Specialists’ higher status challenged

HEALTH system managers are ‘‘constantly patching a leaky roof’’ and the way the sector is organised needs to change, University of Otago Dean of Commerce Robin Gauld says.

Writing in the ‘‘Journal of Primary Health Care’’, Prof Gauld says the health profession had operated the same way for decades, but professionals and patients both needed that to change dramatically.

‘‘The present arrangements need a serious overhaul; not just change, but disruption to the institutions that underpin training and work organisation,’’ he said.

Prof Gauld said three changes were needed if professionals were to cope with the patients of the future: practices should be redesigned to cope with multiborbidity (patients with several diseases), workforce training needed to be interprofessional, and primary health should be at the top of the health professional hierarchy.

More patients had multiple health problems and might need to see several specialists.

‘‘Key questions include whether one professional consultant should be the lead provider of care and coordinate care . . . or whether a generalist or primary care doctor should be the patient’s lead carer.

‘‘In the context of current institutions, there are no easy answers.’’

Given that, medical training needed to change and place an emphasis on various professionals working as teams rather than on individual specialties, Prof Gauld said.

‘‘Professionals should always be looking to the team and identifying their contribution to treating, managing and working in partnership with patients.

‘‘Again, debates around this are ongoing, with various studies pointing to such a need.’’

However, medical trainers had largely failed to change curriculums to reflect that emerging demand, Prof Gauld said.

‘‘A key question is whether traditionally separate training schools should be merged, with complete curriculum redesign and students naturally training together.’’

The health system, as is, undervalued generalists but they would be essential in the future, Prof Gault said.

Traditional notions that specialists had a higher status were outmoded and needed to change.

‘‘There needs to come a discussion on how to rebalance incomes in favour of general practice, and considerations of how to redesign how primary care operates in the broader health system.’’