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!
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