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Funding boost for Indigenous health research programs

The Federal Government has announced $23.2 million in funding for new research projects that tackle Indigenous health challenges, including kidney health and mental wellbeing.

Health Minister Greg Hunt said the National Health and Medical Research Council (NHMRC) funding was aimed at improving Aboriginal and Torres Strait Islander health outcomes.

“Investigation and investment where it is needed is critical to delivering better health outcomes for First Nations Peoples, to protect lives and save lives,” Mr Hunt said.

Monash University will receive more than $320,000 to develop a point-of-care test to diagnose and manage chronic kidney disease, which affects almost one in five Indigenous adults.

A further five projects across five different States will examine social and emotional wellbeing issues affecting Indigenous infants, children, adolescents, and young people.

The direction of future First Nations research will be informed by the NHMRC’s Road Map 3, which will include a yearly report card and a commitment to spend at least 5 per cent of annual NHMRC funding on Aboriginal and Torres Strait Islander health and medical research.

Minister for Indigenous Affairs, Ken Wyatt, said the Road Map 3 had been developed in consultation with communities, First Nation researchers, and the broader health and medical research sector.

Is oral health the unspoken determinant?

BY AMA PRESIDENT DR TONY BARTONE

According to the Australian Institute of Health and Welfare’s (AIHW) report Australia’s Health 2012, most people will experience oral health issues at some point in their life. In fact, oral diseases are recurrently among the most frequently reported health problems by Australians.

Considered a disease of affluence up until the late 20th century, poor oral health outcomes have now become an indicator of disadvantage, highlighting a lack of access to preventative services. Insufficient access to, high cost of, or long waiting periods for dental services; and low oral care education, have all been associated with patients not seeking dental care when it is needed. Of course, non-fluoridised water supplies also has a role in explaining the prevalence.

However, more recently, it is the modifiable risk factors like poor nutrition, smoking, substance use, stress, and poor oral hygiene that are considered to have the greatest impacts on periodontal diseases. 

Dental conditions frequently rank in the top 10 potentially preventable acute condition hospital admissions for Aboriginal and Torres Strait Islander people and were the third leading cause of all preventable hospitalisations in 2013-14, with 63,000 admissions.

Like most other health conditions, Aboriginal and Torres Strait Islander people have poorer oral health outcomes. While Indigenous people currently have most of the same oral health risk factors as non-Indigenous people, they are less likely to have the same access to preventative measures, leading to marked disparities in oral health between Indigenous people and other Australians.

While the majority of oral health concerns are often considered inconsequential, such as avoiding certain foods, or cosmetic with people embarrassed about their physical appearance, there is a significant body of evidence which suggests that oral health may be the undiscussed determinant of health.

More than two decades ago, population-based studies identified possible links between oral health status and chronic diseases such as cardiovascular disease (CVD), diabetes, respiratory diseases, stroke, and kidney diseases, as well as pre-term low birthweight. And the relationship appears to lie with inflammation.

It is clear more research is needed to determine the exact links (if any), between periodontal disease and chronic disease condition, however, the growing body of evidence links poor oral health to major chronic illnesses.

The Government has made numerous financial commitments to improving access to dental services, however, oral health data will continue to demonstrate that without equitable access to dental services, Australians, and particularly Aboriginal and Torres Strait Islander people, will continue to suffer poorer oral health outcomes, and potentially poorer health outcomes, as a result. 

The AMA supports improved Doctor/Dentist collaborations if such partnerships could lead to increased early identification of both chronic disease and oral health conditions, particularly for Aboriginal and Torres Strait Islander peoples, for whom oral health services are less frequently accessed.

Dental Health Week is 6-12 August 2018.

Federal Council communiqué

BY DR BEVERLEY ROWBOTHAM, CHAIR, AMA FEDERAL COUNCIL

The May meeting of Federal Council is condensed to one day immediately before the start of National Conference. While shorter in length, the breadth of matters brought to the Council remains significant. The meeting was the last for outgoing President, Dr Michael Gannon, and several other members – Drs Susan Neuhaus, Gary Geelhoed, Robyn Langham, Lorraine Baker, Stuart Day, Andrew Mulcahy, and John Zorbas. As a result of the election of incoming President, Dr Tony Bartone, and Vice President, Dr Chris Zappala, Drs Brad Frankum and Gino Pecoraro also completed their terms. All have been substantial contributors to the work of Federal Council, in some cases over many years.

Dr Gannon provided an overview of his last weeks in office with highlights including a tour of remote Indigenous communities with the Hon Warren Snowdon, the Federal Budget with its wins for workforce, and attendance at the Council meeting of the World Medical Association in Riga.

The Secretary General’s report highlighted several wins in the Federal Budget which were the result of AMA advocacy. Most important among these was the introduction of a comprehensive medical workforce package. This included the establishment of the Murray Darling Medical School Network with a number of participating medical schools offering end-to-end rural medical school programs; an expansion of prevocational GP places for doctors in training; additional GP training places earmarked for rural generalists; and an emphasis on supporting doctors undertaking training in rural areas.

A major win in the Budget was the overhaul of bonded medical places which will apply to all new participants from January 2020. Existing BMP and MRBS participants have the choice to opt in. The changes offer more certainty and flexibility in how return of service obligations can be satisfied. Federal Council heard that the Secretariat is receiving calls from members expressing their delight in the life-changing outcomes from these announcements.

The AMA’s sustained advocacy for workforce reform included a medical workforce and training summit held in March 2018. An important theme from the summit was the need for a whole of government approach to planning the future delivery of health care and for all governments to collaborate more effectively on workforce planning, training and coordination.

Federal Council noted AMA activity on issues impacting on practice including medical indemnity reforms, private health insurance reforms, the ongoing MBS review, and reports on the significant engagement with aged care policy reform.

The AMA’s public health advocacy remains a consistently strong area of activity. Federal Council received an advanced draft of the Position Statement on social determinants of health, and received updates from the working groups on child abuse and neglect, and health literacy.

The Ethics and Medico-Legal Committee continues its revision of the AMA’s Position Statement on Medical Practitioners’ Relationships with Industry. It has commenced a review of the Position Statement on Conscientious Objection.

Federal Council agreed with a recommendation from the AMA’s Taskforce on Indigenous Health that the AMA sign on to the joint statement by non-Indigenous Australians in support of the Uluru Statement from the Heart.

Federal Council adopted the AMA Anti-Racism Statement which addresses racism in the medical workforce, and expresses support for good medical practice that reflects the cultural needs and contexts of patients.

The Council of Doctors in Training is working on the development of standardised questions to support State and Territory AMAs to run hospital health checks which measure and report on how well health services are meeting State-based industrial agreements and/or accreditation standards for doctors in training.

The Council of Private Specialist Practice has been considering a proposed website to support transparency of doctors’ fees. The Council noted the complexities of such a site and expressed its view that the site must be government-controlled. The Council also noted its concerns that such a website would be unmanageable if its aim is to capture every fee charged by a privately-billing doctor. Council acknowledged that there is a strong desire in government, and from consumers, to improve fees transparency and support patient awareness.

The Council of General Practice reported on the success of AMA advocacy in the Government deferring the introduction of the Practice Incentives Program Quality Improvement Incentive, which would have left many practices financially worse off. Five incentives scheduled to cease on 1 May 2018 will now continue until 30 April 2019.

The MBS Review, through its general practice and primary clinical care committee, is examining funding for GP visits to residential aged care facilities, including funding for telehealth consultation items. AMA advocacy has resulted in the referral to the MBS Review of consideration of funding for wound care items in general practice.

The Council of Public Hospital Doctors reported on its consideration of the impact of technology on workplaces, and the future of work and workers. Further analysis will be undertaken to look at potential industrial implications including task substitution, medico-legal issues, obsolescence, and outsourcing.

The Council of Rural Doctors outlined additional work that the AMA should undertake in considering rural doctor health. including longer working hours, lack of access to resources and professional support, professional and geographical isolation, and limited team support. The Council noted the work underway by the AMA subsidiary, Doctors’ Health Services Pty Limited, in sponsoring a trial of telemedicine consultations for rural doctors.

At the Annual General Meeting of members held on the day following the meeting of Federal Council, members voted unanimously to create a new position on Federal Council for a representative of Australia’s Indigenous doctors, nominated by the Australian Indigenous Doctors’ Association, and who is a member of the AMA.

 

APY Lands medical student awarded scholarship

A medical student who makes patient education films in Pitjantjara language, and who plans to provide health care to the people of Central Australia, is the recipient of the 2018 AMA Indigenous Medical Scholarship.

Pirpantji Rive-Nelson, from Alice Springs, is a final-year medical student at the University of Queensland. He is attending the Rural Medical School in Toowoomba and he plans to return to Central Australia to work as a clinician.

Outgoing AMA President Dr Michael Gannon presented Mr Rive-Nelson with the scholarship at the AMA National Conference in Canberra in May.

The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.

Mr Rive-Nelson told Australian Medicine he felt honoured to receive the scholarship.

“It’s great. It serves two purposes for me,” he said.

“It is a bit of a pat on the back for my efforts, in terms of medicine being quite a gruelling degree and you’re getting constant feedback and always told to improve in many areas.

“So it’s kind of nice to get a pat on the back and know that I’m on the right track. So that’s been great.

“And also to be given the opportunity to come down here to meet some of the bigger players in the medical community. That’s a bit of a treat.

“I think people where I am from will definitely notice it, but I don’t think people will understand the gravity of it and the fact that the AMA is the peak governing body for medicine in Australia. But people will recognise it as an achievement and will be very pleased to see it.

“At the end of the day it definitely bolsters my confidence in medicine in terms of keeping me on track.”

Upon receiving the award, Mr Rive-Nelson said his aspirations included a fulfilling and challenging career practising medicine in Alice Springs Hospital, inspiring youth of Central Australia to pursue health careers, and to take on leadership and advocacy roles within Central Australia and national health care organisations.

“Many Indigenous Australians of Central Australia do not speak English as a primary language, and seeking health care from the Alice Springs Hospital is a daunting experience,” Mr Rive-Nelson said.

“Therefore, I hope to actively assist Pitjantjatjara-speaking patients, and my colleagues, by being a clinician who is able to navigate both languages and cultures competently.”

Mr Rive-Nelson is also making short patient health education material in Pitjantjara language, including a YouTube video on kidney disease, which won an award from the University of Queensland.

Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.

Dr Gannon said Mr Rive-Nelson was a deserving recipient of the $10,000 a year Scholarship.

“Pirpantji Rive-Nelson is a respected member of the University of Queensland medical school, and of the tri-State region comprising the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, the Ngaanyatjarra Lands, and the Central Lands Council lands,” Dr Gannon said.

“He grew up in communities including Irrunytju, Pipalyatjara, and Kalka, and has been exposed to a traditional life that most young Indigenous people can only dream of.

“He is a Wati – a fully-initiated man – and many of his family are Ngangkari – traditional bush doctors. Pirpantji will be the first initiated Pitjantjatjara Wati to become a doctor in the Western medical model, and he will be able to collaborate with Ngangkari to share knowledge and better outcomes for the health of the Central Australian community.

“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community.

“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances. Mr Rive-Nelson is that person.”

CHRIS JOHNSON 

More information is available at donate-indigenous-medical-scholarship

Mr Rive-Nelson’s kidney health video can be viewed at https://www.youtube.com/watch?v=cgIjvo0oQTo

 

 

AMSA President delivers confronting speech

Between the votes for AMA President and AMA Vice President at National Conference, AMSA President Alex Farrell eloquently delivered a powerful address that captivated all in attendance. Among the topics she focused on were gender equity, sexism, racism, harassment, and mental health. Conference delegates gave her a standing ovation.

Below is a transcript her address.

Hello, my name is Alex, and I’m the President of the Australian Medical Students’ Association.

I would like to acknowledge the Ngunnawal people who are the traditional custodians of this land and pay respect to the Elders of the Ngunnawal Nation, past, present, and emerging.

Thank you to the AMA, not only for the chance to address you today, but for the ongoing support you’ve shown AMSA and all Australian medical students.

On my first day of medical school, we were asked to look on either side of us. It was a fun guessing game, which of us three would develop mental illnesses as part of our course.

A few months later, I first became involved in AMSA because, as a student starting to see the broken parts of our system, it seemed to be where stuff got done. Doctors, and by extension medical students, hold a trusted place in society, and I saw AMSA bringing us together so we could use our collective political capital for actual outcomes. Realising that students’ voices mattered in the conversation, and through groups like AMSA and the AMA I could contribute to real change, was incredibly empowering. It was also daunting, because we still have a lot to work on.

Where our organisations speak out, people listen. Students will remember the AMA joining us in the fight for marriage equality for a long time to come. It was a powerful signal to the Australian community that doctors support our queer patients and peers, at a time when many were hurting. It mattered.

The AMA speaking out on the health of refugees on Manus and Nauru mattered.

That is quite the responsibility. Here in this room, you are the people who will continue to set the AMA’s vision and messages going forward. Often that will be on issues affecting the health of all Australians. For today, I want to look a little closer to home, at medical culture.

I am often told that when it comes to changing culture, students are the way forward. This year I’ve sat in countless meetings where reassurances have been given that our problems will be solved, because the younger generation will eventually reach the top, and we have the mindset to create ‘the change’.

The medical students of Australia are extraordinary. But that is a huge burden to place on our shoulders alone, without the structures to support us. We have the least power, and often the most to lose.

‘Generational change’ is a myth when the problems lie in a system that the upcoming generations are still trained to conform to. They will continue to perpetuate that culture, unless it is actively disrupted.

We need support from you, doctors who have power in the system to help us change it.

I’ve been lucky enough to spend this year listening to students and hearing their stories. I’m here representing an exceptional group with diverse backgrounds and experiences.

Medical school has never been without its difficulties. While some may have shifted for the better since your training years, in other ways we face new challenges, and old challenges we hoped would have disappeared.

Challenges in gender equity, and diversity in leadership, in mental health and mistreatment in medical education, and in the growing training pressures that we’ll face on graduation.

To begin, gender inequity is alive and well in medicine today. It covers a spectrum of sexist behaviour, from well-meaning but gendered comments, to clearly abhorrent harassment and assault.

You heard yesterday about the very real barriers women in medicine face on a daily basis. The invasive interview questions, the pregnancy discrimination, the pay gap.

This starts in medical school. Every female student will recall a time they were told to avoid specialties that aren’t ‘family friendly’. I’ve spoken to students told that “there’s no point teaching them how to suture, because they are just going to become a GP anyway”. To a student whose supervisor was well known to either bully or flirt with their female students, and told she was lucky to be picked for the latter.

It’s what we call unconscious bias. Women and men alike, not meaning to, doubt women’s abilities just that much more. Women need to work harder to prove themselves, because they don’t fit the leadership image we all expect to see, whether that’s in an operating theatre or hospital board room. It’s not really about gender or sex, it is about power and authority, and who we see holding it.

Women are under-represented in nearly every position of medical leadership. They are far less likely to be medical school deans, chief executives of hospitals, receive research grants, or be AMA Presidents. They are less quickly promoted, less well paid.

The truth is, most doctors involved in the lower levels of sexism and harassment aren’t malicious. They may think they are being helpful, or flattering, or telling a harmless joke. Many never actually receive feedback that they are being inappropriate. And so the behaviour builds, and the lack of accountability builds, and for the few with bad intentions, the opportunities to abuse power also build up.

As we tolerate less confronting comments, we pave the way for them to escalate unchecked.Everyday sexism looks benign, but it has shaped what medicine looks like, from our first year university students, all the way up to the people here today.

In the past couple of years, medicine in Australia has been rocked by the revelation of endemic harassment. I don’t think anyone will be truly surprised when the next horrible event breaks. We haven’t changed enough to expect them to stop. But it’s not enough to wait till then to be shocked back into action. There’s no more room for apathy in this space.

The same goes for all vulnerable population groups. There are exceptional Aboriginal and Torres Strait Islander medical students but, compared to other students, the barriers to graduating can pile up.

Earlier this year, I was able to speak to the student representatives of the Australian Indigenous Doctors’ Association, AIDA, and hear their stories of daily stereotyping and racist comments, of being regularly told they had taken the place of someone who actually deserved to be in medicine.

A survey by AIDA has found that nearly 50 per cent of our Aboriginal and Torres Strait Islander doctors face bullying, racism or violence a few times a month, or even daily.

While more and more, the makeup of medical students reflects our population, this isn’t reaching the tiers of leadership where the ability to really create change lies.

The hurdles to being leaders and advocates are only escalated when certain groups are less valued and protected in the medical sphere.

For students and doctors in training, the health industry is hierarchical and rigid. Challenging norms simply isn’t safe territory. We know that most students mistreated during their medical training don’t report it, for two key reasons. They don’t know how, and they’re afraid of what might happen if they do speak up.

When asked to elaborate, these are their responses:

“We are taught from our first year that whistle blowing in medicine is career suicide”

“My supervisor could be my examiner”

“I tried – the university told me it was the hospital’s responsibility, the hospital directed me back to the university’

“It doesn’t look good for getting into a specialty program”

Even as someone who has spent this year speaking out on this issue, when I go back into clinical rotations next year, I can’t say with confidence that I’ll report bullying or harassment if it happens to me. I, as so many students are, am worried about what might happen on the wards, but I’m even more worried about what might happen with a report.

Which means that responsibility to speak up lies with you. To take colleagues aside if they might be crossing lines. To create systems in hospitals where reporting doesn’t put students and staff at risk. To demand tangible consequences.

We can change the structure that drives medical culture. We need only look at the issue of mental health, to see this community rally, and say ‘enough is enough’.

The promises from COAG to change mandatory reporting laws to remove barriers for health professionals to seek appropriate treatment for mental health are proof of that. That came from sustained and powerful advocacy, from students and the AMA.

The work is far from done, but as a start I’m hoping I can look forward to not hearing any more stories of students being told that seeing a GP will end their career.

It won’t solve all the culprits behind poor student mental health. As students we are staring down the barrel of the building pressure of vocational training – there are far more of us graduating than there are specialty training places, and by the time it is our turn to apply, it will be reaching crisis point.

Knowing that is the future for us, it should come as no surprise that students are doing anything we can to get ahead. Research projects in the holidays, Masters degrees in parallel with full-time medicine and part-time jobs. We can talk about work-life balance as much as we would like, but while this is the status quo, mental health will suffer.

Once out in the workforce, many of us will take years off clinical practice for PHDs or other pieces of paper to make us better candidates, but not necessarily better doctors. We will follow the signals that Colleges and the Profession send us – for a focus on clinical education and service, like so many of you yesterday placed as a priority, they need to be recognised accordingly.

When it comes to mental health, there is one area where students and senior doctors still seem to often not see eye to eye – resilience.

For us, resilience has become a dirty word. That’s not because we don’t believe in prioritising mental wellness. It’s a word that has been overused, at the worst times. Resilience is a suicidal friend pointed towards mindfulness courses. It takes students at the darkest point, and tells them they just should have been stronger. It acknowledges that the medical training environment is flawed, but at the same time says that the answer is fixing students, rather than seeking larger change. That is what students hear.  

So instead, let’s talk about what they are being resilient against.

Sixty per cent of medical students have witnessed mistreatment in medical education. That’s two in every three. Most the time, this comes as belittlement, condescension or humiliation.

Women are more likely to be mistreated in medical education than men, queer students more than heterosexual, clinical students more than pre-clinical. Consultants are the main offenders in half of the cases.

In the medical world, we are expected to teach and lead as a core part of our work. Doctors spend years learning to practise medicine, but are expected to teach with no training at all.

Your actions matter to the students in front of you in that moment, but also for what they role model going forward. We replicate the examples that were shown to us in our training – so the way you teach now will shape what the medical profession looks in 20 years. If you want to see things change, that is the first place to start.

As a teacher, role model safe practice, good communication, work-life balance. A positive culture is a safe culture.

I know it is not always easy.  As students we take time away from your busy days. Sometimes we don’t know how to help, and know that our gaps in knowledge fall short of your expectations. All students know the feeling of being a burden on their team. But to learn, we need to be in the room, and able to ask those questions.

Medical students want to work hard, and to be good, safe doctors.

You hold the power to impact the lives of your students each and every day. That’s not to say they need to be your first priority. Your patients always come first. But it doesn’t have to be one or the other. It only takes a moment to say good job, or to answer a question, or explain how to improve next time.

That moment can make your student’s day. It can keep their love for medicine going, through all the other parts of this profession that may otherwise leave us disillusioned far too soon.

Thank you to all of you here who make that effort to be positive mentors and teachers. You are appreciated.

I believe that we can build a medical culture that is safe and nurturing. But it can’t wait 20 years, when my peers are filling these seats. It has to start now, and it has to come from the top. In the way you teach, in the way you lead, and in the systems you influence, be part of that change, and I promise, we will do you proud.

 

Disease and wounds get Ministerial attention

Health Minister Greg Hunt used his AMA National Conference address to commit funding towards wound management and Human T-cell Lymphotropic Virus-1 (HTLV-1) programs.

As the keynote speaker at conference’s opening day, Mr Hunt praised the AMA, gave thanks to outgoing President Dr Michael Gannon, and repeated the Federal Government’s long-term health plan for the nation.

He wound up his remarks by announcing the new funding initiatives.

The Federal Government will provide $8 million to form a taskforce, in collaboration with the States and Territories, to combat emerging communicable diseases such as HTLV-1 in remote communities, he said.

Led by the Commonwealth’s Chief Medical Officer, Professor Brendan Murphy, the taskforce will bring together Aboriginal communities, relevant health providers, researchers, clinicians and all levels of Government.

The taskforce will investigate enhanced responses to communicable diseases, including the drivers behind the emerging prevalence of HTLV-1, a blood-borne virus, in remote communities.

It will do this in close collaboration with Aboriginal communities and develop a roadmap to respond to this issue, the Minister said.

“In terms of Indigenous health, one thing that is an unacceptable national shame is the level of transmissible sexual diseases,” Mr Hunt said.

“So the STIs and infections are at an unacceptable level. We will be investing $8 million to ensure that there is a response to the HTLV-1 virus. That’s working with Indigenous communities, under the leadership of the Chief Medical Officer and (Indigenous Heath Minister) Ken Wyatt.”

In relation to wound management, Mr Hunt recognised that it was a personal passion of many doctors.

He told conference delegates that the Government would embark on a comprehensive wound management program.

“I am referring wound management to the Medicare Taskforce for consideration,” he said.

“Secondly, there will be $1 million in relation to a wound management pilot program under the primary healthcare system. And thirdly, it will be the first priority of the new health system’s translation program under the MRFF (Medical Research Future Fund).”

The Minister also committed to legislating in the coming months with regards to medical indemnity, to ensure universal coverage and a level playing field.

That comment was received with instant applause from the conference floor.

Another welcome remark was his insistence on ending the mandatory reporting practice.

“Our doctors… are under stress, under challenge and always facing difficult issues that affect their own mental health,” he said.

“We will continue to work, and I am utterly committed, to ending the mandatory reporting practice.

“We have worked together. There are one or two States who still have some issues, but on our watch, in our time, that will become a reality that every doctor who wants and needs help will be able to seek that help without fear.”

In closing, the Minister thanked Dr Gannon for his work as the AMA President.

Calling him a friend, Mr Hunt described Dr Gannon in terms of Olympic sports.

“More a decathlete meets Greco-Roman wrestler,” he said.

“He is skilled at close quarters grappling and he usually ends up pinning his opponent.

“But at the end of the day, he’s a fine doctor, a fine leader, and above all else, a fine person.”

CHRIS JOHNSON

 

AMA President opens his last conference

Dr Michael Gannon opened the AMA National Conference 2018 by figuratively saying goodbye.

In his last opening address as AMA President, which was at times emotional, Dr Gannon detailed a long list of achievements secured by the AMA during his two-year tenure.

And he poured praise on the organisation he said he enjoyed leading since 2016.

“I must say that it has been a huge honour and privilege to serve the AMA and the medical profession as Federal President,” Dr Gannon said.

“It is demanding, challenging, rewarding, and life-changing. The issues, the experiences, the depth and breadth of policy and ideas, and the interface with our political leaders and the Parliament are unique to this job.

“The responsibility is immense. The payback is the knowledge that you can achieve great things for the AMA members, the whole medical profession and, most importantly, the community, and the patients in our care.”

His address focused largely on the ground covered since the AMA met for national conference in 2017.

Describing it as a “very busy and very successful year for the Federal AMA,” Dr Gannon said time had passed very quickly in the job but much had been accomplished.

“Throughout the last 12 months, your elected representatives and the hardworking staff in the Secretariat in Canberra have delivered significant achievements in policy, advocacy, political influence, professional standards, doctors’ health, media profile, and public relations,” he said.

“We all worked tirelessly to ensure that health policy and bureaucratic processes were shaped to provide the best possible professional working environments for Australian doctors and the highest quality care for our patients.

“The unique role of the AMA in health advocacy is that we are looked to for commentary on the breadth and depth of health policy, social policy, and the health system.”

Dr Gannon said strong and robust advocacy led to a number of policy outcomes at the federal political level.

He said many organisations get nothing for their efforts, but the AMA never gives up.

“To be successful in Canberra, you have to learn to take the knocks along with the wins, then go back again and again for a better outcome,” he said.

“It is breathtakingly naïve to think it works otherwise. And that is what we have done, and keep doing.”

In 2017, the AMA launched its regular Safe Hours Audit Report, which gave added focus to the emerging issue of doctors’ health.

To enhance this focus on doctors’ health, AMA coordination of Doctors’ Health Services continues all around the country, with funding support from the Medical Board of Australia.

“We maintained a strong focus on medical workforce and training places, which resulted in the National Medical Training Advisory Network significantly increasing its workforce modelling work,” Dr Gannon told the conference.

“We secured a number of concessions in the proposed redesign of the Practice Incentive Program, as well as a delay in the introduction of changes.

“The AMA lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents. We focused on effective compliance, and achieving a fair balance between the interests of GP members and Pathologist members.

“We led the reforms to after-hours GP services provided through Medical Deputising Services to ensure that these services are better targeted, and there is stronger communication between them and a patient’s usual GP.

“We successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting. This potentially saves GPs thousands of dollars every year in legal and other compliance costs.

“We ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers. This avoided more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.

“We fundamentally altered the direction of the Medical Indemnity Insurance Review.”

The AMA campaigned on the issue of doctors’ health and the need for COAG to change mandatory reporting laws, promoting the WA model.

It led a nationally coordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.

It campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.

The 2018 AMA Public Hospital Report Card put the political, media, and public focus on the stresses and pressures on public hospitals and all who work in them. The current funding model, based entirely around payments for activity, discourages innovation and is inadequate in addressing the demands placed by an ageing population.

“We prosecuted the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee, my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy,” Dr Gannon said.

“This work was complemented by the launch of the AMA Private Health Insurance Report Card.

“We successfully lobbied for a fundamental change in the direction of the Anaesthesia Clinical Committee of the MBS Review. The Australian Society of Anaesthetists were grateful for our assistance and leadership. Many other Colleges, Associations and Societies have worked out that partnership with, rather than competing with, the AMA is the smartest way to get results.

“We launched a new AMA Fees List with all the associated benefits of mobility and regular updates.

“We saw a number of our Aged Care policy recommendations included in a number of Government reviews.

“We lobbied against what could easily have been an ill-thought-out UK-style Revalidation proposal. Our work resulted in a vastly improved Professional Performance Framework based around enhanced Continuing Professional Development.”

Dr Gannon said the AMA had provided strong leadership right across the busy public health landscape over the past year.

The AMA Indigenous Health Report Card focused on ear health, and specifically chronic otitis media.

The Federal Council endorsed the Uluru Statement from the Heart, acknowledging that Recognition is another key social determinant of health for Aboriginal and Torres Strait Islander Australians.

A product of a policy session at last year’s AMA National Conference was the subsequent updating of the AMA Position Statement on Obesity,

“I think that it is inevitable that we will eventually see a tax on sugar-sweetened beverages similar to those recently introduced in Britain and Ireland,” Dr Gannon said.

“In fact it is so simple, so easy, and so obvious, I worry that it will be seen by a future Government as a ‘silver bullet’ to what is a much more complex health and social policy issue.”

Position Statements on an Australian Centre for Disease Control; Female Genital Mutilation; Infant Feeding and Maternal Health; Harmful Substance Use, Dependence, and Behavioural Addiction; and Firearms were also highlighted.

“We conducted ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees,” he said.

“We promoted the benefits of immunisation to individuals and the broader community. Our advocacy has contributed to an increase in vaccination rates.

“We provided strong advocacy on climate change and health, among a broader suite of commentary on environmental issues.

“We consistently advocated for better women’s health services. And released a first ever statement on Men’s Health.”

New Position Statements were also released on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, Blood Borne Viruses, and Rural Workforce.

“We promoted our carefully constructed position statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, New South Wales and WA,” Dr Gannon said.

“That advocacy was not universally popular. Our Position Statement acknowledges the diversity of opinion within the profession…

“We led the medical community by being the first to release a Position Statement on Marriage Equalityand advocated for the legislative change that eventuated in late 2017.”

In July 2017, AMA advocacy was publicly recognised when the Governance Institute rated the AMA as the most ethical and the most successful lobby group in Australia.

Dr Gannon added that the highlight of the 2017 international calendar for him was the annual General Assembly of the World Medical Association.

“Outcomes from that meeting included high level discussions on end-of-life care, climate change and environmental health, numerous other global social and ethical issues, and seeing the inclusion of doctors’ health as a core issue in both medical ethics and professionalism,” he said.

“I get goosebumps when I read aloud the Declaration of Geneva. It is a source of immense personal pride that I was intimately involved with its latest editorial revision, only the fifth since 1948.

“But our focus remained at home, and your AMA was very active in promoting our Mission: Leading Australia’s Doctors – Promoting Australia’s Health.

“We had great successes. We earned and maintained the respect of our politicians, the bureaucracy, and the health sector.

“We won the support of the public as we have fought for a better health system for all Australians.”

Dr Gannon thanked his family, staff, the AMA Secretariat, Board and Federal Council.

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

 

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.

  1. Provide tax relief to encourage and reward working Australians and reduce cost pressures on households, including lowering electricity prices,
  2. Keep backing business to invest and create more jobs, especially small and medium sized businesses,
  3. Guarantee the essential services that Australians rely on, like Medicare, hospitals, schools and caring for older Australians,
  4. Keep Australians safe, with new investments to secure our borders, and, as always,
  5. 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.