Healthcare (part 2)

The most frequent question I get asked from people back home (in the U.S.) -- both in and outside of medicine -- is, "How does their health care system compare to ours?"

Here are some of my thoughts, 3 1/2 months in, based on observations and experience.  Please bear in mind that while I am at a regional medical center with a catchment area of several hundred square kilometers, I am not in a major metropolitan area which would certainly be a very different practice than what I am currently experiencing -- which is also very different than if I were in a more remote setting.

In short, compared to the United States, health care in Australia is better....and worse.  It really depends on your circumstances and how you measure (what's important to you).

First, I will say that the standard of care and and quality of doctor is quite high.  I work with trainees from all over the world (not just Australia or British Commonwealth nations).  Australia, being as spread out as it is (1/10 the population of the U.S. in a country about the same size as our continental U.S.), needed doctors to service the entire country and so for years allowed (encouraged) foreign physicians to come practice here.  Over 50% of physicians practicing in the country are from overseas, so the populace is quite used to "foreigners' (like me) delivering health care.  In response to the need for more physicians, Australia markedly beefed-up the size of their medical school classes several years ago taking applicants from Australia as well as other countries (primarily commonwealth nations -- Canada being the biggest supplier) who would now be Australian-trained.

Now that those larger classes are graduating, it has made finding residency positions much more difficult since there are now more people looking than there are available positions (many people from British Commonwealth nations have traditionally come here to do part of their training).  This makes positions quite competitive -- especially if you are a foreign graduate (i.e. did not go to medical school in Australia).  One of the better PHOs (Principal House Officers) currently training in our Emergency Department had to do 2 years of Psychiatry just to get into the Australian system since he went to medical school outside of Australia.  Another physician, who is married to an Australian but who went to medical school in her native country of Sri Lanka, was here as a scribe/observer for 10 weeks since she could not get a training position of any kind anywhere in the country.  So, if you are looking to come here to train -- it may be tough to get a spot.

For people trying to get a position as a physician after training, there are indeed spots (and need for your services) but it is a confusing system to negotiate.  GP's basically run the system (their equivalent of Family Practice in the U.S.) and no one sees a specialist unless referred by their GP (unless they are admitted to the hospital -- see later posting).  Your best shot at getting a position is to get certified at a level that makes you desirable to the people at wherever you would be hired.  The progression is somewhat complex (when it was being explained to me, with several trainees in the room, they couldn't agree on the progression -- tough to figure!?)  It appears that after medical school you become an intern and the next year you are a Junior House Officer (JHO) and the next year a Senior House Officer (SHO).  The year after that, you become a Principal House Officer (PHO).  It is at that point that you would apply to the "College" of the specialty in which you want to specialize (e.g. Australasian College of Emergency Medicine, if interested in becoming an Emergency Medicine specialist).  You would take a comprehensive test covering material all the way from the beginning of medical school (biochemistry, anatomy, physiology, you get the idea) and, if you passed the test and had the right recommendations from people in your chosen specialty, you would be accepted into the "specialist pathway" for that college and could now apply for a position of "Registrar".

After your year as a Registrar you could then become a Junior Medical Officer (JMO) and then a Senior Medical Officer (SMO).  These advancements (to JHO and SMO) are made when your training program feels that you have made the necessary progress (usually in about a year at each level, I think).  The final step is to become a "consultant" also known as a "specialist" in your specialty of choice.  To reach this level, you take another test (written and practical), publish acceptable research or do acceptable courses in epidemiology, and then sit before an examining board with your college (enter again the Australasian College for Emergency Medicine, in my case).  Because this last step is not only difficult but also far from a certainty, many individuals drop out of the process and work without spending further time in the training track.  For example, we have several more mature individuals who reached the rank of PHO or SMO who are no longer in training and are just working in the department.

Salaries are not negotiated but are somewhat fixed.  I say "somewhat" because there is a base rate that a doctor at a given level receives but it is then augmented based upon performance in various categories (e.g. involvement with education of physicians in training, involvement with quality improvement issues, patient satisfaction, etc.).  Physicians not in training but with a given level of certification receive a higher salary than those in training at that level, I think, but I do not know for certain.

If all of this seems confusing, welcome to a small window into my world....

Now patients here have to be just that .... patient ("patient" -- get it, it's a play on words) because many things just don't happen quickly or expeditiously (which can be VERY frustrating to an Emergency Physician from the U.S. where an hour delay for an x-ray reading is frustrating).  Many towns have very limited health care facilities so transfers to a higher level-of-care facility (read -- get into a car, ambulance, helicopter, or fixed-wing airplane to get you to a place where they can handle your problem).  If you need a ____________ (fill in your specialist of choice -- let's say "neurosurgeon"), you obviously need to go where there is a neurosurgeon.  But what if your problem is time-dependent?  Well, you either try to transfer faster (helicopter rather than ambulance) or have someone who may have some knowledge in that area cover.  For instance, we have no Urologist so our General Surgeons cover Urology.  Sounds good on paper -- unless you are the one who needs the Urologist.  For a neurosurgeon, we transfer to Brisbane -- a "short" 240 km away.  This really is not that far by helicopter -- unless, of course, you are the one waiting for its arrival and then the necessary transfer time itself all while your subdural is growing in size and putting pressure on your brain.  Then you may be a bit -- how should I say it -- screwed.

I'm going to stop here (come up for air or something -- or do we go "down" for air when everything is upside down?) for now.  I will move on to "universal coverage", public vs. private hospitals, and various specific services -- maybe even an interesting case or two -- next time.  I will also try to get some pictures of the great people with whom I work and of the facility for my next post.  I know I can't compete with Ellie's turtle videos (where is Colin when I need him?) but I will say that if you need a soporific, I should get a prize!

Good-night!

Easter Break

Today (April 20, 2015) is the first day back for school kids after the Easter holidays. They have a solid two weeks off from Good Friday on. All the schools have the same break, private and public, primary and high school, university and technical schools, no difference when it comes to breaks. I can tell you from experience that having that being set for everyone would be a huge benefit to parents. You can plan years ahead if you wanted to have a big family vacation with all the kids, and no one having to miss a day of school. If it's one thing I've found out about Australians is they vacation, a lot. Maybe that's why they have figured out the school vacation dilemma.

We live in a vacation spot here in Bargara. We arrived January 2 this year as one of my first blogs described. We landed at Kelly's Beach Resort in Bargara, having found one room available for 2 nights. We had no idea how busy the area would be with Christmas and New Year's, which is at the end of their summer break. We got REALLY lucky to have found any room, any where in Bargara. Now that I've experienced a full on Spring Break in Bargara that luck has really hit home. We live on the Esplanade in Bargara which is the main "drag". There are many units that are rented out for the breaks, not in our building, but all around us are what we call condo complexes. The owners rent their units out for weekly rentals at very high costs, and they are snapped up. (One of the places I looked out for a long term rental was $1800/month or $900/week short term.) The unit we are in was a short term rental until we rented it for this year. The beaches were full, the roads had a lot more traffic, and you needed a "booking" for a dinner out.

What is really fun to see is how much the vacation time is cherished here. For the last 2 weeks we have seen hoards of families coming back and forth to be beach, to eating establishments, to shopping areas, playing tennis, cricket, bike riding, walking, camping, and really just having fun.

One of the local places where all this fun happens is Bargara Beach Caravan Park.

As the name describes, this is camping, caravan style.

But you can also tent camp on powered sites.

I'm not sure how many sites of each kind they have, but the place was full with no vacancies of any kind.  We had never seen it during a break and it reminded us of San Destin, Florida over Spring break in the US. This is a destination for families coming from New South Wales (where Sydney is located) as it's warmer the further north you travel. Up and down the Queensland coast would be the same, lots of vacationers.

We did travel a bit during the break time. Many people had said the Eumundi area, which is just an hour north of Brisbane, was loads of fun especially on Saturday mornings when the market is on.

I want these!

John wanted this, someone to crack his neck.

We got going early as it was a 3 hour drive on the Bruce Highway, yes, the same highway that we traversed on our first trip to Bundaberg in January. I absolutely HATE this highway. It is a 2 lane, 100 km/hour, death road. The road has a shoulder which is about 8 inches wide. During the day it is drivable, but I've decided that driving it at night is not an option. I'm jumping ahead here, back to the story....as we got off the highway we both had the same deja vu about where we were. As we drove this stretch of highway the first time, the traffic was terrible, bumper to bumper, no end in sight for miles. We decided to get off where there was food, we didn't pay attention to the name of the place, and ended up in a quaint little town with a lovely restaurant. When we tried to get back on the road to get to Bundaberg, we couldn't figure out the round abouts, and that is where both of us realized we had been there before. It was another "Ah ha" moment. 

 We stayed about 4 hours wandering about the stalls and shops at Eumundi. We then drove to Noosa Heads which is a beautiful stretch of beach, with a main drag that has some of the highest end shopping we've seen. http://www.traveller.com.au/hot-to-shop-noosa-1b6tv

Not this shop!

We had dinner at the Noosa Surf Club

It was literally one of the prettiest settings we've enjoyed. We had a lovely meal and headed back to Bundy hoping we'd get some of the drive in before dark. (Reminder here that we are in late Autumn, meaning we're loosing the daylight early.) I volunteered to drive. BIG MISTAKE! This road could have been the death of me, and still may be as you need to use it to get most anywhere. John was tired and woke up about 60 minutes from home. I had managed to get us that far without his "help" but as soon as he awakened he saw me veer to the left, away from the on coming 18 wheeler who had a car trying to pass him on his left. All I know, or saw, was 3-4 headlights coming toward us at 100 km/hour and I needed to move over as best I could. (Remember the really wide 8 inch shoulder?) He wasn't sure what I was thinking as there was no real place to go, but I didn't go off the road, we survived, and I let him drive the rest of the way back.

Now add darkness, oh, and notice the shoulder?

So we made it home, barely. 

The rest of these 2 weeks have been noticeably cooler and less humid. We are still enjoying 75-80 degree days, but with the sunlight leaving so early, the evenings are quite cool. The locals say Winter is the best season here, go figure. We will take whatever the Winter serves up, even down to say 62 degrees at night. We're from Wisconsin, we can take it!

We really think the weather is addicting. It's like a really good drug after you've had surgery. It just makes you feel so good. But like that drug, it'll wear off and we'll be back in the Frozen Tundra soon enough. We'll also be back to where people drive on the correct side of the road and they have real shoulders on those roads. But until then,

I reckon we'll suffer through. Cheers!

First Holiday here and adjustments

Here we are, 3 months into our year. Good time to reflect and see how it's feeling, being gone that is.

I have to say that Easter, being our first holiday away from all the family and friends, is hard. We (Tucker clan) are used to John being tied up at work on holidays. We made the best of it,  we'd go to church, then have a meal together, or just celebrated the fact that some of us were together. This year, John is working, and there is no one here with whom to celebrate. I'm not trying to have anyone feel sorry for me, but it is an adjustment. I received a nice email from Lynn (my sweet daughter in law) looking for a family favorite recipe she could make to have the Tuckers there (JP and Colin) feel some of home when they celebrate their Easter with the Parker clan. I'm so appreciative of the Parkers including Colin and Scott, although I think Scott is going elsewhere for Easter. The Parkers have included all of us at holidays for the past 3 years, which has been lovely for us, Lynn and JP who have not had to miss either gathering as we were together as one big family.

John and I are planning to go to a church service, at a church which haven't tried before, on Easter. We haven't connected with a church yet, not really finding that right match, so we are still looking. I plan to go for a bike ride and/or a long walk Easter Sunday, not really different from any other day of the week.

Easter holidays are a big deal here. The kids are off school for 2 weeks and everyone is traveling. The area where we live is full of families and tourists.  I expect the stores will be full and the restaurants booked solid. Good Friday is bigger than Easter Sunday in that EVERYTHING is closed, except the hospitals, of course. Even the bars are closed. That's huge.

We are in Autumn here, the temperatures are cooling a bit, the sun setting by 6pm, and sweaters (called jumpers here) are appearing in the stores. Having the seasons backward from the US is, how do I say it, confusing. People here are gearing up for their "Winter" which is so weird as that means a high of 75 degrees and a low of 60 degrees.

I can't get my head around that. NOT COLD PEOPLE!

I'll tell you about cold.....never mind, I won't.

Three months in means John is through with his "monitored" practice here and will be a consultant when the paperwork comes through. His role has been that of a consultant meaning he's teaching, team leading, and doing everything a consultant does. A consultant is the highest category of physician in Australia, and one that isn't given haphazardly. There are only 5-6 consultant physician's in the Bundaberg ED, that's out of 30-40 doctors that staff in one way or another. His research, his fellowship in Toxicology and his 30+ years of practice has afforded him this qualification. Well done. (or Good Onya) It also makes him very valuable as Bundaberg wants to stay a teaching facility for Emergency Medicine Residents. They need consultants for that to happen. This month will see 2 consultants leave, the director who recruited John, has taken a job in Brisbane near his home, and another American doctor is leaving to practice in England. Both have been in Bundaberg for 7 or more years and their leaving is a big loss to the department. I told John when he told me the director was leaving that he will be getting a lot of pressure to stay beyond the year he committed to......hate to say it but I am right.....again. Not to worry anyone, I am firm in that I am returning when the year is through, give or take a few weeks. John is also holding firm with that time frame. It's a dilemma, and there is a lot of time left for them to figure it out, but nothing is what we were planning. Ha! That could be the title of this whole experience.

This will end with the update on the House Hunter's International which is still interested in us. I have gotten approval from the unit's owners to film, and the condo association, which believes it would be good for resale and Bargara's profile. I have answered the 16 pages of questions with John's help, and sent photos of the family and the unit.
 http://www.hgtv.com/shows/house-hunters-international

I have no idea if they will ultimately use us, but the gal I'm corresponding with loved the wedding pictures with JP and Lynn, and the boys,

like duh, perfect wedding and adorable couple.

If it were JP and Lynn, not US, it would have happened already. The middle aged couple thing has been done to death.....literally. Oh well, JP and Lynn will have to wait to move to some exotic locale, then they can have try to get on this TV show.

Happy Easter to all reading this, or Happy Pesach (that's Passover), and stay in touch. OH and GO BADGERS!