If Australia could defy the United States embargo on trade with Cuba and embrace that Country on terms of mutual respect, we could access their pool of doctors and possibly prevail on Cuban generosity to train Australian medical students
Presently, Cuba sends it's surfeit of doctors around the world to developing countries such as East Timor where there are some 300-500
doctors working throughout the countryside.
Additionally, Cuba has established a medical faculty in East Timor's university and currently has in excess of 700 East Timorese studying Medicine in Havana.
I understand Cuba also is engaged in developing it's own pharmaceutical industry as an alternative to having to deal with American monopolies who continue to screw us all with over-the-top pricing which forces Australia to implement our own Pharmaceutical Benefits Scheme to make medicines more affordable.

People are people, they are not the property of the state they are born or trained in or by.

Many acquire skills to escape the poverty of their birth.

Should Australia play God and for those who aspire to come here, deny them entry because they have the skills which we need and might be valued elsewhere?

I think not.

I agree with Col Rouge,

Australia already does not make it easy for doctors to come, requiring working in the country side and local examinations, so doctors that come here really want to.

South Africa and other african nations decided that young doctors had benefitted from the countries education and that they should be forced into a "national service" many in distance rural clinics at the pittance of about $1000 per month. They then respond with shock and disgust at the shameful behaviour of the youth when the emigration rate of qualifying doctors goes from 20% to 55%.

The developed world is not stealing the doctors rather the attitude of entitlement is driving them away from where they are needed.

The G8’s noble intention of World health is admirable but Col’s words reflect certain truths;
• There aren’t enough medical workers to go around and those exist are often disproportionally distributed.
• Under capitalism Medical professionals are a commodity that will be adjusted by market mechanisms of supply and demand.
• There aren’t enough medical workers to go around and those exist are often disproportionally distributed.
• People are entitled to sell their talents to improve their lot.
• To many a MD licence is a perceived ticket to a better life.
However, reality is somewhat skewed by the perversions of power and excesses.

Without doing a Humanistic rave (no Col not socialist). I wonder if we couldn’t do a better job of:
• Training and opportunities.
Training our Drs seems a bit like the ‘survival of the fittest’ an all or nothing deal. A medical degree should have levels each entitling the individual to different levels of involvement in the Health area based on achievement, competence etc.
Currently the system turns out Drs. (if they survive) if not ‘taxi drivers’ with potentially a whopping Hex, hardly an efficient use of resources, skills and people.
An obvious conclusion is to expand and better facilities to be more Health INDUSTRY focused even to the point of Health Industry universities.

• Distribution
The current power of medical colleges (unions) accreditation is outdated and geared to maintaining their self interest. A clear perversion of the market mechanism of supply
Medical licences don’t mean that all Drs. are good businessmen or operate in the interest of their customers they serve (sort of).
The Federal Government should borrow from business and act more as a franchisor offering various territories for independent Medical services suppliers (Drs, Clinics, medical consolidations) each franchise would then operate on clearly defined rules and incentives for regional practices. It would be then up to the effort of individual practise to determine revenue. Multiple franchise ownerships would be possible.

Okay team rip it up or improve.

Examinator,

What you are describing has been in place for decades in 3rd world countries.

Primary health care clinics in rural areas are normally staffed by senior nurses who consult, diagnose, prescribe and dispense medicines, and perform minor surgery and child delivery.

More serious cases are referred to the hospitals in the main centres.

These systems where implemented have managed to drastically improve the health of the people in the area.

However, it is also recognised that they are not experts, and that they can and do make mistakes. Their customers have no legal recourse to compensation, but are unlikely to try as they recognise that they are much better off.

In Australia, where an error on the part of a medical pratitioner results in huge law suits, highly trained nurses are not allowed to diagnose (spending a lot of time changing bedpans etc) and doctors will refer to specialists if in the slightest doubt.

Thus the huge increase in demand for highly qualified personnel is purely driven by the huge cost of making a mistake.

If your GP has to pay $150 000 p.a. in insurance, he has to get it from some one.

The answer to the shortage of doctors would be to limit the compensation due to medical error.

Shadow minister,
I think you missed the thrust of my idea.
• Medical Unis teach all facets of medicine including levels of nursing
1. first year common
2. second year nursing practices
3. Third year Theatre etc advance nursing
4. Medical diagnosis etc.
5. internship
6. Jr resident
7. practicing cert
8. Specialist
If some one bombs out at year 4 they are still qualified to be a advanced nurse with the chance to after a year redo year 4 and on. Second failure no more chances unless supported by a major hospital as sponsor.
Year 4&5 could with an extra year become administrator of level 2 hospital (60 beds).
• Distribution franchisee.
1. Only level 7+ with 5yrs experience can hold a franchise.
2. He can employ up to 2 x level 6 as a Jr Residents per level 7(supervisor) in practise. Or a Snr. Nurses Fees would be appropriate. Allowances can be made for years of experience.
As the franchisor the independent commission offers various sites which can include which services are to be supplied. The Dr after vetting would be on a rolling franchise subject to meeting all requirements. Up graded services ie specialists must be approved by the commission. This would avoid bunching or cherry picking. Profits would be the same as applies on any franchise except the on going franchise fee.
The initial franchise fee would help pay for appropriate set up costs balance subsidised by Govt. lesser areas more subsidies.
Sales of practise would be the same as in commercial franchises.

The system I suggest here is just for example.
This system is borrowing from McDonalds only the government is the HO and offer support and financial set up. Mc D gives franchisers a choice of offered placements or buying an existing one. The allocation system helps individual profitability reduces competition on price and all but guarantees a profit.
It still allows private enterprise, better placement, spreading services wider. Where they are needed. The Commission would offer franchises/subsidies on market basis. Insurance would be on bulk rates. Now what do you think

Peter Deutchman,
I'm afraid the theme of your article has been hijacked.
To return to your point; I have long believed that successive Governments have been a party to brain drain from developing countries in preference to putting resources into our own tertiary institutions by providing scholarships for committed medical students to undertake the years of study needed to become trained professionals who otherwise could not afford the financial cost.

There is nothing wrong with Doctors having to do time in rural hospitals. It should be a perequisite as other service professionals such as Police Officers & Teachers have to do their share.

Unfortunately the worst aspects of American Medical practice have infected our health care industry. Health clinics and Private Hospitals have become investment areas for foreign investors that reap the cream of hospital services by inducing Specialists to admit their privately insured patients whilst the Public system picks up the uninsured.

The insurance industry should be excluded from forcing exorbitant premiums on Doctors to insure against litigation by Hospitals indemnifying their Doctors and Governments legislating against 'frivolous' claims. Common law claims should only be permitted in cases of Gross negligence & malpractice where a strong prima-facie case exists.

Examinator,

I did get your point. All I was saying that Australians are spoilt. They can get to see a Dr with no charge to themselves as long as they bulk bill. Who would go to one of these jr franchisees?

Maracas

The point of the training period for young doctors is to give them a broad range of skills in dealing with a large variety of situations with experts to back them up.

This is only available in major hospitals, not rural clinics. Once they have finished here they are fully trained and about 27 years old. At this stage of their life, it is not possible to force them to do anything successfully any more than forcing plumbers or accountants to work in the country.

To get doctors in country, you need to make it worth their while or they will go and soon leave. A doctor in a rural clinic needs to be available 24/7. An uncommitted person will switch his phone off.

S.M.

Working in rural clinics must become an integral part of the training process. Practicioners will be faced with plenty of challenges in the country they won't encounter in the City from being gored by a bull to snake bite and tractor roll-overs.

Doctor's ambitions to own a Mercedes before they're 30 needs to take second place to their Hippocratic oath. Service to the population in rural Australia, the food bowl of the nation becomes an obligation if the expenditure for the training has been borne by taxpayers dollars as it should be.

Besides with modern day technology, internes can have access to instant advice with video links to major teaching hospitals and the added benefit of aerial evaccuation if all else fails.

When experienced doctors are enticed from poorer countries, the quality of health care in those countries is devalued as younger replacements gain their expertise.

Privatisation of Health care in Australia has inflated professional incomes in comparison to the incomes of plumbers and electricians whose services to our community are no less important to peoples health & wellbeing.

Maracas,

I worked for several years in a small town where the local doctor was a close personal friend, in 3 years he never saw a single snake bite, bull goring or tractor roll over, and all the more complicated patients had to be transferred to a larger center such as Canberra where he was not able to be involved in any level with their treatment.

He eventually moved to Sydney for 3 reasons, firstly he wanted to expand his training, the first of his kids needed to go to high school and the local public school was not suitable, and his highly qualified wife wanted to start working again part time in a field that was not available in the country.

Having spent 9 years training (more than a lawyer or accountant) doctors are probably 26/27 and ready to settle down with partners, they are just starting out their carreers and contrary to your glib comment are a long way from being able to buy their first mercedes (more likely to try and pay off their hex debt and then try for their first mortgage).

The concept that their life can be dictated to by a patronising beaurocrasy is insulting. If the gov paid off their hex debt and gave them some reason to stay, things might be different.

S.M.
My school mate's father was the Doctor in the small country town , the centre of a thriving dairying industry where I was born . The district's population was around 3000.
There were three children in that family who all went on to become medical practitioners who had to go to boarding school when they reached Secondary levels because there was only Primary levels to Grade 7 at that time.
The family moved on when the boys reached Tertiary level. Another G.P. replaced the doctor. That was the experience of all the citizens in the town, having to send their kids to boarding school.

I paid a nostalgia visit 3 years ago to learn there was NO resident doctor and the hospital where I was born has become an aged persons facility. My cousin and her husband who are both in poor health have to travel 35 miles for emergencies and get to see a visiting doctor by appointment for ongoing care.

The imposition of Hex debts on University students has been a negative influence on the development of Australia as a 'smart' Nation and I do not support continuation of the scheme. I am in favour of Fee Free education. If you return to my last posting second paragraph (if the expenditure for the training has been borne by taxpayers dollars as it should be.) You will understand that I expect an obligation from Internes to serve some time in rural districts.

The shortage of G.Ps. in Australia has contributed to appalling health statistics in remote Australia, particularly in Aboriginal Communities that even 'stealing of doctors from Poor countries' cannot correct.

If Kevin Rudd rises to the occasion and implements his proposals for improvements to the education and health systems, we might yet be able to say we do not steal doctors from poor countries but train our own.