This is just another Baby Boomer problem as you mentioned.

All industries are the same, whilst health should be given priority over most others, it comes back the 17 and 18 year old scholars who need to be influenced more than any other group, using whatever means.

If the encouragement came by perhaps greater subsidies and incentives for those choosing medical science(to also encourage lower income and rural kids to enter the medical profession, helping to address another problem of doctors in the bush)and lowering the unversity entry mark not to effect calibre, but to attract the bright children marginalized with ineffective or isolated schools who end up good (but not outstanding) scores but have had significant disadvantage.

There should be tutorial focussed learning whilst at university moreso than lectures for these students to keep interpersonal and keep them from drifting away, and if the incentives are there, if the stigma is taken away and doctors are not looked at as workaholics with no personal time, we will get close to the numbers coming through that we need.

A marketing campaign targetted at school leavers is simple. Put some music stars on a poster and get doctors to speak at assemblies, make them more connected with the general public. That is my 2 cents anyway.

Realist,

> This is just another Baby Boomer problem as you mentioned.

Not really, lack of health care affects everyone, especially indigenous people.

There needs to be research on why "our best and brightest" aren't choosing medicine. I can mention a few ideas off the top of my head, but in the absence of a well designed survey, not one of us knows. Most of your suggestions make sense, except I don't really think there's a lot of anti-doctor stigma out there. The conditions, 80-hour weeks and 24 hour shifts, probably drive more bright people into real estate than anything else.

Moonie,

You missed the context. The undersupply of qualified people is a baby boomer problem, the reason for this 'health' issue is that more people shortly will be leaving the workforce than entering it, especially with the proportion of doctors going to retire, and the lack of new recruits. This is a baby boomer problem.

As for surveys, they are good but just dont survey the young, i know on many surveys we did at school EVERYONE LIED and it was a source of amusement. What do you want to find? The reason the brightest and best are steering away from medicine is varied, but in the days gone by many were either doctors or lawyers, now they are across many new frontiers, IT being one of them.

Where did you get the real estate idea from? was that a shot? I missed your point

Well said Kevin. Thank you.

If medical schools followed the Newcastle Uni Med School Barrows and Tamblyn model of Problem-Based Learning, I am certain that we would have more young people entering the medical profession. Newc Uni does not rely on HSC scores alone. Prospective medical students must also engage in an intensive interview in which they are presented with a case study that they are required to solve. The thesis is that people can have a very high IQ and HSC scores, but they may not have well developed problem solving skills, which of course are essential for medical practitioners to have. Even though sophisticated problem solving skills can be taught, the prospective student does require some innate problem solving abilities. I have taught PBL at four eastern state universities. It is a brilliant way to learn. It teaches people to understand how they learn, and it teaches them an understanding of their own understandings.

I have taught nursing at hospitals and across four university nursing programs. Nurse academics have a lot to answer for. They focus on research and philosophical wanking. There are few academics who have laid hands on people called patients since 1985! Tertiary nursing programs in the main are not pragmatic. That is why I returned to the clinical field. The entry standards are generally disgraceful. Nursing has lower entry scores than most other uni programs. Far too many students gain entry to uni nursing programs (on the grounds of disadvantage) - and far too many nursing students are granted a pass level. The standards are very poor in my view. There sould be a two tier system to engage people to enter nursing, vis a vis: a hospital- based hands on system through TAFE, and a university system for those wanting an academic pathway. Bernadette Keane (renowned Vic RPN)predicted our current problems back in 1983. She was not wrong.

Cheers
Kay

Hi Realist -

No, it wasn't a shot, just an aside :) ! A lot of my friends who could have done medicine were driven away by the conditions - either to the US, Europe, or in more than one case, to real estate.

Thanks for clarifying your point on baby boomers. The problem might not just a corollary of an aging population, but you would have to compare the number of graduating doctors with the size of their population cohort to test this. If there is a declining ratio, then it can't be explained completely by the boomer effect. My instinct is that less people are taking medicine because the conditions are rubbish, it's too hard to get into courses, and the courses are way too expensive. However, that's just my opinion and I would want to see some data of some sort to back it up.

My feeling is that Pittman has provided data that proves a shortfall, but no data to examine the causes of that shortfall. He may well have that data, but he hasn't presented it. That the problem would be solved by "less money" to hospitals and emergency departments (as well as targetted spending elsewhere) is just his personal opinion. The only evidence Pittman presents to support his opinion is the result of a community consultation exercise - and as one who has had some experience in community consultation, I don’t personally find it convincing.

I think this is a good article. The system's in decline, and the old top-down models of maintaining it are also rightly dying. The only thing left when one thinks about it is to empower those who really have a stake in making the system work. The suggestion outlined is really a form of self-organisation. (For a good description of this read Geoff Davies' book, Economia).

Without being an expert on the health system, I'd say that a self-organised model is closest to the way nature works and, as such, would have to be an improvement on the way bureaucracies operate. If people were empowered to deal with problems on a number of fronts, my guess is that the problems would be pragmatically dealt with and the current complexity in the system would eventually disappear. It is a truly revolutionary idea.

Hi Kay -

Thanks for this. Not only do the people with high IQs and scores not necessarily have high problem solving skills, they tend to have snon-existent people skills. The people I knew who did go on to Med school (with one notable exception) did so because they got the scores, and have gone on to become supercillious, aloof, unsympathetic and generally bored specialists who would have been better suited to some sort of research.

I think of the neurologist who saw my grandmother, who was having a series of prolongued iscemic episodes, one of which we were told would probably turn into a stroke and carry her off. He abused her for calling an ambulance, telling her she just needed to sit down for the requisite 2 hours while the veins of her brain unclogged. A delightful chap, well worth the commonwealth investment.

If many of us looked after the maintainance of our homes, cars and work places as well as we look after our bodies, then our homes etc would be uninsurable. Many, if not most, of our health problems are allegedly related to lifestyle choices. With an aging population, this is not going to get any better, without some form of management.

For example, according to some figures released some time ago by the AMA, smokers do not "pay our taxes for us", but instead are subsidised by the taxes of non-smokers. If this can be substantiated, then tobacco taxes should be increased with the additional funds directed into health rather than into general revenue.

There are a number of other "lifestyle choices" which relate to general health and those choices which need to be bought should be taxed to cover the short term or ultimate costs to the community. If this meant that I would pay a little extra for my wine and for my occasional fish and chips, pizza or chicken and chips, then so be it.

When I was working full time I had term life insurance. [Insurance for death during the term of the policy, no payout when the policy expired without me dying first.] Because I am a non-smoker, I got a 40% discount on the premium. Presumably the underwriters had done their homework and knew about the relevant risks. Because I have a good driving record, I get a discount on my car insurance. Because my home is deadlocked and has an alarm system, I get a discount on my home and contents insurance. But no non-smoker discount on health insurance, because [I'm told] that the government won't allow it.

[Continued]

I can walk around the supermarket and buy various foods which aren't particularly good for me and not pay GST. But if I buy multivitamins or anti-oxidants, then I DO pay GST. It makes no sense.

Currently, we have a health system which is paid for by all tax payers, but allegedly provides better service to those who take out additional insurance. [Although we sometimes hear about situations where this does not appear to apply.] But this concept is outrageous. A supposedly civilised country can't run a health service based on the "user pays" principle, but I believe that it could and should be run on the principle of "the abuser pays".

Rex,

with all due respect I feel your comments should also factor in this.

Yes, lets suppose we up the anti on smokers with extra taxes, and turn many of the low income and unemployed into destitutes, who turn around and rob good citizens like yourself.

You must realise you are not living in the 1960's anymore, our society has created the fast food/sinful pleasures lifestyle due to the rise of consumerism. Dont blame individuals for choices, when it is the whole society that is doing it and is to blame. Just because you dont like people living a certain manner, dont ostracise people for not adhering to your personal standards.

You cant make people turn radio's off, turn off the computer or TV, they are basic communication mediums.

It upsets me that people in your generation dont attribute the social changes taking place in the world to yourselves, rather you blame us for eating the junk food that you are a shareholder in, you blame us for watching the TV you put in the lounge, and it is just not practical to brand someone a junk food abuser etc, where and how is that policed.

I hope your grand 'abuser pays' theory is implemented, then your generation will foot most of the bill, as older people make up the majority of health costs. I applaud you for not smoking, but does that mean all smokers will surely die a painful death using lots of taxpayers money? no, your assumptions of abuser pays are rediculous, you as a good citizen will end up footing your own bills anyway, or feeling the rough end of the stick.

User pays, whats wrong with that, you get what you pay for. Just remember that more tax on an inelastic good just hurts the people, and i put forward that junk food in my generation is an inelastic good as it is ingrained in our society, and in our NLP since childhood

Good on you Rex. It is about time that health insurance premiums reflected the risk associated with choice and the modern lifestyle and rewarded those with low risk of lifestyle diseases with appropriate low premiums.

Time to move on from the nanny state and start taking responsility for our choices in life.

Reportedly obesity and sloth are becoming bigger health risks factors than smoking. Look at the revolution that has taken place with that insidious past time. Let's recognise these emerging trends of poor diet and exercise and treat them with similar determination.

hardnose