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Safeguarding planetary health, banning nuclear weapons, and the first Nobel Peace Prize born in Australia

Nobel Prize Winner Associate Professor Tilman Ruff is keynote speaker at the AMA Leadership Development Dinner on Friday, 25 May 2018 at the National Portrait Gallery in Canberra. He is Co-President of International Physicians for the Prevention of Nuclear War (IPPNW, Nobel Peace Prize 1985); and founding international and Australian Chair of the International Campaign to Abolish Nuclear Weapons (ICAN), awarded the Nobel Peace Prize for 2017 “for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons and for its ground-breaking efforts to achieve a treaty-based prohibition of such weapons”.

“The World Health Organisation concluded that nuclear weapons pose the greatest immediate threat to human health and welfare. They are the only weapons to loom as an existential threat over all of us, every day that they exist, ready to fire. Yet rather than disarming as they are obligated, all nuclear-armed states are massively investing in not just retaining, but in modernising their arsenals. And tens of additional states, including Australia, claim to rely on nuclear weapons and assist in preparations for their possible use,” said Associate Professor Tilman Ruff.

“The dangers of nuclear war are as high as they have ever been, and growing. Current evidence of the catastrophic worldwide climate effects and famine that would follow a nuclear war using even a tiny fraction of the global nuclear arsenal, and successful approaches to control of other indiscriminate and inhumane weapons, underpin the historic UN Treaty on the Prohibition of Nuclear Weapons. Adopted by 122 nations on 7 July 2017, the Treaty is a planetary health good of the highest order. It provides the only currently defined path to the eradication of nuclear weapons, a stated aspiration of and legal obligation for all governments. As called for by the Council of the World Medical Association this week, all states should join and implement the Treaty without delay.”

Written by Tilman Ruff, MB, BS (Hons), FRACP, AM
Keynote speaker at the AMA Leadership Development Dinner 2018

2018 AMA Leadership Development Dinner

Tilman Ruff is Associate Professor in the Nossal Institute for Global Health at the University of Melbourne; international medical advisor for Australian Red Cross; Co-President of International Physicians for the Prevention of Nuclear War (IPPNW, Nobel Peace Prize 1985); and founding international and Australian Chair of the International Campaign to Abolish Nuclear Weapons (ICAN), awarded the Nobel Peace Prize for 2017 “for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons and for its ground-breaking efforts to achieve a treaty-based prohibition of such weapons”. He headed the IPPNW delegation to and participated throughout the treaty negotiations in New York.

Candidate profile – Dr Gino Pecoraro MBBS FRANZCOG

Nominating for the position of AMA President

My name is Dr Gino Pecoraro and I’m asking for your vote in the AMA National Presidential election.

Australia’s stressed healthcare system needs an upgrade. The ideal time for change is now, with Government reviewing the MBS and private health insurance value and affordability.

Our largely State-funded public health facilities are struggling to meet increasing demand and need ongoing additional funding. Private sector access is increasingly more expensive with non-indexed Medicare and PHI rebates causing greater out of pocket costs.

Some form of indexation (ideally one supported by the AMA) must be embedded in legislation. In this way, rebates can start to reflect the true cost of accessing services and keep medical care affordable.

Ensuring our GPs are adequately paid will help them give patients the time needed to deliver quality care and disease prevention. Ultimately, this will keep patients out of already crowded hospitals and save the health system money.

Similarly, PHI providers need to understand that their moves towards managed care models will not be tolerated and that patient choice of doctor and hospital must be protected in all policies.

Decreased demand for public hospital outpatient and inpatient services means money can be redirected to other areas e.g. emergency department waiting times and chronically underfunded mental health services.

Medical student numbers have radically increased without an increase in the number of postgraduate training positions. No more medical schools are needed. What students and doctors-in-training really need are an increase in the number of fully-funded postgraduate training positions. These positions need to be in the disciplines and locations where shortages exist. Relocation support needs to be provided for these doctors and their families.

The AMA President is expected to be the public face of the organisation and deliver our members’ policies to parliamentarians, the medical profession and the general public.

My extensive experience in medical politics is what makes me the best candidate, and includes:

Senior roles with RANZCOG (Council, Board and Examinations);
Ongoing association with the University of Queensland;
2010 Queensland AMA President and Board Member; and
Current Federal Council representative for Obstetrics and Gynaecology.

I have been instrumental in the Federal Council’s formation of the Council of Private Specialist Practice, developed to serve a previously underrepresented part of our membership. I have acted on the AMA’s behalf to put a stop to the National Maternity Services Framework, which had been formed without a single doctor on the committee. I continue to represent the AMA on multiple Government committees.

An AMA President must be an effective communicator. I’m a seasoned media performer with 25 years’ experience encompassing print, radio, television and online platforms.

I continue to write columns for newspapers and magazines as well as having produced and presented State and national television shows. I have experience in live breakfast, drive and talkback radio.

My eight years’ experience on Federal Council means I fully understand the workings of both our organisation and the Government departments we seek to influence.

* See other candidate profiles on this site.

Candidate profile – Professor Brad Frankum OAM BMed(Hons) FRACP

Nominating for the position of AMA President

As a consultant physician specialising in immunology and allergy, I divide my time between a fractional staff specialist role at Campbelltown and Camden Hospitals, and my private specialist practice at Narellan NSW.

In addition, I run an immunology and allergy clinic at the Tharawal Aboriginal Medical Service in Campbelltown. I also serve as the Executive Clinical Director of Campbelltown and Camden Hospitals.

I have extensive experience in the university, public hospital, and Medical College sectors, and have been a board member of the Southwest Sydney LHD since its establishment. I have been involved in the teaching and training of thousands of medical students and young doctors.

Fourteen years ago, I realised the importance of ‘being a part of the conversation’.

The Campbelltown and Camden crisis was a lightning rod, and a significant reminder that doctors need to be at the centre of healthcare decisions.

If we fail to be present, and if we allow non-medical professionals to have absolute control over hospitals, patients, and our healthcare system, then we must accept the consequences.

Many factors led to the crisis and looking back we need to heed the conditions that contributed to that situation – there was explosive population growth, a dearth of health funding and resources, and a complete lack of Government support.

When our hospital was accused of poor standards of care and a litany of other failings in the early 2000s, the State Government and the media at the time were only too keen to scapegoat the clinicians in order to deflect from the chronic neglect the whole of the south-west of Sydney had suffered from successive governments and the bureaucracy.

People’s careers were in tatters, and those of us demanding due and fair process were subject to serious intimidation.

It was only with the unwavering support of the AMA that I was able to lead the clinicians to stand up to what amounted to the tyranny of the government at the time.

Out of the mess, and really against the odds, we now have the biggest hospital in NSW at Liverpool, a $632 million upgrade occurring at Campbelltown to grow to a 900-bed facility over the next 10 years, and a very successful medical school at Western Sydney University in its 11th year, producing very fine medical graduates.

This episode taught me the value of the AMA, as well as the importance of standing together as a medical profession to advocate on behalf of doctors, patients and a better healthcare system. It led me to join the Council of AMA (NSW), where I have held numerous positions – most recently serving as President.

The lack of imagination and vision in health policy on both sides of politics should be of great concern to all of us.

The AMA can elevate the debate and promote a vision for health and exert great influence at the next Federal election. At times like these, it is the duty of the AMA to step up and demand more imagination and focus on health from politicians who would prefer to coast along with conditions just tolerable enough so that few complain loudly. We owe it to our members and patients to speak up, because if we don’t no one else will.

In the next AMA Federal Election, I will be running on a ticket with Dr Jill Tomlinson from Victoria for Vice-President. Jill and I will work extremely effectively as a team. Jill will bring a range of skills to the position across a range of issues. She has been a strident voice against harassment, a great supporter of junior doctors, and has great knowledge of the application of digital technology.

I believe that together we can provide a strong voice for the AMA.

* See other candidate profiles on this site.

Candidate profile – Dr Jill Tomlinson MBBS(Hons), PG Dip Surg Anat, FRACS(Plast), GAICD

Nominating for the position of AMA Vice President

We are at a critical period of change in health. We are asked by Government and the community to do more with less. Healthcare costs are rising. Technology is changing how we practise, offering opportunities but also challenges. Our profession faces significant cultural change.

The AMA must remain relevant and engaged in this time of change. It needs a strong leadership team who will deliver advocacy, political representation and passion to do better for our patients and for the profession.

If elected, I will make digital strategy a key priority. Within the AMA, this means improving communication and engagement with members by expanding digital services and addressing barriers at State and Federal levels. The AMA must be where doctors are, and must support a strong AMA in every State.

Within the health system, a focus on digital strategy means strong advocacy for systems and programs that work for doctors, not create work for doctors. This is not just about My Health Record, it’s about real time prescription monitoring, secure messaging, data use and security, accessibility, interoperability, care co-ordination, the digital determinants of health and the regulatory and administrative burden on doctors. We must get digital systems right, or else – as we’ve seen with hospital constructions across the country – billions are spent but the final product doesn’t address the needs of patients or doctors.

Preventable illnesses associated with obesity are literally killing our patients. We need a radical, whole of community approach to the problem – one that drives meaningful change. We must advocate for public health improvements and make real investment in general practice, which is the most efficient part of the health system and has been neglected for too long. We must improve mental health care, aged care and veterans’ services. We must reduce inequality, and Close the Gap. We must be inclusive, and support equity and diversity. It’s the fair thing to do but it’s also in the best interests of our patients and the profession.

We must address workforce issues, including doctor and training position maldistribution. We must support medical students and doctors-in-training who are increasingly struggling to manage the overwhelming demands of training and service delivery. We must improve access to flexible training and end discrimination on the grounds of pregnancy, mental illness, disability, parental leave and return to work. We must advocate for marginalised individuals and groups that cannot speak for themselves.

We must fight for an independent profession. Patient care suffers when health funds control access to care or make decisions for patients; corporatisation increasingly affects general practice, radiology and pathology.

I seek your support and your vote at National Conference. I seek your advice and insights into how we can improve health in Australia as, while I have a vision for the AMA, I do not claim to have all the answers. And most importantly, I seek your enthusiasm, passion and engagement – only by working together will we achieve the best outcomes for our patients and the profession.

* See other candidate profiles on thios site.

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 – Dr Janice Fletcher MBBS (Hons 1), MD, BSc, FRACP, FRCPA

Nominating for the position of AMA Vice President

My decision to nominate for Vice President came about after careful consideration about what I could offer the role, and, importantly, if I had the time to commit to the requirements of the position.

After a recent (second) knee replacement I also had to make sure I was fit to run. I, only half jokingly, credit my orthopaedic surgeon for this decision.

Having served as President of the AMA SA I have been exposed to the rigours of such a role.

I believe strongly in the role of the AMA, recognising the issues both at Federal and State level, having worked in South Australia, New South Wales, and Victoria. Coming from a small state, I bring geographic diversity to the executive table.

My professional background is diverse; paediatrics, genetics, pathology and medical administration. I was proud to be the fourth female President of the AMA SA.

As a strongly influential organisation, the AMA must be at the forefront of setting the health agenda for Australia. As experts in evidence-based medicine, we need an evidence-based approach to our profession.

We need to advocate for, and evaluate, research which will give us a true picture of the health needs of the Australian community and the workforce requirements in the next five, ten, twenty years and beyond. And we need to know who is currently being trained, and in what areas.

This will give our next generation of doctors a much better insight into where the jobs will be in the coming years.

In taking this proactive role the AMA will be re-established as the key decision maker, ensuring that the right policies are in place to steer the right course.

I have extensive experience in the public domain, with the media and have worked with all sides of politics.

I have been given a ‘sensible’ tag, which I wear proudly. This role is not about me, but more about the decisions the AMA makes. I bring to the table a considered approach, objectively looking at all sides of an issue. I know when to ‘keep my powder dry’ and when to go in, guns blazing.

Also of benefit to the AMA leadership team is my expertise in the field of genetics. As evidenced by the 2018 Federal Budget, this area of medicine is a key driver of our future and the impact it will have across all fields of medicine is significant. I am an Emeritus Member of the Human Genetics Society of Australasia, with professional respect across the country and internationally.

I am passionate about improving nutrition in our community, particularly in childhood. We must improve nutritional literacy for all Australians. We must also improve genomic literacy for the community, patients and all healthcare professionals.

A focus on the future is what is driving me to nominate for Vice President. As a teacher and researcher, I continue to work with many young doctors and students. If we don’t advocate strongly for them, they will not have a profession, but a mere job.

I am not running on a ‘ticket’ as I know I can represent the interests of all States and Territories and work alongside all President nominees.

If you would like further information or to contact me, please visit my website:

https://janicefletcher0.wixsite.com/aboutjanicefletcher I would love to hear from you.

* See other candidate profiles on this site.

Health Budget steady as she goes

The AMA has labelled the 2018-19 Health Budget as “safe and steady”, but adds that it is notable as much for what is not to be found in it as it is for what is included.

Treasurer Scott Morrison has delivered a Federal Budget with an eye on the next federal election, promising tax relief for middle Australia, significant infrastructure investment and more funding for aged care.

On the health front, the establishment of a new 21^st century medical industry plan to create more jobs and support more medical research projects is a major commitment.

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.

The Government will also 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.

It has dismissed a proposal for a single and separate Murray Darling Medical School, in favour of a network, in what AMA President Dr Michael Gannon has described as a better approach.

Mr Morrison said the plan was 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,” Mr Morrison said when delivering his Budget Address to Parliament on May 8.

Dr Gannon said many of the rural health initiatives outlined in the Budget are a direct response to AMA rural health policies and the AMA Budget Submission.

“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.

“The decision to reject the proposal for a stand-alone Murray Darling Medical School, in favour of a network, is a better approach with the Government instead pursuing a policy that builds on existing infrastructure to create end-to-end medical school programs.

“However, while the Government has made a welcome commitment not to increase Commonwealth-supported medical school places, it has taken the unnecessary step of compensating medical schools with additional overseas full-fee paying places.

“This will not address community need, and instead simply waste precious resources.”

Dr Gannon said overall, the Government had delivered a safe and steady Health Budget, which outlines a broad range of initiatives across the health portfolio.

Necessary funding to aged care, mental health, rural health, the PBS, and medical research, were all welcome commitments.

“But some of the bigger reforms and the biggest challenges are yet to come,” he said.

“Due to a number of ongoing major reviews, this Budget is notable as much for what is not in it as for what is in it.

“The major reviews of the Medicare Benefits Schedule (MBS) and private health are not yet finalised, and the ensuing policies will be significant.

“We are pleased that indexation has been restored to general practice and other specialty consultations, but new and considerable investment in general practice is missing.

“Also, the signature primary care reform – Health Care Homes – did not rate a mention.”

Health Minister Greg Hunt described the Budget as a “record investment in health” and pointed to a previously announced commitment from the Federal Government to public hospitals.

“The Government will deliver more than $30 billion in additional public hospital funding under a five-year National Health Agreement, with funding increasing for every State and Territory, every year,” Mr Hunt said.

But Shadow Health Minister Catherine King said the Budget failed the health test.

The Government was persisting with a plan to cut $715 million from hospitals over the next two years, she said.

“Their hospital cuts are putting doctors, nurses and hospital staff under increasing pressure; forcing delays in surgeries; and making emergency department waiting times even worse,” Ms King said.

CHRIS JOHNSON

Looking forward to more significant announcements

AMA President Dr Michael Gannon said while there were “many significant and worthy announcements” in the Federal Budget, the bigger structural health reform announcements were yet to come.

He said the public hospital funding announcement was consistent with the COAG National Health Agreement, but the AMA Public Hospital Report Card shows how more funding will be needed over the long term.

“This will involve the States and Territories doing their bit to work with the Commonwealth to increase the funding to appropriate levels,” Dr Gannon said.

“The Government is to be congratulated on its ongoing commitment to medical research, and for its positive contribution to improving Indigenous health, especially eye health, ear health, and remote dialysis.

“The investments in aged care and mental health must be seen as down-payments with more attention needed in coming years and decades as community demand drastically increases.

“We need to see a more concerted approach from the Government in prevention. We need to keep people fitter and healthier and away from expensive hospital care.

“Good health policy is an investment, not a cost. We look forward to the finalisation of the private health and MBS reviews, and the reforms that will flow from those processes.

“We expect to see any savings from the MBS Review reinvested into the MBS in the form of new and improved items in a transparent way.

“We anticipate more significant health policy funding announcements ahead of the next election.”

CHRIS JOHNSON

Pic: Dr Michael Gannon with Health Minister Greg Hunt

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