Cancer is a leading cause of death in Australia, accounting for 31% of male deaths and 26% of female deaths in 2001. One in three men and one in four women will be diagnosed with cancer by the age of 75. Australia has a relatively high incidence rate but comparatively low mortality rate in comparison to other developed countries indicating that cancer survival in Australia is relatively good. This suggests the health system is performing well in lengthening survival through early detection and in treatment of cancer.1
A health system can only keep performing well with continual improvement and review. Within the current private health sector, although detection and survival rates are good, there are many areas that could be improved and refined for the benefit of all involved.
The following issues have led to the establishment of the PCPA:
1. The incidence of cancer increases with age and hence the number of cancer patients is likely to grow as the Australian population ages. However, the number of specialist medical oncologists is not increasing. Between 1999 and 2001, the number of medical oncologists actually declined from 187 to 171, although the number of radiation oncologists increased from 117 in 1995 to 182 in 2001. There is no current workforce plan to ensure Australia has a sufficient number of oncologists to meet future demand.2
2. The majority of cancer patients in Australia are cared for by private oncologists and haematologists and treated in private hospitals3 – a fact likely to be surprising to most Australians. Although contributing to their own care both directly and through private medical insurance, private cancer patients at times have limited access to needed drugs and can face difficulty in accessing hospital beds as a result of funding arrangements. These inequities need to be addressed.
3. Private cancer physicians also face issues that limit their ability to contribute to the development of medical knowledge and offer their patients the same range of treatment possibilities offered publicly. Despite the predominance of treatment in the private sector, all training of medical oncologists and clinical haematologists occurs in public hospitals meaning young physicians are denied access to the full range of training and professional development possibilities. Research, particularly trials of new drugs, primarily occurs through the public sector restricting the capacity of private practitioners to contribute in this important area. Administrative requirements in accessing certain drugs consume unnecessary specialist time in private, but not public, practice.
4. Most medical oncologists and clinical haematologists are members of both The Royal Australian College of Physicians (RACP) and the Medical Oncology Group of Australia (MOGA). RACP is responsible for the training and assessment of doctors wishing to practice as physicians. MOGA, a speciality society affiliated with RACP, is a professional association dedicated to the advancement of knowledge in cancer treatment and the promotion of high standards of practice. RACP and MOGA represent practitioners in both the public and private sector but professionals in the two sectors do face different challenges and there is currently no association representing the particular interests of private oncologists or their patients.
1. Figures taken from Australian Institute of Health and Welfare (AIHW) and Australasian Association of
Cancer Registries (AACR) 2004. Cancer in Australia 2001. AIHW cat.no. CAN 23. Canberra: AIHW (Cancer Series no. 28).
3. Australian Institute of Health and Welfare (AIHW) “Australian Hospital Statistics” report, 2006-07.