Outcome of overseas commercial kidney transplantation: an Australian perspective

Metropolitan hospitals are vital to our hospital system. For every tertiary referral hospital in our national capitals, there are at least two metropolitan hospitals. Despite their dominance, they remain the poor cousins of the hospital family, and this relative poverty drew senior clinicians and bureaucrats to a meeting in Sydney recently.* The perennial buzz words — workforce shortages, quality and safety, risk management, training opportunities, effectiveness and efficiency — peppered the presentations. Emergent themes included the declining viability of clinical services, the effects of specialism, dissatisfaction among professionals, a chronic shortage of both senior and junior clinical staff, and the highly inadequate coverage of clinical services “after hours” (which amounts to more than 100 hours per week!). The meeting threw up potential solutions: changing community expectations that every hospital should provide services for all clinical contingencies, and abandoning the “silo ethos” of hospitals in favour of clinical networks with precedence over individual institutions. Interestingly, one suggestion from the floor — that some hospitals cease to be acute general hospitals and become specialised elective centres — was greeted by sustained applause. In short, the consensus for change was overwhelming, but expectations blunted. The meeting also highlighted the emergence of a new species, “ the locumist”. Medical workforce shortages combined with an absence of enforceable professional standards has seen commercial enterprises provide an expanding pool of low-skilled and itinerant locums. These individuals can earn up to $200 000 per year, to the chagrin of specialists, on whom they call for help, and vocational trainees doing the same shift. Meanwhile, the drain on the health budget runs into millions. All in all, there was a refreshing impatience with the status quo and an enthusiasm for reform. Sadly, delay and indecision may see this expectant impatience subside into deadening indifference.