Pharmaceutical companies are reporting a fall in marketing spend on GPs (particularly direct mail, advertising and sampling) as well as industry sponsored clinical trials in Australia. The more cynical suggest most of the pharmaceutical action occurs overseas and government has every right to put constraints on the PBS spend, leaving less in the pharmaceutical kitty for marketing and ‘research’.
Both political parties will be looking for health cuts leading up to the election and one way is to save on drugs. The PBS outlayed $7b alone on atorvastatin (LipitorTM), which is now off patent. Ways to save include allowing others to prescribe (e.g. pharmacists, nurses), widening the time interval of repeat authorisations, e-Script systems that track compliance, moving to generics as patents expire, closer auditing of Home Medicines Reviews, and greater consumer payments (e.g. OTC listings).
GSK has announced it is declaring sponsorship of individual doctors, consultancy on panels etc., ahead of the Medicine Australia Code redraft in two years’ time. Disclosure is expected to lessen the spend.
It is hoped Information Technology (IT) will create efficiencies in our overstretched health system – this may be more from the administrators’ perspective. Many clinicians are saying they are yet to feel real benefits, except for some working in the high-tech specialties.
We feature some of the Information Communication Technology (ICT) advances that Fiona Stanley Hospital is heralding (see P 22 Medical Forum, May edition) but some older doctors see medicos and other health professionals as being largely responsible for content, which translates into more time in front of a screen and less time with patients.
Primary care is being reshaped. Public hospitals are being asked to devolve management into the community with Medicare Locals to coordinate. GP services are a relatively small part of the health budget and the latest health workforce figures suggest we are in the middle of a GP shortage. Enter the cheaper Nurse Practitioner alternative. The federal AMA has a big fight on its hands.
The federal government has responded to strong recent lobbying to fund an extra 116 intern training places (where the other 50 or so graduates end up is uncertain). There is ongoing haggling over how many medical graduates we need, when it may come down to how many we can afford. Training costs will also come under pressure, expect to see more mannequins replacing real patients. In WA, a lot of money has been put into rural training.
Medical graduate salaries have done well, until recently, and in WA in particular. Other disciplines are catching up with Graduate Careers Australia listing dentistry, optometry, earth sciences, and engineering ahead of medicine in the median graduate starting salaries. Mind you, medical graduates enjoy the best employment prospects, with 98% in full-time work within four months of graduation (compared to 54% with Arts degrees). About 3500 medical students are due to graduate from Australia’s 20 medical schools in 2013 and attention is focused on their postgraduate training and community placement because the closer we match expertise with community need, the less hassle politically.