A first day
First day at work with John Radovanovic at the Mater Public Hospital. Thanks to the Mater for a good first day.
Public hospital appointments matter for access: they are how patients without private health insurance get specialist shoulder surgery, and they are where much of the registrar training happens.
How public and private practice fit together
Most Australian specialist surgeons work across both systems. In the private system a patient is referred to a named surgeon, and the cost is met by private health insurance together with any out of pocket contribution. In the public system a patient is referred to a hospital department rather than to an individual, there is no cost to the patient, and cases are ordered by clinical urgency.
Holding an appointment in both means the same subspecialty assessment is available either way. For shoulder surgery that matters, because a shoulder problem that needs a subspecialist is not always obvious from a referral letter, and a general orthopaedic list does not always carry the implants and instrumentation that a complex shoulder case requires.
Why public appointments matter for training
Public teaching hospitals are where orthopaedic registrars do most of their learning. A trainee operates under supervision, sees patients in clinic, and follows those same patients through to review, which is the part of the work that teaches judgement rather than technique. A consultant who takes a public appointment is taking on that teaching as well, and the volume and variety of cases in a public department is what makes the training possible at all.
What a shoulder unit sees
A shoulder service in a public hospital sees the full range of the subspecialty: rotator cuff tears, arthritis severe enough to warrant joint replacement, recurrent instability, fractures around the shoulder, and the stiff and painful shoulders that turn out not to need an operation at all. A considerable part of the work is deciding which is which. Individual results vary, and each case is assessed on its own merits regardless of which system the patient is treated in.
Related information
See also our post on the Mater Public Hospital, and our consultation and shoulder surgery pages.