Volume 190 - Issue 5
Rediscovering university teaching hospitals for Australia
Author: Leon Piterman
Med J Aust 2009; 190 (5): 285-286. || doi: 10.5694/j.1326-5377.2009.tb02404.x
Published online: 2 March 2009
Published online: 2 March 2009
To the Editor: The recent article by Penington, highlighting the apparent neglect by Australian hospitals of actively participating in research over the past two decades,1 is both timely and concerning. During this time, many of our hospitals have seen themselves increasingly as clinical service providers, with teaching and research perceived as additional costs rather than contributions to their status, to the quality of patient care and to clinical and scientific discovery.
My point is not simply to add weight to Penington’s eloquent historical, contemporary and strategic analysis of the nexus between hospitals and universities, but to explore areas that he touched on that need more detailed examination. I refer to the potential link between hospitals and community-based primary care. As Penington points out, “health care is increasingly provided outside hospitals”, yet this vital link between hospitals and primary care is often defunct, particularly when it comes to general practice.
When Penington refers to hospitals working with “general practice networks” to meet the demands of an ageing population and chronic disease, we need to ask: which hospitals and which networks? In Melbourne, we have health networks that include groups of hospitals with extended primary care and community facilities and responsibilities. Driven by casemix funding, the hospitals or health networks have a vested interest in primary care to ensure short patient stays. However, not all states are the same and not all hospitals have similar links with the community.
The other issue of concern is that general practice networks are often politicised and factionalised. Divisions of General Practice do not speak with a single voice, and their state-based organisations and national body do not always represent the views of regional Divisions. Added to the mix of 120 Divisions, we have 22 regional general practice training providers, the colleges (Royal Australian College of General Practitioners, Australian College of Rural and Remote Medicine), the Rural Doctors Association, the Australian Association for Academic General Practice, the Australian Medical Association, etc. Integration of the research, teaching and training activities of general practice or primary health care with hospital networks can only be achieved at a regional level.
We need to think globally, but act regionally. This calls for the formation of new regional consortia including universities, health networks (hospitals), Divisions and regional training providers (responsible for general practice registrar training) to work together on national clinical and health service research agendas in large and well defined geographic regions. If the National Health and Hospitals Reform Commission is to take its role seriously, it will need to move beyond the confines of traditional hospital settings and explore opportunities in the community.
References
- Penington DG. Rediscovering university teaching hospitals for Australia. Med J Aust 2008; 189: 332-335. <eMJA full text>