Just like its international counterparts, the Australian health system is an ungainly beast. Born as a transplanted colonial infant, expanding through world wars and resurgent nationalism, then tempered by the temptations of capitalism and privatisation, it attempts to marry access with affordability and by all international standards does so quite well. The result is a dual private and public system with patients frequently crossing between the two. One corollary of this is that many 'specialists' straddle the systems, or at least those who work in the public hospital system almost always do private work as well. This allows those with appointments in public hospitals, the hotbeds of innovation, research, and tertiary care, to supplement their incomes by solving the access issue through the private system, allowing people to see a specialist more rapidly than their condition's clinical urgency would dictate (and usually in more well-appointed surrounds) at a premium cost.
The outcome is that the best specialists are not turned away from the public system for financial reasons, such that young training doctors are exposed to the best of the best. But by the same token public system wages are not so high that the real mercenaries, who likely would have little interest in teaching, are incentivised to work exclusively in the private system where they can see high throughput, low acuity cases and make their millions. Of course, doctors choose their work locations and casemix for a variety of reasons and generalisations are often inapplicable, but in my experience it is universally true that specialists with a hospital appointment are greatly concerned with both their patients' well-being and their trainees' education. A busy tertiary hospital clinic is a unique experience for a registrar, the term usually applied to junior doctors who've completed their chosen specialty's entrance requirements and are on their way to becoming a specialist themselves. Continually interrupted by calls from the wards or the emergency departments you attempt to see patients from your bosses' (or if you're unlucky your own) lists as quickly as the largely uninterrupted bosses can. Whenever you step out to call a new patient or grab the blood pressure cuff or weighing scale that's been permanently borrowed from your clinic room you're inundated by a deluge of nurses and ward clerks asking you to sign scripts that a boss forgot to, re-issue pathology slips for patients who've lost theirs from the last appointment, and authorise over-bookings for patients who demand to be seen earlier because they're just too sick. If it's a particularly busy day, which more often than not it is, the requests come to you and you're continually apologising to your patients as you cross the floor to open the door for yet another job to be done. By contrast, when patients walk into the consultant specialist's room they are greeted by an air of serenity as experienced eyes pass over them, rapidly planning how the next twenty minutes will progress. The consultant knows the history back to front, so there are only minimal pauses as they jot down a few notes, in contrast to the essays required of junior doctors who are meeting almost every patient for the first time. The physical examination is peppered with empathetic questions about their partner's health or their child's schooling rather than the junior doctor's stilted, "So what do you do for a living?" There's usually even time for a brief chat about the footy. It's no wonder that many a patient specifically requests to see the consultant and 'not just the intern'. Given that patients get the private treatment when they see the consultant and a hurried, serially-interrupted effort from the registrar, it's completely understandable that they would want to see the big fish every time. So when a patient walks into my room with a puzzled look on their face and starts to say, "Oh... I thought I was going to see Professor..." I don't throw up my hands in frustration. Rather I give them a big smile, shake their hand vigorously, tell them I'm their stated boss' protege and that I'm going to do all the boring stuff before getting said boss in to make all the important decisions. Thus mollified, I've then got about two minutes to impress them (hanging off their every word while looking straight at them, furiously touch-typing away usually does the trick) and get enough information out that when the first interruption inevitably comes I can ask them to take off their shoes, weigh themselves, or sit on the exam couch, and put out the spot fire while they're occupied. Fifteen minutes later I ask the question, "Shall I get [the boss] now?" and then mentally score myself based on their answer. So far, no one's complained. A lot of work perhaps and frustrating for sure, but for a little fish to become the big fish it looks up to, the fire always was better than the frying pan.
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