Opinion & Commentary
Paying nurses to play doctor will make system sick
Criticising the nursing profession is like killing Bambi. Nurses who devote their lives to the care of the sick rightly deserve our honour and respect. But the problems with the Rudd government’s changes to Medicare, which fundamentally change the role of nurses in the health system, cannot pass without comment.
Under the legislation passed by the Senate last week, nurse practitioners will for the first time be allowed to bill the Medical Benefits Scheme for treating patients with minor illnesses and prescribe certain medications on the Pharmaceutical Benefits Scheme.
These changes are not only an egregious waste of health dollars. They will also encourage nurses not to work where they are most needed: in public hospitals, feeding, washing and medicating the sickest patients in the nation.
To understand what the problems are you have to appreciate the structural defects with the health system. Since free fee-for-service general practice visits were introduced in 1984, increasing amounts of taxpayers’ dollars have been spent at the least severe end of the health spectrum. To try to contain the cost of bulk-billed services that were immediately overused and quickly became a political sacred cow, the number of medical training places was capped in the mid-1990s. Today’s GP shortage and longer waits for appointments is the result.
As the cost of Medicare spiralled, health spending was controlled at the one point in the system where real savings could be made. Public hospital budgets were tightly capped and bed numbers hugely culled (by 60% since 1984) to limit the number of patients who could be treated. Today’s ever longer waits for elective surgery and emergency admission are the result.
Rationing of services by waiting based on relative need is an unavoidable feature of all government-run, taxpayer-funded health systems.
But what Medicare has produced is an irrational and immoral rationing in the form of an inverse care law.
People with no or relatively minor health problems can see the doctor free of charge and virtually on demand an unlimited number of times at taxpayers’ expense, while people with serious illnesses are denied timely access to care and are forced to wait and suffer in the long queues for essential treatment in overcrowded hospitals.
Paying nurses to substitute for doctors so the ‘worried well’ don’t have to wait is the wrong priority. This will simply pour more money into the part of the system that will do the least to improve health.
Creating an alternative, lucrative career path for practice nurses will also worsen the shortage of nurses willing to work in hospitals and therefore make it even more difficult to increase the number of hospital beds.
It will exacerbate the problems in the nursing profession that have stemmed from the shift from in-hospital training to university-based education in the ’80s.
According to many nurses trained under the old vocational system, university training has been a disaster. The three years spent in the classroom has left many nurses unprepared for life in the wards, leading to premature permanent retirement.
This is backed up by the failure of the federal government’s greatly undersubscribed back-to-work program. Last year, just 541 returning nurses took up the offer of $6,000 cash bonuses, half the number expected and only 7% of the five-year target.
The changes to Medicare aren’t a victory against the doctors club, they’re a win for interest group politics. The nurses union has flexed its considerable political muscle and convinced the government to use taxpayers’ money to pay nurses to do the kind of community-based clinical work that many university-trained nurses now prefer to do.
This is one of the reasons many frontline hospital staff support a return to the traditional system. On-the-job nurse training would enable trainees to discover whether they are actually cut out for nursing.
This would also open up nursing careers to students who are unable to gain university admission. And it would enable many hospital beds to be immediately reopened.
While we clearly need more ward-based nurses, this does not diminish the need for specialist nurses who will require higher education.
Practice nurses have an important role to play in modern health care. But to ensure safety and quality, practice nurses should work in the same clinics in partnership with doctors who have full clinical responsibility for the care of patients.
When the MBS was introduced the M was said to stand for the all the Mercedes that GPs would now be able to afford. It’s the same story this time round. Paying nurses to play doctor will see taxpayers money subsidise a new class of health entrepreneurs. It will not do what all good health reform should promote: the efficient use of scarce resources to ensure the truly sick receive better care.
Any government serious about health reform should end this rort before it has even begun.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies.
