Syd Uni sports clinic
13-04-2006, 12:05 PM
Specialty push a ‘major threat’ 29-Mar-2006
By Paul Smith
THE trend for doctors to spurn traditional general practice in favour of specialised medicine risks undermining the profession’s skills and damaging patient care, the RACGP claims.
The warning comes amid new applications to the Australian Medical Council for sports and exercise medicine and addiction medicine to be granted specialty status — with training programs outside the general practice pathway.
The RACGP — still battling with the Australian College of Rural and Remote Medicine over its demand for a separate rural register — said the financial rewards encouraging primary care doctors to narrow their clinical scope were “a major threat” to the current and future general practice workforce.
The RACGP’s warning is its most vocal statement to date about the impact of GPs abandoning generalist care to move to single-speciality medicine, such as those dealing exclusively with skin cancer. Australian Doctor even reported last year on a new GP-run children-only clinic.
In a submission to the AMC, the RACGP wrote: “Doctors who restrict their clinical scope have been shown to deal poorly with comorbidity, and escalating comorbidity will be an increasing feature of Australia’s ageing population.
“Patients receiving care from specialists providing care outside their area of specialisation have been shown to have higher mortality levels.”
The RACGP stressed that further research was needed to determine whether this was due to specialist-specific training.
The submission also claimed specialisation in primary care often targeted high-income areas of medicine, leaving GPs to deal with less lucrative areas. “This has the potential to lead to further demoralisation within general practice and to validate the craft’s drifttowards fragmentation and away from the more poorly remunerated — but ethically more necessary — provision of comprehensive primary medical care.”
Dr David Humphries, FRACGP and president of the Australasian College of Sports Physicians, which is behind the bid for sports medicine to become a speciality, said the push reflected the increasing knowledge base of the discipline.
“This is going to be a referred speciality — and it’s not about us opening up clinics and creating a monopoly. Ninety-nine per cent of cases seen are adequately dealt with either in A&E or in general practice, but with a speciality there will be the option with difficult cases to refer them to those [GPs] with specialist training.”
Professor David Wilkinson, deputy head of the University of Queensland’s school of medicine, said the pressure for specialisation might be impossible to resist.
“Knowledge is developing so quickly and it’s difficult to argue against expertise,” he said. “There is an expectation from patients that when something happens to them they get the best treatment possible.
“The college may believe that doctors who specialise could lose the ability to deal with complex cases — I’d want to see the evidence.”
By Paul Smith
THE trend for doctors to spurn traditional general practice in favour of specialised medicine risks undermining the profession’s skills and damaging patient care, the RACGP claims.
The warning comes amid new applications to the Australian Medical Council for sports and exercise medicine and addiction medicine to be granted specialty status — with training programs outside the general practice pathway.
The RACGP — still battling with the Australian College of Rural and Remote Medicine over its demand for a separate rural register — said the financial rewards encouraging primary care doctors to narrow their clinical scope were “a major threat” to the current and future general practice workforce.
The RACGP’s warning is its most vocal statement to date about the impact of GPs abandoning generalist care to move to single-speciality medicine, such as those dealing exclusively with skin cancer. Australian Doctor even reported last year on a new GP-run children-only clinic.
In a submission to the AMC, the RACGP wrote: “Doctors who restrict their clinical scope have been shown to deal poorly with comorbidity, and escalating comorbidity will be an increasing feature of Australia’s ageing population.
“Patients receiving care from specialists providing care outside their area of specialisation have been shown to have higher mortality levels.”
The RACGP stressed that further research was needed to determine whether this was due to specialist-specific training.
The submission also claimed specialisation in primary care often targeted high-income areas of medicine, leaving GPs to deal with less lucrative areas. “This has the potential to lead to further demoralisation within general practice and to validate the craft’s drifttowards fragmentation and away from the more poorly remunerated — but ethically more necessary — provision of comprehensive primary medical care.”
Dr David Humphries, FRACGP and president of the Australasian College of Sports Physicians, which is behind the bid for sports medicine to become a speciality, said the push reflected the increasing knowledge base of the discipline.
“This is going to be a referred speciality — and it’s not about us opening up clinics and creating a monopoly. Ninety-nine per cent of cases seen are adequately dealt with either in A&E or in general practice, but with a speciality there will be the option with difficult cases to refer them to those [GPs] with specialist training.”
Professor David Wilkinson, deputy head of the University of Queensland’s school of medicine, said the pressure for specialisation might be impossible to resist.
“Knowledge is developing so quickly and it’s difficult to argue against expertise,” he said. “There is an expectation from patients that when something happens to them they get the best treatment possible.
“The college may believe that doctors who specialise could lose the ability to deal with complex cases — I’d want to see the evidence.”