Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
#HealthyCOP29
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
#iDEA24
#ASMIRT2024
#EACH24
#CHFtalks
#SARRAH2024
Croakey Professional Services
Sponsored content
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
#ChurchillDeepEnd
Planetary Health Equity Hothouse 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
NT election 2024
Queensland election 2024
United States election 2024
Federal election 2025
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Gaza conflict
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Croakey Funding Drive June 2024
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
#QldVotesHealth 2020
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
#HealthyCOP29
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
#iDEA24
#ASMIRT2024
#EACH24
#CHFtalks
#SARRAH2024
Croakey Professional Services
Sponsored content
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
#ChurchillDeepEnd
Planetary Health Equity Hothouse 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
NT election 2024
Queensland election 2024
United States election 2024
Federal election 2025
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Gaza conflict
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Croakey Funding Drive June 2024
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
#QldVotesHealth 2020
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

What to do about the problems caused by super specialisation in medicine?

Among the many competing principles in healthcare delivery and policy are the notions of providing the ‘best possible care for any individual’ versus ‘doing the best for the most at a population level’.

Tied up with this are questions of how to achieve the fairest distribution of healthcare resources, and of health.

On such themes, here is a column, first published in the 10 February edition of Australian Doctor, by the magazine’s political editor, Paul Smith.

It is particularly timely given the current focus on the impact of private health insurance incentives, which, it could be argued, have helped distort health funding towards the procedural end of medicine.

***

How to address the problems of medical specialisation?

Paul Smith writes:

I heard this story* in the Australian Doctor office last week. It was about a patient, a GP, who went to see a specialist because of problems with her eye.

During the consult, the specialist confirmed a retinal tear, but he had to refer her to someone else because he was millimetres beyond his scope of practice. Turns out he was a peripheral retinal surgeon, not a central retinal surgeon.

These experiences are not uncommon, although super specialisation and the way it affects the health system is a vexed issue not discussed enough in the public domain.

You could argue that the rise of the specialist common to most health Western health systems will drag them all towards the financially crippling horrors of the US, a country tragically dominated by the sort of people who proudly claim to be experts in the left big toe.

The issue is on the agenda here because the bloke leading Health Workforce Australia, a relatively new bureaucratic colossus with hundreds of millions in its budget balance, has now started talking about the need to resist.

The HWA chair, Jim McGinty, told the AGPN conference in Melbourne last year: “Specialisation has gone too far, driven by the professions and supported by employers … while at the opposite end, the capacity of GPs, generalists and support workers are not being sufficiently valued or managed. We need a broader, and in the cases of general practice and medicine, a deeper scope of practice.”

He went on to say the agency, as part of its job to remould the country’s health workforce, would focus on “rebalancing specialisation and generalism”.

After his declaration I pestered him for an explanation of the sort of policy options available. He seemed to clam up like a crime suspect under police interrogation. It is difficult to know whether this is because he wants to keep the lid on a big idea or because the agency hasn’t started its thinking on the issue.

One solution proposed by the Productivity Commission in its health workforce report back in 2006 was mainly about rebalancing Medicare rebates away from procedural interventions, with greater rewards for consultative medicine.

Whether governments are ready to spend the money on consultative medicine and make the necessary cuts to procedural rebates seems doubtful — especially after the blood spilt when Nicola Roxon went to slash cataract surgery rebates in 2009.

And given the sky-high gap fees patients of super specialists tolerate, you can also argue that only the most extreme fiddling with Medicare would be sufficient to dampen demand for their care. In short Medicare fiddling remains the sort of policy suggestion that leaves politicians, seeing the brickbats coming their way, in a cold sweat – even when the arguments are in its favour.

There are deeper questions. Is it right to interfere with a doctor’s desire to develop expertise and knowledge? In the last analysis, specialisation is about ensuring the most safe and effective application of medical interventions on patients.

Specialisation also grows partly because, in specialist fields, demonstrable expertise and knowledge is the currency that buys status and a career path within the medical profession.

Couple this with patient demand and patient dollars for “medical experts” and you have an environment in which specialisation flourishes. The real significance of all those population-based studies by Barbara Starfield — the late American academic who showed that more medical specialists in your health system (beyond a fixed point) will mean more death — can be lost in the face of the personal forces operating at these individual levels.

The Royal Australasian College of Physicians at least is suggesting we create “dual-trained” physicians as part of a conservation effort to protect the general physician species. These doctors would have core training in general medicine, in addition to training in a specialty associated with chronic illness — endocrinology or cardiology for example.

The college has warned that “allowing the physician workforce to develop in its current form of narrow specialisation will not address the broad needs of the ageing population and rising rates of chronic disease and co-morbidities”.

And there have also been attempts to roll out a national training program for rural generalists (or GPs with advanced procedural training, depending on your medical politics). The idea is to equip a new generation of GPs with skills in obstetrics, emergency medicine, anaesthetics and surgery after the previous generation was stripped of them through the combined efforts of the specialist colleges and the hospital system.

In the meantime, Mr McGinty and Health Workforce Australia have apparently been doing some demographic number crunching with the aim of listing the actual numbers of GPs, specialists, nurses and various allied health professionals to meet the country’s future needs.

These calculations have been done before – the most infamous example being the 1996 Australian Medical Workforce Advisory Committee conclusion there were 4400 too many GPs in urban areas. A newly elected Howard government ended up capping GP training places to just 400 a year with results that we still live with today.

The HSW numbers are due to be sent to health ministers in March for their consideration. Removing the lid on the agency’s big idea for how to make the changes needed will have to come later.

• After publication of this article in Australian Doctor, Paul Smith received a note from an ophthalmologist suggesting that the case study used in his introduction was wrong in its details: “I suspect your friend had a tear too peripheral to laser with the usual items and instead needed someone with an indirect laser which can get all the way to the periphery.”

But so far as Croakey is concerned, even if the details of the case study are not quite correct, the broader issues are important and worthy of wider consideration.

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Search by: Categories or tags

Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
#HealthyCOP29
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
#iDEA24
#ASMIRT2024
#EACH24
#CHFtalks
#SARRAH2024
Croakey Professional Services
Sponsored content
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
#ChurchillDeepEnd
Planetary Health Equity Hothouse 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
NT election 2024
Queensland election 2024
United States election 2024
Federal election 2025
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Gaza conflict
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Croakey Funding Drive June 2024
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Healthdirect Australia series 2019
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
#QldVotesHealth 2020
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

Search the Croakey Archives

Archives
Facebook
X/Twitter
LinkedIn