Go down under to find SDS opportunities
By Stephen W. Earnhart, MS
President and CEO
Earnhart and Associates
Dallas
As part of my trip to deliver the keynote address to the International Congress on Ambulatory Surgery in Adelaide, Australia, I spent two weeks visiting hospitals, day surgery centers, nurses, government officials, representatives of the health insurance companies, and physicians. The ambulatory surgery picture in Australia is one of opportunities.
Surprisingly, it is not completely dissimilar to our situation. By their own admission, the Australians are about 10 years behind the United States in their ambulatory surgery programs. The major reason is the predominately socialized medicine program, which is similar to the Canadian and United Kingdom plans.
Day surgery centers (as they are called) operate essentially the same as our centers in the United States; however, with 70% of the population base of approximately 15 million people under public insurance, the difficulties lie in getting physicians to leave the hospital and perform their cases in the centers and receiving proper reimbursement for their services. Sound familiar?
Physicians wary of leaving hospitals
Also, the country is just beginning to discuss managed care. The managed care companies have said they will not interfere in the physician/patient relationship and will not dictate health care policy. That also sounds familiar.
Many of the centers have 23-hour stay units; however, those centers must be licensed as private hospitals by the government regulatory agencies.
Some of the centers are profitable, while others are struggling. The predominate surgery center specialties are orthopedics, ophthalmology, and plastics. Most of the 122 licensed day surgery centers are one operating room only and are typically included in the physician’s office.
Nursing is one area that offers many opportunities. Celia Leary, the administrator of the Campbelltown Hospital Day Surgery Unit in New South Wales is the president-elect of the newly formed Australian Day Surgery Nurses Association. She would be delighted to discuss with anyone the opportunities for OR nurses in Australia.
There is quite a shortage of experienced operating room nurses "down under." Very few hospitals or day surgery units employ anyone other than registered nurses to work in their units. Surgical technicians are rare In fact, I could not find one to speak with at all. By the time you read this column, Celia will be established on e-mail, and I would be pleased to forward your comments to her. (See editor’s note at the end of the column.)
OR nurses: Keep this in mind
Before you jump on a plane and seek your fortune in Australian surgery centers, you should know that a typical registered OR nurse with six years experience earns about $16 Australian per hour (that would compare to about $13 U.S. dollars).
An individual earning less than $50,000 Australian per year (roughly equivalent to U.S. dollars) is taxed at 37% of that income; however, many of your health care needs are provided by the government in the public sector. Naturally, not everything is covered. To see a physician of your choice and avoid long waits, you can purchase private health insurance. The cost is about $500 Australian per year; however, there is a large gap between what your private insurance will pay and what the actual physician or facility charge will be.
Cause for concern
This situation is causing a great deal of concern in the country as the government is trying to encourage privatization of the health care system by having individuals use nonpublic health care facilities.
Unfortunately, just the reverse is happening as the purchasers of private insurance find that they have to pay significant out-of-pocket dollars to bridge the gap between what their insurance will cover and what the actual charge is.
There are some lessons we can learn from the Australians. Domiciliary nursing is a program in which nurses from the center go home with the patients and tend to their needs for whatever period of time is necessary. As I understand it, it is reimbursed by insurance and very popular. It gives the nurses income opportunity and more hours than they may normally receive during the workweek. If you would like more information about this program, the leading authority is Lesley Alway. Her e-mail address is: [email protected]. It is a program that we might want to consider as more nursing hours are being cut.
[Editor’s note: To provide feedback or suggest column ideas, contact Stephen W. Earnhart, President and CEO, Earnhart and Associates, 5905 Tree Shadow Place, Dallas, TX 75252. Telephone: (972) 713-6626. E-mail: [email protected].]
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