If you believed the 1991 Census, you would argue that medical specialists well and truly deserved a pay rise. More than a third (4740) reported earning less than $60,000 a year (8330 reported earning more than $60,000), and their average weekly earnings were a mere $1305.50. Professor Stephen Duckett does not believe those figures for a minute: “It’s self-reporting.”
Professor Duckett, dean of health sciences at La Trobe University, estimates specialists’ median earnings about $160,000, with high- flyers in certain disciplines bringing in much more: “More than a quarter of gynaecologist-obstetricians get more than half a million dollars a year,” he says.
Earlier this year, Dr John Paterson, secretary of the Department of Health and Community Services, wrote a paper for the Australian Health Ministers Council that used Medicare figures to estimate earnings in different specialities. The top 25 per cent of cardio-thoracic surgeons earned almost $700,000 each (the average cardio-thoracic surgeon, just under $400,000).
Top incomes for ophthalmologists were close to $600,000 (average $350,000), and top cardiologists, plastic surgeons, gastro- enterologists and dermatologists earned more than $500,000, with average earnings in those areas between $300,000 and $400,000.
Bottom of the heap were paediatricians, general physicians, anaesthetists, psychiatrists and GPs, where the top 25 per cent brought in less than $300,000, and averages ranged from $100,000 (anaesthetists) to $200,000 (paediatricians).
Professor Duckett says there are some anomalies in the payments system that should be fixed, such as the failure of the schedule-fee system to keep up with technological advances in medical procedures: “Some doctors can be paid hundreds of dollars for a quarter of an hour, because the operation used to take two hours but now only takes 15 minutes.” But, he says, these and other anomalies do not justify $100million in extra public hospital payments to doctors.
“Should Victorian doctors get the same as New South Wales doctors, or should the New South Wales doctors get the same as the Victorian doctors? Which is the right base? Some surgeons get four or five times as much as the average worker in a hospital. Is that fair? The doctor is clearly a key person, but so is the nurse, the physiotherapist, and the occupational therapist.”
Nor should it be forgotten that the money to train doctors and specialists comes out of the public pocket (it costs about $150,000 to train a doctor to GP level).
Professor Duckett also argues that a federal health system should introduce a federal award for visiting medical officers to make doctors’ public hospital payments nationally uniform.
If doctors’ workloads in public hospitals have increased under case- mix, he says, they should be paid for any extra sessions, but the payment per session should not increase.
But Mr Graeme Brazenor, a neurosurgeon and chairman of the visiting medical officers’ subdivision of the Victorian AMA, argues that specialists must be compensated for the stresses of increasing workloads and lousy conditions.
Mr Brazenor says many of his colleagues have already quit and he has come close himself: “My public hospital called me to see a man who was dying because he had a bleed into his brain stem. It took them two hours to find a theatre because there were not enough nursing staff.
The registrar was not rostered on to assist; the person rostered was the casualty intern. There was nothing in his training to prepare him to approach a brain stem so we didn’t call him and I operated without an assistant.”
After this operation he had to perform emergency surgery on a young woman who was bleeding into the part of the brain that controls speech and understanding, but the anaesthetist disappeared for more than an hour. There had been a cardiac arrest in the intensive-care unit and she was the only person in the hospital senior enough to resuscitate.
Mr Brazenor “sat with the young lady while she pushed her brain out through the floor of her skull like toothpaste”.
Twice during her surgery he was forced to “unscrub” and leave theatre to search for sutures, a job that would have been the task of the scout nurse, if only there had been one. He left the hospital at 7am, ready to quit, but says he decided to stay and fight for the system instead.
First published in The Age.