Call for technicians to perform surgery

A key adviser to the Government wants "technicians", rather than highly trained surgeons, to perform minor surgery such as eye-cataract, minor-hernia and varicose-vein operations.

Dr George Salmond, chairman of a Government advisory group and former Director General of Health, said technicians commonly performed cataract surgery in Britain and developing countries, a point questioned by eye specialists.

"In places like India they have whole hospitals with one or two medical staff and literally hundreds of people have these operations done. The outcomes are excellent," said Dr Salmond, head of the Health Workforce Advisory Committee's medical reference group.

This would cut costs and help address the shortage of doctors.

He said straightforward procedures, if successful, became standardised over time. Originally performed by surgeons trained for at least 13 years, they could eventually be done under their supervision by technicians who needed less training and were paid less.

Nurses who obtain further qualifications are permitted to prescribe drugs to some patients, and Government health strategies envisage a broader role for them in GP clinics.

The idea has raised eyebrows among medical-specialist organisations, which fear it could undermine surgical standards. "It's a very contentious statement," said the president of the Association of Salaried Medical Specialists, Dr Jeff Brown, a paediatrician.

"Patients want the best possible outcomes and the best and most highly qualified person there to provide those outcomes."

The reference group's discussion document says: "There is growing evidence that many tasks and services currently provided by medical practitioners can be safely and effectively carried out by others who are appropriately trained, such as nurses, technicians or allied health professionals."

The document says a "wide-ranging agenda for change" is needed to address the doctor shortage and that, "tinkering, ad hoc approaches will not suffice".

A College of Ophthalmologists leader, Dr Stephen Best, said some optometrists referred patients for cataract surgery and at Auckland City Hospital nurses supervised by eye specialists handled post-operative care.

The college would consider further similar developments in the use of non-specialists. But he was unaware of technicians doing the operation in Britain. Nor could he envisage it happening here.

Dr Garry Brian, medical director of the Fred Hollows Foundation New Zealand, which trains eye specialists in the Pacific, said the expectations in developing countries were much lower because many people needing the operation were blind, unlike in the West, where patients' vision impairment was less to start with.

Outcomes were not as good either, because the training of specialists in developing countries was "not the same as in the West".

The trend, even in developing countries, was towards specialists doing the operation, although other staff performed the pre- and some of the post-operative care.

"I'm not aware of hospital-loads of technicians doing cataracts in India," said Dr Brian. "I just don't think it happens."

Doctor shortages

No end in sight for doctor shortages. Reasons include:

High student debt, averaging $65,000 at graduation.

Demand for shorter working hours.

Women, now more than half of medical students, expected to swing work/life balance towards life.

More healthcare will be needed, especially by ageing population, coupled with expanding range of treatments.