ABC News 24 recently reported:
“The Federal Government is considering using independent doctors to examine disability pensioners and assess whether they should continue to receive payments.”
While this idea sounds attractive, it is important to consider how systems that currently rely on independent doctors are working.
There is an assumption that such a move will ensure that entitlements are appropriately paid, but there is a potential downside. Not only are there direct costs of such assessments to consider, but issues with diversion of medical resources, the potential for adverse psychological consequences for disability pensioners and associated indirect costs. These problems already occur frequently within the workers compensation system. This should be considered before placing reliance on independent doctors in such a role.
The workers compensation system already relies heavily on independent doctors to determine insurer liability, approve treatment and decide on capacity to work, yet that approach causes many problems within that system.
Much of the problem with independent doctor’s opinions stems from the quality of the assessments. The work is generally less demanding and does not involve clinical responsibility, yet is well paid. Specialists approaching retirement or lacking work for a variety of reasons gravitate towards such assessment work. Some doctors who undertake independent assessments do not have the skills or competence to provide accurate opinions. There are also concerns about bias favouring the payer.
Inaccurate or biased opinions provide fodder for lawyers to argue with potential for legal nightmares. This can cause psychological damage to those who become stuck in the system and can be very costly.
Increased demands for independent opinions has the potential to attract more and more doctors without appropriate skills into the field, further exacerbating current problems.
In theory occupational physicians are the appropriate specialty to assess capacity to work. They are trained to assess the impact of the full range of physical and psychological conditions on capacity to work, whereas other specialties might only be able to assess conditions relating to a particular body system and might not have received training in the assessment of psychosocial factors that can compound physical injuries. Occupational physicians are already in short supply. Such a move can only exacerbate that shortage.
WHAT IS NEEDED:
1) Critical analysis of the effectiveness of independent medical assessment systems to achieve desired outcomes and the associated costs, direct and indirect
2) Review potential impact of such a system on medical manpower
3) Develop systems to ensure quality independent medical opinions incorporating:
i) Codes of practice for independent doctors undertaking such assessments requiring them to demonstrate clinical competence and an understanding of what it means to be truly independent
ii) Training and accreditation aligned to the code of practice
iii) A system of audits to establish compliance with the code of practice