injuryupdate
17-10-2005, 04:08 PM
SMA can enter the summer season this year with a renewed sense of optimism about the potential for growth in the organisation, having seen the annual conference in Melbourne exceed expectations. Linking sports medicine to both injury prevention and physical activity from the conference viewpoint meant that over 1000 people attended. More importantly, the presence of administrators from bodies such as the Department of Health and Ageing at the conference (probably due entirely to the physical activity stream) led to optimism that sports medicine might actually one day become a blip on the political landscape in Australia. Roald Bahr certainly gave an excellent keynote address on the opening day, but was he just preaching to the converted? As SMA members, we all believe that if sports medicine was better funded and resourced across the board that physical activity levels would rise (and therefore heart disease, diabetes and cancer levels would drop). Correct me if I’m wrong but I didn’t see Tony Abbott or Rod Kemp or John Howard (nor Kim Beazley) in the audience at Roald’s talk, and I don’t know that any of them would have been bothered at all by any of the contents.
We live in an age where physical activity and injury prevention should be enormous priorities for Australia and therefore organisations such as SMA, ACHPER, ACSP, SPG etc. should be flush with money. That these organisations (and many of their members) are merely treading water financially is a symptom of the fact that lip service is paid to both physical activity and sport injury prevention but there is no Federal government resolve to make either of these areas work from the top.
If I was giving the Howard Government a mark out of 10 in these areas, it would be zero out of 10 for sports injury prevention and it would be minus 4 or minus 5 out of 10 for physical activity. With respect to sports injury prevention, the Federal Government literally does absolutely nothing and, with respect to physical activity, it has policies which actually discourage physical activity and it has not been motivated to change these policies despite watching activity levels go backwards in the last decade.
As a sports physician I have most vested interest in how my own society (the ACSP) is doing, and at the moment there is much collective backslapping at how the ACSP is about to have its application for specialty recognition assessed for the first time. Included in the application is a letter from the relevant assessment body in 1994 saying that the assessment of sports medicine should proceed in the “near future”. Depending on your time scale, 2005 may seem like the near future from 1994, but in some aspects it is quite a long time. For example, over this period the percentage of women in Australia under 30 who are considered obese has risen from 5% to 13% according to the Australian Longitudinal Study on Women’s Health.
Specialty recognition for sports medicine may seem to those on the outside like an indulgence, but all it would do (if it actually ever occurs) is bring sports medicine in to line with every other recognised area of medicine in Australia. Sports medicine is the only area of medicine in this country that is officially recognised as branch of medicine with a high-quality legitimate training program (which it has been since 1998) but is not considered to be a specialty (general practice in this sense is considered a specialty). Because of this status, ACSP registrars and new Fellows in Australia are actually only given provider numbers (ie, licences to practice under Medicare) by courtesy of the Government breaking its own legislation. Section 19AA of the Health Insurance Act forbids Medicare rebates from being paid to “a patient in respect of a service rendered by a medical practitioner, where the practitioner completed their internship on or after 1 November 1996, unless the practitioner is recognised as a specialist, consultant physician or general practitioner”. Sports physician registrars and new Fellows who completed their internships after 1/11/96 are neither specialists, consultant physicians nor GPs, so strictly speaking they should not be allowed to participate in Medicare.
Somehow this Government is breaking its own rules for the time being, so the need to gain specialty recognition for sports medicine is pretty acute when some of our registrars and even Fellows are literally practising using provider numbers which they are strictly not meant to have and therefore could be taken away on whim by any future government.
I can also guarantee to you that specialty recognition for the ACSP has not been granted over the past 15 years for reasons that have absolutely nothing to do with merit. The ACSP has been lied to by, and has unfortunately believed the lies of, a succession of health ministers, government bureaucrats and even the AMA. The lies have followed the theme of “if you have your house in order and make sure your practice standards and training program are high quality, then you will soon get assessed by the relevant body and specialty recognition will proceed”.
This is actually the complete opposite of the truth. The Government has acknowledged that our standards are high and our training program is adequate by giving our new Fellows and registrars special provider numbers that they aren’t even meant to have. It has refused to do a formal assessment (which perhaps may be finally done over the next 2 years the AMC) because it would be harder to resist the call to bring sports physician rebates under Medicare in to line with other areas of medicine. That it doesn’t want sports physicians to have equal rebates to other branches of medicine can only be due to a philosophical belief that sports medicine should be user-pays rather than underwritten by the Government, which I am sure is the attitude of politicians like Howard, Abbott, Costello, Nelson and Kemp. In fact, I could just imagine that if any of these Liberal Party heavies were in the room at Roald Bahr’s presentation, they would be secretly thinking “…you mean that physical inactivity and obesity levels are much higher in lower socio-economic areas of major cities (which traditionally vote for Labor)…and what exactly is the problem?!”
This government wants sports physicians to be able to stay in practice, so that our top athletes are cared for well and wealthy members of society can also access good sports medicine treatment by paying high out of pocket fees. However they want to keep the government contribution towards sports medicine to a bare minimum as they believe sports medicine is a luxury for the well-to-do rather than an important service for society (a bit like plastic surgery, perhaps).
Specialty recognition would have occurred by now in Australia if the ACSP had followed any strategy other than having a high quality standard of practice and training program. In the United Kingdom, where standards of sports medicine are generally very poor by comparison, the National Health Service has approached the leaders in sports medicine and has given them specialty recognition and huge funding to set up a training program, because they saw a need that was not being met (particularly for their elite athletes).
Ironically, if instead of being appointed director of surgery at Bundaberg Hospital, Dr. Jayant Patel had joined the ACSP training program, I am sure sports medicine would have had an AMC assessment completed by now. If we had actually had a rogue practitioner in our midst who was out there killing people, the audit of the ACSP, which the Government currently claims it has been unable to do over the last decade, would have been prioritised to the top of the queue.
Just as there are no votes in specialty recognition for sports medicine, there are also no votes in sports injury prevention and in promoting physical activity. There are votes in Olympic medals, and hence the Federal Department of Sport has put the majority of its resources into this area. If the government were being honest, which does not seem to be its want, they would rename Senator Rod Kemp the Minister for Elite Sport and admit that they saw no need for a minister for exercise.
If there really was a minister for promoting and assisting sport, he or she would have felt obliged to resign from the Federal Liberal party after Brendan Nelson announced that his Voluntary Student Unionism legislation plan was official Liberal Party policy. This is because with respect to physical activity, the universities of 2005 are the bodies in Australia that have the correct template, and the government wants to smash them for having the cheek to make sporting club membership compulsory. If you actually wanted to make a difference to physical activity levels in Australia (which this government clearly doesn’t), the first thing you would do would be to force every Australian to pay money to join a sporting or exercise-based club. Those who chose actually to participate would be getting partially funded by those ‘members’ who were inactive and who only joined because they were forced to. This would be a tax on inactivity, which is what Australia desperately needs.
We live in an age where physical activity and injury prevention should be enormous priorities for Australia and therefore organisations such as SMA, ACHPER, ACSP, SPG etc. should be flush with money. That these organisations (and many of their members) are merely treading water financially is a symptom of the fact that lip service is paid to both physical activity and sport injury prevention but there is no Federal government resolve to make either of these areas work from the top.
If I was giving the Howard Government a mark out of 10 in these areas, it would be zero out of 10 for sports injury prevention and it would be minus 4 or minus 5 out of 10 for physical activity. With respect to sports injury prevention, the Federal Government literally does absolutely nothing and, with respect to physical activity, it has policies which actually discourage physical activity and it has not been motivated to change these policies despite watching activity levels go backwards in the last decade.
As a sports physician I have most vested interest in how my own society (the ACSP) is doing, and at the moment there is much collective backslapping at how the ACSP is about to have its application for specialty recognition assessed for the first time. Included in the application is a letter from the relevant assessment body in 1994 saying that the assessment of sports medicine should proceed in the “near future”. Depending on your time scale, 2005 may seem like the near future from 1994, but in some aspects it is quite a long time. For example, over this period the percentage of women in Australia under 30 who are considered obese has risen from 5% to 13% according to the Australian Longitudinal Study on Women’s Health.
Specialty recognition for sports medicine may seem to those on the outside like an indulgence, but all it would do (if it actually ever occurs) is bring sports medicine in to line with every other recognised area of medicine in Australia. Sports medicine is the only area of medicine in this country that is officially recognised as branch of medicine with a high-quality legitimate training program (which it has been since 1998) but is not considered to be a specialty (general practice in this sense is considered a specialty). Because of this status, ACSP registrars and new Fellows in Australia are actually only given provider numbers (ie, licences to practice under Medicare) by courtesy of the Government breaking its own legislation. Section 19AA of the Health Insurance Act forbids Medicare rebates from being paid to “a patient in respect of a service rendered by a medical practitioner, where the practitioner completed their internship on or after 1 November 1996, unless the practitioner is recognised as a specialist, consultant physician or general practitioner”. Sports physician registrars and new Fellows who completed their internships after 1/11/96 are neither specialists, consultant physicians nor GPs, so strictly speaking they should not be allowed to participate in Medicare.
Somehow this Government is breaking its own rules for the time being, so the need to gain specialty recognition for sports medicine is pretty acute when some of our registrars and even Fellows are literally practising using provider numbers which they are strictly not meant to have and therefore could be taken away on whim by any future government.
I can also guarantee to you that specialty recognition for the ACSP has not been granted over the past 15 years for reasons that have absolutely nothing to do with merit. The ACSP has been lied to by, and has unfortunately believed the lies of, a succession of health ministers, government bureaucrats and even the AMA. The lies have followed the theme of “if you have your house in order and make sure your practice standards and training program are high quality, then you will soon get assessed by the relevant body and specialty recognition will proceed”.
This is actually the complete opposite of the truth. The Government has acknowledged that our standards are high and our training program is adequate by giving our new Fellows and registrars special provider numbers that they aren’t even meant to have. It has refused to do a formal assessment (which perhaps may be finally done over the next 2 years the AMC) because it would be harder to resist the call to bring sports physician rebates under Medicare in to line with other areas of medicine. That it doesn’t want sports physicians to have equal rebates to other branches of medicine can only be due to a philosophical belief that sports medicine should be user-pays rather than underwritten by the Government, which I am sure is the attitude of politicians like Howard, Abbott, Costello, Nelson and Kemp. In fact, I could just imagine that if any of these Liberal Party heavies were in the room at Roald Bahr’s presentation, they would be secretly thinking “…you mean that physical inactivity and obesity levels are much higher in lower socio-economic areas of major cities (which traditionally vote for Labor)…and what exactly is the problem?!”
This government wants sports physicians to be able to stay in practice, so that our top athletes are cared for well and wealthy members of society can also access good sports medicine treatment by paying high out of pocket fees. However they want to keep the government contribution towards sports medicine to a bare minimum as they believe sports medicine is a luxury for the well-to-do rather than an important service for society (a bit like plastic surgery, perhaps).
Specialty recognition would have occurred by now in Australia if the ACSP had followed any strategy other than having a high quality standard of practice and training program. In the United Kingdom, where standards of sports medicine are generally very poor by comparison, the National Health Service has approached the leaders in sports medicine and has given them specialty recognition and huge funding to set up a training program, because they saw a need that was not being met (particularly for their elite athletes).
Ironically, if instead of being appointed director of surgery at Bundaberg Hospital, Dr. Jayant Patel had joined the ACSP training program, I am sure sports medicine would have had an AMC assessment completed by now. If we had actually had a rogue practitioner in our midst who was out there killing people, the audit of the ACSP, which the Government currently claims it has been unable to do over the last decade, would have been prioritised to the top of the queue.
Just as there are no votes in specialty recognition for sports medicine, there are also no votes in sports injury prevention and in promoting physical activity. There are votes in Olympic medals, and hence the Federal Department of Sport has put the majority of its resources into this area. If the government were being honest, which does not seem to be its want, they would rename Senator Rod Kemp the Minister for Elite Sport and admit that they saw no need for a minister for exercise.
If there really was a minister for promoting and assisting sport, he or she would have felt obliged to resign from the Federal Liberal party after Brendan Nelson announced that his Voluntary Student Unionism legislation plan was official Liberal Party policy. This is because with respect to physical activity, the universities of 2005 are the bodies in Australia that have the correct template, and the government wants to smash them for having the cheek to make sporting club membership compulsory. If you actually wanted to make a difference to physical activity levels in Australia (which this government clearly doesn’t), the first thing you would do would be to force every Australian to pay money to join a sporting or exercise-based club. Those who chose actually to participate would be getting partially funded by those ‘members’ who were inactive and who only joined because they were forced to. This would be a tax on inactivity, which is what Australia desperately needs.