Working in Oz

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applehead

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Hi

I am currently a doctor in the UK

I am moving to Canberra to work as an RMO (PGY 3) in Emergency in August

How does everyone find the hospital environment down under. How does it compare to home? Are drugs different for example?

Would love to hear from you guys

Cheers

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Thanks for your reply

Know about pethidine (hardly ever use it in the UK) but never heard it called meperidine!

In the UK we use generic names for all drugs and never brand names

Lasix in the UK for example would always be called furosemide
 
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Hi

I am currently a doctor in the UK

I am moving to Canberra to work as an RMO (PGY 3) in Emergency in August

How does everyone find the hospital environment down under. How does it compare to home? Are drugs different for example?

Would love to hear from you guys

Cheers

I don't know what the environment is like in the UK, but the drugs all have the same names. We even use MIMS in Australia, although there's an Australian version with some minor differences. Not as big as differences with the US, like meperidine, albuterol, acetaminophen, etc.

The other big difference would be the availability of private healthcare in Australia... but that probably won't affect you in emergency medicine, unless you choose to work at a private hospital.
 
but that probably won't affect you in emergency medicine, unless you choose to work at a private hospital.

How many private hospitals do you know in Australia that actually have an emergency department? - Most that I have come across simply direct those patients to a public hospital, in order maximise their profit from outpatient procedures.
 
How many private hospitals do you know in Australia that actually have an emergency department? - Most that I have come across simply direct those patients to a public hospital, in order maximise their profit from outpatient procedures.

There are plenty. Private hospitals aren't entirely profit-making enterprises in Australia... there are actually a lot of nonprofit private hospitals that are run by religious groups and the like (i.e. Sydney Adventist Hospital). I did some rotations at Sydney Adventist, and they seem to think that they're a public hospital... they have an ED, an ICU, a cardiac ICU, a labor/delivery ward, a clinical school (for med students, nursing students, and the others), several general wards, etc. Starting this year, they even have interns and residents, and they've had registrars for a few years.

I just thought of one other big difference - healthcare guidelines in Australia are less penny-pinching than in the UK. I don't know about daily practice in the UK, but whenever I look at NHS guidelines, I'm always baffled by how many outdated drugs that they use just because of cost. In Australia, they still avoid spending money unnecessarily (like in the US), but if the patient is likely to benefit from a more expensive treatment, they'll always get it.

On the flip side of that, basic healthcare isn't 100% free of charge like it is in the UK. Aussies have to pay up to $34 to fill a prescription... if the drug costs more than $34, the government takes care of the rest (whether it's $35 or $35,000). Also, Medicare usually doesn't pay enough to cover a specialist visit... they might pay the specialist $75 for the visit, but the specialist will often set his fee at, say, $125... and the other $50 comes out of the patient's pocket (or their private insurance, if they have it).

But ED visits are always free (both the consultation and the treatments), so that probably wouldn't affect you either. At Sydney Adventist, ED visits are $300, and the rest is covered by Medicare.
 
Just looked up the data - which can be seen here:
http://www.pc.gov.au/__data/assets/pdf_file/0003/93036/06-chapter3.pdf

There are 556 private hospitals in Australia, of which 24 have an an emergency department (4.3%)
In NSW - there are 173 private hospitals and of those 4 have an emergency department (2.3%, page 60).

So, I guess that you are correct - there are plenty. My statement that most private hospitals - i.e. the other 97.7% in NSW, that divert patients to public emergency departments, may have been exaggerated.
 
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Oh, well, you're definitely correct that "most" private hospitals will refer patients to public hospitals. But a lot of those private "hospitals" are either specialty hospitals (i.e. an Ob/Gyn clinic that mostly does IVF, a psych unit for rich people who don't want to sleep next to people who smell bad, etc.) or a place right next to the public hospital that has nicer rooms. Only a minority are full general hospitals with EDs and the like.
 
But a lot of those private "hospitals" are either specialty hospitals (i.e. an Ob/Gyn clinic that mostly does IVF, a psych unit for rich people who don't want to sleep next to people who smell bad, etc.) or a place right next to the public hospital that has nicer rooms. Only a minority are full general hospitals with EDs and the like.

Good to hear that we agree that most are specialty hospitals, and that are most likely profit driven.

I would also argue that, based even on your own response, that those private hospitals that see pts in the ED are also profit driven. You indicated that the hospital in Sydney charges $300 plus medicare reimbursement rates. This, I would assume, is for the ED services only. Does this also include any other services such as Radiology, Surgeons, Anaesthetics, Inpatient consults, etc.? So if it is a true emergency - is the patient not only on the hook for the $300 - but far more from these services listed above?

My experience (albeit in the USA - which I know is very different, although I now practice here in Australia) - is that in the USA, religious hospitals charge minimal - if anything to provide these services. They are often provided free of charge to patients without insurance. This is very different to religious based hospitals in Australia. Do the same religious institutions offer their services for free to Australians without private health care insurance? A well known Adventist hospital in the USA is Loma Linda - they see patients in the ED without $300 up front - Indeed to charge a patient in the ED upfront would be a federal offence and land the physician and hospital in federal court. The physician would likely be deregistered and land up in federal prison. Clearly this doesn't happen in Sydney - and, unlike Loma Linda where a patient who has no insurance may pay NO money for their services, at the Adventist Hospital in Sydney - they are charged (and collect) $300 up front - on top of the guaranteed medicare reimbursement.

So - do you REALLY feel that the 2.3% of NSW private hospitals that are actually seeing patients in their ED do not have a financial interest towards profit? Seriously? If you really feel that they are there to provide needed services to an otherwise indigent population - without the need to increase profit - why the $300 up front? And what about costs for ancillary services? Provider fees - etc.

I do feel that private hospitals in Australia are profit driven. If they were loosing money - services would be curtailed, especially those that are least likely to generate a sustained income - such as the ED.
 
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T\ Also, Medicare usually doesn't pay enough to cover a specialist visit... they might pay the specialist $75 for the visit, but the specialist will often set his fee at, say, $125... and the other $50 comes out of the patient's pocket (or their private insurance, if they have it)

You are also misinformed here. Good luck finding a surgical specialist that only charges $125 for an initial consult. We'll not even talk about their surgeon fees or Gap payment for any surgery that may be recommended.

BUT - The vast majority, if not all, of the private health funds often do NOT cover outpatient visits. Anything that is above the Medicate reimbursement for an outpatient visit is an out of pocket expense that is not reimbursed by the fund. If a surgeon charges $200 for a visit, and $75 is reimbursable, the patient is out of pocket $125, regardless if they have private health care coverage or not.
 
Look man, I wasn't looking to start an argument. I was just trying to answer the guy's questions.

When I said "$125", that was just a random number off the top of my head. I wasn't referring to a surgical specialist, I was referring to a specialist who I see as an outpatient.

I don't know exactly how the reimbursement works at Sydney Adventist, but it's pretty clear that it's not a profit-driven place. I'll admit that I don't have the numbers to back that up, so I might be wrong... but they're basically like any other nonprofit organization. All of the "profits" go back into redevelopment, education, and research.

The private hospitals don't have to provide free services to indigent populations in Australia because that's what the public hospitals are for.

I didn't say they charge $300 "upfront"... that's just the fee for using the ED. You pay it later, just like at any other hospital.

We can't lump all places into the same group as "private hospitals in Australia." They're all different. I'm talking about Sydney Adventist because I have experience there. I don't know about the others. Your experience is clearly different from mine.
 
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