent human resources.

    Among the many stumbling blocks to their utilisation in extended practice modes are the current legislative barriers and jurisdictional silos in which the statutory ambulance services operate. Emergency Medical Services are simply not on the reform radar despite handling some 3M incidents annually.

    Virtually nowhere in the whole health reform debate has there been effective consideration of the integration of emergency medical services with the health and hospital system, although the professional body Paramedics Australasia has called time and again for this to be done

    Another is the perverse way in which perceptions are moulded by the association of paramedics with a vehicle which is primarily their mobile clinic and mode of emergency patient transport. I’ve never yet heard someone cry out ” call for a police car…” when they wanted a policeman or woman, whereas it is common to hear “… call for an ambulance”. When I am in need I trust that the cry will be ” call for a paramedic …” accompanied by an ambulance if necessary to provide the paramedic with the necessary support and to transport me if needed to more definitive care.

    So we ignore this repository of untapped and underutilised skills represented by the existing paramedic workforce that could be providing our rural communities with extended care. Why? I guess it partly stems from the existing power bases within health and an inability to think outside the box. It’s a shame our policy makers and bureaucrats can’t think more along the lines of creating a healthcare system instead of
    largely perpetuating the existing silos of care.

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    Dear Paramedic.. if you want to be a doctor then train as one. you cant be in two professions at once.. paramedics are well trained and very professional but they are not doctors..are you saying you should be at a clinic seeing people or doing home visits for a practice or ccommunity or what? it is difficult enough to do a home visit scheduled or otherwise in general practice and certainly not a cost effective use of time.. let alone be running an ambulance and trying to treat people as well in a community. The silo mentality excludes GP too from most of the health debate and it is only now, after decades of neglect by the state and federal health departments, that the cost of hospital care is forcing some attention back to primary care. Be Happy


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