A time for strong advocacy

My time as President of AMA (NSW) is rapidly drawing to a close. I have enjoyed the job immensely and am very confident the organisation will continue to thrive with a very talented Board, Council, and professional staff in place to keep working for our members.

The past two years have been notable for a number of challenges. The pressure faced by general practice remains immense. The freeze on indexation of the vast majority of Medicare items remains in place, and as it finally ends over the next two years, the dollar amounts are so small that it seems unlikely the damage inflicted will be undone for many years to come – if ever. Despite the Federal Government’s persistent efforts to mislead the public by quoting the high numbers of bulk-billed items being funded, many of these are for services such as pathology and medical imaging. As well, we are kept in the dark about the number of GP consultations that are now being charged above Medicare rates, and by consequence the extent to which the rebate freeze has resulted in increased out-of-pocket costs for patients.

The AMA has always argued the principle that quality care of patients needs to be appropriately remunerated. Indeed, AMA (NSW) has committed funding to our Future Practice campaign to assist members to run their practices as efficiently as possible. There is good evidence that health systems that fund primary care adequately are more efficient and deliver better population health outcomes.

It is time for the Federal Government to come clean with the population about their intentions for health funding. Does the Federal Coalition believe Medicare should provide universal care in primary health and public hospitals, or does it believe some or all of us should be paying extra for these services? Similarly, what does Federal Labor believe? Medicare is not funded adequately to fulfil this expectation currently. With a Federal election on the horizon, we demand honest answers to these fundamental questions. If political parties believe they deserve our votes, they should be prepared to articulate both their philosophy, and the detail of their health policy.

Our State public hospitals also remain under immense pressure. There seems to be no indication that emergency department activity and complexity, or demand for elective surgery, will drop any time soon. Our population continues to grow. The Medicare rebate freeze almost certainly has led to some of this demand, as traditional general practice struggles to provide after hours care, and access to affordable specialist care remains difficult for those on low incomes. Our State Government deserves credit for pouring record amounts of money into building hospitals. There has also been a large increase in staffing numbers across the public hospital system. Yet the system remains stressed.

It is time for a re-think. Our hospital information management systems remain clunky and, in some ways, unfit for purpose. We integrate poorly between primary care and hospitals, both public and private. Indeed, we integrate poorly between general practice and community specialist practice. We do not use evidence to guide practice as well as we should and provide too much futile care towards the end of life. We sit in endless hours of meetings, but the level of empowerment for clinicians to make meaningful changes is minimal. We are all so busy defining risk that we have lost the ability to take a few that might actually improve our patients’ health, and our colleagues’ work life.
These big and fundamental issues are difficult to articulate to a public that is fed a diet of stories from media about much smaller target issues. The quality and value of private health insurance is really important, but one could be forgiven for thinking it is the only issue affecting the health of the community if one were to go by media attention. That said, AMA (NSW) is outraged by the actions of Bupa, which proposes to make substantial cuts to the levels of benefits it provides its customers, and we will fight it all the way. It is everyone’s right to change their private health care provider if they are unhappy with the level of service. Remember, the private health industry is making record profits, and continues to be heavily supported with taxpayers’ money.

There is undoubtedly a scientific illiteracy in the community that allows anecdotal accounts of individual patient situations to gain more headlines than academic discussions regarding evidence-based care. Just recently I read a story about a person who has been ‘denied access’ to medicinal cannabis for treatment of her ‘rare autoimmune condition’, claiming it is the only effective treatment. I am surprised, as an immunologist, that I haven’t come across any evidence for the use of cannabis for autoimmune disease! Seriously though, there is a constant danger that politicians will be influenced to make bad decisions by this type of media. The AMA remains an absolutely essential voice of reason to moderate and lead these types of discussions.

With a desire to have these important debates about the future of healthcare in Australia, and to articulate not just the problems, but a vision for solving them to both the public and our elected representatives, I am running for the Federal Presidency of the AMA in May this year. I wish to continue my advocacy for equity and inclusion in health on the national stage. I want to provide a strong voice for those who need it. AMA stands up for the needs of the profession, and for the needs of our patients.

Supporting my presidential candidacy is Victorian hand surgeon and AMA Federal Councillor Dr Jill Tomlinson, who is running for the role of Federal Vice President. Jill is known to many NSW members through her surgical fellowship year at the John Hunter and Royal Newcastle Hospital in 2012, her social media advocacy and her previous involvement in RACS and the medical women’s societies. As Vice President, her expertise in digital health and gendered issues including flexible training will invigorate Federal advocacy in areas where it has traditionally lacked strength, in an organisation that has not yet elected a female Vice President this century.

The next AMA Federal President has important work to do. There is a need to fight for the rights of asylum seekers stranded on Nauru and Manus Island for adequate health care and a way out of their current situation. There needs to be constant pressure for solutions to the problem of the poor health of our Indigenous population. There needs to be better access to healthcare for our rural and regional population and better support for our colleagues who are working hard to provide that care. There needs to be sustained pressure on Government to do better with critical public health issues such as obesity, mental health, and the health effects of climate change, global conflict, and displaced persons.

AMA (NSW) has seen membership growth at a time when many voluntary member organisations are going backwards. We recognise the trust that is placed on us when you spend hard-earned money to be part of this peak medical body. Not every decision I make, or statement I put out, will be popular with all of the membership. However, at a time when there is record graduation from medical schools, widespread anxiety about the availability and quality of training pathways for those graduates, major concerns for the health and well-being of the profession, and mistrust of the political system, the AMA is more relevant than ever.

Thank you for allowing me to serve as your AMA (NSW) President.