Allied Health Insights Vol.3 No.2: Who Owns Healthcare Work? Navigating Professional Boundaries and Social Constructs

Last September, the Australian Minister for Health and Aged Care, Mark Butler, announced Unleashing The Potential Of Our Health Workforce: Scope Of Practice Review, with the stated intention of identifying opportunities to remove the barriers stopping health professionals working to their full scope of practice.

This review is coming off the back of the Strengthening Medicare Taskforce Report published in December 2022, (which itself kicked off spirited debate around the nature and role of allied health in primary care), recommending stronger interdisciplinary cooperation in primary care.

In an address at the National Press Club in May of this year, Minister Butler stated: “We cannot build a more collaborative primary care system, or support practitioners to work autonomously, unless we are prepared to get rid of the red tape and outdated silos that prevent team-based care.”

Having received more than 700 submissions, the primary round of consultations for the Scope of Practice Review have now closed, to be followed by recommendations and an implementation plan in the second half of 2024.

Including “allied health” and “scope of practice review” in the same sentence did induce some anxiety on the part of the medical establishment in Australia, with the AMA urging caution, and The Medical Republic blog reporting on Minister Butler’s announcement under the  clickbaity title: Allied Health Is Being Let Off The Leash.

And it was in this context that, late last year, the AMA made a submission to the Podiatry Board of Australia’s independent review of the regulation of podiatric surgeons, stating: “Podiatric surgery is the only form of human medical treatment where a person other than a doctor can take a scalpel and cut into a patient…Not only are they able to cut into a patient, a podiatric surgeon with no formal medical degree or surgical training (Fellowship of the Royal Australasian College of Surgeons – FRACS or equivalent) can then operate on bones, tendons, joints and undertake internal fixation with screws for example.”

Less than two weeks later, Fairfax and 60 Minutes ran stories—Fairfax running with the header Sole Destroying: how surgeons wield scalpels without medical degrees—condemning podiatric surgeons, with the SMH also stating in a TikTok video that podiatrists “perform surgery without having a medical degree”, that they can “pick up a knife with only a podiatry or science degree if they complete training at institutions that are not accredited by the Australian Medical Council”.

This timing is interesting given that the Australian College of Podiatric Surgeons is attempting to access Medicare reimbursement for their surgical procedures.

Amid all this, it is an opportune time to examine and discuss the sociological and historical aspects of the healthcare professions and the boundaries that govern them, and the practicalities and considerations of how evolving scopes of practice can be safely harnessed, while their value is maximised to meet the healthcare needs of the community today and into the future.