Disappointing news this week from CountryHealth SA – on April Fools Day they announced that an agreement has been reached with the AMA(SA) regarding rural doctor contracts
…but neglected to inform the Rural Doctors Association of SA, who not only represent rural doctors in this State but with whom CHSA were supposedly negotiating.
The current impasse remains – apparently around 50% of doctors have signed contracts with CHSA – which means 50% have not. Whilst the AMA(SA) appear to endorse the contract, the RDASA do not. Which makes one wonder with whom CHSA are negotiating….
You can read details from the RDASA webpage media release and letter to members.
Sticking points remain :
(i) a freeze on free-for-service payments for three years
Rural doctors work in private practice and provide oncall services to their local hospital. Freezing fee-for-service payments disadvantages the oncall doctor, who not only forgoes clinic income by attending the hospital, but also faces CPI increases in rent, utilities, staff costs etc.
(ii) EPAS system
The EPAS system has been trialled in some SA hospitals an universally condemned by frontline clinicians. It detracts from patients care and takes significantly longer to complete notes. Whilst not adverse to using an electronic system of hospital notes, such a system needs to be fit for purpose. Rural doctors are hesitant to endorse this system until it is proven to work effectively.
(iii) Payment for ADMITTED non-Medicare patients
It has always struck me as perverse that the oncall doctor attends the hospital for emergency presentations…but in the case of patients involved in a car crash or seriously unwell from overseas, CHSA reneges on it’s obligations to pay the doctor and somehow insists that such patients are ‘private patients’ – which requires the oncall doctor to bill privately.
This is problematic. Critically ill patients are in no position to provide informed financial consent. Moreover, rural hospitals are public hospitals. The fact that the hospital has no resident doctor and requires an on call contractor to attend, should not negate the need to pay that doctor for attending.
Such work is stressful, involves medicolegal risk and a high degree of emergency medicine skill. To spend several hours stabilising a sick patient who is then retrieved to the mainland and then not to be paid for it is a slap in the face for rural doctors – especially when everyone else involved in the patient care is paid (nurses, retrieval, tertiary centre doctors).
Of course, such presentations are not uncommon in places such as Kangaroo Island which have high tourist visitation (200,000 tourists to 4500 locals) and where unsealed roads and wildlife are not infrequent causes of car crashes.