How can Australia have too many doctors, but still not meet patient needs?

If you live in a rural area, you would never think Australia had too many doctors.
from shutterstock.com

Richard Murray, James Cook University and Andrew Wilson, University of Sydney

The statement “we have plenty of doctors in Australia” would probably not pass the pub test. Especially if the pub was in a regional city, a remote town or a less-than-leafy suburb. But it is true all the same – statistically at least.

With 3.5 practising doctors for every 1,000 people in 2014 (4.4 per 1,000 in major cities) we’ve never had so many. In 2003, there were 2.6 doctors for every 1,000 people in Australia, which is closer to the proportion in similar countries now, such as New Zealand (2.8), the UK (2.8), Canada (2.6) and the USA (2.6).

Yet at 2.6 per 1,000 was when we decided we were “short” and went on to double the number of medical schools and almost triple the number of medical graduates in a little over a decade.

And then there’s this question: if we are now so flush with medicos, why do we still need to import so many from overseas? To fill job vacancies, the Australian government granted 2,820 temporary work visas to overseas-trained doctors in 2014-15. In the same year, Australian medical schools graduated another 3,547.

This heroic level of doctor production and importation is right up there internationally. Among wealthy nations, Australia is vying for the top spot, with only Denmark and Ireland in the same league of doctor-production for population.

So why do we have too many doctors, but think we have too few?

Our approach to medical training

In a Medical Journal of Australia editorial published today, we examine the question of “work readiness” in our new medical graduates from arguably the most important perspective: what the community needs from future doctors.

To what extent is our medical training system producing doctors who will be providing the high quality, person centred, affordable health services we need, given we are an ageing population living with higher levels of chronic and complex health conditions?

There have been arguably three problems with the Australian approach to the medical workforce to date. First, we didn’t finish the job of production; second, we’ve allowed too much medical specialisation in major cities; and third, our models of health care and the ways we pay for it are out of step with where community needs are heading.

1. Production

Back in the early 2000s, the biggest issue relating to the training of Australia’s medical workforce was a shortage of doctors in regional and remote areas. So, in addition to boosting medical student numbers overall, we set up rural clinical schools and regional medical schools, and increased admission of students who were already residents of rural areas.

While results of these policies have been positive in terms of graduate rural career intentions and rural destinations, the job was really only half done. What we didn’t do is reform the training that goes on after medical school.

That involves internships and training for one of 64 specialty fellowships, including general practice. Because of that, too many of our medical graduates are now piling up in capital city teaching hospitals, locked in a fierce competition for ever-more sub-specialised training jobs.

Meanwhile regional Australia remains hooked on a temporary fix of importing doctors from overseas. Hence the recently announced funding for 26 new regional training hubs. The aim is to “flip” the medical training model, so the main training is offered regionally with a city rotation as required.

2. Excessive specialisation

There’s no question we need a reasonable number of doctors who are experts in a narrow field. However, there’s now an imbalance between an inadequate number of medical generalists and excessive numbers of specialists in every major medical field.

Regional Australia in particular needs more generalists; that is rural generalist GPs, general surgeons, general physicians and the like.

3. Financing and models of care

Health expenditure is driven by three main factors: growth in population, providing more care for each patient and the increase in the proportion of older people with increased complex care needs.

Improvements in health-care technology means we can diagnose illness more accurately, less invasively and earlier, and we have more effective treatments.

However, in a system that pays on the basis of every service provided (regardless of need) there is also a risk of provider-induced demand. This can lead to inappropriate medical care, with examples in unwarranted eye, knee and back surgery, imaging, colonoscopy, and medication for depression and other conditions.

An undersupply of doctors is associated with lower rates of health-care use, whereas oversupply or mis-distribution can lead to higher rates of inappropriate care. Balancing the distribution of doctors according to need has important consequences for health-care costs.

Time for action

Make no mistake, Australia’s current health system is good by world standards. But the headwinds are building. The population is ageing, we’ve got more people with chronic and complex health-care needs, and the costs of new medicines and technologies continue to escalate.

Having injected a massive boost of doctors into a fee-paying healthcare system without regard to population need, workforce mix, geographic location, health-care models or financing reform, we have put the future at risk.

Let’s not let this bold experiment fail for want of follow-through. We need more urgency in providing the incentives and training opportunities to get our growing junior medical workforce into the specialties and areas that are underserved.

We have to stop allowing medical specialty training to be driven by the work rostering requirements of metropolitan hospitals. We must increase the number of specialist training positions based in regional centres.

And we especially need to expand the number of broadly-skilled rural generalists and get serious about efficient, team based, health-care models. This requires cooperation by all governments, medical schools, specialist colleges and the profession – and the time to act is now.

Richard Murray, Dean of Medicine & Dentistry, James Cook University and Andrew Wilson, Co-Director, Menzies Centre for Health Policy, University of Sydney

This article was originally published on The Conversation. Read the original article.

Australia: Defence – The F-35

The F-35 Joint Strike Fighter is central to Australia’s air defence plans for the years ahead, however, the continuing delays are causing major issues for Australia’s current defence needs. The link below is to an article that examines the F-35 development program in some detail.

For more visit:
http://www.latimes.com/business/la-fi-0612-fighter-jet-testing-20130612-dto,0,4701367.htmlstory

Europe: The Islamic Rape Epidemic

The link below is to an article that reports on what it calls the Muslim Rape Epidemic in northern Europe. Certainly from the report there would appear to be a major issue that needs to be addressed. Certainly I do not for a moment want to imply that all Muslims are to be tainted with this criminal behaviour, as it is similar to Islamic terrorism – a minority and not the entirety.

For more visit:
http://www.wnd.com/2012/07/finally-muslim-rape-epidemic-in-spotlight/

Christian Jailed in Ethiopia Accused of Desecrating Quran

Constitution flouted as he is jailed for two months in Muslim area without court appearance.

NAIROBI, Kenya, October 7 (CDN) — A Christian in Ethiopia’s southern town of Moyale has been languishing in jail for two months after his Muslim business partner accused him of writing “Jesus is Lord” in a copy of the Quran, local church leaders said.

Tamirat Woldegorgis, a member of the Full Gospel Church in his early 30s, was arrested in early August after the Muslim co-worker in the clothes-making business the two operated out of a rented home discovered Woldegorgis had inscribed “Jesus is Lord” on some cloth, area Christians said.

Woldegorgis returned from a break one morning to find that the inscribed words had been cut out of the piece of cloth, the sources said. He then had the words set in the machinery of their tailoring business for inscription on clothing material, only to find later that the inscribed plates were removed from the machinery as well, they said.

The Muslim associate, whose name has not been established, then went to a nearby mosque with the accusation that Woldegorgis had written “Jesus is Lord” in the Quran itself, sources said. Angry sheikhs at the mosque subsequently had Woldegorgis arrested for desecrating the book sacred to Islam, they said.

Other sources said, however, that Muslims accused Woldegorgis of writing “Jesus is Lord” on a piece of wood, on a minibus and then on the wall of a house. As he has not been brought to court, the exact charges against him are not yet known. Woldegorgis denies all accusations, and area Christians insisted he is innocent.

A church leader who requested anonymity told Compass that Christians in Moyale are concerned that Woldegorgis, a married father of two from Hagarmariam village, has not been granted a trial after two months in jail. He said that two days after Woldegorgis was arrested, two friends inquired about him at the Moyale police station; authorities responded by jailing them for two weeks.

“The Ethiopian constitution allows for religious tolerance,” said the church leader, “but to date Woldegorgis has not been taken to court. He is still in a police cell, which is quite unusual for an Ethiopian national, and given constitutional provisions.”

Jijiga, capital of Ethiopia’s Somali Region, has the largest court in eastern Ethiopia, and Christians fear that Islamic principles govern it. In Ethiopia’s federal state system, each state is autonomous in its administration, and most of those holding government positions in Somali Region Zone Five are Muslims.

“We fear that our brother might be taken to Islamic court in Jijiga for trial, which will further threaten his life,” the church leader said. “Where is justice for our brother being in prison without been tried?”

Sources also said that authorities are offering to release Woldegorgis if he will convert to Islam. Woldegorgis is physically weak but strong in his faith, the church leader said, adding that he needs food and other material assistance, as well as an attorney.

Sources said Woldegorgis has been jailed in Zone Five of Ethiopia’s Somali Region, a predominantly Somali area. Moyale, located on Ethiopia’s border with Kenya, is divided between the predominantly Muslim Zone Five and Zone Four, which is populated mainly by ethnic Oromo, with each zone having distinct administrative and judiciary systems. Preaching non-Muslim faiths is not allowed in Zone Five, in spite of provisions for religious freedom in Ethiopia’s constitution.

Hostility toward those spreading faiths different from Islam is a common occurrence in predominantly Muslim areas of Ethiopia and neighboring countries, they said. Christians are often subject to harassment and intimidation.

Ethiopia’s constitution, laws and policies promote freedom of religion, but occasionally local authorities infringe on this right, according to the U.S. Department of State’s 2009 International Religious Freedom Report. According to the 2007 census, 44 percent of Ethiopia’s population affiliate with the Ethiopian Orthodox Church, 19 percent are evangelical and Pentecostal and 34 percent are Sunni Muslim.

Report from Compass Direct News

Church ministry in Syria treads carefully after shut down

The spiritual climate in Syria is a changing one. While Syria’s Christian minority is generally respected, conversions to Christianity from Islam are rare and sometimes met with opposition, reports MNN.

Voice of the Martyrs reports that evangelizing is legal, but visas are not granted for missionary work. And while there is freedom to worship, any activity that could threaten communal harmony is suspect, making it difficult to spread the Gospel.

Despite the challenges, Reach Global in the Middle East and North Africa (MENA) began in 2008. The team working in the area is focused on holistic ministry: meeting physical and emotional needs as well as the spiritual needs of an individual.

They have been working together with churches, national partners, and collaborating with like-minded ministry organizations in order to reach the Syrians with the hope of Christ, and there has been success. A church has been planted.

This June however, the Syrian government closed the doors of that evangelical church. The group is still hoping to meet for worship and Bible study, but they are praying for wisdom and discernment on how to do that and still remain within the law.

Report from the Christian Telegraph

Copts protest persecution in Egypt ahead of Mubarak’s DC visit

Middle East journalist Mary Abdelmassih has reported that on the occasion of Egyptian President Mubarak’s visit to Washington this week to attend the Mideast talks, Coptic Christians in the US and Canada staged a peaceful rally on September 2nd outside the White House to protest the persecution of Copts in Egypt, reports Dan Wooding, founder of ASSIST Ministries.

The Motto of the rally was: “President Mubarak Make Peace in Your Country First.”

In her story for the Assyrian International News Agency (www.aina.org), Abdelmassih said that according to a press release by the rally organizer Coptic Solidarity, based in North America, the Egyptian regime, represented by Mubarak, is a key partner in the persecution of the Copts. President Mubarak comes Washington to market his regime and his family’s through the Palestinian issue, and we must tell him “stop persecuting the Copts…make peace in your country first.”

“Mubarak brought back Coptic persecution to the level experienced under the Mameluke era (1250-1517) in Egypt,” says Coptic Solidarity. “Under the rule of President Mubarak, more than 1,500 of assault on Copts have occurred, without any appropriate punishment given to criminals or compensation to the victims.”

“We want the whole world to know the oppression, violence and attacks on churches and property of the Copts under Mubarak’s rule,” said one rally participant. “They are targeting the Coptic family.”

US-based Coptic activist Magdy Khalil told Coptic Hope-Sat in an interview that Mubarak gets his importance from being a peace broker, and he is coming to Washington to make a deal for his son’s Gamal “inheritance” of the Presidency of Egypt. “He needs to get the green light from USA and Israel on one side and the Muslim brotherhood inside Egypt on the other.” He added that Copts are not important for the regime to take into account.

Commenting on the White House rally, Magdy Khalil told the Egyptian daily Al Dostor that the intensive media presence for the Mideast talks “helped us to deliver a message to the whole world that Christians of Egypt have a problem. While the Palestinian issue is that of territorial dispute, the Copts are suffering from persecution.”

Report from the Christian Telegraph

Australian Election Deadlock Continues But the End Seems Nigh

The political deadlock in Australia is perhaps coming to an end. The Australian Labor Party (ALP) has now formed an alliance of sorts with both the Greens and the Tasmanian independent Andrew Wilkie that currently gives Labor 74 seats (within the alliance) in the parliament. Labor now needs two more seats to form a minority government, seats which must come from the three independents who are yet to decide behind whom they throw their support. The Coalition opposition currently has 73 seats, including the independent National Party member in Western Australia. Obviously, either the ALP or the Coalition can yet form a government with the support of the three independents yet to decide just who they will support. However, the ALP seems to have the edge at this stage, with recent opinion polls suggesting that the majority of Australians would like to see the independents back the ALP. To counter this, it must be said that the three independents were elected from electorates that favor the Coalition
by a long way.

The following videos relate to the current situation in Australian politics:

 

Morocco Continues to Purge Nation of Foreign Christians

New wave of deportations raises concerns for foreigners married to Moroccans.

ISTANBUL, July 1 (CDN) — Moroccan authorities expelled eight more foreign Christians from the country last weekend, bringing the total of deported Christians since March to 128.

Two foreign women married to Moroccan Christians were included in this third wave of deportations since March, raising concerns that local authorities intend to harass the country’s small but growing Protestant community.

“They are all in fear,” a source told Compass, “because this happened to people who are married.”

One of the women, a Lebanese national married to a Moroccan, was diagnosed with cancer last month and is the mother of a 6-year old girl whom she was forced to leave behind.

A Spanish national, Sara Domene, 31, was also deported on Monday (June 28), according to news sources. Domene was working as a language teacher in the Western Sahara, a territory under Moroccan sovereignty.

Authorities called the foreigners to police stations across Morocco on Friday (June 25) and told them they had 48 hours to leave the country on grounds of “threatening public order.”

Other nationals who were forced to leave the country over the weekend came from France, Egypt, Lebanon, Switzerland, Nigeria and Spain.

A source explained that Moroccan authorities are essentially deporting Christians for “proselytism,” which is illegal in Morocco, but in order to justify the deportations they have claimed that the foreigners pose a threat to the state.

In April nearly 7,000 Muslim religious leaders backed the deportations by signing a document describing the work of Christians within Morocco as “moral rape” and “religious terrorism.” The statement from the religious leaders came amid a nationwide mudslinging campaign geared to vilify Christians in Morocco for “proselytism” – widely perceived as bribing people to change their faith.

There are an estimated 1,000 Moroccan Christian converts in the country. They are not recognized by the government. About 99 percent of Morocco’s population of more than 33 million is Muslim.

 

Congressional Hearings

On June 17, the Tom Lantos Human Rights Commission held a U.S. congressional hearing on the ongoing deportations of U.S. citizens and other foreigners from Morocco.

Morocco has expelled about 58 U.S. citizens in the last four months. On Thursday (June 24) authorities informed about 10 U.S. citizens that they had 48 hours to leave the country, but within 24 hours the deportation orders were rescinded.

In a statement after the June 17 hearing, Rep. Frank Wolf (R-Va.), who co-chairs the Lantos commission, said he would lobby for the U.S. government to withhold funds it has pledged to Morocco if he did not see improvements in the treatment of Christians there.

“I will continue to stay with this issue until a resolution has been reached,” he said. “Should this matter remain unresolved, it is possible that I may offer amendments in the Appropriations committee and on the House floor to restrict U.S. foreign aid from going to Morocco.”

In a letter addressed to the Tom Lantos Human Rights Commission on June 17, Ambassador of Morocco to the United States Aziz Mekouar claimed that the deportations “solely and exclusively targeted proselytism activities, which are clearly and categorically forbidden by the laws of Morocco and the precepts of Islam.”

The ambassador said the Moroccan Penal Code imposes fines and prison sentences for those who “use means of seduction in the aim of undermining a Muslim’s faith or of converting him/her to another religion, either by exploiting his weaknesses or needs, or through the use, to this end, of health or educational establishments, as well as shelters or orphanages.”

Moroccan authorities have failed to provide foreign Christians whom they expelled with documented proof or official charges of their alleged proselytism activities. In his letter, the ambassador said the deportations were preferable to the “difficult ordeal” of incarceration and a trial as part of a criminal procedure against the Christians.

Wolf noted that that among those who were deported or denied reentry were businessmen, educators and humanitarian and social workers, “many of whom had resided in Morocco for over a decade in full compliance with the law. Additionally, those deported were forced to leave the country within two hours of being questioned by authorities, leaving everything behind.”

Christian foreigners who were able to obtain official deportation documents have appealed their cases in the Moroccan courts. The hearings for those cases started in May and are continuing.

Report from Compass Direct News

Bomb Attack in Iraq Seriously Injures Christian Students

One person dead in explosions that end classes for students this semester.

ISTANBUL, May 5 (CDN) — At least 50 Iraqi Christian students are receiving hospital treatment following a bomb attack on Sunday (May 2) outside Mosul that killed at least one person and has forced nearly 1,000 students to drop classes for the rest of the semester.

Nearly 160 people were injured in the blasts targeting three buses full of Christians traveling to the University of Mosul for classes. The convoy of buses, which brings Christian students from villages east of Mosul, was making its daily route accompanied by two Iraqi army cars.

“This is the hardest attack, because they attacked not only one car, but the whole convoy and in an area that is heavily guarded by the army,” said Syrian Catholic Bishop of Mosul Georges Casmoussa.

The explosions happened east of Mosul between two checkpoints. A roadside bomb followed by a car bomb reportedly exploded as the buses were clearing the second checkpoint in the area of Kokjaly. The checkpoint was staffed by U.S., Iraqi and Iraqi Kurdish soldiers.

The owner of a nearby car repair shop, Radeef Hashim Mahrook, was killed in one of the blasts as he tried to help the students, sources said.

Sources told Compass that lately there have been indications that Islamic extremists intend to increase attacks against Christians in more sophisticated and targeted ways. There were no warnings of the Sunday blasts.

Nearly 20 of the more seriously injured students are receiving treatment in Erbil, capital of the semi-autonomous Kurdish region. Casmoussa said the Turkish Consulate and the Kurdish Regional Government have offered to transfer students needing more medical care to Turkey.

“Some of them were severely injured in the face, arms, necks or eyes,” said Casmoussa. “Now the Turkish consulate and the government of Kurdistan offer us to bring the most injured to Turkey to continue the care.”

Many of Mosul’s Christians have fled the city after repeated violence targeting them and live in the villages east of the city. The students on Sunday’s convoy were from Qaraqosh, Karamless and Bartella, located nearly 32 kilometers (20 miles) away.

Over 1,000 Christian students, most belonging to internally displaced families, and about 100 university faculty and staff members commute to Mosul every week in buses belonging to the Syrian Catholic Bishopric. About 15 buses served the internally displaced Christian community daily.

“The project of transportation of students will be stopped,” said Casmoussa. “We can’t continue now.” 

While the church has focused on dealing with immediate medical needs, the bishop said the church simply could not take the responsibility of transporting students after such a calculated and fierce attack.

“The chief of army offered to help us again, but it is impossible,” said Casmoussa. “They were with us every day…yet this is the result. We don’t have another solution now.”

Last February, after attacks against Christians left three university students dead, the Chaldo-Assyrian Student and Youth Union proposed that the Ministry of Education open a new university in a safer area on the Nineveh plains. Nearly 3,000 Christian undergraduate students and 250 graduate students are studying in Mosul.

Casmoussa said the Christian community is hoping the University of Mosul will help Christian students who are unwilling to commute to Mosul by sending faculty members to hold semester-end examinations in Qaraqosh.

“This is [an attack] against all the Christian people,” said Casmoussa. “Our culture is immense capital for the future to build our lives, not just to have bread to eat and continue life without any sense.”

Due to the violence against Christians in Mosul, Casmoussa relocated to the village of Qaraqosh three years ago, and commutes into the city to serve his diocese. On Jan. 17, 2005 gunmen abducted him and released him the next day.

Sunni Muslim insurgents have frequently targeted members of Iraq’s Christian minority, especially in Mosul. Iraq’s current government is Shiite-led.

Report from Compass Direct News 

Official Orders Halt to Beleaguered Church in Indonesia

With construction permit in limbo, government also denies congregation’s temporary site.

JAKARTA, Indonesia, April 20 (CDN) — A local government official in Bekasi, West Java last week forbid all worship of the Filadelfia Huria Kristen Batak Protestan Church (HKBP) in Jejalan village.

Regent Sa’duddin on April 12 ordered a halt to all activities of the church, including worship services that have been held on a strip of roadside land since the government on Jan. 12 summarily sealed the church’s building, which was under construction.

Announcing the order at a meeting of government officials with the Rev. Palti Panjaitan, Vice-Regent Darip Mulyana said the reason for the closure of the church’s makeshift site was that worship interfered with “community activities,” though the site is on a nearly deserted roadside bordering vacant fields.

The regent also suggested that the church join with another HKBP congregation in the Graha Prima housing development, far from the Filadelfia church’s site. Pastor Panjaitan said the church objects to this suggestion as it would be impractical, creating time and transportation difficulties.

Mulyana said that Sa’duddin had ruled that the church needs to find a new place to construct its prospective permanent church building because local residents had rejected it – even though the church had secured approval from local residents when it submitted its application for a permit in 2008. The government has never acted on the application, and since then Islamic organizations have organized protests to try to pressure government officials to deny approval.

The church on March 30 filed suit against Sa’duddin for unilaterally closing their church building under construction.   

The church’s Tigor Tampubolon said the church would never have been forced to meet by the roadside if the government hadn’t sealed its building under construction without due process.

“We have been waiting for the government to grant us a temporary permit so that we can hold services, instead of forbidding them,” Tampubolon said. “It’s difficult for the 500 or so members to hold church beside the road, and it would be even more difficult if the location was moved, because most of the people live near the church.”

Tampubolon said the church had purchased 1,088 square meters of land, had obtained signatures of 60 people living near the church as well as letters of agreement from the Jejalan village head and leaders, and had submitted all necessary documents to the government in 2008.

The Bekasi Regency never took any action on the application, saying the permit needed to be discussed and approved by the Bekasi Interfaith Harmony Forum.

In December the church held a Christmas service in a temporary structure on the lot.

“We held our Christmas service there because we had village level permission and were waiting on permanent permission from the regency,” Tampubolon said.

The Christmas service drew a large mob of protestors claiming to act on behalf of the local citizens. The mob demanded that services end and that no Christian worship take place in the area.

The regent then recommended that the church hold services in Jejalan village hall, but when the congregation tried to do so on Jan. 3, another demonstration harried them. Since then the church has held worship services on the roadside.

The Filadelfia congregation has been active since 2000, with services initially held in the pastor’s home. In 2006, a mob of 300 people swarmed the pastor’s home during a Sunday morning service. Claiming to be neighbors, they pressured the pastor to sign a document promising not to hold religious meetings at his home.

Report from Compass Direct News