FEATURE: FUNDING FOR EXERCISE-BASED THERAPIES IN THIS SPECIAL GUEST EDITORIAL, SPORT If everyone was funded fairly – and by AND EXERCISE PHYSICIAN, DR JOHN ORCHARD fairly, I mean according to the evidence of which treatments work and which PRESENTS A COMPELLING CASE ON HOW TO don’t – then there’d be no need to draw any comparisons between exercise-based INCREASE FUNDING AND RECOGNITION FOR practitioners and drug/surgery-based EXERCISE-BASED TREATMENTS. doctors. But if you don’t want to read any criticism of other doctors and their treatment options, please stop reading The question posed by the title and surgical techniques all require now, and perhaps pick up a copy of my of this article is of the utmost great expertise to master, but please recent MJA Perspective “How exercise importance, because exercise- acknowledge in return that exercise medicine has evolved from sports based therapies should be front prescription actually does require medicine” [208(6):244-245] which and centre in our health system. Even expertise as well. Just because you read is the nicer, politically-correct peer- though I think this topic is of critical how important exercise-prescription is reviewed version. importance, I’ll offer some caveats to recently, doesn’t mean you can do it as start with. The conflict of interest is the well as someone who’s been specialising I will elaborate later, but the exercise- first declaration, as I’m a sport & exercise in it for 20 years. If you want to read more based practitioners (SEM physicians, medicine (SEM) physician, so I stand to from medical specialists who are non- physios and EPs) need to form a lobbying benefit if exercise-based therapies are experts in exercise prescription, Google block with the help of an ally (to be better funded (as will the other primary the article “Your doctor does not give revealed across the course of this article). exercise-based groups, physiotherapists a crap about your fitness tracker data”. SEM physicians need physios and exercise and exercise physiologists, EPs). However, SEM physicians, who are doctors, and physiologists, because SEM physicians if anyone reading has been living in an who do care very much about your are too small a group to be able to evidence-free cave for the last decade fitness tracker data, know how to provide the (required) mass delivery and not fully aware that exercise-based interpret it more than doctors who of exercise-based therapy to the greater therapies are effective for preventing and “don’t give a crap” and physios and EPs population. SEM physicians currently treating cancer, cardiovascular disease, who also care about your fitness tracker provide great services to the higher osteoarthritis, back pain, diabetes, data, might be offering you the best socioeconomic segment that can afford osteoporosis and depression, amongst available treatment for your condition, the out-of-pocket expenses, given the other medical conditions, then spend even though they aren’t medical doctors. lack of meaningful government funding some time reading the systematic reviews (either state through public hospitals, in these areas before you pass go. I’m A further warning is to those who or Federal through MBS). If SEM assuming knowledge of the field, with subscribe to the view that “all specialties physicians were funded so that lower the discussion moving on to why one of and practitioners in different fields socioeconomic groups could access the most effective forms of management should stick to their field and refrain services, there would be a different is poorly funded. There also isn’t space to from criticising others”. I’d love to be problem: an enormous shortage of detail that exercise-based management in a position to follow this advice, but SEM physicians. Physios and EPs isn’t as easy as specialists in non- may seem to break this edict in the however, are more plentiful and have exercise-based medical specialties may sections that follow. The reason why the workforce numbers to be able think it is (refer Dunning-Kruger Effect). is that “others” have lobbying to rig the to provide services to the entire I acknowledge that disease-modifying Medicare Benefits Schedule (MBS) in community, but again, with respect anti-rheumatic drugs, chemotherapy order to stop exercise-based therapies to lower socioeconomic groups, only from being properly funded. The onus if the funding follows. should actually be on the non-exercise- based therapies (especially doctors who Physios and EPs need SEM physicians for prescribe drugs and surgery) to prove a different reason, or more specifically, superiority to exercise-based therapies they need SEM physicians to be taken in order to justify far more generous seriously in the specialist medical world. MBS funding. My motivation is to If the status quo of “other” medical promote exercise-based therapies, specialists not taking SEM physicians but some of it may come across as seriously (both in reputation and funding) arguing against doctors who use drugs continues, then there is little hope of and surgery as primary treatment. physios and EPs being taken seriously VOLUME 36 • ISSUE 2 2018 35