General overview

Description of specialtyAnaesthetics is the medical specialty concerned with the pharmacological, physiological, and clinical basis of anaesthesia (intentional reduction of bodily sensation), including resuscitation, intensive respiratory care, and pain management.

Specialist anaesthetists work across the full scope of practice including anaesthesia for surgical and non-surgical procedures (including sedation and all forms of anaesthesia, topical, local, regional and general); perioperative/periprocedural care and management; assessment and management of patients requiring analgesia, critical/intensive care, and patients in emergency and trauma situations (including resuscitation and life support). In many rural and regional hospitals, intensive care and high dependency functions like ventilating patients for retrieval are still performed by anaesthetists.

Number4673 registered specialist anaesthetists9
Gender mix25% female, 75% male

Anaesthetists and eHealth

Examples of relevant eHealth applications


Some example uses of eHealth that anaesthetists benefit from include:
  • Timely access to shared patient records in an electronic format is highly desired by this specialty. Patients are rarely able to give a coherent and accurate medical history prior to surgery due to anxiety and medical problems, and the surgeon’s notes are not always available when they are needed
  • Decision support tools are used particularly by younger and less experienced anaesthetists to rapidly calculate drug doses and infusion rates.

The Medicare rules for anaesthesia rebates are very complex and are subject to change. This means that the legal requirement to provide informed financial consent to privately insured patients about the possibility of out-of-pocket fees and charges can become quite difficult where anaesthetics is involved. Practice management systems are available which make these calculations a lot easier and these are widely used by the major practices.

Current eHealth ‘Position’

  • Anaesthetists place high value on being early adopters of new computer systems: they would like to be early adopters themselves and a strong driver of eHealth adoption is the perception that they stand to gain respect and recognition for being an early adopter
  • In the qualitative interviews it was clear that anaesthetists involved in multiple short procedures, such as colonoscopies did not have time to type in electronic notes in ‘real time’ as the cases moved through the theatre too fast. Also, anaesthetists must move extraordinarily quickly and become very ‘hands-on’ in a crisis – no eHealth skills or technologies are useful in these circumstances
  • Portability of eHealth solutions is of high value to anaesthetists who frequently practice in multiple locations – there has been high penetration of portable smartphone and tablet technologies and the associated ‘apps’ into this group which they predominantly use for drug and infusion calculations, as well as other medical reference tools.

Key insights from eHealth readiness survey

  • Anaesthetists are very interested in eHealth, although their current use is often limited by the solutions available in the hospitals where they practice. They are especially interested in sharing health records with other practitioners (75 percent do not use computers but would like to), showing patients health-related information during a consultation (63 percent) and sharing health records with patients (63 percent). Although patient relationships are not always top-of-mind because their patients are not conscious during operations, anaesthetists appreciate the ability to use computers to share information with patients during a pre-operative consultation
  • Anaesthetists have the lowest level of interest in telehealth (19 percent stated definitely will not use within the next three years, versus 9 percent of all specialists). Although anaesthetists perceive relatively few relevant applications for telehealth due to the hands-on nature of their specialty, interviewees expressed interest in remote monitoring and supervision as well as videoconferencing for training and educational purposes. Of those interested in telehealth, 67 percent stated that they would be very interested in using it for training. As an example, one interviewee mentioned that a remote connection with her supervisor would help her obtain his advice more quickly in emergency situations and also save him from making additional trips back to the hospital if she had questions about a patient. Another interviewee’s practice recently constructed a large videoconference facility for participation in seminars and conferences with other anaesthetists, although they had not yet used it due to the limited number of other practices that had videoconferencing ability
  • Relative to other specialists, anaesthetists share similar perspectives towards computers with one exception: they are less likely to agree that computers help reduce the risk of error in their sector. A possible reason for this response, as provided by interviewees, is that computer use during an operation is risky because it distracts the anaesthetist from paying full attention to his or her patient
  • Despite fairly strong interest, anaesthetists generally perceive fewer benefits from eHealth as compared with specialists in general. They are especially less likely to agree on improved quality of care, increased efficiency, increased access to care, and broadened scope of services. Some of the anaesthetists surveyed were fairly neutral in their opinions towards eHealth because they did not perceive many tangible benefits for their specialty, although they were consistently interested in access to shared health records if a history of prior procedures was included
  • Barriers to adoption are relatively weak for most anaesthetists. The two strongest barriers were concerns about malfunction or downtime (33 percent strongly agree) and compatibility with existing IT systems (31 percent strongly agree). This is consistent with their concerns about risks due to technological failure and the need to maintain internal connectivity with other systems in the hospital setting
  • Anaesthetists were somewhat more likely than their peers to agree that respect and recognition would influence them to increase their adoption of eHealth (11% strongly agree, 38 percent somewhat agree), but professional bodies (15 percent strongly agree, 64 percent somewhat agree) and financial incentives (14 percent strongly agree, 37 percent somewhat agree) still emerged as the two leading drivers for adoption.

Characteristics and practice attributes

Distribution by Age and State


There is a significant mal-distribution of full-time equivalent (FTE) anaesthetists between urban and rural areas. For anaesthesia services, sustainable practice is linked to the practice of surgeons, obstetricians, and other proceduralists. At present, anaesthetists provide services to the population in remote areas on a visiting team basis.
Analysis commissioned by the Australian and New Zealand College of Anaesthetists (ANZCA ) suggests a widening gap between demand and supply in the future, rising from a very small shortage of four FTE anaesthetists in 2008 to a shortfall of 2287 practitioners in 2028. Nearly half of the expected increase in demand can be attributed to demographic change, including ageing of the population. The balance can be largely attributed to rising incomes in the population at large and raised community expectations. 10 In relation to anaesthesia, the increase in number of endoscopic procedures, invasive cardiovascular procedures and imaging procedures has increased the demand for both anaesthesia and sedation.

General workforce trends


A high-level practice profile of survey respondents suggests that:
  • Anaesthesia is a low-volume specialty relative to the other medical specialist segments. 22 percent see fewer than 6 patients per day (versus 9 percent across all medical specialists) and 75 percent see 6-15 patients per day (versus 53 percent across all medical specialists)
  • Anaesthetists tend to practice in multiple locations. Thirty eight percent of respondents practice in three to four locations, versus 23 percent of all medical specialists. Generally anaesthetists work in private consulting rooms with a number of other anaesthetists, and attend patients in multiple hospitals/day surgery centres
  • Anaesthetists are less likely to practice in rural or remote areas. Just 20 percent of respondents surveyed travel to rural or remote areas on at least an occasional basis, versus 31 percent of all medical specialists. Consistent with a ‘visiting teams’ model, over half of the respondents who perform regional or remote work do so monthly or less
  • More than half of respondents receive less than half of their income from the private sector, but 35 percent receive more than three quarters of their income from private practice. This mirrors the fact that more and more elective procedures are being performed in the private sector.
EXHIBIT 30
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Education, registration and accreditation

The Australian and New Zealand College of Anaesthetists (ANZCA) trains and accredits doctors throughout Australia and New Zealand to be anaesthetists, through initial qualification, registration and continuing professional development.
The Australian and New Zealand College of Anaesthetists
630 St Kilda Road, Melbourne VIC 3004
T: + 61 3 9510 6299
F: +61 3 9510 6786
http://www.anzca.edu.au

The specialist qualification for Australia and New Zealand is Fellowship of the Australian and New Zealand College of Anaesthetists (FANZCA). Anaesthetists spend at least five years in specialist anaesthesia training after a minimum of two years of pre-vocational experience after graduating from medical school. This comprises 33 months of clinical anaesthesia, three months of intensive care medicine and 24 months of other disciplines.

Sources of financial reimbursement/role in the healthcare ecosystem

As a rule, anaesthetists in private practice tend to be in large group practices, which share infrastructure and an ‘on-call’ roster. Anaesthetists do not practice independently, as their services are performed in conjunction with a procedural team, and the Medicare eligibility for anaesthesia services is determined by the link to a procedure and the specialist who undertakes it.
Under the Medicare Benefits Schedule (MBS) anaesthesia rebates are determined by the Relative Value Guide (RVG) for Anaesthesia. The RVG structure is based on a unit system, which reflects the difficulty of the service, and the time the service took. Under the RVG structure, the Medicare Benefits Schedule (MBS) fee for an anaesthetic service in connection with a procedure comprises up to four unit components, represented by one or more MBS items:
  • A basic unit value representing the degree of difficulty of the procedure (Initiation of Management of Anaesthesia)
  • A time unit value based on the total time of the anaesthetic
  • Modifying unit/s recognising certain added complexities
  • Associated Therapeutic and Diagnostic Services.11

In addition, an attendance item rebate is payable for a consultation prior to the procedure being performed so that the anaesthetist can take the patient’s medical history and undertake a physical examination if necessary to determine fitness for anaesthesia.


9Australian and New Zealand College of Anaesthetists (ANZCA) Annual Report 2010.
10ANZCA, ‘Australia’s looming anaesthetist shortage’, March 2009.
11Medicare Australia Website PDF Relative Value Guide for Anaesthesia 2011.