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  1. #1
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    Default Almost too pissed off to attend specialty assessment meeting

    I am a sports physician and tomorrow in Sydney there is a preliminary meeting with the Australian Medical Council about the possibility of sports medicine being assessed as a recognised specialty. This may be a cause for great celebration if it actually leads to anything, as the Australiasian College of Sports Physicians has been waiting for over 10 years to be assessed (with previous lobbying falling on deaf ears).

    I am invited to the meeting, but I think I am too angry to go. Because sports medicine is NOT considered a specialty, sports physicians lose out on many benefits compared to other doctors, for example, when a sports physician orders an MRI scan Medicare will not give the patient any rebate, so the costs are a minimum $250-300 out of pocket for the patient (which is the cheapest you can usually get a scan for).

    Recently a patient of mine, who I had recommended have an MRI scan months ago, but she did not go ahead and get it because of the out of pocket costs, saw some other completely irrelevant specialist at a cocktail party (gastroenterologist maybe?) who ordered the test for her. The results were pretty relevant and she is now a bit annoyed that she didn't get the scan months earlier, although she couldn't have afforded it. I feel bad that I was powerless to get her the test at a reasonable price, and that she naively thought I was the best person to see to make the diagnosis so wouldn't go and visit another so-called specialist instead, even after I explained to her how the system worked. It shows how stupid the system is that a sports physician can't order an MRI scan under Medicare for a sports injury but a gastroenterologist or psychaitrist or anaesthetist can.

    If I go the meeting tomorrow, I am liable to piss off the AMC representatives by asking sarcastic questions like "who do you think can do a better examine of the shoulder joint, a qualified sports physician or a qualified gastroenterologist?". The problem is that the bureaucrats would probably take this question seriously and say, "well really we aren't sure, we haven't gone that far along the assessment process yet and we don't know the relative ability of various doctors in that area......yada yada yada.....at this stage we can't conclusively say that qualified sports physicians know anything about sport or medicine or sports injuries at all but at some stage in the future we may address this question in more detail."

    The 'specialisation' assessment is a closed shop rort that is basically a deal between the government and AMA to limit government spending in return for limiting competition to those who are 'in'. I don't know that I really want to spend an afternoon listen to a bunch of liars try to pass off the specialisation 'process' as anything different. I wish they would just give the sports physicians the name of the politician we have to bribe, which types of French wine he or she likes drinking, where he or she would like the 50 cases delivered and when we will be allowed into the inner sanctum in return for lining their pockets, which is the only language they understand. The governments will continue to treat cigarette companies, for example, like royalty, because they pay mega dollars in campaign donations, but will not listen to common sense if there is nothing in for them wrt dollars or votes.

    I will never say that the process for managing medical specialists is fair when certain 'specialists' can order tests in areas for which they have no knowledge, whereas others are banned from ordering tests in areas where they are very knowledgable.
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  2. #2
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    Default You gotta go

    Yeah, I can quite understand your aggrieved stance. As a Sports Physio I prefer to send patients to Sports Physicians, who in my humble opinion and general experience, provide excellent management strategies consistent with a 'Specialist' level of expertise.

    You may be banging your head against a brick wall but unless you and your colleagues keep banging away, nothing will change. Go to the meeting and say your piece - Good luck!

    DPR

  3. #3
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    Default

    So did you go in and blow your top or not?

  4. #4
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    Default

    Went and left early because it was a complete waste of time. Was promoted as a meeting as part of the specialty assessment process and in fact was an internal Australiasian College of Sports Physicians meeting with no AMC representatives present.

    There was no further news to report. The AMC have not gotten back to the ACSP on when specialty assessment will occur, although when they last spoke (early 2004) it was indicated that they would consider it in 2005.

    I asked one question of the ACSP President whether the ACSP was going to complain or lobby in any way in about how sports physician rebates are now clearly well lower than any other recognised doctors (including GPs). He said that he doesn't know who to lobby to (I said try the Sports Minister and Health Minister) and basically they don't want to jeopardise the specialty assessment process by lobbying. Same answer as last 10 years, same non-timetable for assessment.

    I am just going to put my fees up and explain in detail in a handout to the patients that my fees are very low compared to other doctors but the gaps are very high because sports physicians are considered less important than other doctors by the government.
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  5. #5
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    Default

    Sometimes it doesn't do you much good but it can feel good to have a big dummy spit at someone. Best way to do this is to head down to the Coogee Bay tonight and pull the mobile phone out later in the evening. If you want to go one step further, when you get home bash out a quick editorial or opinion piece and email that off to a journal.

    By the way, who is running ACSP these days?

  6. #6
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    Default

    David Humphries is the President. Excellent bloke and very bright. Most intelligent thing he ever did was left Sydney 12 years ago to set up as the only sports physician in Hobart. He has a three month wait to see him as he is a good clinician and basically has no competition. With demand always greater than supply, rebates don't bother him, as he just puts his fees up further and the market keeps meeting them. Hopefully more sports physicians will take the tip and move to places where demand is greater.

    For me, I make enough money to be satisfied, and most of my patients are happy to cop the gap. It might be an ego thing, but I can't stand that a psychiatrist is considered expert enough to order a knee MRI scan but a sports physician isn't, and that a GP who spends 6 minutes telling the patient that he or she doesn't know what the problem is and writes out a referral to see me, in doing that will generate a higher Medicare rebate than I will in actually diagnosing the problem. Surgeons who injure patients' patellar tendons in cutting through them to perform knee arthroscopes on patellar tendinopathy (and these guys actually exist) will generate hundreds of dollars in Medicare rebates, because the system presumes that all operations are justified and they all work, whereas there is only a measely amount of rebate available for me as the tendinopathy expert to try to fix the stuff up that the surgeon was given a handsome sum to create.
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  7. #7
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    Default

    Here is a letter I sent a few weeks ago to the Sydney Morning Herald, but they didn't publish it:

    Our government is constantly promoting how much it is ?strengthening? the Medicare system, but does not explain why it chooses to ?strengthen? some areas far more than others.

    The rebate given by Medicare to patients for similar medical services, performed by different doctors, varies substantially. An initial half hour consultation for patients of a general physician or cardiologist will generate Medicare rebates of $108.85, for patients of general practitioners it is $58.55 and for those of sports physicians it is $49.80. Rebates for patients of sports physicians have been lower (or equal to) every other recognised area of medicine for the last decade.

    Presumably, the government does not see sports medicine as being as important an area to support as other areas. A further example is that the government has funding programs devoted to preventing injuries in many other areas but not sports injuries.

    Injury (or fear of injury) is a common reason why people don?t exercise enough, and whilst the government maintains disincentives for people to exercise, the obesity epidemic will continue unabated. Future governments will need to budget for more services in cardiology and endocrinology because of the heart attacks and diabetes caused by lack of exercise.
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  8. #8
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    Default

    Why not just become a FRACS and go with the flow? A surfie buddy of mine once said why makes waves when you can catch one?
    If you want to be the man, you've got to beat the man

  9. #9
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    Surfers tend to smoke too much dope, so they wouldn't know much about getting ahead.

    Should everyone be a surgeon (FRACS)? Why have conservative management at all? Why even have physical examination? Just book everyone in for an arthroscope of the joint that is painful.

    Basically this is the 'HOW TO' of the Medicare system. Their null hypothesis is that "all surgery" is beneficial to the patient so will be given a substantial Medicare rebate. Any other management (other than surgery) is "unproven" and they will assess it within 20 years or so whenever it is proposed.
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  10. #10
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    Default

    I meant be a FRACS just so you can order your scans and charge the higher prices with a rebate included. Essenitally you just do what you are doing now but instead of calling it "sports medicine consultation" you call it "surgical consultation". It will end up paying for itself and when the patient comes along that needs surgery, that fails your conservative management, you hit the jackpot and cash in by doing the surgery as well.

    Then you whinge to FRACS that ACSP are getting ripped off, lets help them out. They jump on your side and the ACSP is a winner.
    If you want to be the man, you've got to beat the man

 

 

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