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Somehow this reminded me of a medical staff forum at a Perth hospital a few years ago, during which a senior medical leader drew some misdirected derision from the attendees by remarking that we need to start accepting that the care we can provide is going to be of a “silver” rather than a “gold” standard. Of course, we all want to provide the best-quality medical care to our patients, and we are used to being able to do so in Australia. But the realist can see the writing on the wall, as health spending continues growing as a proportion of GDP, the population continues to age, and complexity of care increases. Coupled with headwinds in the private health sector, these factors represent enormous threats to our ability to sustain quality care.

There are more than enough examples, real and threatened, locally and overseas, of governments reducing access to high-quality medical care by pursuing lower-quality substitutes, shifting costs onto patients, and cutting services. The overall standard of care in the United Kingdom appears to be on the decline, owing to the ailing nature of the dominant National Health System and relatively limited alternative options in terms of private sector healthcare.

But in a country like ours, in which patients and doctors are accustomed to extremely good care and a choice between public and private systems, the market should be more powerful. Perhaps our concern should therefore not be that the standard of available healthcare in Australia will reduce from gold to silver (or bronze, or unrefined iron ore) on the whole, but rather that our healthcare system becomes increasingly tiered. People of means will be readily able to access medical care in the private sector, where the less fortunate will be stuck either waiting even longer than they are already, or accepting lesser care from non-medical practitioners.

Resolving this needs our profession to take a hard look at itself, and potentially accept some changes that might not have previously been palatable. We need more doctors if we are to prevent governments looking elsewhere than our profession for the delivery of care. We need greater self-sufficiency of medical training as a State and as a Nation, and we need to structure our training, workforce and service delivery in ways that provide the outcomes that our community wants and can afford. If we don’t engage in this process, we will only have ourselves to blame, as governments cook up inferior non-medical models of care.