Federal Budget delivers – Medicare rebate freeze to be lifted

The AMA welcomes much of the health measures in the Federal Budget and commends the Government for taking action on the Medicare rebate freeze.

AMA President Dr Michael Gannon said the Coalition had won back much of the goodwill it lost with its disastrous 2014 Health Budget by this time handing down a Budget with numerous positive health measures.

Dr Gannon said the staggered lifting of the freeze on Medicare patient rebates was well overdue.

“This is a monkey that has been on the back of the Coalition Government since the 2014 Budget that cut significant dollars out of health. This is the chance to correct those wrongs,” he said.

The freeze will be lifted from bulk billing incentives for GP consultations from 1 July 2017, from standard GP consultations and other specialist consultations from 1 July 2018, from procedures from 1 July 2019, and targeted diagnostic imaging services from 1 July 2020.

The lifting of the freeze on Medicare rebates will cost the Government about $1 billion.

“The AMA would have preferred to see the Medicare freeze lifted across the board from 1 July 2017, but we acknowledge that the three-stage process will provide GPs and other specialists with certainty and security about their practices, and patients can be confident that their health care will remain accessible and affordable,” Dr Gannon said.

“Lifting the Medicare rebate freeze is overdue, but we welcome it.”

Dr Gannon also described many of the health policy breakthroughs in the Budget as a direct result of AMA lobbying and the consultative approach of Health Minister Greg Hunt.

“Minister Hunt said from day one in the job that he would listen and learn from the people who work in the health system every day about what is best for patients, and he has delivered,” Dr Gannon said.

AMA advocacy has also seen, in this Budget, the reversing of proposed cuts to bulk billing incentives for diagnostic imaging and pathology services; the scrapping of proposed changes to the Medicare Safety Net that would have penalised vulnerable patients; the delaying of the introduction of the Health Care Homes trial until October to allow fine-tuning of the details; the moving to an opt-out approach for participation in the My Health Record; and recognising the importance of diagnostic imaging to clinical decision-making.

The AMA supports the Government’s measures to increase the prescribing of generic medicines, when it is safe and appropriate and discussed with the patient, and preserves doctors’ clinical and prescribing independence, with savings to be invested back into the Pharmaceutical Benefits Scheme.

“We also welcome the Government’s allocation of $350 million to help prevent suicide among war veterans; the expansion of the Supporting Leave for Living Organ Donors Program, which allows donors to claim back out-of-pocket expenses and receive up to nine weeks paid leave while recovering; measures to increase the vaccination rate; and the ban on gambling ads during live sporting broadcasts before 8.30pm,” Dr Gannon said.

Mr Hunt said the Budget delivered on the Government’s commitment to guarantee Medicare and ensure Australia’s health system continues to be one of the best in the world.

“It ensures the essential healthcare services Australians rely on,” the Minister said.

“The 2017-18 Budget includes a $10 billion package to invest in Australia’s health system and the health of Australians.

“The Government will establish a Medicare Guarantee Fund from 1 July 2017 to secure the ongoing funding of the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, guaranteeing Australians’ access to these services and affordable medicines into the future.”

The Medicare levy will rise by 0.5 percentage points in two years’ time, to help close the funding gap for the National Disability Insurance Scheme.

“This measure will collect $8.2 billion over four years for the NDIS,” said Treasurer Scott Morrison when handing down his Budget.

Shadow Treasurer Chris Bowen said the Government had failed the Medicare test because it had delayed reversing cuts to Medicare for three years.

“Budgets are about choices and Prime Minister Malcolm Turnbull has made his choices tonight,” Mr Bowen said.

“He has chosen multinationals over Medicare. He has chosen big business over battlers.”

Dr Gannon said the Health Budget effectively ends an era of poor co-payment and Medicare freeze policies, and creates an environment for informed and genuine debate about other unfinished business in the health portfolio.

“We now need to shift our attention to gaining positive outcomes for public hospitals, prevention, Indigenous health, mental health, aged care, rural health, private health insurance, palliative care, and the medical workforce,” he said.

“The thaw in the freeze is the beginning, not the end.”

Chris Johnson

Immunisations in pharmacies

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY

Controversy swirls around this topic. I sounded out several colleagues, including pharmacists.

An infectious disease physician: “(I see) no fundamental reason why not … under certain conditions: they keep recipients on site for 15 mins to make sure they do not suffer anaphylaxis; they [are] trained to resuscitate; they record the vaccination and report to the Immunisation Register and to the recipient’s GP and provide the recipient with an appropriate record. It might suit … families lacking access to bulk-billing GPs or who can’t organise appointments.”

An interested physician recognised this contentious issue, mainly because it disrupts GP-patient relationships.

“I’ve never been convinced (by the AMA), especially (regarding) flu vaccine – where adults >65 and parents of school-age children (need) GP appointments at convenient times. Pharmacists are well-equipped for following procedures, including cold-chain logging and record-keeping.”

Pharmacists recognised the risk of commercial pressures. Some saw pressure from the corporate chains which dominate retail pharmacy. They spoke of decreasing professional satisfaction, rather as can be heard said in general practice about corporatisation.

Westmead Hospital’s chief pharmacist, David Ng, helped set up the first pharmacy program in South Australia. He wrote: “There has been a pharmacy influenza immunisation program in several (American) states since the 1990s. South Australia and Queensland … introduce[d] enabling legislation and training programs several years ago, followed by NSW in 2015. Queensland has extended (these) programs to measles and pertussis.

“This service is underutilised because [there is no] MBS (rebate) and … the need for two pharmacists to be present for one to administer vaccine.

“Large chains … circumvent this by introducing contract GPs or nurse immunisers.

“… the system does not appear ready for a major influenza pandemic!”

An academic perspective

Professor Iqbal Ramzan, Dean of Pharmacy at the University of Sydney, commented: “Falling vaccination rates … pose a public health threat …all health professionals [must) maximise vaccine coverage.

“Most jurisdictions allow pharmacists (with) approved training to provide influenza vaccination. While there may be some disquiet within the medical fraternity, pharmacists have the requisite theoretical knowledge and, with training, the skills required to administer vaccines. Pharmacies offer easy access … this also provides GPs with valuable time to discuss complex issues with their patients.”

To their credit, pharmacists have established sophisticated training and operating procedures. Accreditation is recognised for best practice.

The facts of the matter

A recent paper, Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study,by H Laetitia Hattingh and colleaguesreported on 15,621 influenza vaccinations administered by pharmacists at 76 community pharmacies in 2015.

They found “no major adverse events; less than 1 per cent of consumers experienced minor events, which were appropriately managed. Between 12 per cent and 17 per cent eligible [for] free influenza vaccinations chose to have it at a pharmacy.

“A high percentage was delivered in rural and regional areas [where] pharmacist vaccination facilitated access. Immuniser pharmacists reported feeling confident … and [felt] that services should be expanded to other vaccinations.”

The authors concluded: “Vaccine delivery was safe. Convenience and accessibility were important. There is scope to expand to other vaccines and younger children; however, government funding needs to be considered.”

This is a work in progress. While risk is often part of treatment, its acceptability there is because we can see readily that the risk of doing nothing is greater. This is not as clear in relation to prevention where the risk of developing the condition is vague and located somewhere in the future. But discussions of this sort are an essential part of our national immunisation program’s public acceptability. Whoever does the immunising must be prepared to have it with those being immunised.

No Stroke Untreated

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

At our recent meeting, the AMA Council of Rural Doctors received with great interest a presentation on the Victorian Stroke Telemedicine program, which is successfully delivering equity of access to acute stroke care for people living in regional Victoria.

We all know the ugly face of Cerebrovascular accident (CVA) as we encounter it too often in regional and remote Australia. Of the 55,000 new strokes that occur each year in Australia, 23,000 occur in regional areas. However, in comparison to urban centres, we often deal with this devastating presentation with the knowledge we will not be able to image, diagnose and treat the stroke in time to salvage the cerebral damage.

This may be our Mum, but we will not be in time to start the tissue saving clot busters, endovascular clot retrieval (catheter removal of a clot) is a dream away. Why? It is the reality of living in the bush, the mobile cellular ability to call 000, the distance to the hospital, the flooded out roads, and the limitations of the ambulance services.

If we are fortunate enough to have a CT scanner in our town, we do not have the fortune to have an in-house radiographer to work the CT scanner 24/7. We are GPs out here, we are not neurologists, obvious CVAs are easy to diagnose but out of 100 stroke-like presentations only 50 will be strokes. Once diagnosed, we can be five hours to the nearest tertiary centre by RFDS, Careflight, or chopper.

Luckily here in Australia we find groups of stubborn people who will not take such scenarios as insurmountable. Five years ago, no-one outside of the urban areas received stroke thrombolysis. Now, with the guidance of Professor Chris Bladin, a Melbourne neurologist, and the Victorian Stroke Telemedicine (VST) program, the state of Victoria is able to say the following:

94 per cent of Victoria is within 1 hour from state of the art stroke care. 16 regional centres in all;
More than 1400 telehealth consults for stroke evaluation have been performed;
Of those, 1 in 5 calls result in stroke thrombolysis – some regional hospitals are now thrombolysing patients for the first time with the assistance of VST consultants;
70 patients of the 1400 have been referred for endovascular clot retrieval;
Treatment is safer when delivered with the help of a consultant neurologist, with a 60 per cent decrease in post thrombolysis complications;
There has been a 130 per cent increase in patients with acute stroke treated under 60 mins of hospital arrival; and
There has been a 30 per cent decrease in treatment time – e.g. door to CT, door to stroke thrombolysis times.

How do they do it? The answer is stubbornness, good ol’ Australian stubbornness. This involved a trip to Germany to see how they do it over there. With 16 made-for-purpose telehealth gizmos the stroke specialist can remotely examine patients at the bedside, view PACs, make clinical notes, and speak to distressed families, all in one machine.

It involved gathering a cohort of neurologists from Perth to Christchurch to man the on call phones 24/7. It meant interrupted meals out and gym work outs to be ‘Triple A’, Affable, Available and Able. It meant surmounting suspicion that early thrombolysis was ineffectual. It meant quelling the initial objections from local ED doctors that they did not need a hotshot urban neurologist to diagnose a stroke. It was an attitude of ‘we can do this’ and ‘we can do this together’.

The Victorian Stroke Telemedicine people have a dream for us. They want to roll this out to become Australia wide. The future Australian Telestroke Network (ATN), with the goal of ‘No Stroke Untreated’.

The AMA Council of Rural Doctors was really impressed with the VST program presentation and the results being delivered to patients. However, it clearly needs more support if it is to become a truly national initiative. It needs the backing of governments, and it will require State and hospital support for the on-call neurologist and other staff needed to man this program.

That means recognition by the funding system, the hospital administration to allow for State wide privileging of the on call neurologist. We need to put their 1-300 number on the wall and we need to call them. It requires our support so that we can thank them later for looking after our Mum who just had a stroke.

Training hubs for healthy country communities

BY AMA VICE PRESIDENT DR TONY BARTONE

Regional and rural communities face a range of disadvantages when compared to their city counterparts, not the least which is getting timely access to a doctor.

People living in these areas often have to travel significant distances for care, or endure a long wait to see a GP close to where they live. Getting to see other specialists can be even more difficult.

Inequalities such as these mean that they have lower life expectancy, worse outcomes on leading indicators of health, and poorer access to care compared to people in major cities. Death rates in regional, rural, and remote areas are higher than in major cities, and the rates increase in line with degrees of remoteness.

The overall distribution of doctors is skewed heavily towards the major cities, which means that regional and rural areas are affected by workforce shortages more acutely.

The problem is not a shortage of medical graduates. With medical school intakes now at record levels, we do not need more medical students or any new medical schools – something which the AMA and the Government can agree on.

What is needed are more and better opportunities for doctors, particularly those who come from the bush, to live and train in rural areas.

The evidence shows that they are the most likely to stay on and serve their rural community when they qualify.

Until now, the approach of Federal Governments of all political persuasions to getting younger doctors to the bush has been bonded workforce programs.

This has failed miserably because it did not address the underlying causes of medical workforce shortages, nor make the practice of medicine in areas of medical workforce shortage any more attractive.

I’ve met bonded graduates who decided to buy their way out of the deal.

Though many medical students have positive training experiences in rural areas, progression through prevocational and vocational training often requires a return to the cities.

At this point many trainees develop the personal and professional networks that are not easy to leave. Not surprisingly, many of these trainees are less able to return to practise in under-serviced areas.

Three years ago the AMA developed a significant proposal to address these problems – regional training networks. We see these as vertically integrated regional networks of health services and prevocational and specialist training hubs.

The networks would build on existing infrastructure and enable junior doctors to spend a significant amount of their training in rural and regional areas, only returning to the city to acquire specific skills.

We believe that regional training networks can improve the distribution of the medical workforce distribution by enhancing generalist and specialist training opportunities, and by supporting prevocational and vocational trainees to live and work in regional and rural areas. It is an idea whose time has come and supported by many players in the rural health space.

I was therefore very pleased when the Government announced last month that it will establish 26 regional training hubs across every state and in the Northern Territory, costing about $28.6 million.

According to the Government, the hubs will integrate health services, the medical colleges and other training organisations to increase postgraduate medical training opportunities.

It will be important that the Government works closely with the Colleges and other stakeholders to ensure the program helps to provide the regional vocational training places that are so badly needed.

There is a long way to go before the shortage of doctors in the bush is fixed, but nonetheless, this initiative is an important step in the right the direction. I believe it could make a real difference to access to medical care for regional and rural communities if implemented properly.

Health Financing – building a framework for the long term challenge

BY ASSOCIATE PROFESSOR SUSAN NEUHAUS, CHAIR, HEALTH FINANCING AND ECONOMICS

Health financing is Health Financing and Economics Committee’s (HFE) principal responsibility and central to HFE’s terms of reference. As HFE members will attest, health financing is the largest, most complicated, and all pervasive topic that the committee has the privilege of dealing with.

At its meeting on 1 April 2017, HFE considered the critical elements of current health financing arrangements and the developments and trends likely to impact on those arrangements.

HFE discussed how to build a framework for long term health financing arrangements that are fair, robust and sustainable, and deliver certain and sufficient funding for health care, now and into the future.

This is a challenging task. Health financing is a very complicated policy area. There have been a number of reviews into the system over the years which have discussed (with varying rigour and results) issues surrounding managing costs within components of the health system, with a view to sustainability over the longer term. The overall success of these reviews in terms of lasting, positive improvements has, however, been limited and there have been both overlaps and gaps in their terms of reference.

Public understanding of health financing issues, and the public’s preparedness to consider changes to arrangements for health care, are also limited. Many commentators took this as a key lesson of the 2016 Federal Election. They considered that governments will find it difficult to develop, legislate and implement significant reforms in health without public suspicion of potential impacts on basic Medicare arrangements. Framing a new approach to health financing is clearly not a task for the short-term.

HFE agreed the long-term health financing conversation should be framed in terms of the future health system in 2035. The conversation will need to include all significant stakeholders – organisations and people with a direct interest in the financing of health care, with a view to arriving at a broad consensus on a fair, affordable and sustainable system, and one that takes into account predicted changes in health care needs, advances in medical technology and new information and health management platforms. Consumers should be involved in the conversation.

As a starting point, HFE decided that the AMA could facilitate a discussion around the health system, which could include signalling a number of possible pathways but would not singularly propose a solution.

HFE members noted there is a need to create a space for this discussion that is free of the usual criticisms and stakeholder-positioning that have plagued other reviews and policy processes.

This conversation needs to focus on cost management and obtaining value. It could canvas issues such as whether the health system needs to provide all possible health care to all people at vast and accelerating expense, or should it manage costs by some method.

There needs to be an understanding of the cost drivers going forward, particularly technology and the ageing population, and a national conversation about the level of service we want our health system to deliver in the future.

The conversation should also encompass specific issues identified by HFE members.

These include the need to not only consider efficiency in clinical settings such as hospitals, but also consider efficiency within administration departments, given the growth in these departments within the hospital sector.

Primary health care needs an increased investment, with an understanding of where future pressures and the value of future primary care interventions could be.

The contribution of private health insurance to the overall health system and health financing arrangements also needs to be considered as part of this discussion, particularly given the increasing amount of Government and private spending propping up the industry.

Supporting this work, it would be useful to have a review of the programs run by Government to ascertain which ones are producing good outcomes.

HFE recognised that large-scale change is not likely in the near future. The vision for the future health system must be beyond the three year election cycle. Support from all political parties will be necessary to prevent undermining of solutions.

An important overall outcome of this work should be a ‘vision’ for health financing arrangements that should allow the AMA to be able to hold any Government into the future to account.

The vision also needs to speak to AMA members (and other health care providers) that may be disillusioned or feel abandoned by current arrangements, whether working in general practice, public or private hospitals.

If you have views on how health financing arrangements should change, please contact me. HFE will welcome your input.

The Lighthouse Project

BY AMA PRESIDENT DR MICHAEL GANNON

Last year, when the AMA released its 2016 Report Card on Indigenous Health, it set out a plan for governments to eradicate Rheumatic Heart Disease (RHD) from Australia by 2031. Since the release of this Report Card, the AMA has been a part of growing efforts to reinforce to our political leaders that RHD must be stamped out, and that other cardiovascular health outcomes for Aboriginal and Torres Strait Islander peoples must be improved.

As part of our efforts to improve the cardiovascular health of Aboriginal and Torres Strait Islander people, the AMA has become a founding member of an END RHD Coalition – an alliance of six organisations with a vision to see the end of RHD in Australia, we participated in the inaugural Close the Gap Parliamentary Friendship Group which focussed on the enormous impact of RHD, and we recently met with the Australian Healthcare and Hospitals Association (AHHA) to discuss the Lighthouse Project – a joint initiative of the AHHA and the Heart Foundation to improve outcomes for Aboriginal and Torres Strait Islander peoples experiencing coronary heart disease.

The aim of the Lighthouse Project is to help close the gap in cardiovascular disease between Indigenous and non-Indigenous Australians through the provision of evidence-based, culturally safe care for acute coronary syndrome. With cardiovascular disease being the leading cause of death among Aboriginal and Torres Strait Islander people, and a major contributor to the gap in life expectancy between Indigenous and other Australians, it is imperative that the AMA and other health and medical organisations are actively engaged in this area.

It is unacceptable that Aboriginal and Torres Strait Islander people, who represent three per cent of the entire Australian population, are 1.6 times more likely to die from coronary heart disease than their non-Indigenous peers. It is also unacceptable that Aboriginal and Torres Strait Islander people are less likely to undergo vital coronary tests and procedures once admitted to hospital.

It is clear that the hospital system must better respond to the unique health needs of Aboriginal and Torres Strait Islander patients. Hospitals have an important role to play in improving access to care and addressing disparities for Aboriginal and Torres Strait Islander peoples. This is where initiatives such as the Lighthouse Project are extremely valuable.

During Phase 1 of the Lighthouse Project, cultural competence, having a skilled workforce, appropriate governance and the use of clinical care pathways were identified as four key areas of best practice for improving care for Aboriginal and Torres Strait Islander peoples with Acute Coronary Syndrome. In Phase 2, a quality improvement toolkit was developed and implemented in eight public hospitals across Australia.

Through Phase 1 and Phase 2 of the Lighthouse Project, these public hospitals have achieved culturally safe environments and enhanced staff capacity to respond to the unique needs of Aboriginal and Torres Strait Islander patients, and have reported improved relationships with Indigenous patients and communities.

The Lighthouse Project must be seen as a positive example of how gains in health outcomes can be achieved for Aboriginal and Torres Strait Islander people. I am pleased that the work of the Lighthouse Project will continue, with the Commonwealth Government recently announcing that $8 million has been provided to support Phase 3 of the Lighthouse Project, which aims to extend the project to 18 hospitals across the country and allowing it to reach nearly one in every two Indigenous patients admitted to hospital for a cardiac condition.

Eliminating inequities in health service provision to the Aboriginal and Torres Strait Islander population is vital, and it is encouraging to see that the great work of the Lighthouse Project is being recognised. By increasing cardiovascular health outcomes for Aboriginal and Torres Strait Islander peoples, we can reduce mortality rates, increase life expectancy, and help close the unacceptable health gap that exists between Indigenous and non-Indigenous Australians today.

Bertel Sunstrup 24.1.1931 / 22.4.2017

OBITUARY

Bertel Sunstrup 24.1.1931 / 22.4.2017

On the 24^th of January 1931, Bert was born in Wondai Queensland. His early days were spent in Gympie.

He went to ‘Shore’ Grammar School in Sydney and graduated MBBS at Sydney University. He did his residency in Launceston and Hobart Hospital before joining Dr Gunson at the Northern Suburbs Medical Clinic in 1958. During this time he (like many GPs) also gave the anaesthetics for the surgeons in both the private and public hospitals. Bert then accepted the Registrar job for the Launceston branch of the Peter Mac Callum Radiotherapy Unit working with Dr Harry Holden.

After a few years he went to England and obtained his ‘Radiotherapy/Oncology’ qualification. Bert returned to the Launceston Hospital to work with Dr Holden and then took over the Radiotherapy/Oncology unit when Dr Holden retired. In 1986 the unit name was changed to the Holman Clinic after its founder in 1928-32.

In his profession Bert witnessed a lot of pain, despair and suffering on a daily basis. He was a dedicated and inspirational clinician who always listened with compassion to his patients being mindful of their difficulties especially in coping with everyday challenges with cancer.

In the 1990s Bert “fought Tooth and Nail” to stop the bureaucrats from transferring the Radiotherapy/Oncology Unit to Hobart. He was steadfastly determined and presented irrefutable arguments that we must continue to treat the patients with all forms of cancers in the North of Tasmania. Were it not for him there would be no clinic in the North. Thankfully the Government agreed to keep the Holman Clinic at the Launceston General Hospital

In 1983 Bert purchased a farm in Pipers Brook and started a vineyard with the help of his wife Anne, her sister Jill and son Christopher. His wine ‘Dalrymple’ soon became well received and they won many medals at the wine shows.

Bert’s other significant interest was skiing. When he returned to Tasmania he married Anne, a registered nurse, had three children. They built their own shack in the Ben Lomond Ski Village. He was a wonderfully entertaining, witty and generous man who had some great parties in their shack. Bert and Anne soon joined the Ben Lomond Ski Patrol and he was promoted from Patrol Doctor to President and eventually to Life Member. Once again it was his infectious energy and enthusiasm that encouraged many to join the patrol and keep the skiers safe and, if injured, to provide them with the correct treatment before they left the mountain.

I loved talking with Bert we shared the same values and had similar aspirations and concerns. He was better informed than I in history and would constantly come up with some interesting trivia.

All past, present and future patients in the North of Tasmania and in particular the Launceston General Hospital are indebted to this friendly, unassuming and dedicated man.

I am certain that his children; Katrina, Ingrid and Christopher as well as his medical colleagues will keep his spirit and legacy alive.

Professor Berni Einoder A.M.
Director of Surgery at LGH 1984 to 2014

Technology set to change children’s health

A national initiative, My Health Record, has been designed to help the access and sharing of information to improve children’s health outcomes by using a digital platform.

The new children’s digital health network, the National Collaborative Network for Child Health Informatics, is a collaborative project between eHealth NSW, Sydney Children’s Hospital Network and the Australian Digital Health Agency (ADHA).

My Health Record’s aim is to be patient centred and clinician friendly so as to support integrated care for children and their families. It will also enhance the quality of clinician care through improved decision making tools, including a child’s safety in an emergency.

My Health Record will be a digital summary of a patient’s medical information including diagnosis, outcomes, medications, reactions and allergies. Clinical documents added by healthcare providers could also include Shared Health Summaries and Hospital Discharge Summaries.

Parents choose what information gets loaded onto their child’s record. They also control what information stays on their child’s record and who can access the information. The patient’s record will be part of a national system that will travel with each child.

Accessing and sharing information about their children’s health using a new technology platform will enable parents to accurately keep track of their children’s healthcare that can be easily shared with healthcare providers.

“This can improve their ability to access health services and enhance their experience of health services because their providers have real-time information about each child’s health status, immunisation status, and interaction across the entire health system. The work of the Network will help us realise this vision,” said ADHA Chief Executive Tim Kelsey.

Because My Health Record is a part of the Australian Government’s Digital Health Agency it is protected by security and safety laws at a nationally recognised level.

Meredith Horne

Imbalance in supply of rural doctors continues

The Australian Medical Students’ Association (AMSA) has expressed its concerned by the recent Government announcement it will support 50 medical student places to open a new medical school at the Sunshine Coast University Hospital.

AMSA has called for increased funding of long-term regional specialty training places, rather than the establishment of new medical schools to address the current medical workforce mal-distribution.

The Government’s announcement comes with no detail as to how exactly these places are to come about, but it is believed there will be no further increases to the number of Commonwealth Supported Places (CSPs). It is AMSA’s understanding that support for the new medical school bypassed regular departmental approval processes.

AMSA President and local Sunshine Coast medical student Rob Thomas said: “With Government modelling forecasting an oversupply of 7,000 doctors by 2030, AMSA also believes that it would be irresponsible for the places on the Sunshine Coast to come from new international places.

“The reasoning behind the announcement was that the new medical school at the Sunshine Coast will address local workforce shortages. However, according to the Government’s own modelling, the Sunshine Coast is not in workforce shortage or a regional area. Internships on the Sunshine Coast continue to be oversubscribed.

“This is a solution in search of a problem. The real problem that we face is the disparity in the distribution of doctors between metropolitan and rural and regional areas. A key reason why this disparity exists is that those interested in becoming doctors in rural areas are forced back to the city for most, if not all, of their training.”

Jenna Mewburn, AMSA Rural Health Co-Chair and a final year medical student studying in Wagga Wagga said: “I’m a rural background student who wants to live and work rurally in the future, but at present I will likely have to return to the city to pursue specialty training.

“This will likely fall at a time where I’m looking to lay down roots, making it increasingly difficult to return rurally in the future. Initiatives throughout medical school already exist, including rural origin entry quotas and rural clinical school placements. While there is evidence to support the success of these programs in contributing to the rural workforce, what we need is more quality specialty training places to be funded nationwide.”

AMSA, in conjunction with its Rural Health Committee will continue to advocate for increased speciality training places as a more effective alternative to new medical schools.

The announcement comes at a time when the Federal Government has announced a new decentralisation push, requiring all Ministers to justify whether agencies within their portfolios should remain in the big cities. All Federal Ministers will be required to report by August to Cabinet, detailing which of their departments, entities or functions are suitable for relocation to a regional area.

The Australian Medical Association in its recent submission Assessing the distribution of medical school places in Australia to the Department of Health, highlighted that redistributing medical school places, on its own, will not improve workforce shortages.

Further, the AMA believes that the Government needs to take a longer-term view and recognise that unless additional postgraduate training places in rural areas and undersupplied specialties are made available, addressing workforce shortages in these areas will remain an elusive goal.

The AMA remains committed to supporting doctors in ways to address the imbalance in the medical workforce supply, particularly in regional and remote Australia, especially as it is a contributing factor to the lower health status and life expectancy for people living in these areas.

Meredith Horne

Moving with the times – a new online, member focussed AMA Fees List for 2017

Medical fees are increasingly becoming an issue of both medical and mainstream media scrutiny. For our members, one of the challenges with fee setting has of course been the ongoing Medicare freeze – it has put pressure on practice viability, as medical practitioners bear the burden of inflation and increased costs of running practices, without the corresponding adjustment being made to the MBS and the patient rebate.

The AMA’s position has always been that medical practitioners should use their own judgement to charge an appropriate fee for a medical service.

Furthermore, the AMA takes the view that a medical practitioner should determine in each individual case what is a fair and reasonable fee – taking into account the cost of delivering the service, the circumstances of the case and the patient. There is no doubt that the cost of running medical practices varies across the country, as do overheads such as rent, electricity and insurance.

For many members, the AMA’s List of Medical Services and Fees (Fees List) is a critical aid in providing guidance on what fee to charge.

You may not be aware that the Fees List was first produced as a book in 1973, and (with the exception of 1978) has been updated yearly. In 2016 it was still provided in book form, supplemented via CD-ROM and a limited online website.

We recognise that the Fees List remains a major member benefit. But we also know that in the 21^st century, primarily making it available as a small print book is not a productive, innovative or helpful format for modern practice. As such, the AMA Board took the decision that 2017 will see the AMA Fees List become entirely digital and we will discontinue the printed book. The decision was largely influenced by the dated platform on which the Fees List is built.

However, this is not just a case of switching off the printed format.

The new online offering will be via a dedicated, new look website. It will be more user-friendly, will provide the capacity to search for a fee via a number of criteria, and will have a range of other helpful features and guidance as it matures. The Fees List will continue to be available for download, and in the existing file formats previously available via CD-ROM. For those who may wish to print parts or all of the Fees List for offline use, a PDF will continue to be available online for that purpose.

The intent for the new website is that it will be user-centred, have an intuitive navigation structure and be accessible on multiple platforms – computer or tablet. As part of this transition, we will also be investigating ways to simplify the importing capabilities into medical practice software, where possible.

The move to an online only offering will also provide the opportunity to update the Fees List throughout the year, as ongoing changes are made to the MBS. This will be important as the MBS Review rolls on, as it is likely to result in the biggest update to the MBS in decades.

The AMA is using the upgrade to introduce new purchasing options via licensing arrangements, and to open it up to those previously not able to purchase it – a major criticism of the current arrangements.

Noting that the Fees List is also the benchmark for medical fees set under various State Government regulations such as those which set the fees for workers compensation claims, we want to ensure that there are options for non-AMA member medical practitioners who may need access to particular items, from time to time, to charge for services provided to patients in these circumstances.

Of course, AMA members will continue to receive full access through the improved online format. To that end, we will be asking how you currently use the Fees List, what features you would like to see in an online offering, and other features you would like to see considered as part of the new website.

To start the conversation, please follow the link to a short survey:https://www.surveymonkey.com/r/amalist

Anne Trimmer
AMA Secretary General