Volume 190 - Issue 5
Rediscovering university teaching hospitals for Australia
Authors: Rachel F Dear and Martin H N Tattersall
Med J Aust 2009; 190 (5): 285-286. || doi: 10.5694/j.1326-5377.2009.tb02405.x
Published online: 2 March 2009
Published online: 2 March 2009
To the Editor: Penington identifies the appointment of a National Health and Hospitals Reform Commission (NHHRC) and the suspension of 5-year Australian Health Care Agreements as a “once in a generation” opportunity to rediscover university teaching hospitals for Australia.1
He identifies changes to health funding in Australia since 1975, the growth of “cost shifting” between federal and state governments, and reduced funding for university functions in hospitals as important contributors to the decline of university teaching hospitals in Australia.1
We agree with this analysis, but propose that the privatisation of many outpatient clinics as a result of cost shifting has had a disastrous effect on the clinical training of medical students, residents and registrars. Moreover, the reduced funding of university functions in hospitals has been replaced in “teaching” and community hospitals by industry funding, and the perception that industry has “bought” patients for their “research” agenda by providing data management services through per capita payments and gifts or perks for clinicians.
The infrastructure sustaining clinical research should not be so reliant on industry. Funding from the federal government (in partnership with state governments) is needed to nurture independent research in university teaching hospitals.
Penington highlights the fact that the key element of the university teaching hospital model was leadership of all units by academic clinicians with questioning minds. Since 1975, we believe leadership of units in “teaching” hospitals has changed such that very few are now led by academic clinicians.
We recently experienced a lack of interest by medical specialists in supporting clinical research that had been approved and funded by the National Health and Medical Research Council (NHMRC). The project will evaluate doctor–patient communication about treatment options in oncology, including clinical trials. Participating doctors were required to post letters of invitation to patients and audio-record one consultation per patient recruited (20 per doctor). Specialists in all major teaching hospitals in New South Wales and Victoria were contacted; 17 of 41 specialists contacted in NSW (41%) and 15 of 52 contacted in Victoria (29%) have agreed to participate. The most common reasons doctors gave for not participating was that they were too busy or that there was no reward for participation. It is notable that no specialist from two major teaching hospitals — one in Sydney (3 contacted) and one in Melbourne (6 contacted) — agreed to participate. A concerning theme is that the motivation to participate in trials is driven by financial incentives rather than the importance of the question being addressed or interest in supporting novel investigator-initiated clinical research.
A starting point for improving the quantum and calibre of “independent” clinical research in university teaching hospitals would be to support clinical research infrastructure by providing per capita payments for recruited patients — a model used by industry. Rebuilding independent research capacity in university hospitals will improve the standard of research in this country, and foster clinical research training.
We believe reviving the university teaching hospital model in Australia is an important task for the NHHRC.
References
- Penington DG. Rediscovering university teaching hospitals for Australia. Med J Aust 2008; 189: 332-335. <eMJA full text>