CMOS - GLUE IN THE SYSTEM OR GRIST FOR THE MILL?

Michael Boyd, Camden NSW.
(reprinted from article published in NSW Doctor, May 2001)

Almost twenty years ago a new class of hospital and community doctor arrived on the medical scene. Career Medical Officers were supposed to have been the saviours of a health system, suffering at the time from the lack of available senior level hospital resident and registrar staff. The pool of experienced doctors was expected to stay "in the system" on a career path ( The NSW Dept of Health CMO award).

Unfortunately little career structure was put in place, nor was there any defined training program instituted.

Despite this, many doctors involved enhanced their own training and education, the concept being transformed into a qualified success, not because of any system design but because of the self- motivation, experience and quality of the medical practitioners concerned. These doctors had made a conscious decision to remain as CMO's - often pursuing many years of early specialty level and advanced procedural training in multiple areas in order to maintain and improve their skills. Over the years they became unique - a mix of experience with cross specialist training at a generalist level.

They thus became, by default, the "glue in the system" - occupying jobs that other senior doctors would not, or could not, do. They became the forgotten workforce - "grist for the mill" and in many ways they remain that way today. Those who now have the opportunity to work alongside CMOs,( hospital specialists, registrars and RMOs, medical students and nursing staff) are generally impressed with their dedication and competence, and accept them as a necessary and integral part of the modern medical workforce.

Some have, in the past, expressed doubt as to the longevity of the CMO concept. Time has proved this opinion to be false - CMO's are here to stay and deserve and are demanding proper support, training and remuneration.

With the advent of reduced access to provider numbers, there is the potential that many more will be in the situation of not having a specialist or generalist career structure to follow - more grist for the mill. Their training paths appear just as tenuous, with no defined alternate pathway for those not wishing to be family practitioners or unable to decide which specialty they should pursue.

Four years ago the Career Medical Officers Association of Australia (now the Australasian Society of Career Medical Officers - http://www.ascmo.org.au ) was formed with the aims of supporting CMOs and lobbying political and medical organisations to provide adequate career structure, training and remuneration for this group. Other groups, such as the MMO's (Multiskilled Medical Officers) in the Illawarra, have also formed at local levels with similar aims. The AMA Industrial Officer, Allen Thomas has been helpful and supportive from the outset, recognising the long path on which that we had set ourselves.

Today Career Medical Officers work in many fields of medicine, both in the hospital and community setting. The recent NSW Medical Board annual survey 1999, revealed that, in the hospital system, there are over 700 "other hospital career" based doctors in NSW - i.e. those who are not specialists and are not RMOs or specialists in training. The ASCMO estimates that there are at least 1000 CMOs of all disciplines in NSW alone.

The range of fields is as broad as medicine itself - CMO's are represented in community practice (aviation medicine, community paediatrics, drug & alcohol services, developmental disability, forensic medicine, palliative care, prison and corrective services and also in both public and private hospitals, general medicine, and surgery, orthopaedics, anaesthetics, intensive care medicine, emergency medicine, ambulatory medicine, obstetrics/gynaecology, geriatrics, psychiatry)

Due to the narrow orientation of current medical practice policy towards either family generalists or qualified specialists/trainees, many career medical officers feel unsupported. To reduce this isolation the ama has recently proposed the formation of a defined cmo oriented group within the structure of the NSW AMA, and would encourage any that are interested to contact their AMA representative.

So these are the CMO's - a broadly based, broadly skilled section of the medical fraternity - happy to be the glue in the system, but no longer as grist for the mill.