Public or private care: where do specialists spend their time?

Abstract

Objectives The aim of the present study was to provide data to help clarify the public–private division of clinical care provision by doctors in Australia. Methods A secondary analysis was performed of data from the workforce survey administered by the Australian Health Practitioner Regulation Agency. The questionnaire included demographic and employment questions. Analysis included frequency distributions of demographic variables and mean and median calculations of employment data. Data were analysed from those currently employed in eight adult specialities chosen to provide a mix of surgical and medical fields. The specialties were orthopaedic surgery, otolaryngology, ophthalmology, cardiology, neurology, nephrology, gastroenterology and rheumatology. Results For the specialities analysed in the present study, a large majority of the time spent in patient care was provided in the private sector. For the surgical specialties studied, on average less than 30% of clinical time was spent in the public sector. There was considerable variation among specialties in whether a greater proportion of time was spent in out-patient versus in-patient care and how that was divided between the public and private sectors. Conclusions Ensuring Australians have a medical workforce that meets the needs of the population will require assessments of the public and private medical markets, the needs of each market and the adequacy with which current physician clinical time allocation meets those requirements. By appreciating this nuance, Australia can develop policies and strategies for the current and future speciality workforce to meet the nation’s needs. What is known about the topic? Australian medical specialists can split their clinical practice time between the public (e.g. public hospitals, public clinics) and private (e.g. private hospitals, private consulting rooms) sectors. For all medical specialists combined, working hours have been reported to be similar in the public and private sectors. In aggregate, 48% of specialists work across both sectors, 33% work only in public practice and 19% work only in private practice. What does this paper add? Because of the potential for significant variability across specialties, these consolidated figures may be problematic in assessing the public and private allocation of the physician workforce. Herein we provide the first speciality-specific data on the public–private mix of practice in Australia. Among the most important findings from the present study is that, for many specialists in Australia, a large majority of time is spent providing care to patients in the private sector. For the surgical specialties studied, on average less than 30% of clinical time is spent in the public sector. What are the implications for practitioners? Public policies that are designed to ensure an adequate medical workforce will need to take into account the division of time providing care in the public vs. the private sector. Public perceptions of shortages in the public sector may increase the availability of public sector positions.