Orthopaedic surgeons reject public hospital waiting lists theory

Australia’s growing public hospital waiting lists for elective surgery are not caused by surgeons choosing to work more in private hospitals.

ASOS rejects the proposition that has been advanced by Melbourne Institute health economists Yang, Yong & Zhang in support of the removal of private health insurance subsidies to over 65-year-old Australians.

In a submission to the Senate Committee the authors referenced their paper Effects of private health insurance on waiting time in public hospitals, which states

“As these professionals allocate more time to treating private patients, their availability in public settings diminishes. It is not surprising that a rise in private patient numbers due to increased PHI enrollment is to a large degree offset by the fall in public patient volumes.”1

ASOS members have responded to the above proposition as follows.

National Chairman of ASOS Dr Roger Brighton said, “there is widespread resistance [in public hospitals] to putting on more, younger recent surgical graduates who are crying out for appointments and keen to work in the public hospital system“.

“There are plenty of Orthopaedic surgeons waiting to perform public joint [surgery], but the inefficient system doesn’t allow them. There is not enough funding for the implants, staff, beds, nurses. There is an overabundance of surgeons willing to do the surgery.”
Orthopaedic surgeon, NSW

“Public hospitals cannot do more orthopaedics not because of lack of surgeons but because of lack of funding for implants etc. There are under-employed surgeons who are available to work publicly if the employment was available.”
Orthopaedic surgeon, VIC

“That is very ill-informed. The number of sessions surgeons spend in public hospitals depends on how much FTE they [Ed: public hospital administrators] are given to spend. So some young surgeons who would be happy to do public lists are struggling to get appointments.”
Orthopaedic surgeon, SA

“Surgeons are engaged by public hospitals under contracts that set out their sessions and obligations. A surgeon cannot choose to work in private instead of fulfilling their public contractual commitments—the contracts don’t allow surgeons to work where they please at their own discretion. Most surgeons could do more public operating tomorrow if the sessions existed. The binding constraint on public elective surgery volume is funded theatre capacity, not surgeon availability.”
Orthopaedic surgeon, QLD

CEO of ASOS Mr Stephen Milgate AM said ASOS welcomes the contribution of health economists to health policy. However, there is no substitute for matching any academic advice with eyewitness accounts of what is happening in our public hospital system.

1 Yang, O., Yong, J., & Zhang, Y. (2024). ‘Effects of private health insurance on waiting time in public hospitals’. Health Economics.