As a specialist doctor Tanveer has an appropiate attitude to this bundle of issues.

In contrast to what he says I suspect:

- many doctors do overservice when they have the opportunity

- doctors DO generate their own constant customer base by a regular checkup regime (weighted "in favour of" patients who can pay more)

- a greater supply of doctors then does not necessarily mean the same increased proportion of patients are treated. Many chronically ill or aged patients cannot pay the above standard fee amounts that many/most specialists charge - priority service will continue to go to patients who can pay the most.

- once Doctors are fully trained this lets them off the leash to go to the US or Saudi Araboa etc and earn far more. This is not good for our country

- if they come back there will always be a shortage of specialists (one way or another). As Tanveer says many specialists can go part time because they can easily afford it. This part time phenomenon is another way to cause an artificial shortage ("naturally") generating higher fees per consultation.

- specialists therefore can be paid more per hour to work fewer hours per week (say $100,000 per year for a one and a half day week at the low end of the specialist spectrum).

Probably the overiding reason for a shortage of specialists is a unexpected increase in demand ie. because people are more informed about the ability of specialists to lessen the impact of deseases of age. This allows people to live longer.

So the economics of this issue and professional/monetary motivations of specialists are not as simple as Tanveer makes out. Government's are not as all seeing and all predicting as he expects.

My GP has closed his books to new patients, and it takes 4-5 weeks to get a non-urgent appointment with him. He works from 8am till 7PM six days a week.

Regular checkups are rare in the GP arena, if this preventive medicine was used more we may find that costs actually go down not up.

No many go untreated when they should be, or they drop dead from a heart attack that may have been diagnosed earlier.

My specialist Heamatologist charges me $4.60 a visit over and above the Medicare rebate. (This is at the Mater PRIVATE hospital in Brisbane, I have no medical insurance.) My specialist Rheumatologist bulk bills.

Why shouldn’t Doctors just like anyone else go to any country they like, we sure attract many from overseas.

All the specialists I have seen have been incredibly busy and patients have to wait for over a month to see them. They are dedicated to their patients and will do anything to help.

If a specialist decided to only earn $100,000 per year I suggest he would go bankrupt very quickly, with insurance, staff to pay, rent on medical premises etc.

Governments of all political persuasions over the last 20 years have seen this problem coming and have placed it in the too hard basket.

I think the role of the specialist colleges is the main reason for shortages. The colleges are run by senior specialists to look after the interests of their members. By artificially keeping the number of fully accredited specialists low they maximise the earnings of their senior members, all the better if this keeps junior specialists in the public health system for longer and at lower pay rates. By the time the juniors make it to the top they too want to protect their hard won position, hence the system sustains itself.

The specialists may do a wonderful job and be highly dedicated and professional, but at the end of the day many of them are probably earning 5 to 10 times what a comparably experienced/responsible/dedicated/hard working professional earns in an unregulated industry where market forces set the pay rates and practitioner numbers. This self regulated monopoly over medical specialities seems to be supported by both sides of politics and at the moment the only real calls for reform are coming from the ACCC.

AndrewM has really said it all on the subject of Colleges.

Tanveer Ahmed refers to "comparably low salaries", "the last socialists in the market economy" and "working as cheap labour". A few comments.

The Colleges restrict supply of new specialists to guarentee their members 7 figure incomes. But in the meantime, the poor old "trainees" aren't doing too bad. I would guess the doctors in our public hospitals have an effective income between $200,000 and $300,000 per annum after a couple of years - don't believe the sob stories about low salaries - they (intentionally to appease public outrage)appear low but don't include a wide range of allowances (on call and call out, for taking on management responsiblities etc), access to Private Patient Schemes - a nice little tax avoidance scheme that allows then to share in the fees charged by public hospitals to private (insured) patients, the allowance to support training (which can be used to attend medical conferences which coincidently are held in the Greek islands during our winter), the government funded motor vehicle, paid for parking etc.

The doctors are not the victims in the health system! If Patel ever stands trial in Australia, I think a few people might also change their view about overseas trained doctors as the solution to the problem!

Dear Dr Tanveer Ahmed

Thank you once again for a thoughtful and timely article.

As a nurse of over 30 years duration I have worked with numerous medicos in the public sector. I have witnessed the horrendous hours (anything up to 22 hours without sleep) that resident doctors work. No other industry would expect that of their employees. And, as you well know, the salary in those early years is quite pathetic.

Yes, and as you know, the Colleges are largely to blame for the shortage of medicos. The elites in the Colleges set benchmarks for how many people will pass before they even sit for their exams. I saw this happen time and time again in dermatology and psychiatry. It was extremely demoralising for some of my doctor friends.

And by the way Tanveer, I studied for 15 years whilst holding down full time jobs to gain my five nursing qualifications.

The climate of bullying in Queensland is alive and well - in both nursing and doctoring! Young doctors are leaving QHealth to move to the private sector or interstate, to escape from the horrors of QHealth. It is apalling. Nurses are either leaving, or joining the private sector.

And let's not forget the problem of "public bullying". Heaps of female doctors and nurses are leaving the public sector due to ever increasing verbal and physical aggression from members of the public -especially in Accident and Emergency Departments.

Cheers
Kay

Thank you Tanveer for your article. Thank you to those who have responded.

I am an Australian-trained medical grauduate. I undertook a degree at the University of Melbourne, achieving an honours degree. I work in a Victorian tertiary hospital. I am currently thinking of finding a way out of medicine, without obtaining any medical specialty degree.

I work hard during the week in a system that cannot staff itself. I earn approximately $50,000 p.a., with salary packaging ($8755 tax free) after 6 years of university training (full-time, about 35 contacts hours a week). My school-friends, after 3-4 years of study make about $80,000++ p.a.

I work overtime each day. I often do not get paid my overtime hours. I work in a system that is falling apart. I worked 60 hours a week last fortnight, 20 hours a week more than my agreed hours. I am trying to study for a specialty college exam that has a 30% yearly overall pass rate. I am getting married and trying to buy a house. I want a life where I can see my friends and not be on shift work. I have had enough. There is more to life than the Australian Hospital system. I want out.