Bullying within specialist medical training in Australia: Analysis of the medical training survey, 2020-2023.

OBJECTIVE: Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners. METHODS: Medical Training Survey data were extracted and averaged from 2020 to 2023. RESULTS: Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice. CONCLUSION: Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level.

Questionable evidence and argumentation regarding alleged misuse of Medicare.

What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare.

Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study.

OBJECTIVE: Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. METHODS: out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. RESULTS: Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. CONCLUSIONS: Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.

Medicare-subsidised mental health services from the beginning of Better Access in 2006-2007 to 2019-2020: Descriptive analysis by state, profession and consultation profile.

OBJECTIVE: Since 2006, the Australian Federal Government has aimed at expanding mental healthcare through the 'Better Access' programme of Medicare-subsidised services by private practitioners. We comment on population access to subsidised mental health treatment via health professionals in Australia. METHODS: We descriptively analysed Australian Institute of Health and Welfare (AIHW) data. RESULTS: Increasing percentages of the Australian population of people received Medicare-subsidised services from 2008-09 to 2019-20. Population access to mental health treatment increased from 5.7% to 10.7%. In 2019-20, psychiatrists provided services for 1.7% of the population, while GPs provided for 8.8%, clinical psychologists 2.2%, registered psychologists 2.9%, and other allied health providers 0.4%. Over the period, numbers of Australian psychiatrists providing services increased, but the numbers of patients seen per year, and other indicators, have either been flat or declined. GP, Psychologist, Clinical Psychologist and other allied health consultations increased overall, but again the numbers of sessions have decreased. CONCLUSIONS: Medicare-subsidised private practice has greatly increased population access to mental health treatment. However, there appear to be a relatively limited number of consultations per patient for most provider groups. Further research is required on the effectiveness of treatment through collecting data on casemix and outcomes.

Surfactant-free synthesis of copper nanoparticles and gas phase integration in CNT-composite materials.

Copper nanoparticles (Cu-NPs) represent a viable low-cost alternative to replace bulk copper or other more expensive NPs (e.g. gold or silver) in various applications such as electronics for electrical contact materials or high conductivity materials. This study deals with the synthesis of well dispersed Cu-NPs by using an Ar + H2 microplasma using a solid copper precursor. The morphological analysis is carried out by electron microscopy showing particles with a mean diameter of 8 nm. Crystallinity and chemical analyses were also carried out by X-ray diffraction and X-ray photoelectron spectroscopy, respectively. In the second step, the Cu-NPs were successfully deposited onto porous carbon nanotube ribbons; surface coverage and the penetration depth of the Cu-NPs inside the CNT ribbon structure were investigated as these can be beneficial for a number of applications. The oxidation state of the Cu-NPs was also studied in detail under different conditions.

Atmospheric Pressure Plasma-Synthesized Gold Nanoparticle/Carbon Nanotube Hybrids for Photothermal Conversion.

In this work, a room-temperature atmospheric pressure direct-current plasma has been deployed for the one-step synthesis of gold nanoparticle/carboxyl group-functionalized carbon nanotube (AuNP/CNT-COOH) nanohybrids in aqueous solution for the first time. Uniformly distributed AuNPs are formed on the surface of CNT-COOH, without the use of reducing agents or surfactants. The size of the AuNP can be tuned by changing the gold salt precursor concentration. UV-vis, ζ-potential, and X-ray photoelectron spectroscopy suggest that carboxyl surface functional groups on CNTs served as nucleation and growth sites for AuNPs and the multiple potential reaction pathways induced by the plasma chemistry have been elucidated in detail. The nanohybrids exhibit significantly enhanced Raman scattering and photothermal conversion efficiency that are essential for potential multimodal cancer treatment applications.

Zero-dimensional methylammonium iodo bismuthate solar cells and synergistic interactions with silicon nanocrystals.

Organometal trihalide perovskite solar cells have attracted monumental attention in recent years. Today's best devices, based on a three-dimensional perovskite structure of corner-sharing PbI6 octahedra, are unstable, toxic, and display hysteresis in current-voltage measurements. We present zero-dimensional organic-inorganic hybrid solar cells based on methylammonium iodo bismuthate (CH3NH3)3(Bi2I9) (MABI) comprising a Bi2I9 bioctahedra and observe very low hysteresis for scan rates in the broad range of 150 mV s-1 to 1500 mV s-1 without any interfacial layer engineering. We confirm good stability for devices produced and stored in open air without humidity control. The MABI structure can also accommodate silicon nanocrystals, leading to an enhancement in the short-circuit current. Through the material MABI, we demonstrate a promising alternative to the organometal trihalide perovskite class and present a model material for future composite third-generation photovoltaics.

Salt in the soul, steel in the eye and caution towards the winds: a mariner's guide for navigating a new academic psychiatry department.

OBJECTIVES: This paper describes principles and advice regarding the development of a new academic psychiatry department within a medical school for aspiring academic psychiatrists. We describe general principles based on the experience of the foundation of the Academic Unit of Psychiatry and Addiction Medicine at the Australian National University Medical School. CONCLUSIONS: Perspicacious leadership and organisation are the foundation for an academic psychiatry department which delivers teaching, research and broader intellectual engagement with the medical and broader community.