Better planning of healthcare is certainly a priority as we race towards spending 10% of GDP on healthcare in Australia.

One big bother is the lag time in training doctors. Double the number of medical student positions and it is still a decade before it will start making a difference in the workforce. I think large increases in student places for all healthcare professions should be implemented.

If in the future we approach an oversupply in some professions then places could be set aside for overseas students from impoverished countries. I could not think of a better form of foreign aid than giving these countries health professional places from our excellent teaching institutions.

I am concerned that integration is gaining an increasing status as the cure all for stabilising the health system.

Integration is usually explained as either the states but more often the feds taking over wholesale responsibility for healthcare. The pros sited for this policy include an end to duplication and blame shifting. Fair enough I suppose. But I don’t look forward to trying to get innovative ground up health reforms by dealing with a centralised uber health bureaucracy. The health workforce would be forced to cop more more unworkable top down policy. An example could have been the ageist and inflationary Medicare Gold policy the ALP took to the last election.

Until we address the tertiary centric orientation of healthcare delivery we are not going to be able to deal with demographic challenges ahead of us. Hospitals suck up the bulk of health funding, a smaller chunk is left over for primary care and lip service is paid to health promotion and preventative measures. Early intervention in the primary health setting delivers far more bang for the health care buck than the tertiary component. Australia has more hospital beds per capita than most western countries but all we hear of is chronic bed shortages. Small problems turn into big problems when early intervention in the primary sector is not available.

The longer we shirk health sector reform the harder it is going to be.

The health departments have always collected stats on doctor numbers and a range of bodies ask doctors about their hours of work and intentions eg with regards retirement.It's called "manpower planning" or some politically correct version. The government at least in Qld has opted to make it increasingly unattractive for students to do medicine and the average age of entrants into the new post-grad course is older making the "working life" of a doctor shorter. Dctors have also realised that while everyone wants a 35 hour week, flexi-time, five weeks holiday and a personal island in the Barrier Reef, that they should not be working 268 hours per week....bless them. More women are doing medicine (over half) and many work part-time as they think they should be able to reproduce too. Governments being simple souls have thought that buying cheap doctors from the Third World where they are most needed is the solution as universities cost money. This is reverse trade...we buy their cheap textiles and doctors and export coal and wheat....ideal. Many doctors will not go to the country as there is no cover....why work 268 hours/week?
Meanwhile state and federal governments play pass the parcel with money and health obligations to keep administrators busy and give us the chance to blame evil doctors for health messups. Most hospital beds are blocked with elderly who are there because of inadequate resources in understaffed nursing homew where nurses and other staff are paid peanuts for one of the most demanding jobs. We want aged care and mental health on the cheap and that's what we get. More well equipped nursing homes and aged care would free up hospitals.Improved primary care and preventive medicine would too.

I agree with Mt Pittman - I shuddered however when he used the words "integrated health care planning"; the concept of health planning in the Australian context is an oxymoron of the highest order.

I do agree though, a national planning approach is essential. In the wake of the last federal election Bob Carr even went so far as to suggest the feds could take over NSW health as the first step towards a national scheme; The mad monk had the sense to pretend not to hear the offer as NSW Health is some what of a cot case. And sadly it is representative of what a national approach might look if an overly bureacratic model is adopted.

Australia has restrained health expenditure as a percentage of gdp quite well over recent years compared to our OECD counter parts, at the same time as maintaining high standards. It could be contained even further if health delivery was better coordinated.

A new paradigm of health governance is required; centralised bureacracies have either failed or delivered short of the mark time and time again. An obscene amount of health resources are spent administering departments of health nationally and at a state level. Auditors general do not speak too highly of health administrations. The first step towards reform needs to start with a serious, objective and externally based review of the efficiencies within the offices of the various health departments - that's where the waste is.

And then you can start on the doctors.

Of course, part of the problem is that the better our health system gets, the more people want from it. We no longer 'put up with' niggly things, we get them sorted out.

On a slightly different topic-

Two of my good friends are doctors-in-training. One is in a 'bonded' place, where he gets a subsidy or cancellation on his HECS (not sure entirely how it works) if he works in the country for six years after graduation... thats great for whatever area he works in, but he is quite apprehensive about the idea- he worries he will be stuck in an area with little or no support before he is truly confident in his abilities.

My other friend, who is in her final year of residency, plans to stay in the city. I asked her if she would ever contemplate moving to the countryside, as doctors are so needed? She said "well, maybe, but not until I have a family, and only if my partner could also find work... i'd be so lonely without people around".

I guess what i'm trying to say is, while its nice to talk about sending doctors and other health professionals to rural and remote areas, we have to remember that in doing so, we are asking people to move their entire lives to an unfamiliar place, where they percieve they will have less opportunity for professional support and longer working hours, away from their friends and families.

I know I wouldn't be keen on that combination...

Try being on call 24/7, 365/365. It is like this for some medical officers even in the city. Try a country practice and see how attractive the rural life is for the medical profession. Throw in litigation and the need to save the lives of anyone who decides prang themselves up drunk at 2am on Sunday morning or have obstructed labour. If you knew the reality of the bush, you would never drive outside the metropolitan area. Your chance of survival in a motor vehicle accident is much less. This is on the public record.
Now, who's on call this weekend. Oh, it's me again. Better not have a drink as this may be seen as improper. I could get sued by some do-gooder. Hey, but I'm on call all the time. What can I be thinking?

Yep rural practice is 24/7 365/365, It can be very rewarding but it is no fun when you can't even do the shopping for fear of being bailed up by someone about thier results or just wanting a consult at the check out line.

This is by no means a uniform situation and when the right balance is struck it can be great working environment.