What should the College of Sports Physicians do?

[injuryupdate]

I'd love some responses below or for people to vote in this poll, so I can work out whether it is just me who has the problem.

Some of you may have already read some of my rantings on this site.

The problem is:
Currently the Australian health system government defines every area of medicine (where it recognises the training), except one, as a specialty area, including in fact general practice, which it now considers a specialty. The one area of exception is sports medicine - the government recognise sports medicine training (as administered by the Aust Coll Sports Physicians) but for reasons that are completely inexplicable, refuse to recognise sports medicine as a specialty, claiming it is just an 'area' of medicine. A secondary problem is that because sports medicine is not recognised as a specialty, the government does not pay the ACSP to train young sports doctors (whereas it funds the training of new GPs, new physicians in other areas and surgeons).

The bottom line:
The rebates that the Australian health system offers to patients of sports physicians are lower (much lower in most cases) than patients of all other recognised doctors. In theory this doesn't hurt individual sports physicians, as each doctor can charge whatever they like. However, it means that sports medicine is a fairly elitist field in Australia as the charges of virtually all sports physicians are way above the Medicare rebates. No sports physician would accept bulk billing rates from Medicare when they are less than half the rates of other comparable doctors, so they just charge huge gaps. Another problem is that the ACSP is financially in a lot of trouble because it is so expensive to run a training program with little income (only fees levied from existing sports physicians) and no government help.

What the government line is:
The government has a body called the AMC which can assess branches of medicine to see whether they deserve specialty standard (amongst other jobs). The ACSP has applied to the AMC to be assessed (and its predecessors for the past 12 years) but the AMC basically just fobs off the ACSP and says they have more important work to do than assess the College of sports physicians. The 'government' just says that the ACSP should keep applying to the AMC, but the AMC seems to be completely not interested in ever assessing sports medicine.

What are the options for the ACSP to remedy the situation:
The ACSP has, for the last 12 years, just taken a number and is supposedly standing in the queue waiting to be assessed by the AMC. However, it is dubious as to whether a queue actually even exists. However, the ACSP does not want to rock the boat.

Sports medicine is considered a specialty in the UK, the USA, New Zealand and many European countries as well. They don't have a training program in the UK, but the government has just offered to pay for one so it can be created. A few of the top Australian-trained sports physicians are now working in London because the pay is so much better.

What do people out there think that the ACSP should do about the situation, other than wait indefinitely?
Should we take legal action for anti-discrimination, should we stop training young sports doctors until the government offers to pay for it, should we get patients to sign petitions and/or send emails to the Prime Minister? Or stop whingeing and just accept that sports medicine is the only "third class" area of medicine in Australia and be happy that we are still allowed to be seen in the same room as real doctors who work in hospitals?

[hhh]

Can you add an option to your survey:

relax, doctors do better off than most professions

Remember there are plenty of other ways to bend the rules and get some johnny cash

[injuryupdate]

Agree that doctors are better off than many other professions, but you could use that argument to say that black South Africans shouldn't have been worried about apartheid because they were better off than most of the other blacks in Africa. In fact the South African government did use this argument for 50 years.

I definitely have sympathy for other professionals that don't do as well as sports physicians, but believe it or not (I sound like a footballer about to sign a contract with a different team) this isn't about the money! It is about the health system saying that there is a top tier of doctors ("specialists") and a lower tier ("GPs") and a lower than low tier ("sports physicians"). So it's about status from the viewpoint of the sports physicians. I suppose from the government's point of view it is about money, because they can justify paying less if they can get away with keeping sports physicians on a lower tier.

Money is an illusion. You can live on pretty much any decent income. Your income only starts to worry you if someone is telling you that Joe Blow, who has exactly the same qualifications as you, is earning $50000 more. Then it pisses you off.

[injuryupdate]

Hopefully this is a good analogy as to why the College of Sports Physicians situation is so annoying.

No teams in the AFL complain about the Grand Final being played at the MCG. That is just the rules, it has always been like this and if you want to play in the AFL, you win the Grand Final at the MCG. However, with respect to the Prelim final, the rules say that the higher ranked team gets the home game (except when the MCG insists on having a Prelim Final played there). Because of the inconsistency, teams squeal like crazy over this rule (and rightly so).

If the patients of all doctors were offered low rebates by Medicare and the sports physician rebates were the same as they are now, but equal to all other doctors, then we would just accept them as they are and get on with treating patients and not get worked up by the rebates.

It's just that when the system says that specialist physicians attract a patient Medicare rebate for a consult of x (e.g. $108), unless you specialise in sports medicine, in which case the rebate is less than half this.

I appreciate there are many professions where the government does not fund them at all and in this sense, sports physicians are better off.

It is just frustrating to be officially gazetted as the "least important area of medicine in Australia" which is what the current situation does for sports medicine.

[injuryupdate]

Here is the official government response as to why sports physician Medicare rebates are lower than all other recognised doctors:

Thank you for your query of 16 March 2005 regarding the rebates for sports physicians.

The level of Medicare benefits payable for a particular service flows from whether or not the provider of the service is recognised as a specialist. A Medical Practitioner who, having made formal application and paid the prescribed fee, and who is registered as a specialist under State or Territory law or holds a fellowship of a specified specialist College, or is recommended for recognition as a specialist or consultant physician by a Specialist Recognition Advisory Committee may be recognised by the Minister for Health and Ageing as a specialist or consultant physician for the purpose of the Health Insurance Act 1973. Currently sports physicians are not recognised as a medical specialty.

With regard to the Medicare rebate for Sports Physicians, on 1 January 2005, the Australian Government increased the Medicare rebate for GP attendances from 85% to 100% of the Medicare schedule fee. The Government announced this policy during last year's election and has committed more than $1.7 billion over four years for this measure. For a standard GP consultation, the Medicare rebate has increased by $4.60, from $26.25 to $30.85.

The 100% Medicare rebate is one of a number of measures in the Government's Strengthening Medicare package aimed at making general practice services more accessible and affordable for patients. The 100% Medicare rebate does not apply to services provided by other types of providers such as specialists, consultant physicians, sports physicians, optometrists, allied health professionals, etc.

Services provided by sports physicians continue to attract a Medicare rebate equal to 85% of the Medicare Schedule fee.

I hope this information is of assistance.

Yours sincerely

Medicare Implementation Team
Australian Government Department of Health and Ageing medicare@health.gov.au

Comment:

Therefore the government position is official - sports physicians are not GPs and not specialists. Although it has not been widely publicised, the Australian health system has created a third tier of doctors (non GPs and non specialists) of which the only members are sports physicians. Admittedly this tier sits above allied health professionals with respect to Medicare benefits.

I still think it takes a special (yes like Bruce McAveney I like this word) breed of totalitarian health bureaucrat to declare that sports physicians are fully qualified to work only in a special area but are most definitely NOT specialists.

[jeffreyfrog]

Sports medicine is considered a specialty in the UK, the USA, New Zealand and many European countries as well. They don't have a training program in the UK, but the government has just offered to pay for one so it can be created. A few of the top Australian-trained sports physicians are now working in London because the pay is so much better.

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Tucson Doctors (http://doctorfinders.com/doctors-tucson-az.html)