Candidate profile – Dr Chris Zappala MBBS (Hons), AMusA, GCAE, MHM, MD, FRACP

Nominating for the position of AMA Vice President

The AMA represents an extremely diverse group of professionals and as such our focus and efforts evolve and change to reflect contemporary need.

The enervating effects of bulk-billing and enforced five-minute consultations puts high-quality medicine in jeopardy. General practice has been progressively disinvested despite all the talk about augmenting community based care and preventing hospital re-admission. The Federal Government must understand that many of their objectives for the health of Australians will be realised if they invest properly in general practice. I accept we must also convince GPs that the AMA understands this and holds it as a priority.

The maldistribution of the workforce has not been solved by an exponential increase in medical graduates. Despite clear AMA policy regarding rural training hubs, appropriate industrial/MBS schedule recognition and bespoke rural/regional training models, we still have a problem. Until this is solved we will continue to endure nefarious role substitution models which pander to other tribal groups and damaging medical over-supply in some areas.

Oversupply forces public hospital doctors into a vulnerable enterprise bargaining position and poses a threat to private medicine and our professional credibility from possible over-charging/over-servicing, fee splitting and selling fringe medical services. This data is being released by those who wish to subjugate or cheapen doctors, so the AMA needs to be leading the discussion in order to shape perception and potential solutions.

Exorbitant graduating workforce numbers compound upon the burgeoning group of vulnerable junior doctors. They should be assured of transparent and fair selection and examination processes with open knowledge of workforce trends. The AMA has a clear need to strengthen relationships with Colleges and move us collectively in this direction.

It is not protectionism to want to preserve the freedom of decision-making for doctors and the ability to charge a fee commensurate with training/expertise and the service provided. This preserves high-quality medicine. Pharmacists, non-medical endoscopists, optometrists all encroach on the medical domain with no decisive rebuttal. We are not being enlightened ‘team players’ if we allow medical practice in the future to be harder, less rewarding or diminished in any way.

The public hospital system struggles under perpetual funding shortfalls and a blinkered rigidity that focuses predominantly on targets of dubious relevance to clinical outcomes. This partly relates to operational inefficiency but also politically expedient emphasis on spurious initiatives. Any evolution that simplifies hospital funding and reduces the cost-shifting game would be welcome.

Our Association’s membership worryingly continues to decline, which jeopardises our collective ability to influence. Only the AMA can bring the profession together and has the expertise to achieve medicopolitical outcomes that improve the daily working lives of doctors. Membership must be cheaper and we can engage better through cohesive action amongst the entire AMA family and an expansion of our digital/online capability.

As always, there is much to do. We need the entire AMA family to be effective and united in promoting thoughtful initiatives at every level. There are too many external threats for us not to be at our most potent, but the AMA will need to do things a little different to achieve this. Hopefully, as AMA Vice President, I can contribute to this.

* See other candidate profiles on this site.

Candidate profile – Xavier Yu MBBS/BA FRANZCR GAICD

Nominating for the position of AMA Vice President

Yes, I am a radiologist. But one who actually enjoys engaging with patients and fellow clinician referrers….

I began my medical career 18 years ago, but only recently gained my FRANZCR two years ago. My 16-year doctor-in-training career included stints in general surgical and orthopaedics training programs, while working in hospitals across New South Wales, Victoria and Tasmania, before joining the world of radiology. My current public and private practices include inner city, outer suburban and regional Victoria, as well as interstate through teleradiology.

My credentials include graduate qualifications and advanced training though the Australian Institute of Company Directors, and being involved in AMA committees forever, including as Council of Doctors In Training Victorian representative, and AMA Victoria Board member for six years (including the past two as Vice President). A transition from one VP role to another seems natural enough!

We must unite and rebuild, with collaborative and respectful engagement of the most important asset – you as the member. Our organisation faces increasing challenges with membership recruitment and retention, provision of membership services and assessing our vision: what and where is the future in advocacy for the AMA?

The role of the next AMA Vice President is threefold:

* support act to the President;

* bring good modern governance credentials to the Board, Councils, Committees; and

* listen to the voice of the membership.

My five ‘passions’ include:

* General Practice.

You might find this strange coming from me, but my frequent professional discussions with GPs has highlighted the powerlessness they feel about being able to effect genuine change – and continuing to fight the escalating war on punitive over-regulation and intrusions by threats from task substitution like ‘superpharmacies’. I also hear loud and clear the anxiety from GPs about talk of changes in regards to Health Care Homes, outcome based practice incentives and e-PIP.

* Membership engagement.

To say we have a lack of engagement ‘on the ground’ is an understatement. I want to ‘close the gap’ between President and the ‘normal’ doctor, fostering better member engagement and networking opportunities, and being the person behind the scenes to whom you can freely talk to and get stuff changed. The State and Territory AMAs must be at the forefront of advocacy activity, and therefore be suitably better resourced.

* Culture and systems change.

We have to end the ‘blame game’ in hospitals and workplaces, by lobbying for better mechanisms to improve work-life balance and doctor well-being, assist colleagues in distress without vilification or victimisation, and promoting equity to give opportunities to all our colleagues, regardless of gender, ethnicity, religion or orientation.

* The ‘maldistribution mess’.

Medical school, prevocational and vocational training settings all need to work together better.

* Regional, rural and remote recruitment.

To whom are the doctors going to hand the keys of their practice when they retire?

Follow me on LinkedIn (search “Xavier Yu”) and Twitter (@docxy75) leading up to National Conference for more: I’m more than ‘just a radiologist’….

* See other candidate profiles on this site.

Reducing the intake of GPs trained overseas

The biggest single saving of the Federal Budget will be achieved by axing 200 places from Australia’s intake of overseas-trained GPs.

The total number to be granted visas will now be 2,100. The move, beginning in January, is expected to save more than $400 million over the forward estimates and reduce the demand on Medicare and PBS-listed medicines.

The initiative is also designed to address what the Government describes as an over-supply of medical graduates in urban areas.

The Government insists the savings will be redirected to fund health policy priorities.

Improved targeting of visas, it says, will see overseas-trained GPs directed to areas where there are doctor shortages, such as regional and rural Australia.

“By better managing the total number of doctors entering the system and directing them to areas of need has made available $415.5 million over four years,” Budget papers say.

AMA President Dr Michael Gannon said the full intent of the Government’s plain needed further explaining.

“We really appreciate the contribution made by international medical graduates in the past, and in the present, and in the future to rural Australia,” he told ABC Radio.

“But the ultimate aspiration has to be self-sufficiency in medical graduates, and we applaud the Government in at least starting to introduce some evidence-based measures… that are likely to increase the number of doctors who settle in rural areas, in the regions.

“If you take people who went to high school in the regions, if you train them in the country, they are far more likely to make their careers there. We think they have got it right in this workforce package.

“So basically we’ve got a Health Budget which points to $4.8 billion extra investment, and we’ve got a saving in the Immigration Home Affairs portfolio.

“So, we’re still trying to work that one out. Obviously the idea is that those services are provided under the Medicare system by Australian-trained doctors.

“The reality is that the vast majority of doctors given visas under district of workforce shortage provisions end up working in our major cities; they end up in the middle of Sydney, the middle of Melbourne, the middle of Perth.

“We are interested in measures that are likely to deliver doctors to the bush in a sustained manner. We simply can’t have the situation where people are recruited to jobs in the country or often in the outer suburbs of our metropolitan areas, and find their way into private hospital jobs in the middle of our cities. That’s not a workforce strategy.”

CHRIS JOHNSON

Rural health focus welcomed

The AMA welcomes the Budget announcement of a range of initiatives to improve access to health services for rural and regional Australians.

AMA President Dr Michael Gannon said many of the initiatives outlined in the Stronger Rural Health Strategy as part of the Health Budget – are a direct response to AMA rural health policies and the AMA Budget Submission.

“The evidence shows that selecting medical students with a rural background and providing high quality training in rural areas are the most effective policy measures to address workforce maldistribution,” Dr Gannon said.

“With medical graduate numbers in Australia at record numbers, well above the OECD average, there is a strong emphasis in this Budget on building a rural training pipeline so that it will be possible for doctors to complete their medical degree in a rural area – and then continue to be able to work and train in these areas.

“We welcome the decision to create a pool of medical school places that can be reallocated over time, a nimble way of better responding to community need.

“The AMA has championed a Community Residency Program, focusing on rural areas, and the significant expansion of prevocational training places in general practice announced delivers on that policy proposal.

“The decision to set aside funding for an extra 100 GP training places from 2021, earmarked for the proposed National Rural Generalist Pathway (NRGP), is a good first step in supporting its rollout.

“This will build on the work of the Rural Health Commissioner, who is currently consulting on the design of the NRGP.

“It is also good to see that the Government is funding support for non-vocationally registered doctors to progress to College Fellowship. Rural areas are very reliant on International Medical Graduates (IMGs) to deliver care, and this decision will help them in continuing to deliver high quality care for patients.

“The AMA is also pleased to see the Government take the decision to completely overhaul the bonded medical graduate programs, which have so far largely failed to deliver extra doctors to needy communities.

“The new arrangements will be more flexible, and provide greater career certainty for doctors who have signed up for these programs.”

JOHN FLANNERY

Health Budget at a glance

Highlights of the Health Budget

The Medicare levy increase from 2 per cent to 2.5 per cent announced in last year’s Budget has been dropped. NDIS funding will now be reliant on ongoing revenue instead of the $12.8 billion projected to be raised by the levy increase over the forward estimates.
Medicare funding to increase by $4.8 billion.
The $30 billion five-year public hospital funding agreement.
A $500 million 10-year medical research fund.
A $83.5 millioninvestment from (2017-18 to 2021-22) for a new rural health initiatives that include a Junior Doctor Program, additional Royal Flying Doctor service funding and establishing a Murray-Darling medical schools network.
An extra $1.4 billion for listings on the Pharmaceutical Benefits Schedule.
Investment in new medicines.
Extra $37.5 millionspending on the National Immunisation Program for flu, pertussis and meningococcal vaccinations.
A $154 million healthy living promotion package.
A $90.2 millioninvestment in mental health service improvements.
$82.5 millionover four years for people in residential aged care services.
Funding to promote healthy living and improve community and school sport facilities.

Excerpts from Treasurer Scott Morrison’s Budget Speech 2018-19

Our national economy is strengthening, but it is also true that the benefits are yet to reach everyone. This will take more time. That is why it is important to stick to our plan. There is more to do. We cannot take a stronger economy for granted. We live in a very competitive world. If we make the wrong calls, other countries will ‘cut our lunch’. There is a lot to gain and much to lose. We can’t ease off.

***

In this year’s Budget there are five things we must to do to further strengthen our economy to guarantee the essentials Australians rely on.

Provide tax relief to encourage and reward working Australians and reduce cost pressures on households, including lowering electricity prices,
Keep backing business to invest and create more jobs, especially small and medium sized businesses,
Guarantee the essential services that Australians rely on, like Medicare, hospitals, schools and caring for older Australians,
Keep Australians safe, with new investments to secure our borders, and, as always,
Ensure that the Government lives within its means, keeping spending and taxes under control.

That’s our plan.

***

Tonight we announce a new 21st century medical industry plan to create more jobs in this fast growing sector of our economy. The health sector represents 7 per cent of our economy and 14 per cent of jobs. Our plan will provide more support for medical research projects, new diagnostic tools, clinical trials of new drugs, scientific collaboration, and development of new medical technologies that can be sold overseas. In particular we will back in Australian medical scientists through the largest single investment of the Medical Research Future Fund to date of $500 million over ten years for Australia to become a world leader in genomic research. This is about building another strong and competitive industry in Australia that will generate income and jobs, from the white coats in the labs to the workers making new medical devices on the shop floor.

***

In rural and regional areas we have funded a plan to get more doctors to where they are needed through a new workforce incentive program. This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region. And we have moved to guarantee rural and remote access to dental, mental health and emergency medical services through increased financial support for the Royal Flying Doctor Service. Indigenous Australians also benefit from our $550 million commitment to address remote housing needs in the Northern Territory and $1.7 billion through our primary health care model. Our veteran centric reform package will continue with a planned additional $112 million in this Budget, as will our support for ongoing veterans’ mental health and employment initiatives. Finally, every dollar and every cent committed to delivering the National Disability Insurance Scheme remains in place and always will.

***

Our new five year hospitals agreement, which is being signed onto by the States and Territories, will deliver $30 billion in additional funding, a one third increase over the previous five years. And following last year’s Budget, funding for Medicare and the Pharmaceutical Benefits Scheme or PBS has been guaranteed in legislation. This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV. Lifeline Australia will receive additional support as will funding for Mental Health Research, with $125 million over 10 years from the Medical Research Future Fund.

The Government will also provide $20.9 million to support parents and infants by funding tests for new conditions and ensure that debilitating conditions are picked up at the earliest opportunity. The Government will provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.

***

Just because you are getting older does not mean you should have to surrender your dignity or your choices. We’re living longer. It’s a good thing. We want to preserve and increase the choices of older Australians. To support the choice of older Australians who wish to stay at home and avoid going into residential aged care the Government will be increasing the number of home care places by 14,000 over 4 years at a cost of $1.6 billion. By 2021-22, over 74,000 high level home care places will be available, an increase of 86 per cent on 2017-18. We will also be providing $146 million to improve access to aged care services in rural, regional and remote Australia. We will also provide $83 million for increased support for mental health services in residential aged care facilities, especially to combat depression and loneliness.

Budget 2018: who are the winners in health?

The federal budget was a mixed bag for the health sector, but it delivered significant wins for aged care, rural health and medical research.

Treasurer Scott Morrison announced $1.6 billion over four years to allow 14,000 more elderly Australians to continue living in their home with extra in-home care places. This follows the 6,000 extra places already announced in December. However, given that there are more than 100,000 people on the waiting list for in-home care, the new places are “welcome, but are a drop in the ocean”, according to Associate Professor Helen Dickinson of the Public Research Group at UNSW.

Morrison also announced a $146 million plan to improve access to aged care service in rural areas and $83 million to support mental health services in residential care.

Meanwhile, an $83.3 million rural health strategy aims to place more doctors and healthcare professionals in rural areas, and includes a project to train an extra 100 GPs for work in rural areas.

The other big winner in terms of funding is medical research. The government has allocated $1.3 billion over ten years for a National Health and Medical Industry Growth Plan, including $500 for genomics research.

Here are some other health takeaways from the 2018 Budget:

No rise in the Medicare levy

An $8 billion rise in the Medicare levy to fund the NDIS had been originally pencilled in, but Scott Morrison backed away from the plan last month.

Fewer IMGs allowed to work in Australia

The government will allow 200 fewer international medical graduates into the country than previously planned, capping the yearly intake at 2,100 new IMGs. The government says this will save money, as Australian junior doctors who will take the place of the IMGs are paid at a lower rate.

IMGs will also be hit by a reduction in MBS fees paid to them, in order to fund a network of new rural medical schools in the Murray-Darling basin.

Extra money for PBS listings

The government is providing an additional $2.4 billion for new PBS listings and there will also be several new Medicare rebate numbers. These include a $400 rebate for prostate MRI, which urologists have been calling for for some time. There will also be a $114 rebate for 3D breast cancer scans. Around $700 million has been budgeted for the breast cancer drug ribociclib and the spinal muscular atrophy treatment nusinersen will also be subsidised for the first time.

On the other hand, there will no longer be rebates for MRI knee scans for patients over 55, for some sleep studies, or for spinal fusion to treat chronic low back pain.

Extra money for WA hospitals

Western Australian hospitals will get a $180 million funding boost, which will be directed to the Joondalup health campus, an expansion for the Osborne Park Hospital and the refurbishment of Royal Perth Hospital.

But there will be no new money for public hospitals in other states.

Free whooping cough vaccines for mums

The pertussis vaccine will be added to the National Immunisation Schedule for all expectant mothers, a measure expected to cost around $40 million.

Funds for Flying Doctors mental health outreach

The government will provide $84 million in funding to provide mental health nurses for remote and rural areas.

New funds for rare diseases

An extra $240 million will be allocated for clinical trials for rare cancers, rare diseases and diseases with unmet needs.

Measures to encourage use of generic drugs

New prescription software will enable prescribing of generics by default, with doctors having to manually override the system if they want to prescribe a branded drug. The measure is expected to shave $335 million from the budget.

[Series] Canada’s universal health-care system: achieving its potential

Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care.

[Comment] Who is responsible for the vaccination of migrants in Europe?

A report from WHO exploring the provision of immunisation services to migrants and refugees in the WHO European Region1 provides a stark reminder that European health services are a long way off adapting to the rapid demographic shift that the region has witnessed in the past two decades, amid unprecedented rises in internal and external migration. Migrants are more likely to be under-immunised—putting them at increased risk of vaccine-preventable diseases circulating in Europe—and may face greater disease, disability, and deaths from vaccine-preventable diseases than the host population.

New Secretary General announced

The AMA has appointed Dr Michael Schaper as its next Secretary General.

Dr Schaper will take up the position in late July. He will replace Anne Trimmer, who will leave the AMA in August at the completion of her five-year term.

Dr Schaper will join the AMA from his current position as Deputy Chairman of the Australian Competition and Consumer Commission (ACCC), a position he has held since 2008.

AMA President Dr Michael Gannon said the AMA Federal Council and AMA Board were delighted to secure the services of Dr Schaper, who has considerable background and experience in business, government, and academia.

“Dr Schaper is exceptionally qualified and very highly regarded across a number of peak sectors in the Australian community,” Dr Gannon said.

“His intimate knowledge of the workings of government, business, and the tertiary education sector makes him the ideal leader for our talented and hardworking Secretariat in Canberra.

“The interests and concerns of AMA members, the medical profession, and every Australian who has contact with the health system will remain in very capable hands,” Dr Gannon said.

Chair of the AMA Board Dr Iain Dunlop, who oversaw the national recruitment process, said Dr Schaper’s business background will be invaluable for the Association.

“Like all member organisations, the AMA needs a solid financial base upon which to embark on its vital policy and advocacy activities,” Dr Dunlop said.

“Michael’s impeccable inside knowledge of politics, government, regulation, and the business world will ensure that the AMA’s reputation as one of the nation’s most successful lobby groups is preserved.”

Dr Schaper has a PhD in Management and a Master in Commerce, both from Curtin University.

He has chaired or served on a number of Ministerial advisory committees, and been an adviser to various State and Federal Ministers and Members of Parliament, including the Cabinet Office of the Western Australian Government and the office of a previous Federal Treasurer.

As a manager, he has been the head of both the Bond University and Murdoch University business schools, CEO of a community business advisory centre, and was the Small Business Commissioner for the Australian Capital Territory.

JOHN FLANNERY