March 31, 1988

Article at The Sydney Morning Herald

POLITICS | Return of the surgeons

Orthopaedic returns to NSW hospitals


FOR reasons similar to those in the toothbrush ad, we will call him Dr Chris Pike. He is a 51-year-old orthopaedic surgeon, a skilled and unassuming man with a sense of humour. Last Friday he spent more than three hours in theatre operating on the deformed spine of a 13-year-old girl.

That was his first job for the day, taking him well past noon. He then walked to the other side of the Prince of Wales Children's Hospital to conduct a clinic for children suffering from spina bifida. Afterwards, he returned to theatre, straightened a child's deformed foot, and by early that night, had finished two minor operations.

Dr Pike is one of about 135 surgeons who stayed in the public hospital system when the 1984 doctors' dispute erupted. But about 60 of his colleagues who walked out refused to return, and continued to practise in private hospitals. 

Last weekend, the new Greiner Government struck an agreement for the return of the remaining orthopaedics, in a deal the Doctors' Reform Society has labelled "a total cave-in to the demands of a group of militant doctors".

The absence of the orthopaedics - surgeons who perform important limb and spinal repairs - was the major contributor to the notorious, and electorally damaging (for the ALP), lengthy hospital waiting lists.

Under the negotiated package:

  • Doctors' contracts will be negotiated with individual hospitals, not area health boards.
  • Contracts will detail all the terms of service, unalterable except by the consent of both the hospital and the practitioner, thereby escaping hospital by-laws.
  • Returning surgeons will not be discriminated against.

That is the package according to the doctors. The new Health Minister, Mr Peter Collins, is cagey about that which was actually agreed.

A spokesman for the minister would say only that the Association of Orthopaedic Surgeons has agreed in principle to return to the public hospital system, and that a review of the specialist shortages would establish where the surgeons are most needed.

He said Mr Collins had pledged to make the necessary legislative changes allowing the surgeons to work under contract. Beyond that, the spokesman said, no further undertakings were available.

Already some of the surgeons who stuck with the system are making noises. Sources at one eastern suburbs hospital said some doctors were resentful of the orthopaedics for working themselves into a "privileged" position.

Generally, though, the eastern suburbs have been lucky. While mass resignations rocked the rest of the city during the doctors' dispute in 1984, in the east only about four doctors walked out.

Mr Tim Smythe, chief executive of the Sydney Area Health Service (covering the city centre through Paddington to Watsons Bay) said most of the surgeons in his region had stayed with the system.

"Basically we've got a good bunch of surgeons who just stuck with us," he said. "The two hospitals (in our region) with orthopaedics, Sydney Hospital and St Vincents, have a long tradition of working through disputes and difficulties."

Of the 12 orthopaedic staff at the hospitals, three resigned - one from St Vincents and two from Sydney. St Vincents quickly replaced its loss, while Sydney held its two vacancies open pending the completion of the hospital's reconstruction, which has made operating theatre space scarce.

He said the board had no problems with the deal arranged by the orthopaedics, as most of the hospitals administered by the Sydney region have their own boards and make their own arrangements anyway. Only one was under its direct control.

The other regional authority, the Eastern Area Health Service (Centennial Park through Randwick to Mascot), was more cautious about the new deal. A spokeswoman for the service, Ms Nicole Brodie, said the board would wait to see the details of the agreement before making any statements.

Although the service was not prepared to make any statement, it is understood that only one orthopaedic surgeon resigned in the dispute. Sources indicate the area board is not keen about speaking out because it wants to avoid provoking its orthopaedic surgeons.

A spokesman for the Australian Medical Association's NSW branch, Mr Chris Thomas, said the arrangement made between Health Minister Collins and the surgeons was a return to the previous "honorary" system under which patients with private insurance

were treated as private patients, and those not able to afford private insurance were treated free.

"We don't see it as (the Government) selling out to the surgeons," Mr Thomas said. "We are generally supportive of their attempts to get a fair and equitable deal from the public system."

Dr Bruce Shepherd, one of the leaders of the orthopaedic walk-out, and soon to take over as the president of the AMA NSW branch, was pleased with the result.

"In my mind we were justified from the beginning," he said. "People can say we've struck a deal with the new Government, and we have, but it was ... in the interests of helping people in the best and most efficient way. We've now got to have more doctors involved in the running of hospitals ... it is we who know what the problems are."

The Doctors' Reform Society is outraged that the orthopaedics have got their way. The president of the society, Dr Robert Marr, predicted the"cave-in" was only the first step in the orthopaedics' battle to privatise health care.

"This renegade group has been greatly responsible for the waiting lists that have caused so much suffering," he said. "They're an extremist faction interested in destroying Medicare. We're concerned that, now they've got their way, they will make other demands."

He said doctor-hospital contracts would lead to the means-testing of patients, allowing doctors to class those earning above a certain amount as private patients and charging them "whatever they like".

"Mr Collins is far too close to this small radical group," said Dr Marr. "The efforts of these doctors to increase the waiting lists greatly helped the downfall of the previous government. It's scandalous to see that the first major act of the new minister is to pander to these extremists."

According to sources, Mr Collins is also unhappy about what he regards as political "stacking" of the local area health boards by Labor. The boards, established in 1986, have a membership of 11, led by a chief executive, with one staff-elected member and nine appointed by the minister. The terms of half of sitting board members will expire in December 1989.

Dr Pike will be glad to see the alleged "political appointees" go from area health boards and leave the running of hospitals to professionals.

"Every big public hospital is bureaucratised," he said. "There are countless examples where money could have been better spent, things done more efficiently. And then I have a waiting list of six months, frequently having to stop surgery at 4.30 (pm) because there are no nurses and no overtime. That sort of situation has got to change."

He believes the availability of free medical services, as provided by Medicare, only encourages people to use the system more than they really need. This blows out health spending, and leads the Government to pressure hospitals and doctors to cut back on costs.

"People who are well-off are opting for Medicare when they could afford to pay their own way. That's drawing money away from those who can't afford it,"Dr Pike said.

Dr Marr disputes this.

"What you'll see is the rich getting good health care and the poor and middle class getting downgraded care," he said. "They want the sort of system that exists in the US, and there many people are being bankrupted by their health care bills."

Whatever happens, the fact is the orthopaedics now have more of a say in the State's health system than they ever did under Labor. Judging by the comments, the battle lines have only been redrawn - the surgeons still have to win over their colleagues in the Doctors' Reform Society, as well as public opinion.