Aniello Iannuzzi: Time to pack a punch

RECENTLY, I came across interesting trench warfare in a report about the Pharmacy Guild of Australia.

“… the Guild has again attacked the Consumers Health Forum of Australia [CHF] for daring to question any of its practices … CHF has been targeted for saying the Guild should ‘concentrate on serving the best interests of Australian consumers rather than pharmacists' profits’ ”, the report said.

Regardless of what you think about this skirmish, few would argue the Pharmacy Guild packs a much harder punch for its members than the AMA.

They have protected ownership of pharmacies. They resist supermarkets buying pharmacies while making supermarkets of pharmacies. Pharmacists are allowed to advise and dispense but doctors are not. They can also make large profits on dispensing scripts while the doctor takes the responsibility and blame when things go wrong.

As the weekend’s AMA National Conference has just been in the spotlight, I asked myself how the Guild stays so powerful while the AMA appears to have lost its bite.

So I did some detective work.

The most obvious problem for the AMA is membership, which currently stands at about 26 500 of the 88 293 medical practitioners registered with Australian Health Practitioner Regulation Agency (2010-11 annual report). By my calculation from the publicly available information, this means that about 70% of doctors in Australia are not in the AMA.

The Optometrists Association Australia enjoys membership of about 93% of registered optometrists (2010-11 annual report). The Australian Dental Association’s annual report shows a membership rate of about 13 000, which is around 60% of dentists. In NSW, about 92% of active solicitors are in The Law Society of NSW.

So can it really surprise any of us when government disregards the views of the AMA? Or that the government consults a broad range of medical organisations for advice or to populate its committees?

Given membership is so low, it seems fair for the government to go beyond the AMA for representation of doctors, allowing it to adopt a “divide and conquer” strategy when it suits.

I have been an AMA member since I was a medical student and have always found the services and representation of great benefit. When I served on AMA committees, it was always frustrating to see the investment of membership money go to work for the benefit of 100% of doctors when only 30% of doctors were paying.

When I talk to AMA non-members about why they do not join the AMA, the most common answers are:

• Do not see value for money

• What has the AMA ever done for me?

• No say in policy

• Feel the AMA doesn’t represent me

• Someone else in my practice/hospital is a member, so if there’s a problem, we get the benefits anyway

Value only comes with using services and by weight of membership numbers to create economies of scale.

The behind-the-scenes work done by the AMA would fill a thick book, but if you are not a member you can’t appreciate it fully.

The perception of doctors not having a say and not feeling represented is something that the AMA can and should look at urgently. Voting for senior office bearers at the National Conference is done via a delegate system dictated by the states and craft groups. Just as in any union or political party, factions develop, and the number crunchers rule the day.

It would be a big step forward to allow grassroots members more say about who leads the AMA — if they felt they would be more included, more would join.

The constitutional formulae that dictate membership of boards and councils (state and federal) are often outdated. For example, it is possible to not have a single rural doctor member on the AMA Federal Council or not a single GP on the federal executive.

Doctors-in-training make up more than 20% of AMA membership, but they are under-represented on councils and committees. Some would argue that this is prudent; others say it is undemocratic.

It is a debate we have to have rather than allow more splinter groups to develop.

And the same goes for women. About 38% of registered doctors are female, and this percentage grows annually. However, less than 10% of the Federal Council is female.

On state AMA councils and boards, Queensland has the best female representation, with 3 out of 8 board members. The other states lag well behind.

For the AMA to once again be strong it has to re-connect with doctors. Membership will follow, and then it can tackle government with greater credibility and voice.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Dr Iannuzzi is a member of the AMA and was previously on NSW Council and the federal AMA Council of General Practice. He is a member of the Australian Doctors Fund and on its board of directors. He is also a member of the Dubbo/Plains Division of General Practice, the Rural Doctors Association of Australia, the Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners, and the Remote Vocational Training Scheme.

Posted 28 May 2012

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