2014 AMA National Conference Download the Australian Medicine BUMPER ISSUE app, free at your favourite app store
Budget backlash AMA changes leadership but not message: overhaul co-payments, reinstate hospital funds AMA National Conference: all the news, action and colour, 40 pages, beginning page 17
7 ‘Four-minute medicine’ fears over Budget cuts 9 Public hospitals face funding crunch 10 Doctor training casualty of short-term Budget fix 67 ABC pulls Catalyst show over statins claims 69 Anti-vax message rubbished
INSIDE 70 E-health set for overhaul
ISSUE 26.11 - JUNE 10 2014 www.doctorsdispute.com.au In this issue
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President Vice President 3 Associate Professor Dr Stephen Parnis Brian Owler
the health system. PRESIDENT’S MESSAGE The AMA is also worried about the impact on Budget of broken dreams preventive health care. There is a new financial barrier for people to have vaccinations. The latest figures show a decline in the vaccination rate. The The 2014 Federal Budget is still in the news. A lot of people do not realise that there has also co-payment could contribute to a further decline, been a $5 cut in the Medicare patient rebate. Recent Budgets have raged for a day or two, which would be devastating for public health. maybe a week, but this one is still up in lights. The We are most concerned about vulnerable patients The debate so far has been centred on the co- Government has not been able to move on to other in our society, particularly Indigenous Australians, payments, but I think the public hospital funding things, like bedding it down. those in aged care, the working poor, and those with chronic disease. changes will explode once people turn their The Senate will decide its future, but groups attention to the cuts. such as the AMA will help determine how the There is the example of a young woman that might The traditional public hospital funding blame game BY AMA PRESIDENT Senators view the impacts of the Budget on their present, for instance, with a breast lump. constituents – and influence how they vote. between the Commonwealth and the States – ASSOCIATE PROFESSOR If that’s investigated and the patient has follow-up which we thought may have gone away – will be BRIAN OWLER The AMA believes that the proposed changes in in pathology and radiology, the total co-payments back bigger than ever. health policy have the potential to dramatically add up to about $63 in terms of co-payments alone change the way health services are delivered in this – but even more given the loss of the diagnostic There was a commitment under the National Health country, but not necessarily for the better. imaging bulk billing incentive. And you can add Reform Agreement that the Commonwealth would The medicines on top of that. That is a lot of money for The combined impact of the GP co-payment, the fund 50 per cent of gross funding for our public traditional“ public people on low incomes or people who are elderly or hospitals. That seems to have now disappeared. Medicare rebate freeze, co-payments for pathology chronically ill. It all adds up. hospital funding and radiology, co-payments for visits to emergency And even though the Federal Government is putting blame game departments, and cuts to public hospital funding The safety net is a limit of 10 co-payments for more money into public hospitals, to fund a growth will hit the most vulnerable patients and place people with concessions and people under 16 rate of CPI plus population is certainly well below between the enormous pressure on the capacity of our public years of age. the growth rate in the budgets for health for the hospitals. Commonwealth But there are many people that fall outside of that states, which is usually around 6 or 7 per cent. The Government’s measures will have an alarming safety net, particularly those with chronic disease. and the States It means that the states will have a shortfall. impact across the health system and they indicate And so even a total of ten $7 co-payments, $70, for – which we a massive shift in the universality of healthcare. some people, particularly if there are a number of It’s going to affect front-line clinical services. It’s people in the family, is prohibitively expensive. thought may There has been a lot of focus on GP co-payments, going to affect the training of our young doctors have gone away but people need to realise that it’s not just about There is no doubt that the co-payment will be a that are coming through to be the GPs and other that. big problem for patients in aged care and for the specialists that we need to maintain the sort of – will be back doctors who treat them. standards of health and quality of health care that The AMA is not against co-payments, in principle. we’ve all come to know and enjoy. bigger than ever But we are against the co-payment model the There are red tape issues for medical practices, Government has adopted. There are insufficient too. I do not think the Government has grasped the The AMA will be doing what it can to get changes protections, and there is a cumulative effect. extent of the impact of these co-payments across to these policies. ” COMMENT
5 SECRETARY GENERAL’S REPORT National Conference a timely celebration of the AMA
The AMA National Conference was held over challenges in medical practice. Dr Margaret the adoption of a new AMA Constitution at the the last weekend of May in Canberra with the Mungherera, President of the World Medical Annual General Meeting by an overwhelming theme Global Practice: Australian Perspective. Association and a practising psychiatrist, majority of members and to acclamation of the brought home the reality of access to medical meeting. This significant step forward in the As the Conference followed soon after the services for many in the world when she pointed governance of the AMA provides the opportunity BY AMA SECRETARY Federal Budget, there was plenty of opportunity out that in her home country of Uganda there is for more effective processes to develop strategy GENERAL ANNE TRIMMER for delegates to discuss the impact of the one psychiatrist to every million people! and policy, with greater engagement with Budget during one of the plenary sessions. members. More on this to come. Amid the serious work of the Conference, The debate on the Budget and its impacts This there was also much to celebrate, including On the last morning of the Conference there followed presentations by both Helath Minister the admission of three distinguished members was a very challenging plenary session on significant“ step Peter Dutton and Shadow Health Minister - Dr Alex Markwell, Dr Stephen Parnis, and Dr the demands of caring for those who serve Catherine King. Delegates had a plethora of forward in the Stephen Wilson - to the AMA Roll of Fellows. in combat. The military theme ran through questions to put to the speakers. governance of At the Conference dinner the rarely-awarded the Conference with Dr Brendan Nelson, now Following the official opening by outgoing AMA AMA Gold Medal was presented to Dr Mukesh Director of the Australian War Memorial, as the the AMA provides President Dr Steve Hambleton, the keynote Haikerwal for his outstanding services to the entertaining guest speaker at the Leadership the opportunity address was delivered by the United States medical profession and to the community. Dr Development Dinner. Ambassador to Australia, John Barry, who Hambleton presented the President’s Award to for more effective The Conference concluded with the election provided an entertaining overview of the US the family of Dr Bernard Quin, a Victorian doctor of the President and Vice President which processes to Government’s strategies to address global and who paid for his devotion to his patients with took place under the new Constitution. The domestic health challenges. his life, executed by Japanese troops occupying develop strategy outcome of the voting was the election of Nauru during the Second World War. Dr Quin and policy, The Conference theme was evidenced in several Associate Professor Brian Owler as President was presented as an exemplar of all those of the plenary sessions, ranging from variation and Dr Stephen Parnis as Vice President. with greater doctors who have given their lives for their in medical practice to global health vocational With the induction of the new office bearers patients. Dr Quin’s large family attended what engagement with training. As part of this, a panel featuring and a fitting tribute to outgoing President Dr was a very moving ceremony. members medical association leaders from countries Steve Hambleton, the Conference came to an in Africa, Asia and Britain explored regional Among other highlights of the weekend were emotional but satisfying close.
” COMMENT
6 NEWS ‘Four-minute medicine’ threat to health care
The Federal Government’s $5 cut to the to re-craft the policy because of hostility Medicare rebate and associated financial in the Senate. Labor and the Greens have penalties for doctors who bulk bill could announced their outright opposition to what see the rise of ‘four-minute medicine’ they call a GP tax, and the Palmer United as doctors are forced to churn through Party, Australian Motoring Enthusiast Party, patients to stay afloat, AMA President and independent Senator Nick Xenophon Associate Professor Brian Owler has have all indicated they will not support the warned. measure in its current form. As he prepares to meet with key Senators A/Professor Owler said the AMA was not including Clive Palmer, Nick Xenophon and opposed to co-payments per se: “Many of the Australian Greens, A/Professor Owler our doctors already charge a co-payment, said Federal Budget measures including and we’ve always said that doctors should the $7 co-payment for GP, pathology and charge the fee that they feel is appropriate remarks were encouraging. debate on the $7 co-payment for GP radiology services, disincentives for bulk for their services”. services meant that so far other equally billing, emergency department charges “The AMA is willing to work with the But he said the AMA was concerned concerning changes had been largely and cuts to public hospital funding would Government to come up with better that, in its current form, the co-payment overlooked, including the $5 cut to Medicare have an “alarming” effect on the health solutions,” he said. “We note the Prime proposal did not include adequate rebates, the decision to withhold low-gap system and amounted to a massive shift in Minister’s comments…about being open protections for the most vulnerable incentive payments for doctors who continue the universality of health care. patients – the aged, those with chronic to some refinements of the policy, and I to bulk bill, the inclusion of pathology and In a promising sign that the Government disease, Indigenous Australians and hope that’s a signal that there is some diagnostic imaging services in co-payment is prepared to consider changes to what people with mental illness – did not room to make the changes that protect arrangements and a further extension in the Prime Minister Tony Abbott admitted provide sufficient support for preventive those most vulnerable in society, but also freeze on Medicare rebates. was “perhaps the most difficult policy health measures such as vaccinations, make sure that doctors, particularly in He warned that the multiplier effect of change in this Budget, the Prime Minister and threatened the viability of many diagnostic imaging – where the viability of the co-payments could leave patients indicated his willingness to accept medical practices. some practices may be affected by these substantially out-of-pocket, while doctors “refinements” to the co-payment measure proposals – is able to be considered, and A/Professor Owler said the AMA was keen who decided to continue bulk billing their to secure its passage through the Senate. appropriate changes made.” to talk with the Government about possible patients would have to absorb a big hit to The Government is under political pressure changes, adding that Mr Abbott’s recent A/Professor Owler said the focus of public their income.
MORE P8 7 INFORMATION FOR MEMBERS NEWS ‘Four-minute medicine’ Statutory Review of threat to health care ... FROM P7 the Personal Property
He cited the example of young woman who saw off,” A/Professor Owler told the Sydney Morning Securities Act her GP about a lump in her breast, and was then Herald. “The only way they could do it would be referred on for pathology and diagnostic tests. A/ to see more patients. Instead of doing six-minute The Personal Property Securities Register (PPSR) is the register where details of security interests in personal Professor Owler said such a patient could be up medicine, they’ll go to four-minute medicine. property (not real estate) can be registered and searched. A for $63 in co-payments for just that one episode That’s not something we want to see happening.” of care. supplier of personal property can register their interest on the The AMA President said there was a lot of scope PPS Register to protect their right to repossess property if the He added that doctors who bulk billed faced a to make the policy better, and the Association customer fails to make appropriate payments. This can affect cut of up to $13 for each consultation – the $5 was working with key stakeholders, including in businesses that lease equipment, for example, including rebate cut, the foregone $2 contribution from the pathology and diagnostic imaging, about how it medical practices. co-payment and the loss of the low-gap incentive could be improved in a way that supported the – warning this could have ramifications for care. The main legislation governing the PPSR is the Personal viability of practices and protected the vulnerable Property Securities Act 2009 (the Act). The Government is The AMA has voiced concerns that, through its while still retaining a co-payment. now undertaking a review of the Act, to consider its operation co-payment policy, the Federal Government was He lamented that this was the work that the and effects. The review will pay particular attention to the effectively forcing doctors to implement social Government should have undertaken developing experience of small businesses. policy by making them choose who they should continue to bulk bill. the proposal before the Budget. An interim report is due by 31 July 2014 with “There are a number of things that we need to recommendations on priority actions for the Government A/Professor Owler said doctors working in to consider, focussing on issues raised in relation to small work through, and the disappointing thing about disadvantaged areas were likely to come under businesses. The final report is due on 30 January 2015 and this proposal that has clearly come out of Treasury particular pressure from their patients to continue is expected to make recommendations on how to improve the and Finance without reference to health policy,” A/ to bulk bill, confronting them with some difficult Act. decisions to make about the provision of care. Professor Owler said. “The AMA is now doing the policy work, which really should have been done The AMA encourages members affected by the PPSR and the “If a large proportion of their patients can’t afford [by the Government] way in advance before this Act to provide comments by email at [email protected]. to pay the co-payment, then those practices Budget announcement was made. Initial submissions relevant to small business are sought by 6 might still be bulk billing, but it will be the GP that June 2014, with other submissions open until 25 July 2014. bears the cost, and who will be financially worse Adrian Rollins Full details are available at the Attorney General’s COMMENT website.
8 NEWS Public hospitals face funding crunch
Hard-won improvements in the departments within the four-hour target, performance of public hospitals have been according to National Health Performance put at risk by the Federal Government’s Authority figures released late last month. shock decision to walk away from State The Authority reported that among the funding guarantees and slash the growth nation’s best performing major metropolitan rate of future funding, effectively ripping hospitals, 80 per cent of patients departed billions of dollars out of the system, the emergency departments within four hours AMA has warned. between October and December last year, coming through, but also the increased is no replacement in sight,” he said. “[In As figures were released showing a fall a 10 percentage point jump from the same acuity of the patients that are actually addition], there has been a significant in elective surgery waiting times in New period in 2011. presenting to our emergency departments.” reduction in funding guaranteed for public hospital services in the National Health South Wales hospitals and an improvement Even among the worst performing major The AMA President said the improvements Reform Agreement. This means that there in emergency department performance metropolitan hospitals, there was a 16 were down to the efforts of hospital staff is no certainty that hospitals will be able to nationwide, AMA President Associate percentage point improvement to 51 per as well as investments made through the maintain capacity to reach the four-hour Professor Brian Owler cautioned the gains cent over the same period. National Partnership Agreement. might prove to be temporary given the target of 90 per cent by 2015.” Government’s cuts to hospital funding. “[This was] an impressive improvement in “These improvements are a direct result the face of an increase of almost 57,000 of the specific funding that was provided Adding to concerns is the possibility that In the Budget, the Commonwealth patient presentations at major metropolitan by the Commonwealth to the State and patients seeking to dodge the $7 Medicare disavowed public hospital funding hospitals over this period,” the Authority Territory governments to increase the co-payment will instead turn up at public guarantees made under the National said. capacity of public hospitals, [and] reflect hospitals for treatment. Health Reform Agreement and reduced the efforts of dedicated and hardworking In NSW, the Bureau of Health Information “We all have fears that patients, instead of the indexation of post-2017 funding to doctors and nurses working around the reported that 99 per cent of elective seeing their general practitioners, but also CPI plus population growth, changes the clock in our emergency departments and surgery was conducted on time in the last [those] accessing pathology and diagnostic AMA estimated would strip $20 billion from in other areas of the hospitals that need quarter of 2013, up from 93 per cent in the imaging services, will default to our public the public hospital system in the next five to work efficiently to allow patients to be same period in 2010. hospital system,” A/Professor Owler said. years. admitted from emergency” he said. “We “Our public hospital system is also taking “We’re pleased that there has been an need to build on these improvements.” A/Professor Owler said the cuts a cut under this Budget, and it’s going improvement in elective surgery and endangered hard-won improvements in the But A/Professor Owler warned the Federal to be ill-equipped to be able to deal with emergency department performance performance of public hospitals. Government’s hospital funding changes put any increase in demand that might be in these figures,” A/Professor Owler. “It these gains at risk. provided by the GP, diagnostic imaging and There has been a substantial increase in does show the hard work that doctors pathology co-payment.” the number of patients being seen and and nurses are doing in our emergency “The Improving Public Hospital Services
cleared from public hospital emergency departments to treat the numbers of people agreement has now ceased, and there Adrian Rollins COMMENT 9 NEWS reduced appeal of general practice as a Doctor training a career” the Government’s plan “Planned reforms to general practice “poses serious risks to general financing may also discourage practices casualty of short- from employing registrars,” it added. practice training including: loss Taken together, UGPA said, the changes of general practice education “pose a significant risk to the viability expertise for the delivery of term Budget fix of the general practice profession and access to quality care for all Australians”. training; disengagement of supervisors; the withdrawal The viability of the general practice these decisions to double the Practice The peak group said the Health profession has been jeopardised by the Incentive Program Teaching Payment Department had no experience in of teaching practices and the Federal Government’s sweeping changes for general practice instruction to $200 facilitating general practice training, and reduced appeal of general to medical training, the specialty’s peak for each three-hour session, and lift the the decision to put training programs out body has warned. number of GP training places from 1200 to tender risked making price, rather than practice as a career quality, the overriding consideration – with The decision to axe specialist training to 1500 next year. implications for patient care. ” agencies and absorb them within the But the peak group United General Health Department, combined with cuts to Chair of the AMA Council of Doctors Practice Australia, which includes the Medicine, Dr Churchill wrote that “these valuable programs and fears of massive in Training, Dr James Churchill, AMA, the Royal Australian College of decisions reek of short sighted cost hikes in student fees, has fuelled concerns said there was a risk that workforce General Practitioners, the Australian shifting”. the medical training system, already General Practice Network, General planning expertise would be lost, and under pressure, will prove increasingly Practice Registrars Australia, the the momentum recently gained around He warned of the prospect that medical inadequate, placing the profession at Australian College of Rural and Remote improving the planning and coordination degrees may soon cost hundreds long-term risk. Medicine and the Rural Doctors of medical training – including through of thousands of dollars as fees are the establishment of the National Medical deregulated and universities seek to cope In its Budget, the Federal Government Association of Australia have warned Training Advisory Network – would be with an average 20 per cent cut in federal abolished General Practice Education and the changes risk compromising the dissipated. funding for places. Training (GPET) and the Prevocational profession. General Practice Placements Program In a joint statement, UGPA declared that Dr Churchill said the decision to axe He and Australian Medical Students’ (PGPPP) while axing funding to the “the Government’s plan poses serious the PGPPP, which had provided up to Association President Jessica Dean said Confederation of Postgraduate Medical risks to general practice training including: 975 places for junior doctors to gain the changes risked discouraging students Education Councils and absorbing Health experience in general practice, could loss of general practice education from rural areas and lower socioeconomic Workforce Australia and GPET within the put hundreds of prevocational places in expertise for the delivery of training; backgrounds from embarking on a Health Department. jeopardy. disengagement of supervisors; the medical career. It redirected some of the savings from withdrawal of teaching practices and the In a column in this edition of Australian Adrian Rollins
COMMENT 10 should not be further barriers placed in front of people NEWS AMA IN THE NEWS regarding immunisation. No secrets in health overhaul, Adelaide Advertiser, 20 May Your AMA has been active on policy and in the media on a range of issues crucial to making 2014 our health system better. Below is a snapshot of recent media coverage. Australians would be automatically signed up to an e-health record and have to opt-out if they wanted to keep private details about abortions and mental health issues Print/Online to see a doctor are set to be blocked in the Senate. Former under changes to the PCEHR program. Former AMA Vice AMA President Dr Steve Hambleton said if there will be a President Professor Geoffrey Dobb said if it was left to Anger and praise for budget moves, Sunday Herald Sun, seven dollar charge and if there is extra staff to handle the individuals to put information in the records, it is less likely 11 May 2014 billing, GPs may decide that to stay in business they need they would be relied upon by health professionals on the to charge more. Australians face the end of free bulk-billed visits to the GP front line of care. in the Federal Budget with the introduction of a new $7 Sneaky health fund rise, Herald Sun, 15 May 2014 co-payment. Former AMA President Dr Steve Hambleton Heavy impact on vulnerable, The Australian, 14 May 2014 said the move could reduce GP visits by up to 120 million Almost half a million health fund members will lose up Pensioners, welfare groups, and doctors have attacked the to $1500 in government health fund tax rebates under consultations. Federal Budget’s impact on the most vulnerable. Former a sneaky move in the Budget. Former AMA President Dr AMA Vice President Professor Geoffrey Dobb said access Steve Hambleton warned the fairness of Australia’s health Call to lift drinking age to 21, The Daily Telegraph, 13 May to quality primary care would be more difficult for many system would be destroyed by new charges announced in 2014 Australians. the Budget for doctors, medical tests, and prescriptions. Health experts are pushing for a rise in the minimum $7 doc fee bloopers, Courier Mail, 22 May 2014 drinking age from 18 to 21, saying it will stop young Dutton tells GPs to use windfall to help the needy, The men from getting into alcohol-fuelled punch-ups and car Australian, 16 May 2014 Embarrassing bloopers by Prime Minister Tony Abbot and crashes. Health Minister Peter Dutton said we need to make sure Treasurer Joe Hockey reveal they don’t understand who will be forced to pay their controversial new $7 GP fee. The Medical changes savaged, Herald Sun, 14 May 2014 that free services are provided to the small number of people who can’t afford to provide for themselves. AMA AMA accused Mr Hockey of also getting it wrong when he Changes to Australia’s health system will cause chronic President Associate Professor Brian Owler expressed said the chronically ill would not be hit by the fee. pain for Australia’s most sick and force all to wait longer concerns about the burden placed on patients who were in hospital queues. Former AMA Vice President Professor not included in the safety net. Alarm as thousands of children unvaccinated, Adelaide Geoffrey Dobb said the chronically ill, the elderly, and low Advertiser, 22 May 2014 income families would suffer. $7 children vaccinations, Sunday Mail Adelaide, 18 May Almost three thousand South African children are going 2014 unvaccinated because their parents wrongly believe that Bulk objection to seven dollar injection, Courier Mail, 15 The Abbot Government will not make any exemption on the immunisation is bad. The AMA supports education, rather May 2014 $7 co-payment for parents who vaccinate their children. than the withholding of benefits, for parents who refuse to The Abbott Government’s plans to slug patients $7 more Former AMA President Dr Steve Hambleton said there vaccinate their children.
MORE P12 11 defended the need for the harsh Budget Doctors warn $7 GP impost risks children’s NEWS measures. immunisation, Age, 27 May 2014 Charging parents a $7 fee could deter AMA IN THE NEWS Anti-tobacco crusade a winner, Hobart them from taking their children to the Mercury, 24 May 2014 doctor for routine immunisations. AMA ... FROM P11 Tasmania has been named joint winner of President Associate Professor Brian Owler a national anti-smoking award because said we don’t want to see barriers put up No co-payment yet buy some patients stripes. That is why the importance of of the state’s comprehensive bans on to immunisation programs. already skipping visits to doctor, Sydney the conciliatory tone of outgoing AMA smoking in public spaces. Former AMA Morning Herald, 23 May 2014 President Dr Steve Hambleton on the President Dr Steve Hambleton said Meet healthcare’s new guardian, $7 medical co-payment should not be Patients in poorer areas are already the ACT and Tasmanian Governments Australian Financial Review, 29 May 2014 underestimated. cancelling visits to the doctor in response had both shown strong commitment to New AMA President Associate Professor to the $7 Medicare co-payment. Former tobacco control. Parents jabbed in the wallet, Adelaide Brian Owler said the AMA aims to AMA President Dr Steve Hambleton said Advertiser, 24 May 2014 maintain a healthy dialogue with the the reports, while isolated, were a concern. AMA’s no to co-payment plan, Sunday Abbott Government. Associate Professor Parents who rethink their opposition Canberra Times, 25 May 2014 Owler said the AMA would always take Confusion reigns says AMA, Canberra to vaccination are being slugged up to Doctors in the AMA have voted to oppose the most appropriate course of action. Times, 23 May 2014 $1400 to get their children immunised the co-payment system as laid out in this because of no longer free access. AMA Outrage as anti-vaccine zealots claim it Doctors are unhappy about the bulk month’s Federal Budget, which outgoing Chair of General Practice Dr Brian Morton causes SIDS, Sunday Telegraph, 1 June billing changes announced in the AMA President Dr Steve Hambleton said Budget, warning there could be perverse said he sees no reason why it should not 2014 be given late in life for free. was ‘game changing’ for public hospitals. outcomes. Former AMA President Dr The Ant Vaccinations Sceptic Network Steve Hambleton said the $7 co-payment D’oh! Doctors label Homer’s favourite drop has been caught out claiming a link was causing confusion and some patients Envoy’s call for collaboration, Weekend dangerous, Sunday Canberra Times, 25 between immunisation and sudden infant believed it was already in effect. Australian, 24 May 2014 May 2014 death syndrome (SIDS). AMA President US Ambassador John Berry told Associate Professor Brian Owler said it Less red tape over GP scrips, The yesterday’s AMA National Conference in Former AMA President Dr Steve was appalling to link vaccines to a serious Australian, 23 May 2014 Canberra that Australians had already Hambleton has labelled plans by child health issue. Health Minister Peter Dutton attended made a remarkable advances in medical Woolworths to stock Duff beer in their the AMA National Conference with a science. BWS and Dan Murphy’s stores as AMA boss warns of ‘four-minute medicine’, commitment to reduce red tape for dangerous and increasing the social Age, 2 June 2014 Patients care plan faces overhaul, acceptability of alcohol misuse. doctors, as the controversy over planned Doctors could be forced to churn co-payments continues. Weekend West, 24 May 2014 New AMA president to battle $7 GP fee, through patients more quickly in order to The Federal Government is looking absorb cuts to their income linked to the Royal Australian Colleges of GPs criticises Canberra Times, 26 May 2014 at revamping Medicare payments to proposed GP co-payment. AMA President co-payment system, Australian Financial doctors for treating patients suffering New AMA President Associate Professor Associate Professor Brian Owler doctors Review, 24 May 2014 chronic conditions such as diabetes and Brian Owler has indicated no let-up in the in disadvantaged areas would face The words white coat lobby can strike asthma. In a speech to the AMA National fight against the seven dollar budget co- pressure from their patients to continue fear into the hearts of politicians of all Conference, Health Minister Peter Dutton payment for GP visits and medical tests. bulk-billing. MORE P13 12 Dr Steve Hambleton, 666 ABC Canberra, 12 and the GP co-payment. Dr Hambleton NEWS May 2014 said the aim is to make the population healthier, but the rebates mean many Former AMA President Dr Steve AMA IN THE NEWS areas of healthcare will be unable to bulk- Hambleton discussed the possible impact of the Government’s plan to introduce bill. ... FROM P12 GP co-payments. Dr Hambleton holds Dr Steve Hambleton, ABC NewsRadio, 16 concerns for low income earners, May 2014 Web drug scripts get high-risk warning, Fears those too poor for GP will swamp Aboriginal people and Torres Strait Canberra Times, 3 June 2014 hospitals, Sydney Morning Herald, 6 June Islanders, and those with mental illness. Former AMA President Dr Steve 2014 Online prescription services are Hambleton discussed the proposed GP undermining GP and pharmacy standards Hospital emergency departments are A/Prof Brian Owler, 5AA Adelaide, 13 May co-payment. Dr Hambleton said the AMA 2014 and can put patients at risk. AMA Chair experiencing more and more pressure is concerned about the impact on low of General Practice Dr Brian Morton from seriously ill patients. AMA President AMA President A/Prof Brian Owler talked income earners. said a patient’s death could be a trigger Associate Professor Brian Owler said about the Federal Budget. A/Prof Owler Dr Steve Hambleton, 612 ABC Brisbane, 22 to strictly regulate online prescription the payment could turn hospitals into said that the GP co-payment is going to May 2014 services. a default for people needing medical affect everyone. treatment and testing. Former AMA President Dr Steve Hambleton Co-payment threat to docs, Australian Professor Geoffrey Dobb, 2UE Sydney, 13 discussed the Medicare co-payment. Dr Financial Review, 3 June 2014 May 2014 Hambleton agreed with Dutton that people Radio Former AMA Vice President Professor need to maximise the time they spend with AMA President Associate Professor Brian Geoffrey Dobb discussed the $20 billion GPs and value the health service, but the Owler said doctors aren’t against a co- Dr Steve Hambleton, 3AW Melbourne, 7 Medical Research Future Fund. Professor idea that people are getting unnecessary payment but the specific proposal in the May 2014 Dobb said this is good news for medical health service is not correct. budget creates big problems for many Former AMA President Dr Steve Hambleton research in Australia and is a very doctors, particularly those with practices discussed the importance of exercise and forward-looking initiative. A/Prof Brian Owler, 4BC Brisbane, 26 May with overwhelming numbers of bulk-billed a good diet to avoid cholesterol-related 2014 patients or patients with chronic diseases. problems, workers compensation, and a Professor Geoffrey Dobb, 2GB Sydney, 13 AMA President A/Prof Brian Owler shift away from sick-notes. May 2014 talked about the AMAs fight against Hospitals miss targets, Sydney Morning Former AMA Vice President Geoffrey Dobb GP co-payments. A/Prof Owler said Herald, 5 June 2014 Dr Steve Hambleton, 2CC Canberra, 8 May explains who will pay the $7 co-payment protections are needed for those with More than a third of patients in five of 2014 announced in the Federal Budget and the chronic illnesses and those with financial Sydney’s major hospitals are failing to be Former AMA President Dr Steve AMA’s opposition to the extra cost being struggles. treated in emergency departments within Hambleton talked about doctors no longer applied in emergency departments. A/Prof Owler, 2UE Sydney, 26 May 2014 four hours. AMA President Associate giving out sick notes but rather notes Dr Steve Hambleton, 702 ABC Sydney, 14 Professor Brian Owler said he suspected that say what a person can or cannot do. AMA President A/Prof Brian Owler May 2014 the removal of federal incentives to meet Dr Hambleton said that with issues like discussed alcohol advertising during sport targets would only reduce the likelihood of influenza people should not go to work, Former AMA President Dr Steve and Australia’s problem with alcohol- hospitals meeting their benchmarks. because the disease will spread. Hambleton discussed the Federal Budget related violence.
13 MORE P14 lead to fragmentation of care as people Former AMA President Dr Steve NEWS will visit the doctor less. Hambleton talked about the confusion of the Medicare co-payment already causing AMA IN THE NEWS A/Prof Brian Owler, 5AA Adelaide, 3 June a drop in appointments. Dr Hambleton 2014 said the co-payment will change patient’s behaviour. ... FROM P13 AMA President Associate Professor Brian Owler discussed the impact the proposed A/Prof Owler, 2GB Sydney, 26 May 2014 the Medicare rebate. Dr Steve Hambleton, ABC News 24, 25 May $7 Co-payment would have on GPs as 2014 AMA President Associate Professor Brian well as vulnerable patients. A/Prof Brian Owler, 774 ABC Melbourne, 2 Owler talked about the Federal Budget, Former AMA President Dr Steve June 2014 particularly the GP co-payment. A/Prof Hambleton talked about the AMAs Owler said we need to make sure there is AMA President Associate Professor Brian TV decision to oppose the Federal Government’s proposed GP co-payment. a proper safety net for those who cannot Owler talked about the GP co-payment. Dr Hambleton said the AMA National afford the co-payments. A/Prof Owler said the Medicare rebate is Dr Steve Hambleton, Channel 7 Perth, 9 Conference has called on the Federal also going down by $5 under the scheme May 2014 Council to engage with the government on Dr Stephen Parnis, 774 ABC Melbourne, 26 and medical practices cannot survive Former AMA President Dr Steve this issue. May 2014 bulk-billing under the scheme unless they Hambleton discussed a patient taking reduce the amount of time they spend AMA Vice President Dr Stephen Parnis medicinal marijuana to help treat her A/Prof Brian Owler, ABC1 Brisbane, 25 May with patients talked about the deregulation of university illnesses. Dr Hambleton said medical 2014 fees. Dr Parnis said medical graduates research and clinical trials need to be A/Prof Brian Owler, 702 ABC Sydney, 3 AMA President Associate Professor Brian with five hundred thousand dollars in debt conducted to determine the long term June 2014 Owler talked about the GP co-payment. will discourage a lot of people that would side effects of the drug. A/Prof Owler said AMA members do not make good doctors from going into the AMA President Associate Professor Brian necessarily oppose a GP co-payment, field. Owler talked about a leading British Dr Steve Hambleton, ABC1 Peth, 20 May but they are worried about the vulnerable neurosurgeon has claiming cyclists who 2014 people in society. A/Prof Brian Owler, 702 ABC Sydney, 27 wear helmets are wasting their time. A/ Doctors and patients are increasing May 2014 Prof Owler said helmets save lives and their campaign against the Treasurer’s A/Prof Brian Owler, Sky News, 2 June 2014 prevent head injuries. AMA President Associate Professor Brian proposed $7 Medicare co-payment. AMA President Associate Professor Brian Owler discussed referrals to specialists Former AMA President Dr Steve Dr Brian Morton, 6PR Perth, 3 June 2014 Owler talked about the GP co-payment on after seeing a GP. Associate Professor Hambleton said under the proposals, there Sky News. Associate Professor Owler said Owler said the GP is the corner stone of AMA Chair of General Practice Dr will be a co-payment for everyone. the problem with this proposal is there are the health system and GP’s referrals last Brian Morton talked about the risks of inadequate protections in place for the for 12 months after which the patient will purchasing prescription drugs online. Dr Dr Steve Hambleton, ABC News 24, 22 May most vulnerable in society such as those need a new referral to be able to claim Morton said there is a concern that it will 2014 with chronic diseases.
COMMENT 14 NEWS Your AMA Federal Council at work
What AMA Federal Councillors and other AMA Members have been doing to advance your interests in the past month
Name Position on council Activity/Meeting Date
Dr Richard Whiting AMA Representative for ACSQHC WA consultation workshop on the draft National Consensus Statement on End-of- 6/5/2014 Physicians Life Care in Acute Hospitals
Professor David AMA Representative for ACSQHC WA consultation workshop on the draft National Consensus Statement on End-of- 9/4/2014 Mountain Emergency Physicians Life Care in Acute Hospitals
Dr Robyn Langham AMA Representative for Victoria Medicines Australia Code of Conduct Review Panel 9/4/2014
Dr Brian Morton AMA Chair of General Practice RACGP (Royal Australian College of GP’s) OPTIMIST (Open Primary care Technology that is 9/4/2014 Interoperable Meaningful Useable and Safe) Meeting
Dr David Rowed AMA Member RACGP (Royal Australian College of GP’s) OPTIMIST (Open Primary care Technology that is 9/4/2014 Interoperable Meaningful Useable and Safe) Meeting
Dr Ian Pryor AMA Member MSAC (Medical Services Advisory Committee) Review Working Group for Paediatric Surgery 8/4/2014
Dr Steve Hambleton Former AMA President Panel member The George Institute for Global Health World Health Day forum 2/4/2014
Meeting with Chair of the Medical Board of Australia and CEO of AHPRA 1/4/2014
PPFASD (Parliamentarians for the Prevention of FASD Foetal alcohol spectrum disorder) 26/3/2014
Presentation to Australian Private Hospitals Association National Congress on expanding the 24/3/2014 contribution of the private health sector
Spoke at International Primary Health Care Reform Conference on driving quality primary care 19/3/2014
Dr Iain Dunlop AMA Chair of Federal Council Health Technology Assessment Consultative Committee 1/4/2014
Professor Geoff Former AMA Vice President IHPA Stakeholder Advisory Committee 11/3/2014 Dobb
15
GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
AMA National Conference special report
Held just a week after the Federal policy sessions featuring world-class Budget, it was inevitable that pressing speakers talking on issues including concerns about the Medicare co- the prevalence and prevention of non- payment, public hospital funding communicable diseases, the challenges cutbacks and other controversial faced by medical practitioners in different Government measures would figure large countries, the development of vocational in the deliberations of the AMA National training in global health, variations in Conference. medical practice and caring for those who have served the country overseas. On its first day, 23 May, the Conference – staged at the National Convention The Conference also made several Centre, Canberra – heard directly from decisions fundamental to the direction and operation of the AMA, including the the Government about the reasoning election of a new President and Vice underpinning the Budget when Health President and the adoption of a new Minister Peter Dutton delivered an Constitution. address, followed by his political opponent, Shadow Health Minister And it was an occasion to recognise the Catherine King. Many issues surrounding achievements and contributions of AMA the Budget were canvassed during a members and organisations through dedicated policy session the following numerous awards, as well as rare day. opportunity for the far-flung AMA family to get together. But the three-day Conference was about much more than just the Budget. To view videos and photos of conference proceedings, visit: ama.com.au/ Under the overarching theme ‘Global nationalconference practice: Australian perspectives’, 17 the conference encompassed five Adrian Rollins GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Key events/issues
calling on the Government to re-work its Federal Budget - the debate co-payment plans to include adequate protection for vulnerable patients, enable Medicare co-payment - doctors and members’ practices, but we doctors to waive the co-payment in also make sure that we protect the most exceptional circumstances without penalty, the politics vulnerable in society. and to cover the costs for practices The AMA is pushing for urgent talks with “That sort of detail and issues for patients of collecting and tracking patient co- payments. the Federal Government to overhaul its haven’t really been thought through in the controversial plans for a co-payment current proposal. In a major speech to the Conference, Mr for GP, pathology and radiology services “The Minister has indicated his willingness Dutton argued that the co-payment was a amid concerns the policy will hurt the to talk about these issues, and I hope, vital part of the Government’s strategy to disadvantaged and increase the burden on particularly for…the most vulnerable in rein in health spending growth and make it doctors. society, that we can get the outcome we sustainable. need.” ‘Government has heeded warnings of unsustainable In one of his first statements as newly- “The Government has heeded warnings health spending growth’ Health Minister Peter Dutton about unsustainable expenditure growth,” elected AMA President, Associate Professor The Abbott Government’s first Budget, the Minister said. “We are taking a realistic, The Government has presented it as a way Brian Owler, said that although the AMA particularly its proposal for a $7 co- long-term view…aimed at making real to discourage unnecessary visits to the GP, was not opposed to patient co-payments, payment for GP visits and out of hospital change to set our health system on a sure and has tried to back political opponents the Government’s current plan was flawed pathology and diagnostic imaging services, path.” into a corner by directing the $3.5 billion to and he was keen to discuss changes with was the subject of extensive discussion at be saved by cutting the Medicare rebate by the Government. the AMA National Conference, including There has been much confusion and $5 into the unheralded Medical Research contributions from Health Minster Dutton, uncertainty about the co-payment. “The current proposal has come from a Future Fund. his Opposition counterpart Catherine King, very economic angle, and I think some of Medical practices have reported patients health economist Professor Elizabeth But the strategy has muddied the waters the assumptions and the reasoning behind cancelling appointments because of the Geelhoed, AMA Council of General Practice around whether the co-payment’s primary it is a bit skewed,” A/Professor Owler told mistaken impression the co-payment Chair Dr Brian Morton and numerous purpose is to improve the efficiency of the Australian Financial Review. “What we had already come into effect, while the Conference delegates. primary health spending or redirect funding need to do is to work with the Government fundamental purpose of the policy has from primary health into medical research. to make sure that we not only protect our The Conference passed a resolution remained unclear. 18 MORE P19 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
But the Government has so far failed to and independent Senators. Medicare co-payment - convince many that its co-payment is the Shadow Health Minister Catherine King told
... FROM P3 FROM P18 right policy prescription. The politics the AMA Conference the Labor Party was United General Practice Australia, implacably opposed to the $7 co-payment. In their post-Budget speeches, Prime which comprises seven peak medical “[The co-payment] is a solution based on a Minister Tony Abbott and Mr Dutton have organisations including the AMA, the Royal problem that does not exist,” Ms King said. emphasised the importance of sending a Australian College of General Practitioners, ‘price signal’ to patients about the cost of the Australian General Practice Network “Australia does not have a higher level of health care. and the Rural Doctors Association of GP consultations than the OECD average Australia, said the co-payment as devised and, with an ageing population, increasing Mr Abbott, who admitted the Medicare co- rates of obesity, diabetes and heart payment was “perhaps the most difficult in the Budget needed to be overhauled. disease, policymakers should be focusing policy change in this Budget”, said it UGPA said the $5 cut to the Medicare on measures that keep the population was nonetheless an important measure rebate exacerbated the financial pressure healthy and out of hospital.” because it sent a “necessary price signal, on GPs and, combined with the co- because visits to the doctor might be free payment, made it harder for vulnerable The Greens have committed to opposing to most patients, but they certainly haven’t people to see a doctor. the co-payment, as has Palmer United been free to the taxpayers of this country”. Party head Clive Palmer, who told the Shadow Health Minister Catherine King: Co-payment a Health economist Professor Elizabeth ABC his party’s Senators would “definitely ‘solution based on a problem that does not exist’. Mr Dutton told the AMA Conference the Geelhoed, of the School of Population oppose the co-payment.” last month that the Government would not aim was to discourage bulk billing, which Health at the University of Western back down from the co-payment, but was had spread to the extent that even the Australia, said the co-payment was flawed “You imagine being a pensioner and open to compromise. He said Mr Palmer better off received free care. both in terms of equity and efficiency. earning $300 a week and you’re 87 and you’ve got to go to the doctor four or five had the opportunity to talk through his “Bulk billing was intended to be for patients In particular, it would discourage those times a week,” Mr Palmer said. “That takes concerns with the Government. who could not afford to pay a full fee,” the who needed medical care the most from up one-third of your income because of the Minister said. “It was not intended to be seeking treatment, adding to the nation’s “The first option [for Mr Palmer] is the co-payment. I care about Australians and a drawcard to attract patients from one health bill in the longer term, she said. Greens option, which is to block everything I’m not going to back down.” practice to another. and negotiate on nothing, essentially to The united front of the three parties means be an obstructionist,” the Minister said. “That is why the Government is introducing Senate opposition passage of the co-payment will be virtually “The second model is ... somebody who the [co-payment]. It represents a balance The proposed co-payment may struggle impossible unless the Government is able is willing to add to or improve in their eyes between introducing a price signal and to see the light of day in the face of strong to negotiate a deal. the policy that’s before them.” maintaining access for people who need opposition and criticism in the Senate from care.” Labor, the Greens, the Palmer United Party Mr Dutton told the National Press Club late Adrian Rollins
COMMENT 19 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Medicare co-payment - the economics The co-payment and bulk and children younger than 16 years. After billing 10 visits, their Medicare rebate will be reinstated to its former level. The Federal Government has framed the $7 co-payment for GP, pathology and Mr Dutton said it was reasonable to radiology services as a savings measure ask patients “to take more personal necessitated by what it considers to be responsibility for their health, through unsustainable growth in health expenditure. modest contributions to the cost of their care”, and made it clear that the current Health Minister Peter Dutton said that high rate of bulk billing (around 82 per in the past 10 years spending on the cent) was in the Government’s sights. Medicare Benefits Schedule had increased by 130 per cent and, if left unchecked, the “Bulk billing was intended to be for cost of Medicare would double in the next patients who could not afford to pay a full decade, while spending on public hospitals fee. It was not intended to be a drawcard would surge 150 per cent. to attract patients from one practice to another,” he said. Confronted with these facts, Mr Dutton said, “no-one could deny that action had to Co-payments will not be mandatory, giving be taken. This Government has heeded the doctors the scope to continue to bulk National Conference delegates queue up to have their say on the Budget changes warnings about unsustainable expenditure bill their patients but, Mr Dutton warned, growth”. the Government made “no secret that The health of vulnerable patients will suffer consultations, fewer nursing home visits, we encourage GPs to ask the patient Part of its response has been to impose a and doctors will be left out-of–pocket increased diagnostic testing and more for a contribution, and we incentivise $7 co-payment – comprising a $5 cut in under the Federal Government’s Medicare prescriptions. accordingly”. the Medicare rebate and $2 payment to co-payment plan, the AMA National Health economist Professor Elizabeth doctors – which is expected to save $3.5 Just how punitive these incentives are was Conference was told. Geelhoed, of the School of Population Health billion over five years. detailed by Dr Morton in his presentation to the Conference. In a sobering assessment of the likely at the University of Western Australia, told It means the rebate for the most common effect of the Government’s co-payment the Conference the short-term savings from Medicare item, a Level B consultation, will Dr Morton said doctors who waived the co- policy, Chair of the AMA Council of General the co-payment would eventually prove be cut from $36.30 to $31.30. To soften payment and continued to bulk bill some or Practice Dr Brian Morton warned it could costly because those who most needed the blow for the most vulnerable, the co- all of their patients would find themselves end up costing the health system more by medical care would be among the least payment will apply to just the first 10 visits up to 34 per cent out of pocket for each causing less bulk billing, even briefer GP likely to seek it because of cost. each year by concession card holders service.
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Medicare co-payment - Unintended consequences Central to the co-payment is the market
... FROM P3 FROM P20 the economics economy assumption that as the cost of a service goes up, demand will slow. Services provided without a co-payment did not count toward the 10-visit threshold But Professor Geelhoed said this was for concession card patients and children, based on a bad misreading of the structure making it in the doctor’s interest to impose of Australia’s health system and the nature the $7 charge. of health care, and how different it was from a market-based system. “Of course, there are times where the patient just can’t pay,” Dr Morton said. In a market, prices are set by supply and “GPs will still have the discretion in such demand, whereas in the health system cases to waive the co-payment. The kicker they are heavily influenced by Government, is that every time a GP does so, they will she said. Furthermore, in market models of the economy, demand is driven by want, take a loss [of $5 or 14 per cent for non- whereas in health it is driven by need. And concession adults and up to 34 per cent the market approach assumes perfect ‘Doctors will have to think carefully about who they bulk bill’: AMA Council of General Practice Chair, for children and concession card patients]. information, whereas in health practitioners Dr Brian Morton “If this sting is not enough of a deterrent, have much greater knowledge than Dr Morton warned the policy could have a or ordering just one test, a doctor might patients. remember the service won’t count lot of unintended consequences. instead order several at once to minimise towards the 10-service threshold,” he Professor Geelhoed said that although it The Sydney GP cited the example of a the cost to their patient. said. “Habitual waiving of the co-payment was unclear how patients would respond to patient on Warfarin who switched from will ensure the patient never reaches the He also raised concerns about whether it the co-payment, it was already known that monthly to quarterly visits because of the would discourage parents, especially from threshold, and will see the GP absorbing the less wealthy saw their doctor less often co-payment. He said the treating doctor lower socioeconomic areas, to defer or a loss of between 14 and 34 per cent for and ended up in hospital more frequently, might need to consider putting the patient every service.” partly as a consequence of leading riskier onto a longer acting but much more forego vaccinations and other preventive health measures. Dr Morton said this meant doctors would and less healthy lifestyles. expensive anticoagulant as a result. have to think very carefully about which The co-payment was likely to exacerbate Dr Morton said the pathology and radiology Dr Morton said the consequences of patients they would bulk bill, and under these trends, undermining the efficiency co-payments could also distort decision such changes in the way medical care is what circumstances. and equity of the health system, she said. making around diagnostic tests. Instead accessed and provided would not be good.
MORE P22 21 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
administrative burden,” Dr Morton said. Medicare co-payment - “Each payment system will have its
the economics ... FROM P3 FROM P21 own set of reports and reconciliations. Outstanding payments and bad debts will “If patients become more discretionary have to be managed.” with their GP visits – as the Government is banking on them doing – what will the Where to from here? implications for patient health be? AMA President Associate Professor Brian “I can tell you. There will be increased Owler has indicated the Association is keen suffering, enhanced morbidity, [and] to talk with the Government about how lengthier recovery times. It could also turn the co-payment should be overhauled to a preventable or treatable prognosis into a provide greater protection for vulnerable complex, chronic or terminal one.” patients such as the aged, Indigenous, children and those with mental illness. He said the co-payment would likely increase the incentive for doctors to Dr Morton warned that, flawed though shorten consultation times and increase the co-payment policy was, the medical the temptation to increase the reliance on profession should think carefully about medicines as a quick fix to get one patient whether it would be wise to reject it out the door and another one in. outright. National Conference delegates deliberate on the Federal Budget As unpalatable as the Medicare rebate cut Practical considerations they reach the 10-visit threshold. real time is going to be problematic.” was, it was unlikely to be undone, and, Added to this were practical issues primary “Government alternatives for cost control health providers would have to take into “Many practices who submit patient claims He added that practices which bulk billed could be far worse”. account in implementing the co-payment, don’t so in real time – they batch the their patients would need to overhaul Professor Geelhoed said consumers put a including reviewing billing policies, claims and send them at the end of the their billing practices and provide multiple greater value on services they had to pay informing patients about the co-payment, day, every couple of days, [or] at the end payment options, increasing overheads. for, so co-payment “in some guise may be reconsidering the timing and frequency of of the week,” Dr Morton said. “Identifying part of an eventual reform solution”. lodging rebate claims, and tracking child when a concession card holder or under “These will not only add to business and concession patients to measure when 16 has reached the 10-service threshold in expense, but also the practice’s Adrian Rollins
COMMENT
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GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
But Health Minister Peter Dutton told the AMA National Conference that much of the commentary on the Budget Hospital funding becomes mired decision was “dead wrong”. “We are not reducing funding for public hospitals,” Mr in blame game once more Dutton said, pointing out that the Commonwealth’s contribution would grow by 9 per cent a year in the next The Abbott Government’s “unconscionable” decision to expenditure], and in what appears to be a very brutal way three years before scaling back to 6.5 per cent annual slash future contributions to public hospital funding has for the states and territories,” the former AMA President growth from 2017. reignited the wasteful Federal-State blame game and will said. cut treatment to thousands of patients, the AMA National “What we will not be doing, unlike the previous Conference was told. No more hospital funding guarantees Government, is providing open-ended funding guarantees for inefficient and unrestrained growth,” he said. In one of his last speeches as AMA President Dr Steve In the Budget, the Federal Government disavowed public Hambleton lamented that the Commonwealth’s Budget hospital funding guarantees made under the National “Hospitals,” Mr Dutton said, “are the responsibility of the decision to walk away from hospital funding guarantees Health Reform Agreement 2011 and scaled back states and territories”. to the states and change the indexation of future indexation of its contributions from mid-2017 to the New AMA President Associate Professor Brian Owler contributions had delivered a major set-back to efforts to consumer price index and population growth rather than said that although Mr Dutton was correct to say the end the political tug of war over public hospital financing the efficient growth dividend. and would lead to much fewer additional hospital beds Commonwealth’s contribution to public hospitals was AMA analysis shows that the combined effect of these than had been planned. increasing, “it’s a reduction from the funding that they measures will be to strip $20 billion from public hospitals agreed to put into the health system under the National Dr Hambleton said that during his five years as AMA over the next five years. Health Reform Agreement”. Vice President and then President, policy over public At an emergency meeting held in the aftermath of hospital funding had gone virtually full circle, from the A/Professor Owler, a neurosurgeon at the Children’s the Budget, all State and Territory leaders (except WA familiar Commonwealth-State stand-off to “an attempt Premier Colin Barnett) declared that the Commonwealth’s Hospital at Westmead, Sydney, told the Australian Financial to implement the AMA plan for a single funder…to an unilateral termination of hospital funding agreements was Review that “it’s one thing to say it’s the states’ problem unconscionable abrogation of responsibility to the public unacceptable, and warned that, as a result, funding for and push it back to the states, but at the end of the day it hospital sector”. 1200 extra hospital beds would be axed and there would is about patients, their health care, and if the states don’t “The Commonwealth Government has used a very blunt be an annual $300 million a year cut in concessions for have the ability to fund it, then front line medical services instrument to deal with [forecasts of growth in hospital pensioners and seniors. are going to suffer”.
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24 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Hospital funding becomes mired in blame
game once more ... FROM P3 FROM P24
Dr Hambleton said the Commonwealth’s decision had derailed hopes for a concerted national effort on health reform, and instead the country would be plunged into yet another debate on tax transfers and the adequacy of the GST. “The battles over public hospital funding appear to be never ending,” he said. “The nation cannot afford for public hospitals to be used as pawns in political battles over sovereignty and reform of the Federation. [They] need certainty of funding arrangements to plan for and deliver services.”
Emergency department access As part of its plans to introduce a Medicare co-payment, the Federal Government has relaxed rules to allow public hospital emergency departments to charge a co- payment for patients presenting with ‘GP-like’ health complaints – a measure deemed necessary to prevent patients trying to dodging the GP co-payment from clogging public hospitals EDs. But Newly-elected AMA Vice President and emergency physician Dr Stephen Parnis said there were serious practical and ethical issues around implementing such a charge. “In emergency departments, we treat people according to medical need,” Dr Parnis said. “We would hate to see people not seek emergency treatment when they needed it.” He said the idea of trying to assess patients for the seriousness of their conditions when they arrived at emergency departments would be too hard to implement: “The only way you can really assess whether or not someone is an emergency case is once you have treated them”. Adrian Rollins COMMENT
25 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
The Review will look at the criteria used development, but we need to keep the Medicine calls finally get answered in assessing whether or not access pressure on [the Department] to allocate to a medicine should be subject to proper resources to the phone line service,” authorisation, as well as examining all Professor Dobb said. The widely-loathed PBS Authority February this year were answered within current Authority Required listings. Prescription system is to be reviewed as part 30 seconds, with 16 per cent of callers Mr Dutton said he expected the review of Federal Government efforts to cut down forced to wait two minutes or longer to The Review will be conducted in tranches, to result in savings of more than $7 on red tape, potentially saving doctors and speak with a clerk. with those medicines subject to most million a year, with a significant number of authority requests to be assessed first. medicines removed from the Authority list. patients thousands of hours wasted waiting In its submission to a systematic review of for telephone calls to be answered. authority listed medicines being conducted This group of medicines includes cancer He said the review would be undertaken Health Minister Peter Dutton revealed by the Pharmaceutical Benefits Advisory treatments, as well as multiple sclerosis in consultation with the AMA, the Royal at the AMA National Conference that he Committee, the AMA said doctors spent the and arthritis drugs, and the results of the Australian College of General Practitioners, the Society of Hospital Pharmacists, had initiated a review of the Authority equivalent of 25,000 patient consultations assessment will be presented to a PBAC Medicines Australia and other groups. Prescription scheme following AMA calls each year waiting for their calls to the meeting in November. Authority free call service to be answered. that the system be streamlined. Treatments for psychiatric, cardiovascular The terms of reference for the review will be finalised by the PBAC at its meeting But the Minister knocked back the AMA’s The AMA said the pointlessness of the and eye conditions will be included in the next month. suggestion that the system be scrapped system was underlined by the fact that only second tranche, which will be considered altogether, arguing that “there are occasions 2.8 per cent of calls to the service did not at a PBAC meeting in March next year. The draft terms of reference can be viewed at: when the Authority system is important result in prescription authorisation. The final tranche of medicines, which will http://www.pbs.gov.au/info/reviews/ to ensure that patients are only given “Allowing patients to get the medicines include drugs used in palliative care, will be authority-required-listings medicines that are safe and appropriate”. they need as quickly as possible is an considered in July next year. In a further move to cut the administrative There are currently 447 PBS-listed absolute priority for the Government,” Mr Former Chair of the AMA Therapeutics burden on doctors, Mr Dutton told the medicines that can only be prescribed with Dutton told the AMA National Conference, Committee, Professor Geoffrey Dobb, said AMA National Conference that from early the specific approval of the Department of adding that “we are also committed to reducing unnecessary red tape and last month that the Department’s efforts to 2016 five of the 10 current PIP Incentives Human Services. paperwork for health professionals when push more medicines onto the streamlined would be collapsed into a single measure Doctors complain that they regularly they prescribe medicines”. Authority list (which means doctors do not centred on continuing quality improvement experience lengthy delays waiting for calls need to get prior Department authorisation in general practice. The Government said the review would to the Authority Prescription line to be but just include the relevant four-digit code “We will continue to work with the AMA “build on the PBAC’s consideration answered. on the prescription) was welcome, but and others to finalise details of the new of a submission from the AMA that more needed to be done. incentive and improvements to PIP,” the Recently-released Department of Health recommended the movement of a number Minister added. figures show that only half of all calls to of medicines from Authority Required to “Moving more medicines into streamlined
the service between October last year and Authority Required (Streamlined)”. approval arrangements is an encouraging Adrian Rollins COMMENT 26 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
risks a decision being made on price, clinically appropriate to do so, or to stop General practice put in jeopardy rather than quality and the long-term inappropriate admissions,” Mr Dutton said. interests of the patients.” The decision draws heavily on the by training changes The group said GP training must be recommendations of the Horvath review profession-led and apprenticeship-based, of the Medicare Locals system, which and accreditation must remain with The Federal Government has been told “These investments will allow more found the network established by the specialist medical colleges. its move to scrap GP training agencies medical graduates to pursue careers in previous Labor Government had delivered and programs risks undermining access general practice, and more doctors to The criticism, combined with widespread inconsistent and unsatisfactory outcomes. to quality care and puts the viability of the practice in areas of greater patient need,” discontent over the introduction of a The AMA has long expressed profession in jeopardy. Health Minister Peter Dutton told the AMA Medicare co-payment, suggests the Government faces a formidable task in dissatisfaction with the Medicare Locals In a strong response to the abolition of National Conference. soothing medical profession concerns. system, and an AMA survey of doctors General Practice Education and Training But United General Practice Australia found that many felt Medicare Locals were and the end of the Prevocational General Mr Dutton attempted to go part of the way (UGPA), which includes the AMA, the Royal of little relevance, provided limited support Practice Placements Scheme, the nation’s at the AMA National Conference, where he Australian College of General Practitioners, and, on occasion, operated in competition peak general practice groups, including the the Australian General Practice Network, put some flesh on the Government’s plans with existing medical services. AMA, have issued a joint warning that the General Practice Registrars Australia, the to abolish Medicare Locals and replace decision “poses serious risks to general Rural Doctors Association of Australia and them with Primary Health Networks (PHNs). In its submission to the Horvath Review late practice training”. several other groups, said the changes The Minister said that from July next year 61 last year, the AMA recommended reforms “The plan, including very short would undermine GP training and called for Medicare Locals would be replaced with a that focused on moving to a network of implementation time frames, poses a urgent talks with the Government. smaller, but not-yet specified, number of PHNs. primary health-controlled organisations significant risk to the viability of the general that were led by, and responsive to, GPs; UGPA said they would reduce the appeal of “Absolutely essential to their future and their practice profession and access to quality general practice as a career, result in the success is that they need to engage properly that focused on supporting GPs in caring care for all Australians,” the groups said in loss of GP education expertise and deter with general practice and have GPs at the for patients, working collaboratively with the joint statement. practices from employing registrars and centre of the model,” Mr Dutton said. other health care professionals; were not In its Budget, the Federal Government offering training. overburdened by excessive paperwork The Minister said PHNs would “better announced savings from the abolition and policy prescription; were focused on It was particularly concerned about the match” local hospital network boundaries of GPET and Health Workforce Australia decision to fold the functions of GPET [of which there are 123], and would have addressing service gaps, not replicating would help fund an extra 300 GP training within the Department of Health. well-defined roles. existing services; and were better aligned places, a doubling of the PIP payment for with Local Hospital Networks, with a strong three-hour GP training sessions to $200, “The [Department] has no experience in “They will not be direct providers of emphasis on improving the coordination $300,000 infrastructure grants for up to facilitating general practice training,” UGPA services, but will link up services to meet between primary care and hospitals. 175 general practices and $35 million for said. “The decision to put the general community needs and keep people out the GP Rural Incentive Program. practice training program out to tender of hospital - either in the first instance, if Adrian Rollins COMMENT 27 INFORMATION FOR MEMBERS
EXPRESSIONS OF INTEREST MEMBERSHIP OF THE ADVISORY COMMITTEE ON MEDICINES SCHEDULING (ACMS) AND THE ADVISORY COMMITTEE ON CHEMCIALS SCHEDULING (ACCS)
Medicines and chemicals scheduling is a classification system that • clinical pharmacology controls how substances will be made available to the public. Medicines • pharmacy medicines and chemicals are grouped into Schedules that require similar regulatory controls over availability to protect public health (e.g. Schedule 4 – • medical practice medicines only available on prescription; Schedule 5 – substances • consumer health issues relating to the regulation of therapeutic goods requiring appropriate labelling and packaging). • industry issues relating to the regulation of therapeutic goods. The Department of Health is seeking expressions of interest from experts interested in contributing to the work of the national scheduling For the ACCS, applicants should have expertise in at least one of the framework via membership on the Advisory Committee on Medicines following fields: Scheduling (ACMS) or the Advisory Committee on Chemicals Scheduling • regulation of scheduled chemicals in Australia (ACCS). • veterinary medicines or veterinary pathology ACMS and ACCS • industrial or domestic chemicals ACMS and ACCS are statutory expert advisory committees under the Therapeutic Goods Act 1989. They are responsible for providing advice to • agricultural or veterinary chemicals the Secretary of the Department of Health on the level of access required • clinical aspects of human poisoning for medicines and chemicals. • occupational health issues, particularly as a medical practitioner To be considered for a position on either of these committees, applicants should have expertise in an area relevant to the assessment of • consumer health issues relating to the regulation of chemicals. substances that warrant restricted access. Remuneration and travel will be determined by the Remuneration Specifically for the ACMS, applicants should have expertise in at least one Tribunal. of the following fields: Further information on these positions and to receive an EOI • regulation of scheduled medicines in Australia application pack, email [email protected]. • toxicology or pharmacology EOI are due to the department by 22 June 2014. 28 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
past AMA Victoria President, was elected as Vice President, prevailing in a three- Key events/issues way contest with former AMA Queensland President Dr Richard Kidd and former Chair of the AMA Federal Council Dr Roderick AMA changes leadership McRae. The position of AMA President became vacant following the decision of incumbent Dr Steve Hambleton to step down following a gruelling three-year term during which he was at the forefront of national debate on health policy while simultaneously steering the Federal AMA through a period of internal upheaval. A/Professor Owler is a driving force and the face of New South Wales’ ‘Don’t Rush’ anti-speeding campaign, and he appears on billboards and in television ads warning of the risks and damage associated with road accidents. He has also been a prominent campaigner for stronger laws to minimise alcohol- related violence, and greater community profession had been maintained and education about the health harms caused enhanced. by alcohol abuse. Sydney neurosurgeon Associate Professor the endorsement of his colleagues in In his acceptance speech, A/Professor In particular, he said, Dr Hambleton had Brian Owler has been installed as the a contest with long-standing AMA Vice Owler paid tribute to Dr Hambleton and given the AMA a calm, effective and AMA’s 23rd Federal President following President Professor Geoffrey Dobb for the Professor Dobb, who he said had together persuasive voice on the national stage elections held at the AMA National position. provided strong and effective leadership during a politically turbulent period while at Conference. In a wholesale changing of the guard at for the AMA and ensured its national pre- the same time managing the organisation A/Professor Owler, immediate-past the head of the organisation, emergency eminence in national debates on health through a difficult period when it was President of AMA New South Wales, won physician Dr Stephen Parnis, immediate- policy and issues affecting the medical without a Secretary General. 29 MORE P30 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
AMA change’s leadership ... FROM P3 FROM P29
Associate Professor Brian Owler at the AMA National Conference Dr Stephen Parnis received congratulations upon his election as AMA Vice President
“The last three years have not been easy for Steve,” A/ the successful Scrap the Cap campaign, the Federal Dr Parnis, who has in the past campaigned vigorously Professor Owler said. “There were times that he really election, the e-health review and – most recently – the on emergency access targets in hospitals and improving kept the AMA going, [but] from the outside you would Queensland public hospital dispute, where his ability to work conditions for hospital doctors, told the Conference never guess the difficulties we had.” build consensus and thrash out a solution acceptable to he was honoured and humbled to have been elected AMA all was outstanding. Vice President. While spending countless hours ensuring the AMA continued to operate smoothly, Dr Hambleton at the A/Prof Owler said Professor Dobb had been an excellent “The office itself is not the issue, it is what you can same time ensured the medical profession’s views on an Vice President and support for Dr Hambleton throughout achieve in that role,” Dr Parnis said. “I ask you to watch enormous range of medical and health policy issues were his presidency. very closely over the next couple of years, because I heard loudly and clearly, the new AMA President said. intend to give this job everything I have got. I promise “The hardest thing about the [AMA President] election the new President my utter support, loyalty and good A/Professor Owler told the Conference Dr Hambleton’s we have been through is that I admire Geoffrey and counsel.” third year in office was a stand-out for the quality and respect Geoffrey as much as anyone,” the AMA President Both men have been elected to a two-year term. breadth of his advocacy and work in advancing the said. “His contribution in the past few years has been interests of patients and doctors, including through enormous.” Adrian Rollins 30 COMMENT GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
INFORMATION FOR MEMBERS National Conference endorses constitutional change Free tool to track registration requirements The AMA Federal Council has been representative from each of AMA NSW, relieved of administrative and governance AMA Western Australia, AMA South The AMA has developed a free online • Store all certificates of completion; tool to help doctors to keep track of responsibilities and freed up to concentrate Australia, AMA ACT, AMA Victoria, AMA • Keep a log of practice-based on formulating policy under changes to the Queensland, AMA Tasmania and AMA the information they need to meet the reflective activities, including AMA Constitution endorsed by the AMA Northern Territory, and a nominee from the Medical Board of Australia’s annual clinical audits, peer reviews and National Conference. Doctors-in-Training Special Interest Group. continuing professional development perfomance appraisals; and (CPD) requirements. The Conference gave overwhelming The Board is directed under the • Log hours spent on online learning, support to the changes, which AMA Constitution to take account of, and Each September, practitioners, reading journals, teaching and Secretary General Anne Trimmer has said promulgate, the medico-political policy when renewing their Medical Board other activities. will advance the twin objectives of the AMA: decisions of the Federal Council. registration, may be required to to protect and advanced member interests, The system keeps a tally of hours, At a meeting immediately following the provide evidence they have complied and to influence health policy and debate. enabling practitioners to keep track of National Conference, an interim executive with the Board’s CPD requirements. what needs to be completed before The Constitutional changes have been of the Federal Council comprising A/ The AMA CPD Tracker has been the end of the registration year. the subject of lengthy discussion within Professor Owler, Dr Parnis, former developed to enable doctors to the AMA, and seek to modernise the Treasurer Dr Elizabeth Feeney, former The Tracker has been developed progressively gather and organise the governance of the organisation and lay the Chairman of Council Dr Iain Dunlop and two taking full account of the information needed to substantiate groundwork for a more efficient structure. Federal Council nominees was appointed requirements set out in the Medical to carry out the functions of the Board of declarations made to the Board about Board’s Continuing Professional Under the changes, responsibility for Directors until its first meeting, due in the CPD, so that evidence can be quickly Development Registration Standard. overseeing the day-to-day administrative next couple of months. and easily produced on demand. and governance functions of the The service is free to AMA members. organisation have been invested in a Board A/Professor Owler told the Conference The AMA CPD Tracker can be used to: Non-members can subscribe for an annual fee of $250. of Directors. the changes would “liberate the Federal • List courses completed, including Council to be the policy making body it The Board comprises the AMA President the organisation that accredited To register for the product, please should be”. Associate Professor Brian Owler and the CPD activity; sign up here. Vice President Dr Stephen Parnis, a Adrian Rollins COMMENT 31 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
years ago,” Dr Hambleton said. underestimated the AMA. Keynote speeches “The reform agenda of the Government “Our cause was the right one – and we poses significant risks and challenges for won. This was a truly great moment for the Medicare and the health system – and AMA, and I was proud to be a part of it.” we are talking about the very structure of The AMA a voice of judgement and reason on health The AMA’s influence was obvious on other Medicare - our universal health system.” health lobby, the Association was listened issues as well, including its concerns to carefully by Government, and had The former President said the changes also about Medicare Locals and GP Super a responsibility to be a voice of sound included opportunities for the profession, Clinics – both programs which have been judgement and reason on issues affecting but to make the most of these the AMA abandoned by the Abbott Government – both the medical profession and the health would have to continue to be an active and the need to overhaul the Personally of the broader community. and constructive contributor to policy Controlled Electronic Health Record system, discussions. which has been reviewed. “Others look to us for leadership and example,” Dr Hambleton said. “It is vital – “Our message [has been] that everybody Dr Hambleton paid tribute to his colleagues in politics has to get smarter about health always – for the AMA to be in a position for their support and good counsel during policy, especially about how we spend his three years as AMA President and two where its views are heard and seriously health funding. years as Vice President. considered by the Government of the day. “It was going pretty well until Budget night. He gave particular recognition to immediate “If we oppose something, we must explain People just got very dumb all of a sudden.” past AMA Vice President Professor Geoffrey why, and offer a better alternative. If we are Dobb, his predecessor as President, Dr going to tear something down, we need to Dr Hambleton backed his call for Andrew Pesce, current AMA Secretary Dr Steve Hambleton gives his last speech as propose something better to go in its place. constructive engagement by citing AMA President General Anne Trimmer and her predecessor significant recent successes in AMA “That is advocacy. That is engagement. Francis Sullivan, AMA Executive Officers advocacy, including the Scrap the Cap This is part of the way we influence the Dr Liz Feeney, Dr Iain Dunlop, Associate Former AMA President Dr Steve Hambleton campaign that saw the proposed $2000 Government.” Professor Brian Owler and Dr Stephen has urged the Association to remain limit on tax deductions for self-education Parnis, the AMA Federal Council, the AMA a strong, intelligent, principled and The former President said the AMA’s skills expenses scrapped by the incoming Secretariat, as well as his wife Deb and constructive voice for health reform in the of persuasion had never been of greater Coalition Government, and the resolution of their children. face of Federal Government changes that importance than now, given the scale of the Queensland public hospital contracts pose “significant risks” to Medicare and the the Abbott Government’s plans to transform dispute. “It is a great honour to be AMA President,” health system. the health system. he said. “It is not easy. There are many “This was genuine trench warfare,” he challenges but, if we stand together, we In his final speech as President, Dr “It is change that is possibly more radical said. “The Queensland Government was can achieve many things.” Hambleton told the AMA National and far-reaching than the Rudd reforms that determined to not take a backward step. Conference that, as the nation’s leading I confronted when elected Vice President five They underestimated the profession. They Adrian Rollins COMMENT 32 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
relationship further. death rates between 1990 and 2012. Keynote speeches “I told him that ‘It’ would be a damn silly Ambassador Berry said the US and reason to abandon something that might Australia were also partners in what was turn out to be true love, and true love it was one of the most exciting and important Personal loss underlines call for end of disease – for nearly 10 years,” Ambassador Berry research projects yet – understanding the said. “But, in 1996, this horrible disease human brain. had shrunk my six-foot-two, 200-pound athlete partner to less than 100 pounds. In Brain research has become a major June of that year, he died in my arms. focus of the Obama Administration – last year, President Barack Obama launched “Thankfully, the world responded to the the BRAIN Initiative to investigate brain terrible ‘It’ of 1985 – the disease we function, and has backed it with $300 know as AIDS. As a result of passionate engagement and research, new drugs have million in 2014 and 2015 alone. given hope – and life – to millions.” “The President hopes that we can Ambassador Berry said HIV remained one eventually map the brain as we did with the of the world’s biggest killers, but deaths human genome,” Ambassador Berry said. from AIDS were down 30 per cent from Like the human genome project, the BRAIN 2005, and he urged governments around Initiative is conceived as a transnational the world, including Australia and the US, effort, and Ambassador Berry said he to do more and commit to an AIDS-free was excited by the opportunities for generation. collaboration between US and Australian Aiming for an AIDs free generation: US Ambassador to Australia, John Berry He said the international effort against neuroscientists, who he said were at the AIDS, and programs such as the Global forefront of work in the field. United States Ambassador to Australia together to improve health and beat Fund, vaccination campaigns and John Berry recalled the anguish of seeing disease, Ambassador Berry said all global transnational medical research efforts “Your first-class research facilities like the his partner waste away with AIDs in a health challenges were also “personal”. showed what could be accomplished when Queensland Brain Institute and Melbourne deeply personal and powerful speech to Brain Centre are not just cutting edge, but In a moving illustration, he recounted how, nations worked together. the AMA National Conference. are ‘leading edge’ in worldwide efforts to in 1985, on just their second date, his The Ambassador cited as an example child tackle these challenges,” he said. Issuing a call for governments and partner revealed he had AIDS and said he and maternal health programs that had communities around the world to work understood if he did not want to take the helped halve child mortality and maternal Adrian Rollins COMMENT 33 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Policy sessions Variation in medical practice: are Australians getting world-class health care?
Speakers: were more than seven times as likely to undergo cardiac catheterisation as those Professor Anne Duggan, Senior Medical living in other areas, while the variation was Adviser, Australian Commission on Safety up to 11-fold for knee arthroscopy and four and Quality in Health Care times for hip replacements. Dr Rob Grenfell, Director of Cardiovascular Health, Heart Foundation The findings, part of a joint Commission/ Australian Institute of Health and Welfare Professor Michael Buist, Chair of Health report (see http://www.safetyandquality. Services, School of Medicine, University of gov.au/publications/exploring-healthcare- Professor Michael Buist highlights the human cost of co-payments Tasmania variation-in-australia/), were echoed in data were not given the medication they needed system to monitor the outcome of common presented to the conference by the Heart when they were discharged, and there treatments. Revelations of major discrepancies in Foundation’s Director of Cardiovascular were inconsistent care plans. In a forthright presentation to the the treatment provided to patients with Health, Dr Rob Grenfell. similar conditions but living in different “I often comment that the correct term Conference, Chair of Health Services at the areas formed the backdrop for a detailed Dr Grenfell said figures provided by for patients should in fact be punters,” Dr University of Tasmania, Professor Michael discussion of variation in medical practice Victorian hospitals showed that up to Grenfell told the Conference. “I would be Buist, highlighted the prevalence of at the AMA National Conference. a third of patients who had suffered worried about family members with heart preventable human error in clinical care. a myocardial infarction needed to be failure as to what care they may receive.” Senior Medical Adviser to the Australian He cited a 1999 study showing that 11 per readmitted to hospital. Commission on Safety and Quality in Such evidence has raised concerns about cent of patients died because of the failure Health Care, Professor Anne Duggan, told While the tendency of patients to stop how health care is delivered, including of hospital staff to attend, while other the Conference that an investigation into taking their medication after a couple of equity of access to care, the extent to fatalities were attributed to an inability to medical practice variation in Australia had years was part of the problem, research which advances in treatment are adapted following procedure, absentmindedness, found patients in some areas of the country also showed that a significant proportion and adopted, as well as the lack of a “cognitive failure” and other shortcomings.
34 MORE P35 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Variation in medical practice: are Australians getting world-class health care? ... FROM P3 FROM P34
‘Patients should be called punters’: Dr Rob Grenfell ‘The art of medicine is to deal with uncertainty’: Dr Stephen Parnis Wide national variation in medical practice: Professor Anne Duggan
Professor Buist said clinicians needed to look at patients as people, while hospital quality Dr Parnis said that “dealing with unwarranted variation in practise can set the course for and safety units needed to engage with clinicians, particularly junior doctors and nurses. cost containment and improving safety and quality”. Professor Duggan said that while “not all” variation in treatment was problematic, and Dr Grenfell said there needed to be better and more accurate data collection regarding in fact could be due to differences in population, patient preferences and practise treatment and outcomes, including tracking readmissions. innovation, there were obviously many instances where it was unwarranted and signalled He said the focus of reform also had to change. possible problems including inappropriate care, safety and quality issues or inadequate resources. “We have had a financial reform agenda [in health], not a clinical reform agenda. We need a focus on actual clinical improvement, empowering clinicians and, hopefully, AMA Vice President Dr Stephen Parnis, who chaired the session, said the practice of patients to drive change,” Dr Grenfell said. medicine was often fraught with uncertainty, and part of the “art of medicine is to use one’s professional training, skills and experience to deal with that uncertainty”. Adrian Rollins COMMENT
35 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Policy sessions The global challenge of non-communicable diseases
Speakers: Professor Rob Moodie and Associate Professor Harry Minas, along with Professor Rob Moodie, Professor of Public Health Advocacy Institute Director Public Health, Melbourne School of Professor Mike Daube warned that Population Health rapid industrialisation in Asia, Africa, Associate Professor Harry Minas, Global South America, the Middle East and other and Cultural Mental Health Unit, Melbourne parts of the world was bringing with it School of Population Health the unwanted scourge of lifestyle-related Professor Mike Daube, Director, Public diseases. Increasing recognition of mental health in non-communicable diseases: Professor Harry Minas Health Advocacy Institute Professor Moodie said that in the two told the Conference, alcohol consumption processed foods each year – about double decades to 2010, heart disease had in low income countries had grown at an the growth rate in high income nations. The unwillingness of governments to emerged to become the wold’s most annual rate of almost 3 per cent, compared adequately regulate tobacco and alcohol Driving the point home, Professor Moodie prevalent disease, and stroke had risen to with just 1.1 per cent in wealthy nations, and to educate people about the health revealed that in Indonesia 40 per cent be third most common, displacing killers while the discrepancy regarding tobacco risks posed by poor diet and inactivity was such as diarrhoea, respiratory infections of boys aged between 13 and 15 years use was even more marked – growing by smoked, as did almost 70 per cent of men. contributing to the rapid spread of non- and pre-term birth complications. communicable diseases to industrialising 2 per cent a year in developing countries at By comparison, among Australian men, the countries, the AMA National Conference The mounting death toll from heart attacks a time when its consumption had virtually smoking rate has dropped to around 20 was told. and strokes had been associated with rapid stagnated in the developed world. per cent. increases in the consumption of alcohol, In a policy session that set the scene Increasing affluence had also brought with Professor Moodie and Professor Daube tobacco, sugar and unhealthy fats in for ensuing discussions about aspects it unhealthy changes in diet. People in low told the Conference the consumption of developing countries. of global health, Melbourne School of income countries were guzzling an extra tobacco, alcohol, soft drinks, packaged Population Health faculty members In the 12 years to 2009, Professor Moodie 5.2 per cent of soft drink and 2 per cent of foods and other harmful products in
36 MORE P37 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
The global challenge of non-communicable diseases ... FROM P3 FROM P36
developing countries was being driven by corporations Cultural Mental Health Unit at the Melbourne School armed with massive marketing budgets and decades of of Population Health, told the Conference that until experience in pressuring policy makers and consumers recently the importance of mental health as part of the while at the same time sidelining public health initiatives. effort against NCDs had been overlooked, but that was beginning to change. Professor Daube showed just how big such promotion efforts were. He cited Nielsen research showing People with mental illness generally smoke more than that $150 billion - a quarter of all global advertising the general population, and are significantly more likely expenditure – was spent on promoting food, fast food to die from heart disease and respiratory disorders, but alcohol and tobacco last year. the scarcity of mental health specialists and a lack of political interest had meant the incidence of NCDs among Underlining what was at stake for such companies, the mentally ill had generally been overlooked, Professor in Australia alone tobacco and alcohol between them Minas said. generated around $14 billion of revenue each year,
‘Failure to prevent NCDs a political, not medical, failure’: Professor Rob Moodie Pofessor Daube said. He said the country could not afford to continue to overlook the suffering caused by NCDs among those with Professor Moodie said such companies were investing mental health problems. heavily in low income countries, attracted by the opportunities for growth unencumbered by few, if any, Professor Daube said the success of tobacco control public health measures, citing Phillip Morris’s recent $190 efforts in Australia to date provided a guide to what to do million upgrade to its manufacturing facilities in Indonesia. and what could be achieved. Advertising was just part of the armoury such companies He told the Conference that success did not come quickly brought to bear, he said. or easily, and depended on people and groups forming coalitions, fostering consensus, devising comprehensive “Failure to prevent NCDs is a political, not medical, policy prescriptions and articulating clear messages. failure,” Professor Moodie said. “Alcohol and ultra- processed food and drink industries use strategies similar Those taking on the tobacco, alcohol and fast food to the tobacco industry to undermine effective public industries needed to understand how governments health policies by biasing research findings, co-opting operated, work with media, lobby to curb industry policy makers and health professionals, lobbying against marketing and expose the tactics of opponents of regulation…[and] blatantly ignoring codes of conduct”. regulation.
Big tobacco, food, alcohol agressively grooming new markets overseas: COMMENT Professor Mike Daub Associate Professor Harry Minas, of the Global and Adrian Rollins 37 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Added to this inexperience was problem, Dr Mungherera said the WMO and medical shared by countries such as Australia, of groups within Africa were working on Policy sessions encouraging them to practise where the innovative ways to harness the skills and need was greatest. knowledge of doctors who have chosen to Practising globally: regional challenges “The biggest problem in Africa is that 95 work abroad. per cent of the population live in rural She said the WMO was working on a Speakers: workers. areas, but just 5 per cent of doctors work scheme to encourage expat African doctors in rural areas,” she said. Dr Margaret Mungherera, President, It is a similar story across Africa and, visiting home to give lectures, conduct World Medical Association indeed, much of the developing world, In an attempt to address this problem, ward rounds, undertake research or even where millions – through lack of money several governments have resorted to donate a month of their time to local Sir Sabaratnam Arulkumaran, President, and human resources – have access bonding medical students with obligations clinical practice. British Medical Association to practice in rural areas upon graduation, to only the most rudimentary of health In addition, 20 national African medical but Dr Mungherera said this was not Professor Teerachai Chantarojanasiri, services. associations were in talks about Vice President, Thailand Medical only a violation of the right of people to In a number of African countries, Dr harmonising their qualifications to make Association practice where they want, it had the effect it easier for doctors to migrate to other Mungherera said, governments were of discouraging people who might have beginning to take steps toward the creation countries within the continent, as a way to Doctors feeling hard pressed by the undertaken medical training. of national health systems, but such work retain their skills within the region. seemingly endless demand for their was still in its infancy, and faced many In addition to internal migration from the services should spare a thought for Though Thailand’s 23 medical schools train significant barriers, among them a shortage country to the city, African doctors often World Medical Association President, Dr far more doctors – 2500 a year – than of doctors and other health workers, a lack migrated overseas, lured by much better Margaret Mungherera. pay and conditions then they could expect most Africa countries, Vice President of the of hospitals and other infrastructure, and Thailand Medical Association, Professor In her native Uganda, Dr Mungherera is in their home country. the cost of medicines and other treatments. Teerachai Chantarojanasiri, said his country one of just 36 trained psychiatrists, serving Added to this brain drain, many of those One of the most pressing problems is the had a similar problem with access to care, a population of 36 million people. To even who remained in their home country moved lack of trained doctors. particularly in rural areas. begin to meet the need for their specialist out of clinical practice into non-clinical knowledge and skills, Dr Mungherera and Dr Mungherera said Africa’s medical jobs, including working for international “Although we are producing 2500 doctors her colleagues focus much of their effort workforce was very young – 90 per cent organisations which, again, offered better a year, it is still not enough,” he said. on training, research and supervision, of doctors were less than 10 years out of money than might be had in public or “Access to health care has improved but amplifying their reach by instructing health medical school. private practice. demand and supply is not equal.”
MORE P39 38 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Practising globally: regional Overseas conflicts and disasters: the
challenges ... FROM P3 FROM P38 challenge of caring for those who serve
As in Australia and Africa, most doctors graduates to the Speakers: cities and larger towns, leaving a gap in care for the large Lieutenant General Peter Leahy, former Chief of Army, proportion of Thais who continue to life in rural areas. Australian Defence Force Professor Chantarojanasiri said the country relied on an Major General Professor Jeffrey Rosenfeld, and army of 20,000 health volunteers in rural villages and immediate past ADF-Reserves Surgeon General communities to provide primary care. Commodore Duncan Wallace, Psychiatrist, ADF Centre for Medical students whose training is paid for by the Mental Health Government are obliged to work in the public health system for three years upon graduation, and students The AMA National Conference has called for better care for from well-off families often paid to train overseas, Australian Defence Force (ADF) personnel and veterans, particularly the United States, in order to avoid this including improved coordination between Government obligation, Professor Chantarojanasiri said. agencies, health services and doctors, and research to identify emerging health issues. British Medical Association President, Sir Sabaratnam High Anxiety: Commodore Duncan Wallis highlights anxiety disorders in the ADF The National Conference unanimously supported a motion Arulkumaran, said that Britain, like Australia, faced committing the AMA to develop a policy to improve the the challenge of an ageing population, which raised the health and wellbeing of Defence Force personnel and The Conference was told that, since 1999, more than prospect of increasing national health bill as the number veterans following presentations from former Chief of 45,000 members of the ADF had served overseas, with of people who required complex care for an extended Army Lieutenant General Peter Leahy, Navy psychiatrist almost half undergoing multiple deployments. period during their latter years of life expanded. Commodore Duncan Wallace and immediate past ADF- AMA President Associate Professor Brian Owler said many “The problem at the moment is the increasing proportion Reserves Surgeon General, Major General Professor had paid a heavy price for their devotion to their duty. Jeffrey Rosenfeld. of people over 65 years,” he said. “The birth rate is 2.1 “Members of our armed forces put themselves in harm’s and the replacement level is 2.6, and although we are Lieutenant General Leahy, Major General Professor way on a daily basis, facing risks to both their physical and prolonging life expectancy, we need to increase healthy Rosenfeld and Commodore Wallace spoke at the mental health,” the AMA President said. “Doctors have a life expectancy.” Conference’s Overseas Conflicts and Disasters: the proud history of caring for our servicemen and women, and challenge of caring for those who serve session, chaired by we want to improve the care they receive.” Adrian Rollins new AMA President Associate Professor Brian Owler. COMMENT MORE P40 39 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Overseas conflicts and disasters: the challenge of caring for those who serve ... FROM P3 FROM P39
particularly the prevalence of bomb blast injuries as a result common among ADF members than the broader of improvised explosive device attacks. community. “Bomb blasts are very severe injuries, the worst I have In 2010, the 12-month prevalence of all anxiety disorders seen,” he said. “The thing about these injuries is that they was 14.8 per cent in ADF members, compared with 12.6 are a triad of trauma, including the blast wave effect hat per cent among the general population. damages internal organs, the penetration of fragments from Unsurprisingly, post-traumatic stress disorder was much the bomb, and then the heat effects from the hot air blast more common among Defence personnel. The 12-month causes burns.” prevalence of PTSD among ADF members was 8.3 per Major General Professor Jeffrey Rosenfeld said advances cent, compared with 5.2 per cent in the broader population, in training, technology and resources meant many soldiers and the incidence of obsessive-compulsive disorder among survived severe injuries. ADF personnel was more than twice that of Australians in ‘Bomb blast injuries ... the worst I have seen’: Major General general. Professor Jeffrey Rosenfeld He said medic training was focused around the importance Commodore Wallace said the extent of depressive disorders Commodore Wallace told the Conference that in of providing effect care in the first five minutes following among ADF personnel was particularly marked – a 6.4 per Afghanistan alone, 40 Defence personnel were killed and trauma (referred to as ‘Platinum Five’). cent it was more than twice that in the general population. more than 260 wounded in action, including seven who He said experience in Afghanistan and Iraq had seen the suffered traumatic limb amputations and 38 cases where re-emergence of tourniquets as a life-saving tool, because The speakers told the Conference that one of the biggest traumatic brain injury was the primary diagnosis. “what is killing wounded soldiers is bleeding”. problems was getting returned Defence personnel with mental health issues to admit they had a problem and seek Lieutenant General Leahy, who is Chair of the Soldier Major General Professor Jeffrey Rosenfeld said all soldiers help. On charity, said changes in the nature of conflict and carried a tourniquet, and it had saved many lives. improvements in medical care meant that many soldiers Lieutenant General Leahy said among soldiers there was But he admitted trauma care was only part of the story. were surviving wounds that would once have proven fatal. a stigma attached to admitting they had a mental health “It is not just what happens in Afghanistan,” he said. “It is problem, and Commodore Wallace cited research showing As a consequence, he said, they were returning home clearly what happens back home [as well].” that almost 37 per cent delayed seeking help because they with much more severe injuries, including amputations, feared it would prevent them from being redeployed, 27 fractures, hearing loss, traumatic brain injuries and multiple Commodore Wallace said that, in addition to their physical per cent felt such an admission would harm their career severe wounds. wounds, many personnel suffered mental health problems prospects, 27 per cent were concerned others would treat as a result of their service. Major General Professor Jeffrey Rosenfeld detailed to them differently, and 25 per cent thought it would make the Conference just how severe these injuries could be, He said research showed anxiety disorders were more them seem weak. 40 MORE P41 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Overseas conflicts and disasters: the challenge of caring for those who serve ... FROM P3 FROM P40
In his book Exit Wounds, retired Major General John “Many doctors have and are serving in the ADF, or are part Cantwell wrote that although much had been done by the of the framework of health services put in place by the ADF ADF in recent years to address mental health and promote and the Department of Veterans’ Affairs. awareness of the problem, “much of the target audience “But things can be done better, and the AMA is keen to isn’t listening, or can’t bring themselves to admit that the message is aimed at them”. work with the ADF, the Department of Veterans’ Affairs and personnel and veterans themselves on ways to improve the Commodore Wallace said the ADF provided a range of delivery and integration of services, so that all get the care services and support, but noted the rehabilitation success they need.” rate was higher for personnel with physical injury (72 per cent return to work) as opposed to mental health problems The resolution passed by the AMA National Conference has (40 per cent). called for the development of AMA policy in a number of key areas: Lieutenant General Leahy said that for many soldiers, the transition out of the ADF was particularly difficult and • research to monitor the health of ADF personnel and problematic. veterans injured during ADF operations, to identify emerging health issues and better inform the future He said that despite improvements in recent years, there Persistant stigma about mental health among veterans: Lieutenant Peter Leahy delivery of health services; remained problems for soldiers leaving the ADF to access Department of Veterans’ Affairs services, and there was a • arrangements for seamless health care delivery to Adelaide surgeon Dr Susan Nuehas, who moved the lack of support for the families of returned servicemen and ADF personnel and veterans, including the relationship motion, said the draw-down of troops serving overseas, women during what could be a difficult transition to civilian between the Department of Veterans’ Affairs (DVA), ADF particularly in the Middle East, presented a unique life. health services and other health care providers; opportunity for the nation to get the treatment of its veterans right. Associate Professor Owler said many returned from • the development of a unique service/veteran health overseas service with multiple co-morbidities and complex identifier to improve the coordination of health care for “We have an opportunity not to repeat the mistakes of care needs, providing a challenge for carers and health ADF personnel move across to either DVA health care the past,” Dr Nuehas said. “This is a rare opportunity services. arrangements or Federal/State funded services; and in health care, and it is important that the AMA has policies formulated to ensure that veterans get clear, “The medical profession has shown an enormous • exploring the potential to expand existing non-liability comprehensive care.” commitment to the care of ADF personnel and veterans health care arrangements for veterans to a broader over many years. range of conditions beyond those currently identified. Adrian Rollins COMMENT
41 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
experienced specialists. Policy sessions One of the obstacles most commonly raised is discussions about global health training is the challenge of identifying appropriately skilled and experienced supervisors to Global health vocational training: training. oversee in situ training in resource poor countries. But, Dr Nash said, the fact that few medical colleges But Dr Georgina Phillips told the Conference this was far has its time come? included global health in their vocational training curricula from an insurmountable problem. meant that many seeking to develop a career in global Speakers: health were either frustrated or left largely to their own Dr Phillips talked of the success of the Visiting Clinical Lecturer Program she helped set up involving the Divine Associate Professor Rosemary Aldrich, Director of devices in piecing together a career path. Word University and the Modilon General Hospital in Medical Services, Calvary Mater Hospital, Newcastle Dr Suman Majumdar said a survey of medical students Madang, PNG. identified three main obstacles standing in the way of Dr Georgina Phillips, emergency physician, St Vincent’s people pursuing a career in global health – not realising She said under the program, advanced emergency Hospital, Melbourne that it was an option; family and personal choices; and medicine trainees lived at Divine Word University and Dr Suman Majumdar, infectious diseases physician, training pathways. provided academic, clinical and bedside teaching for rural Burnet Institute, Melbourne health students, as well as working alongside their PNG Dr Majumdar said that it can be daunting for doctors-in- colleagues. Dr Vincent Atua, Director, Emergency Department, training interested in global health that, which colleagues Modilon General Hospital, Madang, PNG in other specialties have a clear six-year training pathway, Dr Phillips said, where a placement lasted longer than there is nothing similar for them. three months, the VCLP was recognised as a valid site of training by the Australasian College for Emergency Medical colleges have been put on notice that years of Associate Professor Rosemary Aldrich had a similar Medicine. neglect of global health in vocational training has to end, experience, albeit at a later stage in her medical career. as increasing numbers of doctors clamour for opportunities She recounted how, when she went looking for global The Conference heard a first-hand account from Modilon to train and work in the speciality. health training opportunities, she drew a blank. General Hospital Emergency Department Director Dr Vincent Atua about what the Program had meant for his Global Ideas Forum founder Dr Lloyd Nash, who chaired A/Professor Aldrich, who is part of a group of liked- hospital and patients. the session, said increasing awareness of, and exposure minded doctors who have developed a draft Global Health to, yawning inequities in health care around the world was Practice Curriculum that is being considered by the Royal Dr Atua said the arrangement had resulted in “huge driving demand among medical students, junior doctors Australasian College of Physicians, said that at the time improvements” in the delivery of emergency care, including and even well-established practitioners for global health there was a gap in global health training opportunities for a much better organisational culture.
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INFORMATION FOR MEMBERS Global health vocational training:
has its time come? ... FROM P3 FROM P42 AMA Careers Advisory Service From graduates preparing their first resume to experienced doctors seeking to carve out a An important spin off, he said, was the development of a new career path in the Commonwealth public service, the AMA Careers Advisory Service is Primary Trauma Care course, which had seen 500 local been on hand to provide practical advice and information. primary health care workers receive training in trauma care. Since the Service was launched in September, medical practice. Among these have been those Dr Atua said that, so far, eight local specialist emergency AMA Careers Consultant, Kathryn Morgan, has looking for non-clinical roles in Commonwealth physicians had been trained with support from physicians handled dozens of inquiries from members and State public services that take advantage of and instructors who had come to PNG under the Visiting looking for help and advice on advancing their their skills and experience. careers, both within medicine and beyond. Clinical Lecturer Program. The Service is constantly updating content on The Careers website, which is at: http:// Dr Nash said one of the biggest concerns for colleges its website, including listings of career-related careers.ama.com.au/, gives members access events being staged across the country, and uses was that they lacked the systems and expertise to provide to both general and specific careers advice and feedback from members to help add and develop the necessary personal support for trainees working in information. In addition to direct links to external resources. resource poor countries. websites and specific sources of information, the Service also offers practical advice for medical Members are encouraged to visit the website, if But he told the Conference that, rather than trying to professionals as their medical careers advance. they haven’t done so already, and we welcome develop such capacity in house, it made more sense to look feedback, which can be submitted via the online a developing partnerships with organisations like Australia The Careers Service provides information and feedback form on the website. Volunteers Abroad, which already had extensive experience support relevant to all stages of an individual’s career, from medical students looking for There will be further updates on developments arranging for the safe and effective placement of staff in assistance preparing internship applications in the Careers Service in coming months as we challenging environments. - particularly writing resumes and covering develop more ways to assist members along their Dr Suman Majumdar said a survey of medical students letters - through to doctors in training who want medical career path. to brush up their interview skills to give them a had identified If you or your colleagues would like to convene competitive edge at all-important medical college a skills workshop facilitated by Kathryn, please Adrian Rollins interviews. contact her at: COMMENT But the Service is not only there for those in the Phone: (02) 6270 5410; early stages of their medical careers. It has also 1300 884 196 (toll free) helped qualified medical professionals looking to apply their skills and expertise in jobs beyond Email: [email protected] 43 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
It said that Government should consult with reported that Dr Selcan Yüksel and Dr the AMA on any proposals to substitute Erenç Yasemin Dokudag were charged Other resolutions for the role of medical practitioners with “praising a criminal, insulting religious be rigorously assessed “to ensure the values and damaging a mosque”. Dutton in which he said he was willing to community continues to receive health care Dr Yüksel, of Istanbul Medical School’s AMA puts vaccinating contemplate an expansion in the range of to the high standards they currently enjoy Çapa Hospital, said she had to get off pharmacists on notice services pharmacists could provide. and deserve”. a minibus at Kabatas on the day of the incident because the roads had been “I don’t believe pharmacists want to be Adrian Rollins The AMA has stiffened its resistance to blocked. When she saw injured people doctors, nor retailers,” the Minister told attempts by pharmacists, nurses and other being taken to the Bezm-i Alem Valide the Australian Pharmacy Professional Sultan Mosque, she ran to their assistance, health professionals to exceed the limits Conference on 13 March. “[But] the time End persecution of acting on her “doctor’s reflexes,” according of their training and encroach on areas of is right to commence a discussion about to the Today’s Zaman report. medical practice. Turkish doctors: AMA the future of pharmacy… so I am open Dr Yüksel told the court: “There were The AMA National Conference endorsed to discussions about an agreement which The AMA has added its voice to people under the influence of tear gas, a strongly-worded motion proposed by Dr pays for tangible services and interventions international condemnation of the Turkish people who had been hit by canisters, Xavier Yu and Dr Stuart Day highlighting that will provide better patient outcomes.” Government over its decision to prosecute people who had broken limbs and people concerns that the push by several In the motion adopted by the AMA National doctors who provided emergency care bleeding. I entered the mosque to help occupational groups to expand their scope Conference, it said it was “extremely for demonstrators injured during anti- people as a doctor with training in treating of practice is happening without adequate concerned” that patient safety and quality government protests last year. trauma and general surgery. There were scrutiny and is putting patients at risk. a lot of people. If we hadn’t helped them, of care had been put at risk by the At least people died and 8000 people were many people would have died, or people The issue has leapt to national prominence expansion of roles of non-medical health injured in clashes between protestors and with broken body parts could have lost after the Pharmacy Board of Australia late practitioners into areas outside their range security forces during the demonstrations, limbs.” last year declared that it believe vaccination of expertise. which began as a rally against a proposed was within the current scope of practice park redevelopment but quickly turned Dr Dokudag said it was “an extraordinary The National Conference has called on the of pharmacists, and the Queensland into a full-blown protest against the rule of situation, like an earthquake or a flood. We AMA Federal Council to “demand that all authorised a trial under which pharmacists Prime Minister Recep Tayyip Erdogan. are being accused of praising a criminal, Health Ministers ensure that non-medical insulting religious values and damaging were given authority to administer Last month, two doctors were among more health practitioner boards enforce limits a mosque. This can’t possibly have been vaccinations. than 250 people put on trial for their role in on scope of practice to those validated by our purpose. We acted on our professional the protests. Concerns have been fuelled by remarks comprehensive assessment on education, reflexes. We were taught that it is a crime earlier this year from Health Minister Peter training and competence”. Turkish newspaper Today’s Zaman not to do what we did.”
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End persecution of Turkish medical organisations, both domestically and internationally, to publicly support the Turkish doctors and their right to
doctors: AMA ... FROM P3 FROM P44 adhere to the principles of medical ethics and medical neutrality.” The AMA National Conference unanimously passed a resolution calling on the Turkish Government to immediately “The AMA will be raising this matter with the Australian drop legal action against the doctors. Government,” Dr Hambleton said.
The call came as international medical leaders – including The resolution passed by the AMA National Conference World Medical Association (WMA) President, Dr Margaret called for the AMA to: Mungherera; British Medical Association President, Sir Sabaratnam Arulkumaran and Vice President of the Thailand • strongly advocate for the rights of doctors in Turkey to Medical Association, Professor Teerachai Chantarojanasari provide medical care to the ill, injured, and unwell in any – attended the AMA National Conference in Canberra to situation without fear of physical, professional, or legal discuss global health issues. sanctions from their government and ministries; The WMA, along with 10 international medical • publicly condemn the new laws in Turkey, which are not organisations, has raised concerns over the actions taken compatible with a democratic or just civil society, and are against the Turkish Medical Association and provisions both an infringement of citizens, and their doctors, civil contained in the new Turkish health law that criminalise emergency medical care and require routine reporting of all liberties, and grossly unethical; confidential patient information to state authorities. • immediately join with, and add its support to, other Outgoing AMA President Dr Steve Hambleton said the like-minded medical groups who have already acted on Turkish government had an obligation to respect the sacred this issue, and to encourage other medical groupings duty of physicians to care for those in need and to uphold nationally and internationally to do so; and people’s right to health care. • immediately call for the Australian Government, as a “The AMA agrees that Turkish judicial authorities should friend and ally of Turkey, to advocate that the Turkish safeguard international principles of medical neutrality government rescind these laws and end the persecution and medical ethics and ensure doctors are not sanctioned of doctors carrying out their professional duty. on the grounds of having complied with these principles,” Dr Hambleton said. “The AMA strongly encourages other Adrian Rollins
COMMENT 45 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Ian Frazer, Sir Gustav Nossal, Dr Brendan Nelson, Professor Fiona Stanley, Professor Awards Robin Warren and Professor Barry Marshall. Dr Haikerwal recognised the interests of members and patients at In explaining his decision to nominate Dr almost every level of the organisation,” Dr Haikerwal for the Gold Medal, said he had for gold medal service to Hambleton said. been at the forefront of many issues pivotal health Dr Haikerwal has long-standing to the health care system. involvement in the AMA. “He played a significant role in securing Former AMA President and prominent GP the future of medical practice during the Dr Mukesh Haikerwal has been awarded He became an AMA Victoria State the prestigious AMA Gold Medal, the Councillor in 1995, rising to be State indemnity crisis, he led the profession in Association’s highest honour, in recognition President in 2001 and, four years later, embedding the principle and practice of of his outstanding service to the medical became the Federal AMA President. informed financial consent, he highlighted the glaring deficiencies in the care of profession and the community. The Melbourne-based GP has held numerous important and demanding Indigenous Australians, and called attention In one of his last acts as AMA President, to the risks posed by the burgeoning Dr Steve Hambleton bestowed the award positions within the Association, including Chair of the Taskforce on Indigenous Health number of medical school places without on Dr Haikerwal in a ceremony at the AMA accompanying provision for the capacity of National Conference Gala Dinner. and the Committee on the Care of Older People, as well as serving on the General the training pathway,” Dr Hambleton said. Dr Hambleton told the dinner Dr Haikerwal Dr Mukesh Haikerwal receives the AMA Gold Medal from Practice, Public Health, Therapeutics, and “Not only this but, as AMA President, he had been a leading figure in the medical Dr Steve Hambleton Doctors in Training committees. confronted the spectre of medical racism, profession for many years, and his long list and led the AMA in condemning abuse of of treatment as well as improve efficiency of significant and enduring achievements But, impressive though this record of international medical graduates.” of, and access to, care. warranted the Association’s highest involvement is, the criteria for the Gold accolade. Award make it clear that it is not to be One of Dr Haikerwal’s abiding passions Dr Hambleton said Dr Haikerwal had been bestowed “by virtue only of holding any has been to advance the adoption and instrumental in putting the AMA at the “In the last two decades, Dr Haikerwal office or position within the Association”. has been an extraordinarily active and integration of information technologies into centre of the e-health debate, leading the committed member of the AMA, advancing There have been just 22 other recipients of the practice of medicine, because of the Association’s enthusiastic support for the the AMA Gold Medal, including Professor potential to enhance the safety and quality adoption of e-health.
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of the AMA for many years, and has been a generous Dr Haikerwal recognised for gold mentor and source of support for many of the Association’s
medal service to health ... FROM P3 FROM P46 leaders. “Amid all this, he has continued to maintain a busy “It is an issue that remains both essential, yet unresolved, general practice, and showed tremendous courage and but not for wont of effort by Dr Haikerwal, who continued determination to resume work after suffering serious to work hard on e-health following his presidency, most injuries in 2008.” recently as the Clinical Lead for the National E-Health Transition Authority.” Dr Haikerwal has been recognised for his outstanding contribution with a string of honours, including the Dr Hambleton said that, since leaving the AMA Presidency Centenary Medal, Fellowship of the AMA, the AMA in 2007, Dr Haikerwal has continued to be an influential President’s Award and being made an Officer of the Order Dr Steve Hambleton presents the Presidents Medal to Dr Bernard Quin’s son, Father Peter Quin figure. of Australia. executed by Japanese troops occupying Nauru during the In 2008-09, he was a Commissioner on the Australian “Dr Haikerwal is a most deserving recipient of the AMA Second World War. Health and Hospitals Reform Commission, which Gold Medal,” Dr Hambleton said. recommended major changes including the introduction Before the war, Dr Quin, accompanied by his wife and five Adrian Rollins of activity-based funding in public hospitals and the children, worked for eight years on Nauru as the Australian establishment of local hospital networks. COMMENT Government Medical Officer, providing health care for the He is regular contributor to public debates and is looked to A doctor’s courageous dedication local inhabitants - many of whom had leprosy - as well as as a trusted advisor by Health Ministers across the political the island’s expat community. spectrum. to his patients finally recognised When Nauru was attacked by German raiders, Dr Quin took “Dr Haikerwal’s contribution has extended beyond this A Melbourne-based doctor whose extraordinary dedication his family to Melbourne before returning to the island at nation’s shores,” Dr Hambleton said. to his patients ended up costing him his life has been the request of the Australian Government (who made him an honorary captain) to provide medical care for Australian posthumously awarded the AMA President’s Award at the “He has been a member of the World Medical Association’s troops and the local population. AMA National Conference. Council since 2007, and in 2011 became the first At the end of 1941, the Japanese began bombing Nauru, Australian to be elected as Chair of the world body. In In a moving ceremony, outgoing AMA President Dr Steve and the Australian troops withdrew. But Dr Quin and four this position he has fostered the pursuit of ethical care, Hambleton presented the family of Dr Bernard Quin with other Australians, including the island’s Administrator Lt professional standards and the freedom of doctors to treat the Award in recognition of his dedication and sacrifice. Colonel Frederick Chalmers and pharmacist W. Shugg, all people.” Dr Quin, a Victorian GP and member of the British Medical courageously elected to stay, a decision that end up “Dr Haikerwal has been a keen and selfless supporter Association (Victoria Division – now AMA Victoria) was costing them their lives. 47 MORE P48 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
The end came in March that year, when A doctor’s courageous a US squadron bombed the island and Dr dedication to his patients Quin and his compatriots were executed by finally recognised the Japanese troops in retaliation. Dr Hambleton said the story was harrowing
... FROM P3 FROM P47 and confronting, but Dr Quin’s conduct was inspiring. “Dr Quin would have known the risks to his own safety by staying on Nauru after the Australian troops had left,” the AMA President said. “His professionalism and dedication to the Nauruan people led him to make a truly courageous decision to stay, to not abandon them, and for that Dr Steve Hambleton with the Quin family following the award ceremony at the National Convention Centre, Canberra decision he paid with his life.” Dr Hambleton said Dr Quin was far from Dr Hambleton paid tribute to the tireless devotion to the people of Nauru embodies efforts of Dr Quin’s family to have his the only casualty in the story. His wife Mary what it truly means to be a doctor.” sacrifice acknowledged, and said the AMA and five children knew that his personal Dr Hambleton said that, in honouring Dr was proud to recognise his devotion to his safety was at risk, but did not find out for Quin, the AMA also paid tribute to “those patients. two years that he had died. He never had a members of our profession who have funeral. “It is fitting for the AMA to offer him put their patients’ needs above their proper recognition and to uphold Dr Quin To add to their anguish, their loss has own in order to provide ongoing care for The Japanese invaded and occupied the as an exemplar of the provisions of the never been officially recognised, the others, and who have never been formally island in mid-1942, and took Dr Quin and Declaration of Geneva, by which a doctor AMA President said: “The Australian War acknowledged”. the other Australians prisoner. pledges to consecrate his or her life to the Memorial cannot formally recognise Dr service of humanity. The award was accepted by Dr Quin’s son They endured months of privation, Quin as he was not a serving member of Peter, who attended the ceremony with including virtual starvation, such that by the the Australian Armed Forces, nor was he “We are proud and honoured to recognise more than 50 family members. beginning of 1943 Dr Quin was unable to assisting Australian military forces when he his exceptional service as a medical walk. was killed”. practitioner – his selfless commitment and Adrian Rollins
COMMENT 48 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
SA dodges a bullet as Victoria behind the other jurisdictions in its actions to protect Victorians from the effects of tobacco, and needed to runs out of puff on tobacco reinvigorate its efforts. control By contrast, both the Australian Capital Territory and Tasmania were both given an A grade. A last-minute decision to ban smoking in outdoor dining The ACT was recognised for its “excellent legislation areas spared the South Australian Government the addressing exposure to passive smoking as well as ignominy of being the joint recipient of the malodorous comprehensive legislation on restrictions on tobacco AMA/ACOSH Dirty Ashtray Award at the AMA National marketing”. Conference. It was also given credit as the first jurisdiction to withdraw In a ceremony before more than 100 guests, AMA Victoria government investments from the tobacco industry and, President Dr Tony Bartone was forced to accept the Award in addition to a prohibition on all point-of-sale advertising, – bestowed on the State or Territory that in the past year it is considering limiting the number of retailer licences, has done the least to protect its citizens from the hazards restricting tobacco sale hours and jacking up license fees of smoking – after the SA Government’s move two days to sell tobacco. earlier to prohibit smoking in alfresco dining areas and restore funding for anti-smoking campaigns left Victoria Tasmania received marks for its vigorous anti-smoking alone at the bottom of the nation’s tobacco control league campaigns and strong passive smoking laws, and received table. kudos for some of the most comprehensive and effective laws against smoking in public places and work vehicles in The judges of the annual AMA/ACOSH National Tobacco the nation. In addition, the State prohibits all point-of-sale Scoreboard, now in its 20th year, gave the Victorian advertising, with no exemptions and has comprehensive An unimpressed AMA Victoria President, Dr Tony Bartone, reluctantly Government a C for its failure to crack down on smoking bans on retailer and customer reward schemes for tobacco accepts the Dirty Ashtray Award from Dr Steve Hambleton in a wide range of public locations areas including outdoor products. eating areas, entrances to buildings, hospital grounds, and New South Wales, Western Australia, Queensland, South campaigns, while the WA Government was told it needed to areas adjacent to ventilation ducts. Australia and the Northern Territory were all awarded a close a loophole that allowed smoking in beer gardens, the In addition, Victoria was castigated by the judges for failure B grade, indicating that while they deserved credit for Queensland Government tarnished its record by allowing to take specific action on rates of smoking among pregnant continuing to act on smoking, they could and should be exceptions to the ban on smoking in licensed venues and women, new mothers and those with a mental illness. doing more. investing tobacco companies, an issue that also cost the Northern Territory points. They lamented that the State, which had for many years The New South Wales Government lost marks because of
had been the national leader in tobacco control, had fallen its decision to cut spending on mass media anti-smoking Adrian Rollins COMMENT 49 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Anaesthetics pioneer applauded “Every year, millions of patients are given anaesthetics, But, two years ago, Mr Ah-Sam realised a new approach and Professor Leslie’s work has helped make their use was needed. safer, with fewer complications and adverse events,” Dr by colleagues “I had seen a lot of health issues and inequality which have Hambleton said. greatly impacted on our people’s health,” the father of four A Melbourne-based anaesthetist who has won international Professor Leslie has published more than 140 research said. recognition for her investigations into the phenomenon of papers and made more than 170 research presentations, patient awareness during anaesthesia has been recognised “I felt that, as a health worker, I was only scratching the and has devoted countless hours to her profession, with the AMA Woman in Medicine Award. surface of a deep-rooted problem. including helping train aspiring anaesthetists and Head of Research at Royal Melbourne Hospital’s undertaking vital work accrediting the education programs “I felt that I could do more to help my people’s plight, which Department of Anaesthesia and Pain Management, of specialist colleges and hospitals, both in Australia and forced me to make a decision – stay as a health worker, or Professor Kate Leslie, was presented with the award by internationally. maybe study medicine.” outgoing AMA President Dr Steve Hambleton during a “Professor Leslie’s long list of achievements make her a Now in his second year of a Bachelor of Medicine degree ceremony at the AMA National Conference. deserving winner of the AMA Woman in Medicine Award,” at the University of Newcastle, Mr Ah-Sam believes that, as Dr Hambleton said the award was made in recognition of he said. a doctor, he will be able to achieve much more to improve Professor Leslie’s outstanding contribution to improving the Adrian Rollins Aboriginal and Torres Strait Islander health. quality of care for patients in Australia and internationally, “I want to be a voice for my people as I sit at the table with as well as her service to the medical profession. the policymakers to maybe influence or effect changes that “Professor Leslie is a leader in every sense of the word,” Dr Time to bust the myths on have positive outcomes,” he said. Hambleton said. Aboriginal health “There are a lot of negative stereotypes and myths about “Not only is she recognised internationally for the contribution Aboriginal people and their health. she has made to understanding and improving the use of Decades spent caring for remote Indigenous communities “Our health can be different and better, just by the anaesthetics, she is immediate past president of the Australian on the wrong side of the nation’s infamous health gap has changing attitudes, views and beliefs of the broader and New Zealand College of Anaesthetists, is immediate past left 2014 AMA Indigenous Peoples’ Medical Scholarship Australian community and the powers that be.” Chair of the Committee of Presidents of Medical Colleges, winner, Wayne Ah-Sam, determined to bring health has extensive research interests and is directly engaged in inequality to an end. Outgoing AMA President, Dr Steve Hambleton, presented teaching the next generation of anaesthetists.” Mr Ah-Sam with the AMA Indigenous Peoples’ Medical For almost 20 years, Mr Ah-Sam, a proud Kalkadoon/ Scholarship, valued at $9000 for each year of study, in a Professor Leslie’s work on patient awareness has helped Gungangdji man, did what he could as an Aboriginal health ceremony at the AMA National Conference. refine the administration of anaesthetics, including through worker to improve health and relieve suffering in far-flung the use of brain monitoring. communities across Australia’s Top End. Dr Hambleton said the scholarship was designed to
COMMENT MORE P51 50 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
home” once he finished his degree. best traditions of the medical profession, Time to bust the myths strived to ensure quality health care was “I see myself returning to country and provided for all in his community, including on Aboriginal health going to where I am needed the most many groups that often fall through the
... FROM P3 FROM P50 – somewhere in an Indigenous remote cracks of the health system. community back home,” he said. Dr Sanati Pour, who trained in and The scholarship was established in practised medicine in Turkey before 1995 with a contribution from the migrating to Australia, began working in the Commonwealth Government. Victorian public hospital system in 2005. Adrian Rollins In 2008, he moved to Mildura where he COMMENT undertook GP training and joined a busy local practice. Dr Mahdi Sanati Pour accepts his award Caring for those on Dr Hambleton said that during his training the fringe in Mildura, Dr Sanati Pour realised there was a shortage of specialised services in issues preclude regular health checks by A Turkish-born GP who has broken down rural and regional areas, particularly for male GPs; as well as a weekly refugee culturally and linguistically diverse groups. barriers to the treatment of socially isolated health clinics where recent arrivals are and marginalised communities in rural Dr Steve Hambleton with Wayne Rah-Fam “Dr Sanati Pour saw how differences in given comprehensive health assessments, Victoria has won the AMA Excellence in language and culture can throw up big including of their mental health. encourage and support Indigenous Healthcare Award for 2014. barriers that hamper access to medical students who are preparing for careers in Dr Mehdi Sanati Pour, who works as a GP services, and he has taken it upon himself “This award recognises and acknowledges medicine, particularly those intending to in Mildura, has been recognised for his to try and bridge these gaps in health Dr Sanati Pour’s tireless efforts to achieve work in Indigenous communities, and Mr extraordinary work in overcoming cultural, care.” the best possible health outcomes for the Ah-Sam was a worthy recipient. social and linguistic barriers to provide Sunraysia community, particularly for those Among his initiatives, Dr Sanati Pour “The AMA understands and supports the specialist care, especially mental health has organised health workshops and who – for reasons of culture, language and unique contribution Indigenous health services, for many unwilling or unable to assessments for the local Turkish social isolation – might otherwise not get professionals and Aboriginal-controlled access mainstream health services in the community; after-hours Pap screen the care they need,” Dr Hambleton said. health services can make to close the Sunraysia region. sessions, run by a female Pap smear gap and improve the health of Indigenous “He is truly a worthy winner of the AMA Presenting the Award at the AMA National nurse, to provide screening and health people,” Dr Hambleton said. Excellence in Healthcare Award.” Conference, outgoing AMA President Dr information for women in full-time work Mr Ah-Sam said he intended to “return Hambleton said Dr Sanati Pour had, in the and those for whom cultural and religious Adrian Rollins COMMENT 51 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
A year of achievement, state by state Best Public Health Campaign 2014 – AMA New South Wales Getting governments to admit they were wrong and convincing them to change course is never easy, but State and ‘Alcohol-related Violence’ Federal AMAs who managed to achieve just such feats were feted in a ceremony at the AMA National Conference. Outgoing AMA President Dr Steve Hambleton presented a string of awards recognising the outstanding success of AMA organisations around the nation in saving governments from themselves and lobbying for better outcomes for their patients and communities. The details of the awards were:
Best Lobby Campaign 2014 – The relentless and strategic efforts of AMA South Australia AMA South Australia resulted in the State Government and Opposition changing their respective policies and locking in support for the co- ‘Co-location of the Women’s and Children’s Hospital location of the Women’s and Children’s Hospital with the with the new Royal Adelaide Hospital’ new Royal Adelaide Hospital. AMA WA President Dr Richard Choong accepts the National Advocacy Award Dr Hambleton said it was a very significant outcome, achieved by AMA South Australia through its insistence that clinical outcomes be accorded the same importance AMA New South Wales showed great leadership and resourcefulness in creating the ‘Alcohol-related Violence’ as efficiency in assessing the co-location plans. The co- campaign. location of the two services will ensure that women facing pregnancy and birthing complications will receive the best Conducted amid a spate of violent assaults linked to possible health care. drinking, the campaign effectively highlighted the serious health consequences of the nation’s drinking culture. AMA South Australia lobbying helped convince the SA The campaign’s blunt but carefully worded messages hit Government to overcome its long-held reluctance and the mark, and continued to be heard even amid NSW’s commit to invest $600 million in the project. tragic toll of alcohol-fuelled deaths and injuries. The judges were impressed with the effectiveness of AMA The campaign was characterised by close collaboration South Australia’s campaign, which centred on demands for with other concerned organisations, which was a great a better functioning hospital system. strategy to extend its reach and change attitudes. AMA South Australia President Dr Patricia Montanaro accepts the Best Lobby Campaign Award 52 MORE P53 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
a wide range of issues of appeal to all sections of the A year of achievement, state by medical profession, including doctors in training, mental
state ... FROM P3 FROM P52 health, Alzheimer’s disease, and an interesting piece on health care in Western Sydney.”
Best State Publication 2014 – Feature articles were characterized by great attention to detail, and regular interviews with leading personalities AMA New South Wales such as Ita Buttrose were well written and informative. ‘The NSW Doctor’ National Advocacy Award 2014 – AMA Western Australia ‘Campaign against Curtin University Medical School’ AMA Western Australia took a lone and courageous stand when it decided to oppose plans for a new medical school AMA NSW President Dr Saxon Smith accepts the Best State Publication at Curtin University, which had backing from within the WA Award Government as well as other medical professions. share views on important health care challenges. Blog The advocacy effort undertaken by AMA Western Australia contributors have written about end-of-life care, workforce was diligent and persistent. AMA Western Australia was and training, public and preventive health, creating a effective and made sure that its messages could not be unified health system, and reprioritising care in response to ignored. Adding to its effectiveness, AMA WA engaged changing demands. AMAQ President-Elect Dr Shaun Rudd accepts the New Media Award in public debate in a manner that upheld its dignity and The space provided for feedback and discussion is highly status. The Best State Publication prize was awarded to The NSW valued by users, and is a source of great insight for AMA Queensland in helping it to keep up with issues of Doctor for the quality of its research and the variety of Most Innovative Use of Website or New issues covered in every edition. Government decisions and importance to the medical profession. Media 2014 – AMA Queensland election commitments that affect the medical profession The AMA Queensland last year also launched a user were thoroughly examined, leaving readers confident they ‘AMAQ Website’ friendly website. The new look website is fresh, vibrant, and were fully informed. easy to navigate. The new Health Vision Blog site developed by AMAQ has One judge remarked that, “[The NSW Doctor ] covered made a space for the medical community to converse and Adrian Rollins COMMENT
53 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
Study of shortcomings in care wins $10,000 prize
A study of the rates of guideline-recommended investigations and therapies for acute coronary syndrome (ACS) was awarded the annual MJA/MDA National Prize for Excellence in Medical Research at the AMA National Conference. The paper, published in the Medical Journal of Australia, was entitled “Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study”, and looked at variations in the care of patients with acute coronary syndrome despite the presence of well-developed clinical guidelines.
Using data from local registries in Australia and New Dr Dereck Chew accepts the MJA-MDA Award from Dr Steve Hambleton and Dr Rosanna Capoalingua Zealand, the researchers found there was incomplete implementation of evidence-based guideline Of the 1436 patients with myocardial infarction (MI), 1019 They concluded that “a focus on integrated clinical service recommendations, with variations in care appearing to (71 per cent) were treated with angiography, 610 (43 per delivery may provide greater translation of evidence to correlate with differences in clinical outcomes. cent) with percutaneous coronary intervention, and 116 (8 practice and improve ACS outcomes in Australia and New per cent) with coronary artery bypass grafting. Geographical challenges, patient characteristics (including Zealand”. The in-hospital mortality rate was 4.5 per cent, and the cultural diversity), health workforce and the health policy The judges from the MJA’s Editorial Advisory Committee environment were identified as likely factors contributing to recurrent MI rate was 5.1 per cent. recognised that this research, conducted with robust and the uneven application of the guidelines. After adjusting for patient risk and other variables, transparent methodology in a difficult real-world setting, significant variations in care and outcomes by hospital This study set out to measure rates of guideline- contributes to the very important endeavour of improving classification and jurisdiction were evident. recommended interventions and in-hospital clinical ACS the health of patients with suspected and confirmed acute events using public records and health network data from The authors identified variations in the application of the coronary syndrome. 478 sites and 4398 patients with suspected or confirmed ACS evidence base and varying rates of in-hospital clinical ACS across Australia and New Zealand. events. The prize was $10,000. COMMENT
54 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
New members of the AMA Roll of Fellows
Two former State AMA Presidents and a leading GP advocate were inducted into the AMA Roll of Fellows at the AMA National Conference. In a formal ceremony highlighting the outstanding contribution they had each made to the AMA and medical profession, former AMA Queensland President, Dr Alex Markwell, former AMA Victoria President, Dr Stephen Parnis and leading GP advocate Dr Stephen Wilson, were added to the Roll of Fellows by outgoing AMA President Dr Steve Hambleton. “The new Fellows have all excelled in their medical careers, across many specialties,” Dr Hambleton said. “At the same time, they have dedicated themselves to working to improve conditions for doctors, and to make the Australian health system work more effectively for patients and communities.” The following are excerpts from their citations:
Dr Alex Markwell of health to reduce the burden of preventable disease, most notably trauma- Ever since graduating from the University related injury and death, and lifestyle-related of Queensland in 2002, there have been conditions such as type 2 diabetes. two enduring threads running through Dr Steve Hambleton with AMA Role of Fellows inductees, Dr Alex Markwell, Dr Stephen Parnis and Dr Markwell’s work and activities – a Dr Markwell has also been a consistent and Dr Stephen Wilson commitment to the well-being of her effective advocate for improved medical patients and the broader community, and education, including as Chair of AMA through to her work as a Senior Lecturer at Dr Stephen Parnis, MBBS a determination to improve the lot of the Queensland’s Council of Residents and the University of Queensland. DipSurgAnay FACEM medical profession. Registrars, and later as Chair of the Federal In recognition of her selfless and tireless Throughout an interesting and varied As President of AMA Queensland in 2012 AMA Council of Doctors in Training. She efforts, which embody the AMA’s ethos and 2013, the emergency physician was has fought hard on behalf of junior doctors of integrity and care for both patients and medical career that has taken him across a tireless champion of policies to improve to increase clinical training capacity, members, Dr Markwell has been appointed the country and across the world, Dr Parnis well-being, including by enhancing health improve work hours, and safeguard doctor the inaugural Ambassador for the AMAQ has had a keen and abiding interest in literacy and tackling the social determinants health. This commitment has also carried Foundation. medical education and training.
MORE P56 55 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
INFORMATION FOR MEMBERS New members of the and alcohol, stamp out attacks on health workers and improve end of life care. AMA Roll of Fellows Essential GP tools at the click Dr Stephen Wilson ... FROM P3 FROM P55 of a button General practice can have few more passionate Through more than a decade of activism, the and effective advocates than Dr Wilson. The AMA Council of General Practice • checklists and questionnaires in emergency physician - who recently completed The Perth-based GP, who has been in practice has developed a resource that brings PDF format, available for printing; a two-year term as AMA Victoria President – together in one place all the forms, for almost 30 years, is active at all levels of the • commonly used forms in printable has been at the centre of big issues that have guidelines, practice tools, information AMA and Government advancing the interests PDF format; shaped and, at times, threatened to derail, and resources used by general of general practitioners and their patients. medical education. practitioners in their daily work. • clinical and administrative The former AMA WA Vice President is a long- guidelines; and As current Chair of the AMA Council of Salaried The GP Desktop Practice Support serving Chair of the AMA WA General Practice Doctors, an Australian Salaried Medical Toolkit, which is free to members, has • information and other resources. Council, and since 2008 has also been an Officer Federation Councillor, a long-serving links to around 300 commonly used important member of the Federal AMA Council In addition, there is a State/Territory Chair of the AMA Victoria Industrial Relations administrative and diagnostic tools, Subcommittee and a member of the Medical of General Practice. tab, with information and forms saving GPs time spent fishing around specific to each jurisdiction, such as Training Review Panel of Australia, Dr Parnis Dr Wilson’s keen sense of justice and fairness trying to locate them. WorkCover and S8 prescribing. helped see off Federal Government plans to has led him to practise in less affluent The Toolkit can be downloaded from cap tax deductions for self-education expenses communities where the need for his services The information and links in the the AMA website (http://ama.com. (the successful ‘Scrap the Cap’ campaign), has been greatest, and he has been a Toolkit will be regularly updated, and au/node/7733) to a GP’s desktop helped medical trainees win representation prominent critic of policies that increase health its scope will be expanded as new computer as a separate file, and is in medical Colleges, and led the successful costs. information and resources become not linked to vendor-specific practice negotiation of ground-breaking enterprise available. agreements for doctors in training and medical In keeping with his concern about access to management software. health care, Dr Wilson has long pushed for GP Members are invited to suggest specialists in Victoria. The Toolkit is divided into five shortages in regional areas to be addressed, additional information, tools and Important as this work has been, Dr Parnis categories, presented as easy to use and is a knowledgeable advocate for better use resources to be added to the Toolkit. has also thrown himself into promoting public tabs, including: of information technology in providing health Please send suggestions, including health. He is a vigorous and resilient advocate care. • online practice tools that can be any links, to generalpractice@ama. who has been at the forefront of AMA Victoria accessed and/or completed online; com.au efforts to reduce the harm caused by smoking Adrian Rollins COMMENT 56 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra
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Gala Dinner Leadership Dinner Coctail Function
Canberra’s National Arboretum was the Australian War Memorial Director and former More than 100 delegates attended the President’s spectacular venue for the Gala Dinner, held on AMA President Dr Brendan Nelson was the guest Welcome Reception at Canberra’ National Saturday, 24 May. At the dinner, World Medical speaker at the annual Leadership development Convention Centre on Friday, 23 May. At the Association Chair of Council, and former AMA Dinner. The dinner, organised and hosted by the reception, outgoing AMA President Dr Steve President, Dr Mukesh Haikerwal was presented AMA Council of Doctors in Training, was held on Hambleton presented a string of awards including with the AMA’s highest honour, the Gold Medal. Friday, 23 May at the Australian War Memorial. National Tobacco Scoreboard Achievement Award, the AMA/ACOSH Dirty Ashtray Award, the AMA Woman in Medicine Award, the AMA Excellence in Healthcare Award and the AMA Media Awards.
57 of these corporations and diminish the market for pharmaceutical cures for the diseases PUBLIC HEALTH OPINION researched in coming decades with money from The budget war the research fund. The lack of logic and policy manifest by the Dust from the explosion of the Budget bomb line were ignored, presumably because they recent health budget is not just breathtaking. It is has yet to settle. It is hard to see what buildings would require intelligent analysis, political asphyxiating. remain and what the final body count will be. effort, recruitment of the medical profession to formulate policies, and guts. Co-payments for bulk-billed consultations will preferentially affect those least able to pay - Then, miraculously, when the budget was the less well-off and the self-funded retiree released like a missile from a drone, the struggling with the costs of diabetes and heart sustainability of health care was no longer a The jumble of ideas disease. Co-payments are the biggest bomb reason for attack. Instead, (taking a page from “is haphazard, insensitive BY PROFESSOR craters immediately visible that distress and the Gospel of Bush and Blair, like the missing STEPHEN LEEDER upset just about everyone. weapons of mass destruction in Iraq), the to (one must charitably unfindable unsustainability crisis did not deter As in war, logic and truth were early casualties. assume) unintended but fully those with their fingers on the buttons. We were told for months before the Budget that predictable side effects, and the health system was unsustainable, yet the Co-payments, now rebadged as a revenue evidence suggests otherwise. stream to fund a Medical Research Future Fund disingenuous in its use of that the College of Physicians – perhaps with The argument was economic, meaning that we erroneous scare tactics about irony or perhaps not – termed “visionary”, were are running out of money, which is nonsense. fired off to the amusement of the Prime Minister sustainability The determination of sustainability is political - sitting listening to Budget. Funny weird, yes, but as a rich society we can sustain what we want not funny funny. ” to sustain, be it war or peace. We can buy jet fighters, detention camps or hospitals at will. The Medical Research Future Fund will support The jumble of ideas is haphazard, insensitive to research decades hence that, the Treasurer Co-payments were touted as a way to make us (one must charitably assume) unintended but believes, will enable us to cure diseases such all pay more at the point of use of health care fully predictable side effects, and disingenuous as dementia and the degenerative disorders and so rescue health care from bankruptcy. But in its use of erroneous scare tactics about that are now epidemic worldwide. Oddly, the in general practice? This is not where the big sustainability. fact that these diseases can be prevented costs are. Co-payments were dropped from the was not only dismissed, but the money for Strong resistance to its more ethically sky. preventive programs - and a national agency objectionable elements, of which the co-payment Smart bombs at that – not blitzing the wealthy designed to deal with the forces such as food, is paramount, is surely justified. We deserve but those who are bulk billed – served by the alcohol, tobacco and urban design that cause much better than this. least politically powerful medical craft group. these problems - was removed, much to the Massive opportunities for efficiency savings delight of the brewers and the food industry. Too This Budget is a disastrous beginning for the new in hospitals and the pharmaceutical supply much prevention would mess with the profits government.
COMMENT 58 will be waived. The Government appears to have GENERAL given little thought to the needs of families or the PRACTICE $7 MBS co-pay fails to pressure this will put on lower socio-economic groups. This situation becomes even worse when several pass the means test family members are sick at one time, or they need to make multiple visits, undergo numerous tests, and get several prescriptions, all in a There has been so much focus on the $7 co- will be particularly difficult for pathologists, as couple of days. For people on benefits, cash flow payment measure announced in the May Budget they rarely see the patient. If GPs are expected to will be a real problem. that the community seems largely unaware that collect the $7 on their behalf, that will only add to the Government is also proposing that Medicare the administrative burden for practices. rebates for GP attendances, along with rebates With this proposal, the Government is asking all for pathology and diagnostic imaging services, BY DR BRIAN MORTON patients to contribute to their health costs. will be cut by $5. Every other MBS item will have also effectively be cut because of the freeze on If patients cannot afford this, the Government If the Government hopes indexation. seems to think that GPs should act as some sort “to get its co-payment measure of de facto safety net. From 1 July next year, I’m not quite sure how Health Minister Peter through the Senate it is going Dutton thinks he is strengthening general every time we waive the MBS co-payment we practice. The Government is simply withdrawing will be taking at least a $5 cut in our pay for the to have to construct a better significant support for patients to access frontline service – if a patient holds a concession card or care and shifting more costs on to them. is younger than 16 years the hit to income will be model. One that supports our $13 to $16.10. In addition, the Government seems to have given sickest and most vulnerable, little thought to the costs that will be imposed The Government is also going to exclude the $7 and the practitioners who care on practices as they endeavour to collect the $7 paid out-of-pocket from counting towards the co-payment. new Medicare Safety Net! The Government’s for them revised Medicare and Pharmaceutical Benefit GPs visiting residential aged care facilities will Scheme safety nets will do less to catch those ” be expected to collect $7 from each patient they with large health care costs. see. Some practices will require more equipment, If the Government hopes to get its co-payment a larger reception desk, and more staff to While the thresholds for the Medicare Safety Net process payments, manage bad debts and do will be reduced and streamlined, the proportion measure through the Senate it is going to have the banking. There will be additional processing of out-of-pocket expenses that count, and the to construct a better model. One that supports costs with EFTPOS fees and transaction costs. It benefits payable, will be decreased. When it our sickest and most vulnerable, and the will mean having to run a cash float and all the comes to medication, the thresholds are also set practitioners who care for them. additional security concerns, cost and headaches to be increased every year. The AMA stands ready to assist the Government that go along with that. Patients with concession cards or children to get this right, to make sure there is better For one period of illness there will be multiple younger than 16 years will be expected to pay support for our vulnerable patients and for those $7 co-payments that have to be collected. This $70 out-of-pocket before the MBS co-payment who are at the frontline of their medical care.
59 COMMENT DOCTORS IN The consequences for later stages of training TRAINING are even more significant, as the loss of these Sweeping Budget rotations threaten hundreds of prevocational posts around the country. changes dramatically These decisions reek of shortsighted cost shifting, as the Federal Government looks to vacate the prevocational space. alter training landscape At the same time the Federal Government expects its State and Territory counterparts to fill shortfalls in training funding it has created, it In recent weeks, much has been said of the the coming months will be to ensure that has abandoned the National Health Partnership 2014 Federal Budget and its impact on patients workforce planning expertise is retained and no Agreements, resulting in a reduction in growth and doctors. momentum lost during the move from Adelaide BY DR JAMES CHURCHILL funding for the states. Between a $7 co-payment for each GP, radiology to Canberra. Unfortunately, the education Budget papers and pathology service, Medicare rebate cuts General Practice Education and Training is also contained perhaps the most dangerous paradigm and few protections for the vulnerable, only a being absorbed by the Department of Health, a shift for medical education. These hostile Senate currently stands in the way of the significant shake-up for GP training, along with a Coalition Government’s vision for a wholesale proposal for future competitive tender processes With an average 20 per cent cut to federal “ change to a user-pays health system. decisions reek for general practice training providers. funding for each university place, lower indexation arrangements and the deregulation This move to shift more costs on to patients The Confederation of Postgraduate Medical of shortsighted of student fees, universities are likely to soon comes at a time that health systems around Education Councils was also singled out for a the world, most notably the United States, have be charging students hundreds of thousands of cost shifting, complete cut in its federal funding; nobody has embraced the need for equitable access to dollars for a limited number of medical places. been identified to pick up the CPMEC’s good health care for all, particularly those who cannot as the Federal work in the prevocational space. The effect will be a higher education system in afford it. which a medical degree will soon be completely The only good news from the Budget was Government After the dust has settled, however, it’s clear that out of reach for those not fortunate enough to the creation of an additional 300 GP training the Budget has also made a number of changes have chosen rich parents. looks to to the landscape of medical training. Health places - funded, however, by cutting the valuable Prevocational General Practice Placements While scholarship programs are welcome, vacate the Workforce Australia, created by the nation’s Health Ministers in 2009 to formulate a National Program (PGPPP), which had provided up to 975 international experience demonstrates that the prevocational Training Plan for Australia’s medical workforce, rotations for junior doctors to gain experience in prospect of high postgraduate debts deters will be dissolved, with its functions transferred to general practice. students from poor backgrounds and can drive graduates away from less-well-remunerated space the Commonwealth Department of Health. Notably, in South Australia, PGPPP had been specialties, such as general practice. While the Government is promising that a providing required Emergency Medicine core
” commitment has been made to continue rotations for 23 internship places, which will be All in all, it’s clear that the AMA Council of essential projects, including the National Medical cut unless additional public hospital ED rotations Doctors-in-Training has much to work on in the Training Advisory Network, the challenge during can be urgently found. coming weeks and months.
COMMENT 60 SALARIED • the Queensland contracts dispute – the harm DOCTORS that has been caused, the remedies that are Salaried doctors an being applied, and the lessons to be learned. There is nothing minor about any of these issues. essential voice in the AMA What is clear is that, while we have a system of health care that is among the best in the world, its future is far from guaranteed. This is my final article as Chair of the Council of In recent times, these articles have focussed on: Salaried Doctors. I have served on the Council for • palliative care and the need to better address five years, including three as Chair, and believe end-of-life decisions; now is the appropriate time for me to relinquish this role. • revalidation as a discussion initiated by the What is clear is that, while BY DR STEPHEN PARNIS Medical Board, but no real details yet to be The necessary reorganization of membership “we have a system of health considered; records to reflect salaried doctor membership care that is among the best in is now taking place, which delays the election • funding cuts at both State and Federal levels, of my successor. In the interim, Dr Barbara with inevitable implications for access; the world, its future is far from Bauert – the Northern Territory Representative on • medical registration and the problems guaranteed AMACSD - has kindly agreed to Chair AMACSD experienced with AHPRA and the 2010 and represent Salaried Doctors on Federal national system; ” Council. • generalism as a necessary medical skill set, Providing insufficient resources will inevitably My time with AMACSD has been thoroughly given the complexity of contemporary patient harm our ability to provide the care we expect satisfying – and turbulent. In my years on presentations; to give, and that Australians rightly expect to the Council, we have contended with many • rights of private practice - a complex, long- receive. challenging issues affecting the Australian health standing, and invaluable part of public hospital system. One of the principal roles of the AMA is to work; support, represent and defend doctors and I have written about many of these issues in • clinical governance as a mechanism for others who work to maintain our health system Australian Medicine in recent years. improved standards of care; in the face of harsh criticism, dramatic funding cuts, personal risk, mounting workloads and Of course, these articles have only touched the • workforce issues and the challenges of responsibility, and an increasingly complex and surface of the myriad number of issues that training today’s junior doctors through to difficult industrial landscape. affect salaried doctors and their patients. To independent practice; varying degrees, these issues have had a direct The current situation in Queensland merits • safety in the medical workplace; impact on clinical standards, working conditions, special mention. We have consistently called for training opportunities and patient access to • supervision of trainees as an essential part of a less belligerent approach from the Newman medical care. medical education; and Government, and an acknowledgment that the
MORE P62 61 INFORMATION FOR MEMBERS SALARIED Salaried doctors an DOCTORS Medical claims for diagnostic imaging and essential voice in the AMA pathology provided to patients in public
... FROM P3 FROM P61 hospital emergency departments vilification of the medical profession in Queensland was utterly Diagnostic imaging and pathologist in public hospitals under a medical misguided. The resolution achieved in recent weeks is not perfect, specialist members should be aware practitioner’s name and billing but it is a much better outcome compared with what could have they are legally responsible for all provider number, the practitioner occurred. services claimed under Medicare that must be made fully aware of, and be I remain concerned about a broad trend away from collective are billed under their provider number prepared to accept responsibility for, bargaining, largely based on ideological motives. This is something or in their name, even if the billing was that billing; we must monitor carefully in coming years. done by hospital administration. • where services claimed are being We must also recognise that the issues played out in Queensland Pathology and diagnostic imaging rendered in a public hospital, have the potential to resonate through all health systems around services for patients in public hospital medical practitioners should seek a the country. emergency departments are covered written guarantee from the hospital that the arrangement is not in breach The dispute also demonstrated that the combined advocacy of the by Australian Government funding of the relevant Australian Health Care AMA and Australian Salaried Medical Officers Federation – working arrangements and are not eligible for Agreement; and closely together, as we absolutely must - can genuinely protect the Medicare benefits. interests of doctors and the health system in which they work. Emergency patients are to be treated as • public hospitals must provide doctors with full records of all medical Within the AMA, the Council of Salaried Doctors has been public patients until a clinical decision determined to deal with the question of salaried doctor to admit has been made and the patient accounts raised in their name. representative numbers in the AMA. This issue been on our agenda has elected to be admitted as a private If you believe your provider number for some years, and we consider the current constitutional reform patient. may have been used in ways that process as the ideal time to obtain clarity around the salaried doctor More information about this is available contravene the relevant provisions in membership category. the Health Insurance Act, the AMA from the Medicare website: https:// recommends you contact your State If the Queensland contracts dispute has demonstrated anything, it www.medicareaustralia.gov.au/ AMA Office. As this issue affects is that the interests and impact of salaried doctors are an essential provider/business/audits/public- employment contracts, State AMAs will part of the collective voice of the AMA. hospital-emergency-depts.jsp be able to coordinate representation for As I hand over the reins to Dr Bauert, I take this opportunity to thank The AMA provides the following advice affected members. everyone who has been involved in the Council of Salaried Doctors to members about the use of provider for their help, support and good judgment. The importance of what The AMA will keep abreast of Medicare numbers in public hospitals: we do should never be underestimated. compliance matters through its • where medical services claimed participation on the DHS Compliance COMMENT against Medicare are being rendered Working Group. 62 RURAL HEALTH a desire to see persecution of the unwell who seek taxpayer-funded care? It certainly embraces use of barriers to the One Term Tony? access of care, which in turn creates cost shifting to the states via public hospitals.
Considering there was no genuine consultation Encouraging preventative health care, not Fourth, the Budget applies harsh new with doctor representative groups, and no sound discouraging it, is where the savings lie. eligibility criteria for youth unemployment input from the medical coalface, regarding benefits. The $2 “bonus” for GPs is no such thing. It will proposed changes to health care financing, this be eaten up by tax collection administration As a wealthy society with no real budgetary was indeed an “enlightened” Federal Budget. costs. crisis, we do not want or need the divide The litmus test for me was to see if our ‘brave’ between rich and poor to be accentuated. BY DR DAVID RIVETT Secondly, the Budget slashes public hospital new government embraced the deregulation of funding for the states. We do not want the young unemployed pharmacy advised by the National Commission persecuted and denied support. of Audit. They did not, so I will not use the word Indeed, if we pursue this line of thought that less We must realise that if we do cut this support, brave in regard to this Budget again. is more then, rather than embracing as heroes those citizens shaking collection cans at the we will force some into crime and extremism, Though, thankfully, it is hard to picture many of roadside to support their local children’s hospital and many others will suffer worse mental health the proposed Budget changes getting through or other hospitals, perhaps we should denigrate outcomes. the Senate in their current form, it is worth them. These are not attractive outcomes for society. having a look at them in detail. But let us get focussed. Why cannot our elected representatives realise The first is to apply a GP tax, imposed on those this? who actually use health care most frequently: Apparently, in the eyes of this removed-from- What are the options? the aged; those stricken with cancer; children; reality Budget, it makes economic sense to let chronic disease sufferers; residential aged care the ill perish with minimal care. Perhaps charities These are clear. facility residents; the Indigenous; plus those who focussed on expanding health care should be If we must choose enforced medical co- want to embrace preventative care. banned, and the seriously ill and poor not offered care but be publicly belittled and expeditiously payments, providing we seriously believe there is In brief, it will most heavily on those most often removed. Such thinking is immoral and unsound a fiscal crisis facing Australia, then for heaven’s unable to pay, and also penalises those most nonsense. sake, let’s have payments confined to those who prepared to seek help to stay healthy (and thus can afford them. reduce downstream tertiary care costs where Thirdly, the Budget freezes Medicare rebates That is, let them be targeted, not just applied the big dollars go). The wealthy, who could and for specialist consultations. as a blanket thrown over all and suffocating the should make co-payments, are not targeted. Specialists are already being hit with the Budget most needy. bail-out tax levy. Now those compassionate Such a simplistic policy smacks of a philosophy enough to bulk bill will see their incomes slide. Secondly, cost-shifting between the states and which is un-Australian. Aussies are generous Patient gaps will grow, resulting in less private the Commonwealth must end. people. We care. We are not a nation of bean- care, and more demand for public care. counters. We value mateship, not elitism. We value It all too often pervades and perverts policy. caring more than costing. We are proud of our What is the philosophy underlying these Perhaps a single funder of health care is the only current universal access to quality health care. changes? Is it stupidity? Or worse, does it reflect way to be rid of it.
63 COMMENT AMSA influences graduates to favour higher paid How much would you pay specialty pathways, and away from fields where there may be greater community need. Beyond the inequity, this political move may lead to become a doctor? to a sacrifice in the quality of medical school admissions.
Following the release of the Federal Budget, a this ban. It is already the experience of medical The 2008 Bradley Review of Education found big question high school students around the students that the admission thresholds of that rural, remote, Aboriginal and Torres Strait country are asking is, “how much would you pay postgraduate full-fee places are lower than that Islander students, as well as students from to study medicine?” of equivalent Commonwealth Supported Places, low socioeconomic backgrounds, already face due to financial barriers to access. significant barriers to tertiary education. BY AMSA PRESIDENT Currently, the student contribution to medical JESSICA DEAN education costs are capped at $9792 a year. Medical school entrance should be a meritocracy, If we want a representative workforce, we need This amount means medical graduates are left not a socioeconomic hierarchy. to work to remove such obstacles to access. with a manageable HECS debt on completion of For many high school students, a potential Following the Review, the-then Government For many their degree. $180,000 debt may lead them to question committed to the goal that 45 per cent of people current“ doctors, But this picture is set to change. medicine as a career option. aged 25 to 34 years would hold a bachelor’s medical education In its Budget, the Government announced it If they do manage to find or borrow the money, degree or higher by the year 2025. The changes was heavily would cut its contribution to course fees by 20 the outlay and debt may significantly affect in this Budget are likely to significantly hamper per cent, while the interest rate on student loans their future choices. There are already stories efforts to reach this goal. subsidised or even would go up. Furthermore, tertiary education fees of parents mortgaging homes to fund their For many current doctors, medical education was free. I wonder are to be deregulated. children’s medical education. Students struggle heavily subsidised or even free. I wonder if, had financially though medical school already. Long if, had you had If market forces are applied, universities will be you had your time again, what would have been contact hours and huge workloads mean it is your time again, able to set their own prices. For courses such your debt threshold? How much would be too very difficult to maintain part-time employment as medicine, high demand and the low supply much? what would have while studying medicine. Combine this with of places will mean that course fees have the inadequate income support programs, and the been your debt potential to skyrocket. The Grattan Institute For more information, please see AMSA’s Official result for many is life below the Henderson threshold? How estimates that medicine course fees could rise Policy homepage at: https://www.amsa.org.au/ poverty line. advocacy/official-policy/ much would be by as much as 270 per cent, pushing the annual cost to $37,000 and putting the total bill for a Pushing up the cost of a medical degree could too much? Jessica Dean is the President of the Australian medical degree at $180,000. also exacerbate imbalances in the medical Medical Students’ Association. Jessica is a 6th workforce. ” In 2008, the Australian Government placed year Medicine/Law student at Monash University. a legislative ban on undergraduate full-fee The potential for heavy course debts to influence She is currently completing an Honours Project domestic places. Postgraduate courses, such as specialty choices is concerning. Studies have in Bioethics at The Alfred. Follow on Twitter @ at the University of Melbourne, were exempt from shown that increased debts from medical school AMSAPresident or @yourAMSA 64 COMMENT to demonstrators at protests in Istanbul last ETHICS AND year. We have highlighted this issue through MEDICO-LEGAL Honouring courageous the media, and will raise it with the Australian Government. colleagues, past and The AMA has raised similar concerns in the past in relation to colleagues in Bahrain and Syria, we have publicly supported the Australian Red present Cross and International Committee of the Red Cross (ICRC) ‘Global Life & Death’ campaign, and we have formally adopted the adopted the World At this year’s AMA National Conference, we medical care. Australian troops withdrew after Medical Association’s Regulations in Times of the Japanese began bombing the island at the Armed Conflict and Other Situations of Violence, BY DR ELIZABETH FEENEY had the unique opportunity to show our support for colleagues, both past and present, who end of 1941; however, Dr Quin chose to stay and Declaration of Seoul on Professional Autonomy and Clinical Independence, Declaration of demonstrate exceptional service as medical continue to care for the local Naurans. Geneva, and the Declaration of Tokyo: Guidelines practitioners while working in areas of armed Dr Quin’s professionalism and dedication to for Physicians Concerning Torture and other The AMA conflict. the Nauran people led him to make a truly Cruel, Inhuman or Degrading Treatment or
will“ continue to One of the most moving moments from this courageous decision to stay, to not abandon Punishment in Relation to Detention and advocate for the year’s AMA National Conference came when the them, and for that decision he paid with his life. Imprisonment. President’s Award was presented to the family of rights of doctors In honouring Dr Quin with the President’s Award, The AMA will continue to advocate for the rights Dr Bernard Hazelden Quin. working in areas the AMA paid tribute to those colleagues working of doctors working in areas of armed conflict in areas of armed conflict who have put the of armed conflict Dr Quin was killed in Nauru in 1943, executed to carry out their ethical duties to patients and by Japanese troops along with four other needs of their patients above their own and have others, to care for the sick and injured impartially, to carry out their Australians, in retaliation for the United States’ never been formally recognised for their sacrifice. without fear of prosecution or punishment. ethical duties to bombing of the island. While the President’s Award was the opportunity We will continue to campaign for governments to to honour our colleagues from the past, the patients and others, Dr Quin originally went to Nauru with his family, protect doctors and other health care workers so AMA continues its support for doctors working to care for the his wife and five young children, to work as an that they may undertake their professional duties overseas today in areas of armed conflict. sick and injured Australian Government Medical Officer to care for in relative safety. Through our advocacy, we impartially, without the Australian troops as well as the local Nauran National Conference delegates endorsed honour our colleagues, both past and present, population. Dr Quin left Nauru with his family in a resolution in support of members of the who have placed themselves at great personal fear of prosecution 1941 but returned by himself on request from Turkish Medical Association who face legal risk to care for others during conflicts throughout or punishment. the Australian Government to continue to provide action for providing emergency medical care the world.
” COMMENT
65 HEALTHY Australia lie in the technology. Start-up costs, AGEING transmission quality and data security are all Telehealth could be the hurdles. To address these problems, the Telehealth answer for better aged care Financial Incentives Program offered incentives to eligible health professionals and aged care services to encourage investment in One of the key challenges for our ageing by Flinders University, which is investigating the video technology to enable consultations with population is access to medical services. effectiveness of online technologies to support specialists, consultant physicians and consultant aged and palliative care patients in South The current model for aged care patients with psychiatrists. More than 3000 specialist Australia. limited mobility imposes big demands for time on providers took up the incentive during its four The Flinders University project aims to years of operation. BY DR RICHARD KIDD clinicians, who are frequently required to leave their surgeries and travel to see their patients. demonstrate increased access to team care and specialist clinical services, and fewer When access to medical services is inadequate, unnecessary hospital admissions. health outcomes are poorer and there are The key challenges to the At conclusion, the project will evaluate a increased visits to hospital emergency “use of telehealth in Australia departments. technologically enhanced model of providing care, and propose costing and governance lie in the technology. Start-up The recent Commission of Audit report arrangements to support ongoing operation. recognised that Australia’s health system is costs, transmission quality and In the Flinders University study, 145 palliative not equipped to face future challenges posed data security are all hurdles by our ageing population, and recommended and aged care patients have been given a mobile the Government explore opportunities to tablet configured with simple access buttons. The ” improve efficiency in health care delivery and tablet is their portal for access to medical care in the comfort of their own home. effectiveness. We are all looking for a better health care The University has reported solid progress since delivery model for ageing Australians, and One option for achieving just this is through services began operating in mid-2013. Patients improved opportunities to coordinate care across greater use of telehealth. reported feeling more connected to their clinician providers. In 2013 the Federal Government, through its when using videoconferencing than using the The early signs are that telehealth technology $20.6 million Telehealth Pilots Program, funded telephone. In turn, the technology enables health has potential to offer an efficient and effective several pilot projects to investigate the potential care providers to review more patients, and in a solution. It is hoped a successful Flinders for improved health care delivery through way that is more targeted to assessment scores. University telehealth trial will provide the telehealth. They can also monitor patients in real time, foundation for wider telehealth service without the delays associated with travel time. Of particular interest to the AMA Committee for development and implementation to support our Healthy Ageing is the $2.5 million project, led The key challenges to the use of telehealth in care for our older patients.
COMMENT 66 NEWS ABC dumps controversial statins program
Doctors complain they are still dealing investigation into the program after being with the fallout from an ABC program deluged with complaints by organisations that made controversial claims about the such as the National Heart Foundation as safety of statins before being pulled by well as individual medical practitioners the national broadcaster for breaching and its own resident health expert Dr standards of impartiality. Norman Swan. GPs have reported they are still The investigation, finalised last month, encountering patients who unilaterally found that the second episode of the decided to stop taking statins after program breached the broadcaster’s rules viewing or hearing about claims made on for impartiality, while the first episode the ABC science program Catalyst that presented information in a way that statins were overprescribed and their underplayed and undermined mainstream benefits exaggerated. medical advice about the health benefits of low saturated fat diets. The first episode of the two-part series ‘Heart of the Matter’, broadcast in October In its report, the ABC’s Independent last year, gave prominence to unorthodox Audience and Consumer Affairs Unit said information was presented. that was referred to was doubted in the views questioning the value of diets low there was “an inherent danger when any narration and directly challenged – and in saturated and trans fats, while the program present criticisms of medical “In our judgement, the quality of [episode often emphatically rejected – by other second episode emphasised the views of practices or advice, that people will one] would have been enhanced if it contributors. researchers who claimed statins caused act without consulting experts or fully had more clearly communicated why significant side effects - claims that have considering the consequences”. the National Heart Foundation hold their “Although the program did not explicitly subsequently been withdrawn - that It said the Catalyst program had omitted views,” the report said. “Little substantive endorse the unorthodox view, the outweighed their benefits. important information and had slanted evidence was presented to support their language used by the reporter tended to The ABC launched an internal the way competing views and conflicting perspective, and the strength of evidence add weight to the contrarian argument.”
MORE P68 67 NEWS ABC dumps controversial statins program
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The report was more damning about the second episode, Dr John Abramson from Harvard Medical School and which called into question the benefits of taking statins. British cardiologist Dr Aseem Malhotra have withdrawn The authors cited data statements made in their papers after figures used as the “Flaws with the program’s presentation did result in a “ basis of the claims were found to be incorrect. finding that editorial standards had been breached,” the from an uncontrolled investigation found. “The program’s treatment of use of The authors cited data from an uncontrolled observational observational study that statins in secondary prevention focused solely on mortality study that indicated almost 18 per cent of patients taking benefits in a way that reinforced the view that statins were statins suffer side effects, but inflated the findings. indicated almost 18 per cent overprescribed, and their benefits exaggerated.” “The side effects of statins – including muscle ABC Managing Director Mark Scott said that, as a result symptoms, increased risk of diabetes (especially in of patients taking statins of the investigation, both programs had been removed women), liver inflammation, cataracts, decreased energy, suffer side effects, but from the ABC website, and a note had been added to the sexual dysfunction and exertional fatigue – occur in Catalyst website reinforcing advice that viewers should approximately 20 per cent of people treated with statins,” inflated the findings not makes changes to their medication without seeking Dr Abramson and his colleagues wrote in their conclusion. appropriate medical advice. ” This figure was subsequently repeated in an article by Dr But Mr Scott defended the broadcaster’s decision to Malhotra published in the same edition of the BMJ. Dr Abramson appeared on the Catalyst program and investigate the use of statins. But, in an editorial published on 15 May, BMJ Editor in claimed that statin manufacturers distorted evidence about the side effects of using their medicine. “The Catalyst programs were very engaging, attracted Chief Dr Fiona Godlee wrote that “this [20 per cent] figure large audiences and clearly touched on an issue of is incorrect”. The researcher who blew the whistle on the error, Oxford importance to many Australians,” he said. “The link Dr Godlee said the statements by Dr Ambramson and Dr University Professor of Medicine Rory Collins, believes the between statins and heart disease is a matter warranting Malhotra “did not reflect necessary caveats and did not withdrawal of the statements does not go far enough, and investigation and coverage on our programs.” take sufficient account of the uncontrolled nature of [the] has pushed for the papers to be retracted. But the shadow over the Catalyst series has deepened data”. Dr Godlee has questioned whether a retraction is justified after one of the researchers featured calling into question Furthermore, “during the revision process, the authors given the incorrect statements were secondary to the the use of statins has subsequently withdrawn a key placed more certainty on the 18 per cent figure I their primary focus of each article, but has referred the matter claim, and his findings are the subject of an investigation conclusions, and this was rounded up to ‘nearly 20 per to be assessed by an independent panel. by the British Medical Journal, where they first appeared. cent’ in a summary box”. Adrian Rollins
COMMENT
68 The National Health Performance Authority’s Health NEWS Communities: Immunisation rates for children in 2012- Major study proves vaccination- 13 report showed around 75,000 children five years or younger were not fully immunised last financial year, and autism link a myth in pockets of the population immunisation rates were well below the level required to achieve herd immunity. In particular, in North Coast NSW among one- and two- Anti-immunisation campaigners are continuing to peddle and the development of autism or autism spectrum year-olds and Eastern Sydney for five-year-olds, at 86.1 misinformation despite the results of a comprehensive disorders (ASDs). per cent, 89 per cent and 86.2 per cent respectively. international review that found no evidence of a link The research, based on examination of five cohort Significantly, about 15,000 of these children had parents between vaccination and autism. studies involving more than 1.25 million children and who had lodged conscientious objections to vaccination. The organisers of a Sunshine Coast health expo have five case-controlled studies involving more than 9920 been heavily criticised for inviting the founder of the children, found there was no statistical data to support The results echo Council of Australian Governments Australian Vaccination-skeptics Network (AVN), Meryl a relationship between childhood vaccination for the Reform Council figures showing worrying gaps in Dorey, to speak at their event, particularly given the commonly-used vaccines for measles, mumps, rubella, immunisation in some areas that threaten to undermine widespread alarm the group has caused by spreading diphtheria, tetanus and whooping cough, and the protection against infection. According to the Council, development of autism or ASDs. falsehoods about the safety of vaccines. in parts of NSW vaccination rates among children aged The NSW Health Care Complaints Commission has Senior author Professor Guy Eslick from the Sydney between 12 and 15 months have slipped as low as 81.1 issued a public warning following an investigation into Medical School said these vaccines were those most per cent, while in South Australia, just 77.1 per cent claims made by the AVN. commonly cited by anti-vaccination groups as posing an of Indigenous children in the same age group are fully autism risk. immunised. In a statement released on 30 April, the Commission reported that the AVN “does not provide reliable Professor Eslick said that, until now, there had never Professor Eslick said this was particularly concerning information in relation to certain vaccines and been a quantitative data analysis of any relationship because of serious outbreaks of measles, whooping between autism, ASDs and vaccination. vaccination more generally. The Commission considers cough and other vaccine-preventable diseases both that AVN’s dissemination of misleading, misrepresented “Our review is the first to do so, and we found no within Australia and abroad. and incorrect information about vaccination engenders statistical evidence to support this idea,” he said. fear and alarm and is likely to detrimentally affect the “The increase in parents deciding not to vaccinate their Professor Eslick said the finding was significant because clinical management or care of its readers”. children has substantially decreased herd immunity, of the reluctance of a small but significant proportion of increasing the risk of catching potentially more serious The warning came as Sydney University researchers parents to vaccinate their children because of fears it infectious diseases,” he said. “The risks incurred by not release the findings of a study into claims made by many can lead to autism. immunising a child is increasing substantially.” anti-vaccination campaigners that immunisation is linked Concerns of a link between vaccination and autism to autism. Professor Eslick’s research was published in the journal spring from a study, since discredited, published in The Vaccine. The systematic international review found that there was Lancet in 1998, that claimed to have established such no evidence of a link between childhood vaccinations an association, Adrian Rollins COMMENT
69 Health on the hill Political news from the nation’s capital
Govt considers opt-out clause in Former AMA President Dr Steve Hambleton was medication management reviews and chronic e-health overhaul part of as three-member panel commissioned by disease planning items be uploaded to the MyHR, Health Minister Peter Dutton to review the PCEHR. and to add a flag to alert clinicians if a patient had Patients may be required to actively opt-out of The results of the review, which was completed restricted access to or deleted a document from having an e-health record under changes being last December, were released by the Government the record. considered by the Federal Government as part of last month. an overhaul of the troubled Personally Controlled The review also recommended that the National Electronic Health Record scheme. Among the review’s 38 recommendations, it E-Health Transition Authority be dissolved and proposed that participation in the My Health replaced by the Australian Commission for The Federal Government is considering the Record (MyHR) system – as it would become – recommendations of a review it commissioned Electronic Health, which would be advised by should become an opt-out arrangement from the committees that included clinicians. into the PCEHR, including suggestions it be turned beginning of next year. into an opt-out scheme, be re-named MyHR, The Federal Government has committed $140 This has been seen as a critical change that and include arrangements to make it clear when million to continue the roll-out of the PCEHR while would immediately make electronic health records patients change or withhold information. it considers the findings of the review. more clinically useful, because knowing every The PCEHR, which was commissioned in mid- patient had a record would encourage doctors to Mr Dutton said the review had provided “crucial 2012, has met resistance from the medical use the system. advice” on how the PCEHR could be improved, profession and has failed to elicit widespread indicating that the existing system was likely to be interest among patients because of a series of One of the criticisms of the PCEHR was the extent overhauled. perceived shortcomings. to which patients had control of what appeared in the record, particularly their ability to remove or “The Abbott Government fully supports the Doctors, in particular, have been reluctant to shield information. use the system because of its limited clinical concept of a naitoonal e-health record system, utility, the additional burden of establishing and This arrangement undermined the clinical but it needs to be effective, functional and easy maintaining electronic patient records, and usefulness of the e-health record for doctors, for all Australians to use, while being clinically unresolved medico-legal issues. because they could not be confident that it relevant to our doctors, nurses and other frontline contained all relevant medical information. health care providers,” the Minister said. “It’s In the early part of this year, little more than one clear many of the existing problems with the million people had registered for an electronic To help address this, the review recommended PCEHR system stem from the rushed early health record, and a handful of medical practices there be a requirement that copies of Medicare implementation.” accounted for a large proportion of the records items for health assessments, comprehensive that had been created. assessments, mental health care plans, Adrian Rollins COMMENT 70 Strong passion fruit and tropical WINE Cat’s urine or quaffing aromas are evident, with tight WINES TASTED bucket loads of acid. It remains delight – the wine that the country’s chief wine export, 1. Neederberg Winemakers Reserve 2012 1 making up 70 per cent of all Sauvignon Blanc, South Africa - the colour varieties sold by New Zealand is light lime. The nose exhibits zesty lime and divides the world on international markets. green pea fragrances, with floral herbal notes. Palate is juicy and forward with subtle acidity. All regions of New Zealand BY DR MICHAEL RYAN Overall, enjoyable and sitting somewhere except around Auckland are between Australian and NZ styles. 2 The discussion of acid in wine its ancestry probably includes renowned for producing SB can Asking drinkers’ opinions Pinot. In turn it, along with – the sole exception being 2. Cono Sur Especial 2012 Valle de Casablanca on a foundation grape like Cabernet Franc, is a parent of Auckland’s Kumea Estate. Sauvignon Blanc, Chile - The palate has Sauvignon Blanc (SB) is like Cabernet Sauvignon. Marlborough is the most prolific asking State of Origin fans to generous fruit and mild acidity with a funky, Sauvignon Blanc is a widely area, with multiple recognized earthy taste. Very pleasant but idiosyncratic. clap when the opposition scores sub-regions. a try. It polarizes a room. planted variety found all around the world, though it Australia produces more herbal, 3. Middle Earth Nelson 2013 Sauvignon Blanc, Aromatic, sharp, crisp and zesty 3 appreciates cooler climates. It grassy styles of SB, though New Zealand - a slightly deeper green/yellow are some of the more measured is the third-most planted white Tasmanian SBs understandably colour. The nose has classic New Zealand descriptions it attracts. in France, after Ugni Blanc and produce aromas similar to gooseberry and passion fruit aromas, with flinty Less flattering, some have Chardonnay. The Loire Valley minerality. The palate has generous fruit with acids characterized it as like “feline those in NZ vintages. The is its home, with Sancerre and complimenting the overall mouth feel. Moderate urine passing through a Juniper Adelaide hills, Western Pouilly-Fume being regions sweetness and structure make this wine a little 4 bush”. of significance. If the wine is Australia, Coonawarra and the Limestone Coast are all major more complex than Marlborough SBs. There is no doubt it’s flavor exposed to oak, it is termed SB producing areas, and it finds is pronounced. Aromas of Fume Blanc – a term coined 4. Shaw and Smith Adelaide Hills 2013 - ale its way into the Semillon blends the green spectrum abound, in California. In Bordeaux, it green in colour, with grassy floral notes on the that are prolific in Western such as grass, gooseberries is often blended with a close nose. The wine maker tells me there is a hint of relation, Semillon. Australia. and nettles. Sometimes it has grapefruit present. Certainly, some passionfruit passion fruit and lychee notes, I’ve also heard it referred to Chile produces more earthy aromas are present. This is bone dry on the 5 with a hint of flintiness or as the accountant’s wine, the SB wines. It is believed that a palate, with lip-smacking crispness. It is a very minerality (wine nerds note: this reason being it is picked, quickly lot of these wines are actually good representive of what Australian SB is like. is caused by methoxypyrazines fermented in stainless steel, has descended from Sauvignonasse and thiols present in the wine). no oak exposure and can be grapes - the genetic bastardry 5. Cloudy Bay Te Koko 2010 Marlborough Sauvignon Blanc probably bottled early and released within rolls on. South Africa’s SBs are Sauvignon Blanc - a deep yellow colour, with a originated in the Loire Valley of four to six months of picking. somewhat grassy and tropical. tinge of green. There are complex lemon herbal France, rather than Bordeaux, as Hence, getting the cash flow California, Oregon and even aromas with mandarin and spices like ginger. previously thought. started. Mexico make some SB. Russia, On the palate it is a full, rich wine with subdued DNA studies show that it is the New Zealand Sauvignon Blanc Ukraine and Romania have acidity. Overall, a lush complex version of a NZ progeny of Savagnin, a wild type remains the darling of whites some plantings. Austria and SB. This wine is made with wild yeast ferment of vine with a long history, and in the New World of wine. Switzerland also grow SB. and some lees contact. Some bottle age adds to 71 the complexity. My personal favorite of the SBs. COMMENT