Letters

Report on Australian surgeons

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.602b (Published 04 March 1995) Cite this as: BMJ 1995;310:602
  1. Thomas B Hugh
  1. Visiting surgeon St Vincent's Hospital, Sydney 2000, Australia

    EDITOR,—Simon Chapman's glowing account of the Baume inquiry into Australia's surgical workforce is tinged with his political views.1 Professor Baume's central conclusion—that the cause of surgical waiting lists in Australia is a shortage of surgeons, which in turn is due to excessive control over surgical training by the Royal Australasian College of Surgeons—has been rejected not only by the college but also by the Australian Medical Association and the specialist surgical societies. His suggestion that, if numbers of surgeons cannot be increased rapidly, incompletely trained people should be allowed to substitute for surgeons is widely regarded as being silly.

    The Baume report has been criticised not only for inaccuracies (for example, overestimating the population of Australia in 2001 by three million) but also because it ignores facts, preferring instead views based on Professor Baume's “suspicion” or anonymous submissions by disgruntled groups or individuals. Surgeons presented Professor Baume with evidence that cutbacks in public hospitals related to the budget were the cause of long waiting lists and indicated that, if they were allowed to work to full capacity, their waiting lists would disappear rapidly. This evidence was largely ignored in the conclusions of the report.

    Professor Baume's conclusion that hospital bottlenecks in Australia are due to a shortage of surgeons, who, he said, are relucant to work in public hospitals, is an untruth that has left surgeons gasping. In general surgery there are virtually no unfilled consultant vacancies in urban Australia, where waiting lists are longest. When such a vacancy was advertised recently at Westmead Hospital (a teaching hospital of the university in which Chapman works) almost 100 people applied.

    Chapman says that Professor Baume drew attention to the “fantastic incomes” of surgeons. This phrase does not appear in the report, and the fantasy is therefore Chapman's. Fantasy, however, is an appropriate word, as Professor Baume pointed out that the quoted Figures for doctors' incomes may be inaccurate and that the amounts represent gross income, from which practice expenses (ranging from 50% to 90%) need to be deducted. Australian surgeons' net incomes are, in fact, modest compared with those of other professional groups.

    Chapman, a colleague of Professor Baume, describes him as “a creative egg cracker in medicopolitical cake baking.” This assessment of Professor Baume is not shared universally by Australian doctors. The late Professor Fred Hollows, who encountered Professor Baume when the latter was minister for aboriginal affairs, was extremely critical of him,2 and many Australian surgeons support his view.

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