Doctors say they’ve been handed the rough end of the pineapple in pay deal with the State Government #qldpol #smoqld #keepourdoctors
IT’S just after 6pm when three besuited, middle-aged men hurry down the concrete path to Health Minister Lawrence Springborg’s office in the ornately decorated old Parliament House.
One of the trio, intensive care specialist Professor John Fraser, has the special task of carrying a thick ream of paper bearing the signatures of more than 800 doctors.
The signatures were penned in anger during a meeting at Kangaroo Point’s Pineapple Hotel over the Government’s fiercely opposed doctor contracts just 24 hours earlier and are now being delivered right to Springborg’s doorstep.
The doctors, which include Australian Medical Association president Dr Steve Hambleton and state president-elect Dr Shaun Rudd, arrive already riled by a day of acrimonious debate over the contracts both inside and outside State Parliament.
Less than two hours later the group re-emerges, this time with a small spring in its step.
They have secured a government guarantee for a round of fresh talks. It’s the first glimmer of hope for a break to a deadlock that has dragged on for months.
But Fraser quickly points out the step forward is more like a “first date” than a “consummation”.
“We need to get all the parties around the table so that this doesn’t crumble away and we don’t want to build something in sand that just falls over,” he says.
The “first date” follows a combative courtship pitting 2800 senior doctors against the State Government.
On one side, doctors warn the public hospital system is headed for cardiac arrest should medical specialists come good on their threat to resign. Standing firm in this firing line is Springborg, who vows he will not try to stop them.
So how did it come to this?
IF YOU ask the Liberal National Party, the genesis of the stoush can be traced to the very same Pineapple Hotel almost a decade ago when the then Beattie government struck a new doctor pay deal.
The “Pineapple agreement” involved hefty allowances for doctors to solve a critical shortage of specialist doctors.
In effect, it extended an allowance paid to just a small number of specialists to a much bigger pool of senior doctors across the state.
The allowance was supposed to be a form of compensation for the money senior doctors attracted to the public hospital system through the treatment of private patients.
But, in reality, the deal became a virtual no-strings attached pay rise that ended up costing taxpayers $804 million over a decade, a report by the state’s Auditor-General last year revealed.
“The revenues generated have been significantly less than the allowances they are paid,” he found.
Rather than acting as a cost-neutral scheme, the allowances were treated by hospital managers and senior doctors alike as a carrot to attract and retain specialists.
“While they (senior doctors) are bound contractually to participate in private practice arrangements and generate revenues, the system has never held them properly accountable for this,” the report continued.
Half of the doctors had failed to record any revenue from private patients in the 2011-12 financial year. And more than 90 per cent of the doctors did not generate enough revenue to cover the allowance.
The audit also found serious systemic flaws allowing a smaller cohort of doctors to directly pocket all the money paid by private patients treated in public hospitals by failing declare the income.
About 10 per cent of senior doctors have permission to directly charge private patients and pay a set fee to the public hospital for the use of taxpayer-funded facilities. Those doctors are banned from claiming overtime on days spent treating private patients for significant periods of time.
But the Auditor-General found in a single year one in every 10 doctors was ignoring the ban.
A second damning report by the Auditor-General last month discovered that out of a sample of 88 high-earning senior medical officers, seven appeared to have not shown up to work during rostered hours for more than 30 days at a time.
But allegations of widespread absenteeism could not be proven because of the lack of “basic accountability” of the hospital’s attendance monitoring systems, according to the report.
Eight senior medical officers were found to have been treating private patients in public hospitals while failing to declare the income and four were treating private patients without any permission to do so at all.
For Springborg, the findings formed the basis for shifting doctors on to more rigorous contracts.
“It’s going to provide more ability to measure productivity and actually drive better value-for-money patient outcomes and that’s the simple reality,” he says.
“The evidence for it is all contained in the Auditor-General’s report last year which said the system of private practice has paid out $800 million without any discernible benefit for patients.”
According to the report, about 1200 senior public hospital doctors have been, on average, raking in $100,000 a year on top of their lucrative base salaries, effectively for doing nothing.
Senior doctors are earning between $340,000 and $420,000 a year after taking in all entitlements.
Together Union state secretary Alex Scott agrees the allowance was effectively a “pay rise in disguise” for doctors, but says it was a failure of the system and not senior doctors.
Doctors have accused the LNP of using the systemic flaw to demonise them as crooks to weaken the case against signing documents Australian Medical Association legal advice calls “draconian”.
The bigger picture beyond attempts to crack down on allowances, however, is a more deeply rooted ideological shift to a system that could give the private health sector a run for its money.
In practice, that means replacing collective bargaining for doctors with a system of contracts the Government describes as similar to those found in private hospitals.
While both sides are quick to argue
money is not a factor, there is consensus the cost of the state’s health system is spiralling out of control.
When the LNP came to power in 2012, the health budget was $11 billion. It is now $12.3 billion.
“It’s risen by about 11 per cent,” Springborg says.
“We think health expenditure growth in the vicinity of 3 or 4 per cent is probably sustainable.”
The LNP’s solution to the problem was contained in a health blueprint released 12 months ago.
At its core is the opening up of public health to contestability, which could potentially see private firms bid for work delivering services normally the domain of Queensland Health employees.
Switching high-salaried doctors to individual contracts easily fits with this broader plan to more closely mirror arrangements in the private sector.
“We have to get away from the issues of rostered overtime to more of a flexible system where we actually count what is actually done in our hospitals not just hours that are paid for,” Springborg says.
Hambleton, however, argues that factors such as an ageing population and advancements in medical science are responsible for spiralling costs and not doctors’ pay packets.
He says doctors are not opposed to the idea of contracts, only their unfair conditions.
“The Government wants to move to contracts, let’s do it,” Hambleton says.
“(But) let’s make them fair, let’s make them by agreement, let’s make them engaging.”
So what is the hang-up?
UNLIKE the previous agreements underpinned by collective bargaining, the contracts will more rigidly lock doctors into a roster that includes predicted overtime and weekend work.
Any unexpected overtime would be paid after doctors lodged a claim form to justify the extra time.
They would also have less notice of sudden shift changes during normal working hours, but would receive more notice for changes impacting late-night shifts.
Doctors fear the move will expose them to unfair rostering and a top-down approach to setting hours.
The LNP counters it will crack down on unnecessary and, in some cases, dubious overtime claims.
The second key change is the scrapping of the old private practice scheme in exchange for a system where senior medicos would have bonus pay partly tied to performance targets.
Doctors say they are not opposed to key performance indicators, but they need to be realistic.
“I think having KPIs is a good idea,” says Brisbane neurosurgeon Lindy Jeffree. “I think it’s even reasonable to have pay linked to KPIs but I’m not going to sign up part of my salary to a KPI that can be changed after I’ve signed it.
“That’s specifically written into the contract and some of the suggested KPIs are things out of our control like getting discharge summaries done on all your patients within a certain period of time.
“There are significant errors in hospital lists. If I’m responsible for all the discharge summaries of the patients that the hospital thinks are mine, I’m not going to be able to achieve my KPIs if they get the patients wrong.”
The biggest deal breaker, as far as Hambleton is concerned, is the removal of the right for doctors to take disputes and unfair dismissal cases to the Industrial Relations Commission.
Hambleton says it means doctors unhappy with their performance targets would have little recourse.
Springborg insists doctors would be able to have their gripes heard through a dispute resolution process or, as a last resort, in the Supreme Court.
Together Union representative Sandy Donald, a Cairns Hospital anaesthetist, says recourse in the Supreme Court would cost up to $100,000 and could take years for a resolution.
“Do you think going to the Supreme Court, a delay of 6-24 months, at a cost of tens of thousands of dollars … is the same as going to the Queensland Industrial Relations Commission where we can potentially get a hearing the same day for no cost?”
The sticking point will be one of the key issues when discussions reopen with doctors on Monday.
“I have always said that the Government was very happy to sit down with doctors and work through any of the real issues to make sure that we address and provide the assurances,” Springborg says.
“The important thing of course is the basis of the contracts stay intact.
“But it’s how we actually implement (the contract) and that’s the policies and procedures that are needed for those assurances for doctors.”
For many doctors, the key is having fair contracts that reflect their commitment to public health. It’s about the Newman Government showing respect for the profession. says the stakes are high for the issue to be resolved, and quickly.
“People are jumping already,’’ she says. “Some that were full-time are going to part-time in the public sector and starting private practices.
“This is very distressing because I believe in the public system. I don’t want this to be the death of our public system.’’
Source: News.com.au