General overview

Description of specialtySurgery is the branch of medicine that deals with the diagnosis and treatment of injury, deformity, and disease by manual and instrumental means. The Royal Australian College of Surgeons admits Fellows in the following sub-specialties: Cardiothoracic Surgery, General Surgery, Neurosurgery, Orthopaedic Surgery, Otolaryngology Head and Neck Surgery, Paediatric Surgery, Plastic and Reconstructive Surgery, Urology and Vascular Surgery.
NumberThere are approximately 3800 registered surgeons in Australia.36
Gender mix10% female, 90% male.

Surgeons and eHealth

Examples of relevant eHealth applications

Some example uses of eHealth that surgeons currently and could possibly benefit from include:
  • Greater supervision and training for practitioners in rural and remote Australia through telehealth
  • The drive towards universal digital imaging is strong in surgery, and joint standards for the use and viewing of digital images have been developed by the RACS in conjunction with the Royal Australian and New Zealand College of Radiologists. Simplification of diagnostic imaging by eliminating the transfer of hard copies and designing appropriate transfer arrangements. Standardisation of systems between corporate diagnostic imaging services has been raised as an important requirement by surgeons frustrated at having to use different systems for different providers in private practice
  • Improvements in quality and safety, and the ability to audit practice, particularly if it is advocated by medical defence organisations or the College
  • The use of shared patient records for multidisciplinary care of complex patients is cited as a particular need for those surgeons who are managing severely injured patients (trauma and burns), patients with complex congenital problems or cancer. Shared records kept in the public sector cannot be transferred to the private sector which is a source of frustration for surgeons in these areas. These clinicians rely heavily on input from nursing and allied health
  • Standardisation and simplification of referrals.

Current eHealth ‘position’

  • Surgeons are relatively low users of eHealth and do not believe that computers are important in their specialty, that their use is expected or that most practitioners in their network use computers. However, surgeons do employ eHealth tools relatively often for billing and patient communication (outside of consultation and sharing information)
  • Surgeons perceive little value from eHealth, and especially believe that it is unlikely to improve quality, safety or continuity of patient care. Surgeons perceive that eHealth will not improve collaboration and typically would not like to access shared patient records
  • They face few strong drivers for adoption, but are facing some patient pressure to use eHealth tools.

Key insights from eHealth readiness survey

  • Relative to other specialists, surgeons are especially likely to use computers for billing (82 percent use computers versus 66 percent of all specialists). Surgeons are less likely to use computers for accessing clinical reference tools (58 percent) and viewing pathology results (52 percent)
  • Surgeons are relatively uninterested in telehealth (65% stated that they either probably would not use or definitely would not use telehealth within the next three years, as compared with 49% of all medical specialists). During interviews, surgeons were especially concerned about how telehealth might be employed as they underscored the importance of telehealth as a tool to enhance rather than replace care. As a tactile, hands-on specialty, the surgeons interviewed were especially interested in maintaining face-to-face connections with patients and practitioners. However, they did acknowledge the value of videoconferencing for education and training purposes
  • Surgeons are the least interested of all specialists in using computers to share health records with their patients (62 percent do not use and do not need a computer to share health records with patients). They are also less interested in accessing a shared health summary for their patients (31 percent strongly agree versus 51 percent of all specialists). Additionally, surgeons are also much less interested in using interactive decision support for prescribing (55 percent do not use and do not need) and for test ordering (49 percent do not use and do not need)
  • Surgeons are moving towards computerised health records. 22 percent use computerised records only and a further 54 percent use a combination of paper-based and computerised records
  • Surgeons are much less likely to perceive benefits from eHealth. Relative to other specialists, they are much less likely to agree that eHealth will improve collaboration (27 percent strongly agree), efficiency (26 percent strongly agree), continuity of care (25 percent strongly agree), quality of care (17 percent strongly agree), and patient safety (just 12 percent strongly agree and 18 percent strongly disagree). During interviews, some surgeons mentioned that using computers during consultations slowed them down because of the additional time it took for them to find patient information and to download images
  • Despite their below-average perceptions of eHealth benefits, surgeons’ perceptions of barriers are relatively consistent with perceptions among specialists in general. The leading barriers for surgeons are maintaining compatibility with existing IT systems (33 percent strongly agree), concern about patient privacy breaches (28 percent strongly agree) and concerns about system malfunctions or downtime (28 percent strongly agree)
  • Adoption drivers for surgeons are relatively weak. The strongest are financial incentives (18 percent strongly agree and 41 percent somewhat agree) and professional bodies (13 percent strongly agree and 56 percent somewhat agree).

Characteristics and practice attributes

General workforce trends

The general trend towards private hospital services is particularly strong for surgery.37 Currently more than 80 percent of elective surgery in Australia takes place in the private sector. The financial rewards for practising in the private sector are considerably greater than in the public hospital system, however most surgeons continue with part-time public hospital appointments which offer academic and social prestige, a more interesting and complex patient mix and the opportunity for teaching and research. Further growth in demand for surgeons to work in the private sector is likely to be at the expense of the hours that surgeons work in the public sector.

A high-level practice profile of survey respondents suggests:
  • High patient volumes: over 40 percent of the sample see 16–25 patients per day, and over 20 percent see more than 25 patients daily
  • Multiple practice locations: over half of the sample practices in three or more locations
  • Relatively high regional or remote service usually on a ‘fly-in, fly-out’ basis which is sponsored by State and Territory Governments: nearly one quarter of the sample performs regional or remote service at least fortnightly (12 percent daily)
  • Substantial private sector practice: 85 percent of respondents receive more than half of their income from private practice and more than 60 percent earn more the 75 percent from private practice.

EXHIBIT 37
(D)

Education, registration and accreditation

The Royal Australasian College of Surgeons (RACS) is the organisation responsible for training surgeons and maintaining surgical standards in Australia.

The Royal Australasian College of Surgeons
250-290 Spring Street, Melbourne VIC 3002
T: + 61 3 9249 1200
F: + 61 3 9249 1219
http://www.surgeons.org

The specialist qualification for Australia and New Zealand is Fellowship of the Royal Australian College of Surgeons (FRACS). Doctors with a minimum of two years postgraduate experience may apply for entry into the Surgical Education and Training Program. Each of the nine surgical divisions (Cardiothoracic Surgery, General Surgery, Neurosurgery, Orthopaedic Surgery, Otolaryngology Head and Neck Surgery, Paediatric Surgery, Plastic and Reconstructive Surgery, Urology and Vascular Surgery) has a board for training in that specialty. Upon successful completion of the Surgical Education and Training (SET) program for each specialty, trainees receive their Fellowship. They may then work independently as surgeons within the specialty in which they qualified. All medical practitioners are required to continually update their skills and ensure their knowledge is current through continuing professional development and practice audit.

Sources of financial reimbursement/role in the healthcare ecosystem

In the private sector Medicare reimburses patients for visits to a specialist 85 percent of the Medicare scheduled fee. In addition, the doctor may choose to charge a further gap above the scheduled fee.

Where people receive their treatment in-hospital as a private patient they are eligible for a Medicare rebate equal to 75 percent of the Medicare Schedule fee. If they hold Private Health Insurance (PHI), they may also receive a rebate from their PHI fund.

Patients receiving surgical services in the public hospital system are treated free of charge, however they are not eligible for choice of doctor and may be treated by trainees who are supervised by the specialist on call.

A GP referral is required to access a surgeon in the private sector.


36AIHW Medical Labour Force Survey 2008, published in 2010; excludes ophthalmologists.
37‘The outlook for surgical services in Australasia’, Centre for Population and Urban Research, Monash University, June 2003.