In regard to SA, apparently (from report of local ACEM faculty chair who is director of our ED), there were earnest discussions amongst FACEMs at the recent Winter Symposium in regard to how SA achieved sig pay increases for FACEMs. The answer lies in SA faculty being small and relatively cohesive. It is unlikely that similar industrial action will be easily achievable interstate. Winter has brought again issues of bedblock. There has been an announcement that two major Adelaide Hospitals will receive each an extra ward for "acute medical cases" requiring not more than 36/24 care.
Nurse practitioners continue to play a valuable role in our ED (one of Adelaide's three major ED's). They see 8% of all comers. Nursing in general is seeking to "push boundaries" with roles such as clinical initiatives nurse (initiating investigations before a patient is seen bu the ED MO). In Victoria these are called nurse practitioners. There continues to be a paucity in the supply of experienced doctors willing to work in public hospital ED's. Issues such as bed-block impact on morale of all ED staff. At the same time, hospitals try to limit cancellations of elective surgery. I wonder when they will start to "rationalise services". Near city rural regional hospitals are seeking to change their ED models of care to that of hospital employed doctors, with local GP's no longer being prepared to see all patients presenting, especially when they are from "out of town". I think there will be work available for a long time to come for any doctor with competency in emergency medical care.
Dr Joy Treasure
There have been significant changes to the industrial landscape in SA over recent months with the FACEM group being particularly vocal and prepared to resign achieving a special deal with a significant pay increase. However, non FACEMs working as consultants in public hospitals were not included by the FACEM group.
This issue is yet to be resolved. Specialty groups, including physicians and paediatricians were unhappy about the inequity of the outcome. The basic principle of parity of pay across specialities in the public health system was not realised in the new Enterprise Bargaining Agreement (EBA). There is concern that militant industrial action is required to achieve an equal outcome.
The Rural Emergency Skills Program is funded by the State Government which will continue beyond the original three year contract. Dr Joy Treasure, SA ASEM Councillor, has been closely involved both in its management and teaching. Similar in structure to the EMST and ELS it provides weekend emergency workshops in rural town and regional centres covering both medicine and trauma, adult and paediatric.
There is an ongoing controversy regarding the status of Royal Adelaide Hospital. It is unclear whether Royal Adelaide Hospital will be upgraded or replaced by a new Marjorie Jackson - Nelson Hospital on a new inner city site. The Health Minister is in favour of building 'GP Plus Centres'. To serve as primary health clinics and including paramedical services. The aim will be to reduce pressure on public hospital emergency departments. This is a line commonly taken by State Governments though there is no research to back this up.
There is to be a trial at three sites in the public hospital system of the use of 'hospitalists' (known elsewhere as CMO's). These will apparently be recruited from the USA and will be employed in departments such as paediatrics and anaesthetics. Increasing numbers of nurse practitioners are well accepted especially in ED's.
The ambulance service continues to expand it's role, to the point of covering rural towns when no doctor is available to be on call. Back up medical supervision is provided by phone.
The state Government proposed to regionalise hospital care in rural SA upgrading four sites and downgrading all others. Downgrading implied that some would offer only overnight admission. Others would be classed as community hospitals allowing more extended care with better facilities. The latter four sites selected for upgrading were to receive significant extra funding to allow investigation and treatment of rural patients who would otherwise have needed transfer to the city. However rural SA protested so loudly about the proposed plan (involving reductions of service in many centres with risk of loss of resident doctors) that it has been shelved for re-drafting.
Dr Joy Treasure
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