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the nsw
doctor
The official publication of the Australian Medical association (NSW)
COLLEGIALITY
creating a better
community
ELECTION WINNERS
new
60
PRINT POST APPROVED PP255003/00999
AMA (NSW) secures
registrar positions
Vol 7 - number 03 - May/June 2015
Tour Highlights in 2015 and early 2016
Wallace in the Malay
Archipelago
Paediatrics in China
8 – 25 September 2015
Gain insight into the Chinese approach to
paediatrics and child care while learning
about the history and society of this
extraordinary country.
16 – 27 October 2015
Midwifery and Childcare
in Vietnam
Ophthalmology and Eye
Care in South India
Explore compact yet remarkably diverse
Ecuador and cruise on a private yacht
around the Galapagos Islands.
15 – 26 November 2015
16 – 29 November 2015
See a side of Vietnam well off the tourist
trail and learn about the midwifery system
in this beautiful and welcoming land.
Immerse yourself in South India’s culture
and natural beauty and examine eyecare
through professional visits and talks.
Obstetrics, Gynaecology
and Fertility in Cuba
Medicine in Sri Lanka
Medicine and Society
in Cuba
Travel through Sarawak, Singapore and
Indonesia in the footsteps of one of the
greatest naturalists in history.
Ecuador and the Galapagos
14– 27 November 2015
19 – 30 November 2015
There is only one Cuba. Experience Cuba’s
music, culture and healthcare system
against a stunning natural backdrop.
12 – 25 October 2015
17 – 30 January 2016
Sri Lanka is crammed full of cultural
treasures, wildlife and unspoilt
landscapes. Examine the culture and
medical system of this exciting new
destination.
For full itineraries and more tours please contact:
Jon Baines Tours (Melbourne)
Tel: +61 (0)3 9343 6367
Email: [email protected]
www.jonbainestours.com
Medical History
Mediterranean Cruise
Learn about the region’s medical and
military history in boutique comfort.
Includes lectures and shore excursions.
4 – 15 February 2016
One of our longest running tours, this
itinerary takes you to the heart of Cuba’s
society, culture and healthcare system.
contents
the nsw
doctor
The official publication of the Australian Medical association (NSW)
The Australian Medical
Association (NSW) Limited
ACN 000 001 614
Street address
69 Christie Street
ST LEONARDS NSW 2065
Mailing address
PO Box 121, ST LEONARDS NSW 1590
Telephone (02) 9439 8822
Outside Sydney Telephone 1800 813 423
Facsimile (02) 9438 3760
Outside Sydney Facsimile 1300 889 017
Email [email protected]
Website www.amansw.com.au
The NSW Doctor is the bi-monthly publication
of the Australian Medical Association (NSW)
Limited.
Printing by A.R. Rennie Printers, Caringbah.
Views expressed by contributors to The NSW
Doctor and advertisements appearing in
The NSW Doctor are not necessarily endorsed
by the Australian Medical Association (NSW)
Limited.
No responsibility is accepted by the Australian
Medical Association (NSW) Limited, the
editors or the printers for the accuracy of
the information contained in the text and
advertisements in The NSW Doctor.
The acceptance of advertising in AMA (NSW)
publications, digital, or social channels or
sponsorship of AMA (NSW) events does not
in any way indicate or imply endorsement by
the AMA.
Executive Officers 2014-2015
President Dr Saxon Smith
Vice President Professor Bradley Frankum
Chairman of Council Dr Michael Steiner
Honorary Treasurer Dr Andrew Zuschmann
Chair, Hospital Practice Committee
Dr Ian Woodforth
Chair, Professional Issues Committee
Dr Adrian Cachia
Director Dr Sandy Jusuf
DIT Representative Dr Danielle McMullen
features
11 Internship: the good, the bad, the ugly
14 Beyond the GP co-payment battle
16 Freezing specialists’ fees
18 GP Toolkit on the small screen
20 AMA (NSW) scores major wins in state election
22 Talking about sexual harassment in medicine
26 Industrial relations’ success stories
28 Life-saving research in Tanzania
30 March on Machu Picchu for cancer research
32 Reaching youth at risk of extreme ideologies
40 Women in medicine
regulars
2 President’s word
3 From the CEO
4 AMA active
6News
8 DIT diary
24 Medico-Legal
35 Events
38 Golf events
42Members
14
20
18
28
22
44 Member services
Secretariat
Chief Executive Officer Fiona Davies
Medical Director Dr Robyn Napier
Chief Financial Officer Walter Edgar
Director, Medico Legal and Employment
Relations Andrew Took
Director, Policy & Communications Sim Mead
Director, Services Kerry Evripidou
Editor
Andrea Cornish
[email protected]
Designer
Nikki Zacharatos
[email protected]
Advertising enquiries
Michelle Morgan-Mar
[email protected]
18
14
President’s word
Dr Saxon Smith
President, AMA (NSW)
Creating collegiality
It is through the support of peers that we
become better doctors and deliver better
care to patients and the community.
The image of a doctor emotionally
breaking down outside a hospital in
America after the death of a 19-yearold patient has captured widespread
mainstream and social media attention.
This is a scenario that is repeated daily
around the world as doctors try to help
their patients when they are at their
greatest need. But usually it is not
captured or shared in such a public way;
rather it is our colleagues, friends and
loved ones who see the impact of one
of those days. It is a poignant reminder
of the importance of those social
foundations that keep us together even
on the toughest of days.
It has been 20 years since I started
my journey through medical school,
internship and specialist training; and 10
years since I began my involvement with
the AMA. In fact, some of the problems
splashed across recent media are the
same reasons why I decided to get
involved with the AMA in the first place. I
wanted to champion a culture change in
the profession – one that supported you
when you were sick; allowed part-time
training and work when your personal
circumstances needed it; looked after
its junior doctors to develop the future
healers and leaders; and, accepted its
own human frailties.
My career has been interrupted,
turned upside down and inside out due
to health problems. I was diagnosed with
[email protected]
ulcerative colitis (the other inflammatory
bowel disease to Crohn’s disease) in
the last year of medical school. This
began a rollercoaster ride with chronic
illness, which at the time robbed me
of my passion, confidence, fitness and
even my image of self. I was obsessively
diligent with my medications in an
attempt to control this disease – at one
point taking 16 tablets a day, as well as
using embarrassing topical therapies.
Despite all of this, at its worst I still
needed to visit the bathroom 20 times
in a morning due to severe abdominal
pain. After my weight dropped to 60kg
(from 75kg prior to being diagnosed),
I then ballooned to nearly 100kg as a
complication of long term high dose oral
steroids. As an intern, every morning was
a struggle to get to work – trying to time
the 10-minute drive between episodes of
urgent painful need to visit the bathroom.
All my sick leave and holiday leave
was taken up by hospital admissions,
investigations and simply being sick.
This was not the life I had dreamed for
myself nor a way for anyone to live and
work. I subsequently had long periods
not working and three major surgeries
to remove my entire large bowel (colon)
over a 12-month period, which were
associated with significant complications,
and subsequent years of piecing my life
and health back together.
During this incredibly hard time I was
@drsaxonsmith
2 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015
lucky that I had family and friends around
me to pull me up when I was at rock
bottom. I also had amazing support from
colleagues and hospital administration. I
even had a random visit in hospital from a
cousin of a family friend who lived in rural
Queensland, but had been through the
same thing. I was also aware that I was
one of the lucky ones, as I know other
people with whom I worked were not as
supported by the system around them.
They felt isolated by colleges, hospital
administration and, at times, even by
colleagues. This left them trapped, lost or
pigeon-holed in their careers due to the
limitations of their health. This inequity
is what drove me to join the AMA and
turn up to my first doctors-in-training
meeting.
Collegiality is a living thing that is fed
or starved by our actions and interactions
with each other. It is important to stand
with and stand up for our colleagues. It
is through this support of peers that we
become better doctors and deliver better
care to patients and the community. dr.
www.facebook.com/amansw
From the CEO
Working for you
Fiona Davies
CEO, AMA (NSW)
From policy and advocacy, through to supporting
doctors through industrial and medico-legal services,
the AMA (NSW) is working on behalf of doctors, the
health system and patients.
We would like to welcome members and
non-members to the annual state-wide
edition of The NSW Doctor. This is the
edition we send to every doctor in NSW.
The edition provides those doctors
who are not currently AMA members a
chance to see how much work the AMA
does on behalf of doctors, our health
system and our patients. We rely on the
support of doctors and with this support,
we know we make a unique and critical
difference to health in NSW and in
Australia.
In this edition, we showcase just how
significant that work has been with the
AMA delivering major achievements
at a state and federal level for all
doctors. At a federal level, there has
been considerable focus on the GP copayment and we cover this story on page
14. We continue to also be very mindful
of the implications of the freeze in MBS
indexation, which is now proposed to run
until 2018.
Federal AMA has also been active on
the issue of public hospital funding.
The AMA also stood up for health
in the NSW State Election. We put
forward a package of policy priorities.
This package went beyond standard
hospital infrastructure and covered the
broad range of issues impacting on our
healthcare system, from increasing
involvement of GPs in hospitals and
hospital-based care, to better resourcing
of end-of-life decision making.
However, the AMA is more than just
policy and advocacy; we also work to
support you professionally through our
industrial and medico-legal services.
Our highly experienced medico-legal
and industrial team understand that
you want to be able to focus on being a
doctor and caring for your patients. We
are there to help with contracts, staffing,
disputes or any issue where you need
expert guidance.
In between all of the politics and the
industrial and medico-legal services, the
AMA also takes the time to have some
fun. Some of my favourite events in the
AMA year are the Women’s High Teas.
Once again, we held two events, one in
Sydney and one in Newcastle. While both
events were very different, they were
both wonderful opportunities for female
doctors to connect with each other and
talk about how we can better support
each other. I would like to thank all of
the doctors who attended the events.
If you are not an AMA member, please
take the time to see what we have been
doing for you and consider lending your
support by joining the AMA at
ama.com.au/join-renew dr.
[email protected]
14TH ANNUAL Continuing Professional Education (CPE) seminar
This 1½ day seminar covers current developments in medical practice with updates in the treatment of diseases,
preventative health issues and is designed to assist experienced practitioners towards meeting the CPE
requirements.
Date
| Saturday, 25 July – 9.00am-4.00pm and Sunday, 26 July – 9.00am-1.00pm
Venue | Y3A Theatre, Macquarie University (enter Balaclava Road)
Cost | AMA members $150.00. Non-members $200.00.
Includes morning teas and lunch on Saturday.
This seminar will be submitted for QI&CPD points approval by the RACGP QI&CPD Program.
Register online: www.amansw.com.au
For more information or to make a booking Jenni Noble phone 02 9902 8140 or email [email protected]
www.amansw.com.au I 3
Media
AMA active
AMA (NSW) President, Dr Saxon Smith, spoke to The Sydney
Morning Herald about Phenergan:
AMA (NSW) President, Dr Saxon Smith, and Councillors,
Dr Fred Betros and Dr Kean-Seng Lim, spoke to ABC TV
about health in western Sydney:
AMA (NSW) President, Dr Saxon Smith, spoke to Triple M and
2GB about lower crime rates in Kings Cross following pub
lockouts:
AMA (NSW) President, Dr Saxon Smith, spoke to ABC’s PM
about the AMA (NSW) psychiatrist survey:
AMA (NSW) President, Dr Saxon Smith, was one of the
experts to talk about important health matters for the 2015
NSW State Election in this Herald story:
AMA (NSW) President, Dr Saxon Smith, spoke to Channel 7
about the importance of vaccination:
Health Project Services
Health Project Services provides a comprehensive
range of consultancy services, including research,
strategic planning, property search and acquisition,
project delivery, and medical property management.
It also offers ad hoc consulting services to clients
already running their own project, who may need
some expert advice along the way. For more
information visit healthprojectservices.com.au.
Health Project Services is offering one member
the opportunity to use its services. Submit your
property development proposal directly to dean.c@
healthprojectservices.com.au for your chance to win
this exclusive offer.
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Whether you already have a SMSF or you’re
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Innovative thinking. Traditional values.
News
Oral Health:
A User’s &
Practitioner’s
Guide
This Active Learning
Module has been
approved by the
RACGP QI&CPD
Program.
Total Points: 40
Category 1 points
15 August 2015
9am – 5pm
$315
Holistic dentist Dr Ron Ehrlich gives
a clinically focussed and handson workshop designed to provide
medical practitioners and allied health
professionals with a practical and
systemised approach in assessing the
oral cavity, detecting the important
signs of local and systemic disease that
manifest there, and managing these
appropriately for their patients.
Register here:
drronehrlich.com/oral-health/
Mental Health funding confirmed
Mental health services will have their funding
renewed in a move to give them certainty, Minister
for Health Sussan Ley announced in April.
Ms Ley said the 12 month extension – worth almost $300 million –
would allow frontline services to continue to be delivered while work
progressed on the current Mental Health Review. Ms Ley thanked
the sector for their patience and said negotiations would commence
immediately, with priority placed on frontline services.
“This review will allow Government to form long-term plans to ensure
our high quality mental health services continue to provide the right care
at the right time in the right setting.
“However, most people also recognise that to achieve this,
improvements need to be made in the way mental health is organised
and funded in Australia and it’s important this opportunity for positive
reform isn’t rushed.
“Therefore extending funding for another 12 months will provide
frontline mental health services with clarity and certainty while we work
through the complex issues raised in the review.”
Ms Ley said the Abbott Government had tasked the Mental Health
Commission to complete a review into the mental health sector following
an election commitment.
Ms Ley said the Government was currently working through the
findings of the review and it would be released soon.
The announcement was welcomed by the Australian Medical Student’s
Association (AMSA).
AMSA President, Mr James Lawler, said this was particularly
important in order to provide certainty for the mental health sector until
the release of the National Mental Health Commission report.
“AMSA congratulates Minister Ley on this decision – without it, the
mental health sector and its clients faced an uncertain future after
June 30,” Mr Lawler said.
“Forty-five per cent of Australian population will suffer from one or
more mental health conditions during their lifetime.
“Young people in particular are at risk of poorer mental health, and
services which provide early intervention, long-term treatment and
public health awareness are vital.” dr.
Australia Day Honours 2015
Special congratulations to Campbelltown surgeon
Dr Andrew Gatenby, who received an AM for
significant service to medicine, particularly as a
colorectal surgeon, and to the community of south
west Sydney.
The semi-retired colorectal specialist started
practising in 1978, and was appointed to the
newly-opened Campbelltown Hospital as a young
surgeon.
Dr Gatenby was a general surgeon before
following an interest in colorectal and bowel
cancer.
AMA (NSW) would also like to congratulate
Prof David Lubowski, who received an AM for
significant service to medicine in the field of
colorectal surgery as a clinician and researcher,
and to professional organisations.
Prof Lubowski is Head, Department of Colorectal
Surgery, St George Hospital and holds senior
teaching positions with the University of NSW.
He currently has operating priviledges at
Hurstville Private Hospital, St George Public
Hospital, St George Private Hospital and Prince of
Wale Private Hospital.
In memory of
Dr Charles Rowland
Bromley Richards
AMA (NSW) would like to
acknowledge the passing of
Dr Charles Rowland Bromley
Richards, a longstanding
member of the association
and esteemed member of the
medical profession.
Dr Richards passed away peacefully after
a short illness at Manly Hospital on 26
February 2015 at age 99.
A revered gunner medical officer of 2/15
Rd Rgt, Dr Richards was one of the last
surviving doctors forced to work on the
Thai Burma railway, also known as the
Death Railway, during World War II.
Born 8 June 1916, Dr Richards was the
beloved husband of Beth (dec), father of
David and Ian (dec), grandfather of Charlie
and Belinda, Guy-Barratt, Lee-Bromley,
Angela, Robert, Tim and Salli.
He was a civilian doctor, teacher,
researcher and leader, as well as a friend
and confidant to numerous individuals
over several generations. dr.
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DIT diary
Dr Eliza Milliken
Junior Doctor
Equality must be for all
All forms of discrimination equate to one
thing: anti-humanism.
Since vascular surgeon Dr Gabrielle
McMullin’s comments regarding sexual
harassment ignited a national debate, female
doctors (including Dr Carolyn Tan) have been
compelled to come forward with their own
accounts of sexism at work. For myself, the
media commotion was timely − it hit just
two days after the AMA (NSW)’s Women In
Medicine Sydney High Tea, where a panel
of medical women at the top of their fields
deliberated on the role of women in medicine’s
past, present and future. My impression of the
experiences shared in that room by talented,
empathetic and ambitious women was, whilst
great advances have been forged by admirable
trailblazers, the path of medicine remains a
minefield for female candidates.
Something about Dr Tan’s story struck
me that seems to have been otherwise lost
in the noise of ‘blowjob gate’. Dr Tan called
Australian surgeons an ‘Anglo-Saxon male
boys’ club’ and this is a critical adjective.
Shirley Chisholm, the first African American
US Congresswoman and the first woman to
run for a US Presidential nomination once
said, “In the end, anti-black, anti-female, and
all forms of discrimination are equivalent to
the same thing: anti-humanism.” The thing
about boys’ clubs is not only do they refuse
admission to women but they also only admit
one type of boy; one who fits certain criteria
in regards to looks, interests, socioeconomic
background, sexual preference and even
ethnicity.
This is not to say that I do not think the
female doctors in training both past and
present have a claim to wrongdoing and
mistreatment. However, I also believe that
despite being a woman, being Caucasian, able
bodied, heterosexual and comfortable with
identifying as the gender I was assigned at
birth (now sometimes called cisgendered as
opposed to transgendered) has also offered
me relative advantages in comparison to some
other junior doctors. I have had conversations
with colleagues who felt strongly that
workplace opportunity, including progression
in training programs was being limited by their
race, their religion or their sexual orientation
and could offer solid anecdotal evidence that
this was the case. Bullying and fear affect not
only women, but can affect any outsider.
Sensitivity to minority issues is sometimes
painted as ‘political correctness gone mad’.
Journalist Miranda Devine responded to
Dr Tan’s story by labelling it part of the
hysteria for “man bashing”. Devine rejected
that “anyone sensible” would have thanked
Dr McMullin for “turning neurosurgery into
a gender battleground”. However, if political
correctness is the price for making a safe
environment for all-comers then it’s a small
one − besides, it’s basic professionalism.
We are all elevated by remembering that
oppressing women is often part and parcel
of cultural structures and institutions where
one type of person has achieved dominance
and prevents other types of people (read:
minorities) from achieving success on their
own terms, without conditions. Gender
equality is a battle not yet won and it requires
our attention. But we also need to recall that
differently abled people, people of colour,
those with different sexual preferences,
and individuals who don’t identify with the
gender they were assigned at birth, will all be
protected by a ‘club’ that is for all persons and
not just for those who fit a narrow definition of
‘boys’. dr.
Dr Eliza Milliken is a doctor-in-training and
will be writing a regular column for The NSW
Doctor, giving a fresh perspective on issues
affecting the medical community.
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Feature
Dr Neil Jeyasingam
Psychiatrist
How to prepare for
internship
Dr Neil Jeyasingam shares his advice on how
to survive your internship, choose a specialty
wisely and balance work/life commitments.
I had no real interest in medicine
when I first went into university. This
ambivalence didn’t prepare me well
for experiencing internship, which
comprised bullying, deception, betrayal,
and frequent disappointment – and that
didn’t even include the nurses. It was
also one of the best years of my medical
career.
My experience will almost certainly
not echo yours, but many of the pivotal
moments are worth consideration…
“What is your reason for doing
medicine?”
If it’s “to help people” or “for the
betterment of society” – congratulations.
There’s not too much I need to
encourage apart from reminding you
that this should not be the entirety of
your existence.
Now suppose your goal is career
advancement. You may be disappointed
with the hospital you’ve been allocated
and cursing that you didn’t stack your
preferences. Generally, no one cares
which hospital you did your internship
in. Plus, don’t be disappointed if you
didn’t get one of the “cruisy” hospitals –
an easy term prevents you from learning
anything, a harsh and confronting term
makes you a better doctor in the end – if
handled well.
Don’t be mistaken, you are still here
to learn. As a general rule, reading up
about at least one patient a day will keep
you in good stead, and if you are able to
start this habit early enough you will see
the benefits pretty soon.
Now, say you entered medicine with
a particular specialty in mind. Firstly,
can I say that hardly anyone I knew in
my batch ended up doing the specialty
that they thought they were going to
do. Don’t discount other experiences –
instead, choose your terms in order to
complement and facilitate the decision.
If you’re interested in colorectal surgery,
do a gastroenterology term. If neurology,
do a psychiatry term. If general practice,
do a surgical term. If cardiology, do
a respiratory term. Emergency and
intensive care terms are great for rapid
acquisition of multiple practical skills,
whilst surgical terms actually tend to
have you doing more general medical
work as most of your time will be spent
in ward care. Keep your options open
– the best way to avoid learning is to
convince yourself that you’re never
going to use information in that domain.
It’s not rationalisation, it’s laziness
combined with self-deception.
And when it comes time to choose?
Find a second year registrar in the
specialty you are thinking of, and then
ask away. Don’t ask consultants – we’re
all keen to have protégés to boost
our egos and will always provide an
idealised version of our field. You only
know your specialty decision is correct
after the first year of the training
program, and never before. Lastly, do
not make the single most common
mistake and choose a specialty based
on a charismatic individual. You probably
want to become that doctor, but not
necessarily in that field.
And if you entered the field for
money… oops.
“What is my life’s passion going
to be?”
If your first response is “not medicine”,
congratulations. You’re on track to a
healthier attitude to work. Medicine is
a profession – that is true, it shapes us
as we try to live in it. But there actually
is an outside world, and if ignored it
will disappear by the sixth month of
traipsing fluorescent-lit linoleum.
It is crucial to maintain a life outside
of medicine – your relationships will now
be far more important to you. Family,
friends, love, hobbies – any interest
beyond the hospital will be harder to
maintain, but must be done in order to
centre yourself. If you haven’t already,
take up a sport, something reasonably
scheduled that you can afford to miss
occasionally (depending on overtime
rosters).
Holiday preparation will also become
harder, and you’ll find that often the
initiator for holidays comes from your
family and friends rather than yourself.
Allow time for yourself as well – use
your ADOs and remember to explore
the world. I don’t remember too much
stitching from my surgical term in the
country, but I have an irreplaceable
collection of photographs of sunrises
over the foggy fields that I still treasure.
Why is the social dimension so
important? Well, unfortunately I’m too
aware of the literature regarding mental
illness and strain for house officers. It’s
not going to be helpful to go into it here,
but it is worth thinking about.
“How bad is it going to be?”
I had a nightmare registrar once who
made it his personal mission to belittle
every resident he had out of earshot
of his consultants. As a young doctor
without awareness of boundaries of
practice, but also aware that I was still
early in my career, I did not realise
what my rights were until after he was
fired for gross misconduct. I would have
dropped out of medicine if it wasn’t
for my then-girlfriend cushioning the
How to prepare for internship...con’t
mental blows and helping me to reorient
myself. But I still kick myself now for
not responding differently – not just for
myself, but for my patients.
Likewise I had a difficult term with
responsibility for several teams. It
was a never-ending juggling act of
haemodynamically unstable patients
and a profound lack of support. But
my strongest memory from that was
going out for drinks with friends from
high school, sitting there thinking, ‘I
am talking with an accountant and a
manager, and for the entirety of tonight,
unlike every hour of the last eight
weeks, I do not need to think at all about
medicine’.
Be aware of your rights and
responsibilities, and also about
workplace codes of conduct. It actually
does matter to know the difference
between performance feedback and
bullying – but it is useful to have a first
response to criticism as being, ‘is there
something about myself that I can
improve?’
You absolutely must have a general
practitioner, and talk to them or
trusted parties if there is any problem
whatsoever. Fix problems early, and
never, ever suffer in silence.
“How good is it going to be?”
Brilliant.
I worked with a great bunch of people
who all helped each other out – doing
each other’s cannulae, picking up shifts,
that sort of thing. We held parties,
complained about our experiences, and
had this dizzying camaraderie that only
happens from people embarking on an
incredible shared experience.
We fortunately learned early on
that we knew nothing whatsoever and
got used to asking questions, which
worked. We may have been bright, but
we were inexperienced, and everyone
else knew more than we did. Amongst
our superiors, there were good and
bad clinicians, but I received the best
advice of my career from a urology
registrar who advised me, “You learn
something from every person you meet.
Sometimes, you learn what not to do.”
Once you work out that your career –
and life – is about growth, and becoming
a better person every day, it’s amazing
where things will go.
So enjoy your internship, and make
the right decisions early. And hopefully it
too will be one of the best years of your
career. Because it will mark the point
at which every following year becomes
even better. dr.
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Feature
Facing the freeze
The AMA has faced down several threats to general
practice, but one critical policy remains in place
– the indexation freeze for all Medicare schedule fees.
The past 12 months have been
tumultuous for general practice, with
threats to general practice shapeshifting
from a $7 patient co-payment, to a
$5 cut to the Medicare rebate. The
rise and fall of ill-thought out health
policies has already been a battle of epic
proportions, but one more challenge
lies ahead – and it could have an even
greater impact on general practice.
Freeze on Medicare rebates
While the Coalition government recently
dumped its hugely unpopular $5 cut
to rebates, its freeze on Medicare
indexation rates remains on the table.
The rebate freeze was originally
introduced by the Labor government
to take effect November 2013 to
July 2014. It was then extended by
the current Coalition government
for another two years. Now the
Government is threatening to keep the
freeze in place until 2018. The costs of
running a general practice have risen
substantially in this time, yet Medicare
rebates remain frozen. As a result,
many GPs are being forced to look at
ways of maintaining the viability of their
practice. For some, this means they will
have to start charging a fee, or increase
the fees they already have in place. For
general practices in socio-economically
disadvantaged areas, where patients
would be unable to pay higher fees, it
could mean they would have to close
down altogether.
How much will it cost?
New research reveals that a
continuation of the indexation for all
Medicare schedule fees until July 2018
would result in GPs charging around
half their patients an $8 co-payment to
survive.
According to research published by
the Medical Journal of Australia, the
indexation freeze could result in a loss
of income for GPs of $384.32 per 100
eligible consultations, or more if the GP
is rural based.
Researchers from the Family Medicine
Research Centre at the University of
Sydney used data from the Bettering the
Evaluation and Care of Health (BEACH)
program between April 2013 and March
2014 to assess “direct encounters
between patients and GPs for which at
least one Medicare Benefits Schedule
or Department of Veterans’ Affairs
general practice consultation item was
claimable”.
They assessed the effect on GPs’
income of both the indexation freeze and
the now retracted $5 rebate reduction,
both individually and together.
The researchers found that the freeze
would cost GPs $384.32 (in the 2017–18
financial year) per 100 consultations,
requiring an $8.43 co-payment per nonconcessional patient consultation.
“Even though the rebate reduction
has been retracted, the freeze will have
greater impact with time – nearly double
the amount of the rebate reduction by
2017–18”, the researchers wrote.
“For economic reasons, the freeze
may still force GPs who currently bulk
bill to charge co-payments.”
The pain would be even greater for
rural GPs, they found.
“As the rural incentive is higher
than the urban, GPs claiming the rural
bulk-billing incentive item would face
a greater relative loss in rebate income
due to inflation: 10 cents more per nonconcessional patient in 2015–16 ($2.84)
and 29 cents more in 2017–18 ($8.72).”
The research backs what AMA
President A/Prof Brian Owler has been
warning the public about for months.
Early in the fight to oppose cuts to
general practice, A/Prof Owler pointed
out that Medicare rebates have already
been frozen for almost two years, and
the Government’s plan will see that
freeze extended for a further four years,
while inflation grows at an average
annual rate of 2.5 per cent.
AMA fights the
co-payment in
2014/15
FActs and figures
3 More than 7000 emails to MPs via doctors4health.com.au
3 In January 2015, the AMA’s leaders were quoted in more than 600 interviews,
communicating to an audience of over 44 million media consumers
3 A
MA supported the RACGP’s ‘You’ve been targeted’ petition information for
practices and patients
3 A
MA provided practices with posters, letters for patients and information from
The new arrangement essentially
delivers GPs, specialists and allied
health professionals a six-year pay cut –
reducing the money they have to operate
their practices, including paying staff
wages and rent, utility costs, medical
supplies and training and IT charges.
“What’s going to happen is that as
specialist and GP practice costs rise,
they’re going to have to stop bulk billing,
they’re going to have to stop using nogap schedules, and people are going
to have to pay more out of their own
pocket,” A/Prof Owler said.
What is the AMA doing now?
The AMA continues to consult with
government, doctors and the public on
the indexation freeze and its impact
on general practice. The AMA has had
good success in garnering opposition to
the Government’s earlier co-payment
strategies, and should the indexation
freeze remain on the table, it will
continue to advocate strongly on behalf
of general practice.
AMA (NSW) will be distributing leaflets
to GP offices throughout the state,
raising public awareness about the
Medicare freeze and how it will affect
general practice. dr.
www.ama.com.au. Since 1 January, there have been more than 11000 hits on
the information for practices page of www.ama.com.au.
3 GPs
in local communities gathered to stand against the proposed changes.
They put iPads on reception desks to encourage emails to MPs. They
arranged to meet local MPs, they organised local events and they educated
their patients about the value of general practice.
The GP co-payment:
from cradle to grave
(and back again)
May 2014: The Abbott government
proposes a mandatory $7 co-payment
for general practice, pathology and
diagnostic imaging in the budget.
While doctors could keep the $7 copayment, the government sought to
cut the Medicare rebate by $5.
Dec 2014: Growing opposition from
the AMA and other groups forces the
government to change direction. It
reduces the co-payment to $5 and
exempts children and concession card
holders. The government also cuts the
rebate by $20 for consultations under
10 minutes to combat so-called “sixminute medicine”.
Jan 2015: Newly appointed as
Health Minister, Sussan Ley takes the
Government’s controversial changes
to Level A and Level B consultations
off the table.
March 3 2015: Minister Ley
announces the co-payment plan and
the $5 cut to the rebate have been
dumped; however an indexation freeze
on the Medicare Benefits Schedule
remains in place.
Feature
Specialists: the impact of the freeze
The Government’s freeze on Medicare rebates for specialists
will increase out-of-pocket costs for patients.
While much focus has been directed on the GP co-payment
issue, the AMA is also warning the public about the impact of
the ongoing freeze on specialist fees.
According to AMA President A/Prof. Brian Owler, the
continued freeze means fewer specialists will participate in nogap schemes, which is turn means the out-of-pocket expenses
for patients will skyrocket.
It is currently proposed that all CMBS rebates will be frozen
until 2018, meaning that by 1 July 2018 rebates will have
remained static since 1 November 2012, a period of five years
and eight months.
Of course, there is no guarantee that there will be an
adjustment in July 2018.
The response from private health insurers has been mixed.
Some insurers have indexed their schedules but are unlikely to
continue to do so in the face of such a long Government freeze
on indexation.
In these circumstances, if specialists increase their fees
and charge more than the no-gap schedule, the private health
insurer reverts back to covering only 25 per cent of the MBS
schedule fee.
As costs increase and Medicare payments remain the same,
it will inevitably lead to more patients with out-of-pocket
expenses. Increases in healthcare costs could also encourage
people to reconsider their private health cover. Not only would
this increase pressure on the public system, it could lead to
higher private insurance premiums.
AMA (NSW) President Dr Saxon Smith said he has been
conscious of keeping consultation costs down to date, but
eventually he will have to look at restructuring fees to ensure
the viability of his practice.
“I haven’t increased my fees for the past two years in a bid to
make consultations as accessible as possible for my patients.
Unfortunately, the Government’s proposal to maintain a freeze
on indexation rates will eventually force me to look at charging
patients more.”
He added, “While the freeze will impact procedural costs,
there is also a significant impact on consulation costs. Patients
with chronic conditions will especially be hit hard.”
This is an issue the AMA is already lobbying the Government
on and it will continue to do so until the issue is resolved.
This issue also has important implications for fee-for-service
(FFS) VMOs in NSW because of the direct link between CMBS
increases and FFS VMO remuneration. dr.
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Feature
It’s time to talk
AMA (NSW) created a video based on the GP Toolkit
for doctors on providing care to victims of domestic
violence. The NSW Doctor reports.
“One in five women disclose domestic
violence for the first time to their GP
and you could be the only person they
tell,” said Dr Deborah Bateson, Medical
Director of Family Planning NSW, in a
video recently developed by AMA (NSW)
for doctors providing care to victims of
domestic abuse.
The video highlights important
information from the GP Toolkit, a
domestic violence resource created
specifically for doctors.
Helen Campbell, executive officer
at Women’s Legal Services NSW –
the organisation that produced the
toolkit – also appeared in the video to
give doctors advice on listening with
compassion.
“Many women won’t necessarily
disclose [domestic violence] immediately
– they may drop some hints, see if the
doctor responds compassionately and
that will help the woman be encouraged
to talk about what’s happening to her.”
Dr Bateson added that sometimes the
questions need to be a bit more direct.
“If you have got suspicions of
domestic violence you might want
to say something like, ‘Are you ever
frightened of your partner?’, ‘Do you
mind if I ask, have you ever been hurt,
or hit, or slapped by your partner?’
And sometimes it’s useful to say, ‘I
actually ask a lot of my patients these
questions.’”
According to Dr Bateson, doctors need
to keep in mind that many women want
to talk.
“Sometimes we can feel a bit nervous
around asking, but we well know
through the evidence that women really
want to be asked.”
Once a woman has confided, both
Dr Bateson and Ms Campbell indicate
it’s critical the doctor listen respectfully
and without judgement.
“It’s very important to respond in
a way that validates the woman’s
experience and to assure her that
whatever is happening is not her fault
and that it’s not ok to feel unsafe in your
own home and that there are ways that
we can assist that woman to find a safe
way out of that situation,” Ms Campbell
said.
When patients do indicate they are
experiencing domestic violence, it is
imperative doctors discuss a safety
plan. Check for immediate concerns:
does she feel safe going home after the
appointment? Are her children safe?
Does she need an immediate place of
safety? Does she need to consider an
alternative exit from your building?
“We need to ensure that we listen
to the woman’s concerns. She will be a
very good judge of her safety. It may be
that you need to contact the domestic
violence line within the consultation. I’ve
certainly done this on many occasions.
It may be that you need to involve the
police straightaway at that time,”
Dr Bateson said.
For many women, the time they decide
to leave the situation is actually the time
when the danger will be greatest.
Women’s Legal Services NSW outlined
a wide range of referral sources in the
GP Toolkit, so practitioners can guide
women to appropriate support centres
– refuges; counselling and or access to
legal services, should patients need to
take action to get a protective order from
the court.
In the video, Ms Campbell explains
the importance of taking detailed notes
during consultations with women
experiencing domestic violence.
“There are ways the legal system
will respond to or compensate her for
injuries. And in those circumstances, the
doctor’s notes may be a very important
part in helping that woman get the
protection she needs from the legal
system. Make sure the notes are signed
and dated. They need to state the facts,
rather than providing general opinions.
Instead of putting, ‘my patient seemed
distressed,’ you need to be able to say,
‘my patient was shaking, she was crying,
she had difficulty speaking about the
situation she was in.”
And in cases where the children of the
relationship are experiencing violence,
doctors have a duty to report to Child
Protection Services.
“Doctors are mandatory reporters
when it comes to the protection of
children.
“However, there is no obligation to
disclose a confidence where there is
an adult woman who is experiencing
abuse in her home. Those decisions are
a matter for that woman to make for
herself,” Ms Campbell said. dr.
For more information about the GP
Toolkit, or to view the video go to
itstimetotalk.net.au or vimeo.com/
amansw
Save the date
AMA (NSW) Charitable
Foundation Gala Dinner
The 11th annual AMA (NSW) Charitable Foundation Gala Dinner will be held
Friday, 23 October 2015. The special guest speaker will be Rosie Batty, family
violence campaigner and Australian of the Year 2015. This year’s event will
support the Luke Batty Foundation, which was established in February 2014 after
Luke Batty was killed by his father at cricket practice in Tyabb, Victoria.
Dr Fred Betros, AMA President Dr Saxon Smith and Dr Kean-Seng Lim face the media
Feature
Winning the election
While candidates fought to win their
seats in the NSW State Election, it
looks like the real winners were the
AMA (NSW)’s priorities for health.
The ballots have been counted and
despite a state-wide swing of more than
9 per cent toward Labor, the Coalition
has retained government with a strong
margin.
In the lead-up to the election, AMA
(NSW) lobbied both the Coalition and
Labor parties – meeting with key people
including the Health Minister, Shadow
Health Minister, the Premier, and
associated personnel from their offices.
In addition, AMA (NSW) organised a
series of meetings between grassroots
AMA members and their local politicians
(both MPs and candidates).
AMA (NSW) outlined its key goals
in the AMA (NSW) 2015 State Election
Priorities for Health. The policy papers
focused on eight specific areas:
Increasing GP involvement in the public
health system; Improving the health of
rural and regional communities in NSW;
Improving access to health services;
Improving end of life care; Improving
health funding certainty; Improving
health outcomes through public health
initiatives; Providing world-class
medical education and training; and
Increasing the involvement of medical
practitioners in decision-making.
NEW TRAINING PLACES
The first of the AMA (NSW) priorities for
health, Improving the Health of Rural
and Regional Communities in NSW,
was launched in Dubbo. AMA (NSW)
President, Dr Saxon Smith, visited
Dubbo Base Hospital to meet with local
doctors and media to highlight the goals
outlined in the policy paper. He called for
funding of $30 million over four years
to boost doctor numbers in rural and
regional NSW.
“Forty per cent of the NSW population
lives outside of Sydney and it is well
known that patients from rural and
regional areas face higher costs and
longer travel times to access medical
care,” Dr Smith said.
“Medical graduate numbers have
doubled in the last five years as part of
a plan to address the severe medical
workforce shortages in NSW and
Australia.
“We must not waste this once-ina-lifetime opportunity to provide an
adequate medical workforce in regional
NSW,” he added.
Shortly after, the Coalition
government announced its plan to base
60 new registrar positions in outer
metropolitan and regional hospitals.
“Given time, this will help solve the
doctor shortage being experienced
in country NSW,” Dr Smith said in
response.
In the lead-up to the election, the
Coalition made several other promises
that were closely aligned with AMA
(NSW) priorities.
Key pledges included:
• Nearly $1 billion for upgrades to
Westmead Hospital, this was in
addition to several multimillion dollar
promises for other hospital upgrades
around the state
• Funding for 700 new doctors
• Prior to the election, AMA (NSW),
ASMOF and Health Minister Jillian
Skinner signed a memorandum of
understanding making feedback from
senior doctors an important part of
hospital managers’ annual reviews
Dr Colin McClintock, Dr Randall Greenberg, AMA President Dr Saxon Smith
and Dr James Yeung at Dubbo Base Hospital
In the lead-up to the election, the
Coalition pledged nearly $1 billion for
upgrades to Westmead Hospital.
• Funding the Foetal Alcohol Spectrum Disorder Clinic at Westmead Hospital, taking
over from the pilot program FARE started
• Removing the co-payment on chemotherapy for public patients, as well as other
drugs for conditions such as HIV, Alzheimer’s, Crohn’s disease, ulcerative colitis,
cystic fibrosis, psoriatic and rheumatoid arthritis, severe allergic asthma and rare
diseases
• The Coalition pledged not to introduce nurse-led walk-in clinics co-located at
hospitals
• Five paediatric surgeon positions for the Children’s Hospital Network and a
commitment to improve paediatric services in NSW
While the Coalition won the election, it should be noted that by election day, Labor
was also pledging nearly the same amount of money as the Coalition for Westmead
upgrades, it also pledged to remove co-payments for chemotherapy, and had
promised significant spends on hospital infrastructure. dr.
Jillian Skinner has been
reappointed as Health Minister
Going forward
Shortly after the election Premier Mike
Baird announced his cabinet. Significantly,
Jillian Skinner will retain the Health
portfolio.
“AMA (NSW) has a good working
relationship with the Minister and I look
forward to continuing to work with her
towards better health outcomes for people
in the state,” Dr Smith said.
He added, “AMA (NSW) welcomes the
news Pru Goward has taken over the
mental health portfolio.
“This also presents a good chance to
improve the health of people in NSW.
“A new minister will bring a fresh
perspective and I will be happy to work
with Ms Goward on improving mental
health services, particularly those in the
public sector,” Dr Smith said.
“It’s especially pleasing that Ms
Goward has been named the Minister
for Prevention of Domestic Violence and
Sexual Assault.
“Domestic violence is a problem that
crosses many jurisdictions – health,
law and order, and community services
to name a few – and I’m glad the
Government appears to be making this a
priority.
“I look forward to discussing with the
Minister the role doctors can play in
helping to fight this scourge,” Dr Smith
said.
AMA (NSW) looks forward to continuing
to advocate on behalf of a better health
system for doctors and patients in 2015.
Feature
Sexual harassment and the
medical profession
by AMA President A/Prof Brian Owler
This opinion piece was first published in The Age, The Sydney
Morning Herald and The Canberra Times on 25 March, 2015
As President of the AMA, I am proud of Australia’s medical
profession and those within it who provide such high quality
care to the Australian community. It is challenging to hear
assertions that members of our profession act in a way
that is unacceptable, particularly when it comes to sexual
harassment.
As the former Victorian Police Commissioner, Ken Lay,
recently wrote, it is easy for an organisation or profession
to become defensive when faced with such an issue. I can
understand that many members of the profession who have
acted faithfully as mentors for young men and women in their
early careers feel affronted by the accusations that sexual
harassment is rife.
When these accusations were raised, I had a similar
reaction. But in response I wrote to all AMA members about
the issue and asked for their feedback. Our State and Territory
AMAs have also sought to gain information by surveying our
members.
I don’t know whether sexual harassment, bullying, or other
unacceptable behaviours are ‘rife’. What I do know from the
feedback, independent of the recent media, is that it exists and this is unacceptable. As AMA President, I have undertaken
to address this issue.
It does matter how frequently this occurs, and at what level.
However, the threshold for deciding whether to act on it is not
the frequency, but whether it exists at all. Other professions
face similar problems. As for the medical profession, we
should set the example. We should be the benchmark.
Unlike local health services or the medical Colleges,
the AMA is not an employer, and we have minimal punitive
measures that we can enforce. However, the AMA is unique in
covering the breadth of the profession, and has a leadership
role. The Federal AMA’s mission statement is to ‘Lead
Australia’s doctors and promote Australia’s health’. Therefore,
we are in a unique position to address these and other issues.
Last week, I called a number of College Presidents and
asked them to attend a meeting in Canberra to address the
issue of sexual harassment in the medical profession. The AMA
Federal Council supported my proposal to host a Roundtable,
which was held in Canberra to address this topic.
No one should expect that one meeting will ‘fix’ this issue.
Rather, I hope that the meeting is an opportunity for the
medical profession to map an agenda for work in three main
areas.
The first is to ensure that we have the procedures and
policies in place through the Colleges, and also in the
workplaces. For many trainees, the Colleges are a major focus.
But it must be remembered that we have prevocational doctors
whose only relationship is through their employer, which is
the relevant jurisdiction’s department of health via their local
health district. For others, the employer may be a corporate
body, such as the case with salaried general practitioners. All
of these groups must have the proper policies in place.
The second, and more difficult, area is that of protection and
security in accessing appropriate reporting procedures. While
I continue to disagree with the assertion that doctors should
keep quiet about sexual harassment for fear of jeopardising
their careers, we need to ensure that doctors, at any stage of
their career, can lodge a complaint without fear of reprisal or
discrimination. We will only successfully
tackle this issue if we provide such
protection. The AMA and others need to
ensure a safe environment for victims to
speak out.
Finally, we need to change the culture
within the profession. The surgeons have
been singled out, but the feedback that
I have received indicates that the issue
is much more widespread. Much of the
problem is what could be described as
more insidious and lower level, but just
as destructive. Negative comments and
putdowns can be devastating to the growth
of a young person’s career even though
they may not reach the threshold for that
person to lodge a complaint.
I remember two distinct ‘pearls’ from
my days as a medical student and intern.
The first was sitting in a microbiology lab
at the University of Sydney when Professor
Yvonne Cossart pointed to Royal Prince
Alfred Hospital and said ‘those guys are
really mean to each other when it comes to
politics, but when one of them is in trouble
they will do everything they can to help’.
She had a lot of respect for ‘them’. The
second was when Professor Chris O’Brien
said to me that ‘we are all colleagues; we
may have different seniority, but we are all
members of the profession’.
They may have both passed on, but I
remember those words like yesterday. To
me, their words embody a sense of what it
means to be part of the medical profession
and, indeed, explain a good deal of my
motivation to be AMA President. It is about
being part of the ideal that puts the care
of others as the pinnacle of a career in
medicine. As medical professionals, we
may be competitive, but my colleagues
- who make sacrifices to care for others are deserving of my care too.
To me, the fact that sexual harassment
exists is unacceptable. I have spoken to
others, such as General David Morrison
and former Commissioner Ken Lay, who
have dealt with similar issues. Our issues
and roles are somewhat different, but our
resolve is not.
The medical profession must set the
benchmark. However uncomfortable it
is, we must look at our behaviours and
pull up the behaviours of others. The
AMA is taking this issue seriously. If we
cannot look after our own in the medical
profession, then how are we able to look
after the Australian public? dr.
Professional
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Cultural change
A cultural change is needed within the
medical industry to wipe out sexual
harassment, agreed members of a
medical roundtable meeting in April.
The meeting, which was attended
by more than 40 industry leaders and
convened by Federal AMA discussed the
need to protect whistleblowers within the
medical industry.
“Apart from the stigma and shame that
those making the complaint may feel,
there is concern about the repercussions
that may follow such a complaint,”
said A/Prof Brian Owler. “This must
change. We need safe environments
that all members of the profession can
access to discuss their concerns about
the behaviour of colleagues and be
able to voice complaints without fear of
recrimination. This needs to be followed
up by action, with due process, and
protection of the complainant.”
The round table meeting took place in
response to widespread accusations in
the media that sexual harassment in the
medical community is prevalent.
The media storm was sparked by
senior surgeon Dr Gabrielle McMullin,
who suggested to women entering
medicine that “complying with requests”
accredited data centre
for sex from male colleagues is a safer
option than reporting the harassment.
Her comments have since provided a
springboard for discussion.
Commenting to The NSW Doctor,
Dr McMullin said, “I was astounded by
the response to my comments about
sexual harassment and had no idea how
widespread it was.”
She added, “I am amazed that the
medical community and in particular
the College of Surgeons has reacted
so strongly, which indicates what an
enormous problem they have been
presented with.
“I am very pleased with how much
action has occurred and it seems
sincere. The issue is an enormously
difficult one to manage however and
I have no illusions about that. There
are many different dimensions to the
problem. One of the major issues is
producing a process that victims trust so
that they will report incidents and then
there needs to be a process to deal with
the abusers.
“We need more women at the highest
levels and quotas may have to be
considered to achieve this.”
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Medico-Legal
Director, Medico-Legal
and Employment
Relations – Andrew Took
Senior Legal Advisor
Rebecca Haynes
Policy and Legal Advisor
Andrew Campbell
Ivy Tseng
Changes to the
international criminal history
check for AHPRA
First announced last November, the National Boards and the Australian Health
Practitioner Regulation Agency (AHPRA) have implemented a new procedure for
checking the international criminal history of medical practitioners, as of 4 February
2015.
This new approach requires certain applicants and practitioners to apply for an
international criminal history check (ICHC) from an AHPRA approved vendor, which
is Fit2Work.
Practitioners must apply and pay for the ICHC from Fit2Work before submitting
their AHPRA registration application. You will be given an ICHC reference page and
check reference number which will need to be included in your AHPRA registration
application.
Once the results are available, Fit2Work will notify both you and AHPRA as well as
send the results directly to AHPRA.
People who will be affected by these changes to the international criminal history
checks are:
•N
ew applicants who have declared a criminal history outside of Australia and/
or have lived in one or more countries other than Australia for six consecutive
months or more since the age of 18;
•R
egistered practitioners who are seeking to renew their registration if:
o there has been a change to their criminal history in one or more countries
other than Australia since they last declared to AHPRA, or
oa
t any time of the year have informed the relevant National Board that they
have been charged with an offence outside Australia that is punishable by a
sentence of imprisonment of 12 months or more, or
oh
ave been convicted of, pleaded guilty to or are subject to a finding of
guilt by a court for an offence, outside Australia, that is punishable by
imprisonment;
• Practitioners who are registered under Trans-Tasman Mutual Recognition (TTMR)
from 4 February 2015 who declare a criminal history outside of Australia and/or
have lived, or been primarily based in one or more countries other than Australia for
six months or longer, when aged 18 years or more.
There are no changes to the existing domestic criminal checks.
For more information and a link to Fit2Work, you can visit the AHPRA website.
For any other registration enquiries, please contact AHPRA on 1300 419 495. dr.
Sarah Connor
Katie Pearce
Solicitor
Kym Gardner
Paralegal Officer
Eden Weller
ACCC focus on medical practitioners
and the health sector
The Australian Competition and
Consumer Commission (ACCC) has
announced their new compliance and
enforcement priorities for 2015, one
of which includes competition and
consumer issues within the health
sector.
Rod Sims, chairman of the ACCC,
commented at the launch of the 2015
edition of the ACCC’s Compliance
and Enforcement Policy in Sydney
in February that competition and
consumer issues in the medical and
health sector needed to have increased
attention.
As a new priority area for the ACCC,
Mr Sims highlighted that there were
numerous issues of concern including:
•A
llegations about attempts to
limit access to products, patients,
procedures or facilities;
•A
nti-competitive conduct by medical
professionals, especially in regional
areas; and
•A
range of consumer issues including
allegations of unconscionable conduct
and misleading and deceptive conduct
by medical professionals.
The ACCC also commenced a review
of the private health insurance industry
that was focused on the adequacy and
transparency of information about
private health insurance. The ACCC has
flagged the possibility of a review of the
health sector as well.
The aim of the ACCC is to increase
awareness both within the medical
profession and the broader health
industry about the rights and obligations
of both consumers and businesses
under the law.
To read the media release on the
ACCC’s announcement of new priority
areas for 2015, as well as the full
speech given by Mr Sims and the 2015
Compliance and Enforcement Policy go
to www.accc.gov.au dr.
Candid camera – can you provide evidence
in court by video-conferencing?
We receive many calls from members who have been
subpoenaed to appear as a witness in court. Occasionally the
subpoena requires that the doctor give evidence at a time
when the doctor will be interstate or overseas.
Once you have been served with a subpoena to attend court
and give evidence, one of the options you can request if you
will not be within the jurisdiction at the time of the trial is to
ask the party who has issued the subpoena to seek orders
from the court to allow you to give evidence by telephone or
audiovisual link.
NSW Courts have “a broad discretionary power to make
orders for the taking of evidence by audiovisual link”, which is
subject to the Uniform Civil Procedure Rules 2005 (NSW) (“the
UCPR”).
Rule 31.3 of the UCPR provides that “if the court so orders,
evidence and submissions may be received by telephone, video
link or other form of communication.”
The Evidence (Audio and Audio Visual Links) Act 1998 (NSW)
(“the Act”) allows the NSW Court to direct a person to give
evidence to the court by audio link or audio visual link from
any place (other than the actual courtroom or wherever the
court is sitting) in or outside of Australia.
Section 5B (2) of the Act also outlines situations where a
direction to provide evidence by audio or audio visual link
should not be made, including if the facilities are unavailable,
or the evidence can more conveniently be given at the
courtroom.
If there is any objection to the court making a direction to
use audio link or audio visual link, the court must not make
the direction unless the party making the application satisfies
the court that it is in the interests of the administration of
justice for the court to do so.
Factors that will influence the court in deciding whether
to approve a witness to give evidence by audio visual link
include: whether the evidence is centrally important,
whether adequate facilities are available, the presence of
technological difficulties, and the length of time required for
cross-examination. Ultimately a court must decide whether
allowing a witness to give evidence by audio visual link would
be practical and fair.
If you find yourself in a situation where you have been
served with a valid subpoena to give evidence and at a time
when you will be interstate or overseas please contact the
Medico-Legal team at AMA (NSW) for advice. dr.
Medico-Legal
Industrial Services in action
The following case studies highlight how AMA (NSW)’s
Medico-Legal and Employment Relations team assists members.
Case study 1 | Individual
Flexibility Arrangements
Dr X runs a private medical practice.
One year ago he employed a medical
receptionist (Ms Y). When Ms Y agreed to
start work at the practice, she and Dr X
arranged for an above award pay rate in
lieu of overtime and penalty rates. There
was also an agreement she would receive
three weeks annual leave instead of four.
Ms Y would take leave without pay when
the practice closed at Christmas.
About one year into the role Ms Y
resigned and asked to be paid out the
extra annual leave and overtime. Dr X
then contacted the AMA for help.
Firstly, we looked at whether the
agreement he had with Ms Y was what
is referred to as an Individual Flexibility
Arrangement (IFA) in the Fair Work Act
2009, the Health Professionals Support
Services Award 2010 and the Nurses
Award 2010. Secondly, we considered
whether the arrangement was properly
made and enforceable.
What is an IFA?
An IFA is an agreement to vary a term
or terms of an award or enterprise
agreement to suit the genuine needs
of an employer and their individual
employee.
Only certain terms can be varied.
Under Section 7 of the Health
Professionals and Support Services
Award 2010 and the Nurses Award 2010
these are:
•A
rrangements for when work is
performed, such as working hours
• Overtime rates
• Penalty rates
• Allowances, and
• Leave loading
Typical agreements include above award
salaries in lieu of annual leave loading
or flexible working arrangements where
parents start and finish early to collect
children from childcare or school.
What are the employer’s obligations?
The employer has a responsibility to
ensure that the employee is better off
overall than if there was no IFA.
The employer’s ‘better off overall’
assessment will usually involve
comparing the employee’s financial
benefits under the IFA with the financial
benefits under the award. The employee’s
personal circumstances and any nonfinancial benefits which are significant to
the employee can also be considered.
An IFA must be in writing and signed
by the employer and the employee. If
the employee is under 18 years of age, it
must also be signed by the employee’s
parent or guardian.
Once an IFA has been made, the
employer must ensure that a copy of
the IFA is given to the employee. The
employer should also retain a copy.
Can an IFA be signed at the same time
as an employment contract?
No, an IFA can only be made after the
employee has commenced employment
and is entitled to the minimum award
conditions prescribed by their award.
This means an employer cannot ask a
prospective employee to agree to an IFA
as a condition of employment.
How is an IFA terminated?
The IFA should include information
about termination. Generally, an IFA
may be terminated by agreement or by
either party giving the required notice.
The Health Professionals and Support
Services Award 2010 and the Nurses
Award 2010 require 13 weeks’ notice.
IFAs made prior to 4 December 2013
require 28 days’ notice.
What happened to Dr X?
Dr X’s agreement with Ms Y was probably
not an IFA as it was not in writing
and was made prior to employment.
Further, it attempted to vary annual leave, which is a minimum
entitlement under the National Employment Standards.
To prevent the matter escalating, we assisted Dr X to
negotiate with Ms Y an informal resolution. Dr X and Ms Y were
finally able to part ways on amicable terms.
Help! What should I do if I want to have an IFA?
If you are thinking of having an IFA with either a prospective
or existing employee contact the AMA Medico-Legal Division
on 9439 8822 for advice. We can help you negotiate an
arrangement that complies with the awards and legislation. We
can also help to formalise this in a written agreement, using
one of our many employment law templates.
Case Study 2 | VMoney issue
A VMO member, Dr A, telephoned us at AMA (NSW) because her
payment claims were consistently being processed late, or in
some cases not at all. Dr A was quite inconvenienced by the late
payments, as she had mortgage payments and other financial
commitments which depended on the prompt payment of her
payment claims.
Dr A sought our assistance with recovering her unpaid
claims, as well as seeking to ensure that future claims would be
paid on time. We asked Dr A a number of follow up questions to
establish the background circumstances, as well as for her to
forward us copies of the outstanding payment claims.
Action taken
Under the VMO Determinations, the Public Health Organisation
(PHO) is required to make payment to a VMO within 30
days of the receipt of a valid payment claim. As this had not
been occurring, we made contact with the appropriate VMO
processing centre to determine where the problem was
occurring.
In this particular case, it became apparent that Dr A’s PHO
had inadvertently not been forwarding her payment claims to
the processing centre for payment. In light of this information,
we then made contact directly with the PHO to discuss Dr A’s
issue.
Result
As a result of our discussions with the PHO, all outstanding
VMO claims were settled promptly. All subsequent payment
claims to date have been paid within the stipulated 30 day
period.
It is also of interest to note that, under the VMO
determinations, payment claims that remain unpaid after
45 days of receipt begin to accrue interest (the applicable
rate at the time was 6.5% p.a.). The PHO was happy to make
the payment which helped to compensate Dr A for the
inconvenience caused.
Follow up
With the introduction of the online payment claiming system
“VMoney” across most PHOs in NSW, some of the issues with
the paper based system may disappear, and we anticipate that
new issues and challenges may arise.
AMA (NSW) is currently consulting with a number of different
stakeholders to assess the success of the new electronic
system. We welcome any and all feedback from VMO members.
Please contact the AMA NSW Medico-legal and Employment
Relations team at 02 9439 8822 or [email protected]
to discuss VMO payments or any other VMO matters. dr.
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Feature
Giving children a chance
Prof Robert Booy is conducting life-saving research in
Tanzania to determine whether vaccination can prevent
children with HIV/AIDS from catching pneumonia.
One experience during Prof Robert
Booy’s last trip to Tanzania in 2014
painfully underscored the importance of
his research.
He was on his first paediatric ward
round, when he was urgently called to a
fly-ridden room with few beds and even
less medical equipment.
“I didn’t even realise it was the
intensive care ward – it looked like a
kitchen,” he recalled.
A 14-year-old girl, called Anna, was
lying unconscious and unresponsive, with
a blank stare in her eyes and making
deep respirations.
Prof Booy wasn’t the treating doctor,
but he watched as the other medical
professionals gave her sugar water
through a drip. He described the plastic
dextrose bottle as leaking from multiple
punctures and ants circling inside the
surface.
The team turned the girl on her side to
perform a lumbar puncture and within
seconds she died.
“The lumbar puncture released
pressure and caused her brain to cone …
I watched over the course of two or three
minutes minimal efforts being made
in the so-called intensive care ward, as
doctors performed a lumbar puncture –
which actually killed her.”
Prof Booy took the fluid from the spinal
tap to the laboratory and looked at it
under the microscope.
“It was pneumococcus – so the very
thing we wanted to prevent, someone had
just died from in front of my eyes.”
Since 2009, Prof Booy has been
conducting research on whether vaccines
to prevent pneumonia, which are readily
available in first world countries, are
effective at preventing children with
HIV/AIDS from catching the germs that
cause pneumonia from colonising in their
throats.
“There’s no intensive care unit for
looking after these kids so prevention is
so much more important. Once they get
sick, it’s very difficult to stop them from
dying,” he said.
Pneumococcal colonisation of the
nasopharynx is especially common in
young children and is a pre-requisite
for pneumococcal disease. Those with
immunosuppression, such as HIV, are at
higher risk of colonisation and disease,
especially at older ages.
Currently, vaccination schedules
are only offered to children less than
six months of age, despite the large
impact of pneumococcal disease in older
unvaccinated children with HIV.
Prof Booy conducted a study to assess
the prevalence of, and risk factors for,
pneumococcal carriage in HIV-positive
children aged less than 15 years.
He found the overall carriage rate was
81% and was at least 76% in those aged
Prof Robert Booy with members of his research team in Tanzania
Tanzanian women with multicoloured kanga in front of the hospital
5 to 14 years. The results also indicated
weight gain (due to an increase in
health as a result of antiviral drugs) and
exposure to caregivers with respiratory
symptoms as being risk factors for
pneumococcal carriage.
His latest research, which is currently
being analysed and the results of which
will be finalised in the next month,
addressed whether vaccination can
prevent the acquisition of carriage and so
protect against the disease.
Prof Booy first became interested
in infectious diseases when he was a
medical student more than 30 years
ago, when AIDS started to become more
prevalent.
Ten years on from that, he was working
in London’s St Mary’s Hospital with
children who had HIV, many of whom
came from Africa. It was there he saw
the impact of pneumonia, which was
really a death sentence for children with
immunosuppression.
He spent the next 10 years trying
to work out how to design his study
on nasopharyngeal carriage of
streptococcus pneumoniae and
eventually set up a research study
with HIV/AIDS orphans in Kenya.
Unfortunately, civil unrest in Kenya in
2007 shut down the research pilot and
he was forced to start again in Tanzania
in 2008/09, with the help of Dr Geofrey
Makenga and Dr George Mtove.
Prof Booy described the many
challenges he faced over the last decade
as being extremely frustrating and
laborious.
“Every country has its own
bureaucracy. To get through all the red
tape and the paperwork – both locally
and internationally – as well as getting
the financial assistance to run the project
took several years to make it happen.”
Prof Booy added, “Before the dawn
came the extreme darkness and I wrote a
poem about how difficult it was to get the
project started. I literally had no water
and no power and was dealing with a very
Harunor, a Tanzanian farmer with polio
Prof Robert Booy with Dr Geofrey Makenga
slow bureaucracy. And then there was the
heat. But suddenly things came good and
we got started.”
Prof Booy worked with Joint Project
Malaria in Tanzania and received grants
and vaccines from Pfizer and Sanofi
Pasteur, as well as some anonymous
donations.
As a result of Prof Booy’s research,
225 kids with HIV received vaccinations,
who otherwise would not have.
“We managed to get a supply to not
only vaccinate the kids, but to show how
effective the vaccines were at preventing
children from catching these germs in
their throat.”
He added, “The next steps are to
complete the analysis and if we do show
the benefit we expect to, we will strongly
recommend that the World Health
Organisation provides recommendations
and people on the ground to conduct
catch up vaccinations for all children with
HIV/AIDS from six months until 16 years
old.” dr.
Feature
Spiritual journey
Doctors Padmini and Daya Howpage will
trek Machu Picchu in May to raise money
for cancer research in honour of their
daughter, Sashie.
Photo courtesy of Hill Shire Times
One week before Dr Sashie’s Howpage’s
24th birthday she developed crippling
chest pain that was so intense she
collapsed. The irony of the situation was
that she was working a night shift as a
junior doctor and was too stressed to
really think about the cause of the pain.
According to her mother, Dr Padmini
Howpage, Sashie dismissed her
symptoms and to her family’s horror,
she declared her intention to do the
night shift the following day.
“She felt strongly about not letting
her colleagues and patients down,”
Padmini explained. “As parents we were
concerned, but she was an adult.”
The next day, Sashie woke with
terrible pain and decided to check the
small, firm lymph node she had felt on
her neck about a week previous to the
pain.
The radiographer who took her X-ray
invited her to step in to the reporting
room to have a look at the scans. She
was alone.
“The echoes of the telephone call
my husband received still lives with us.
She was crying loudly in the waiting
room oblivious to the horrified patients
looking at her: ‘Dad, it’s cancer. I know
it is. I’ve seen this kind of chest x-ray
before’.”
CT scans later revealed parts of
her lung collapsing under a mass.
Sashie was diagnosed with Hodgkin’s
Lymphoma in May 2012 and underwent
radiotherapy and chemotherapy at
Westmead Hospital Cancer Centre,
where she had been placed as a medical
student three years earlier.
“Life changed forever for us,” Padmini
said. “We met wonderful professionals
and realised how amazing our friends
and family are. We survived the storm.
It’s such a cliché, but learning to enjoy
what you have now is something our
family is better at doing. We are happy,
but isn’t that an irony that happiness
becomes a relative term?”
The portacath left Sashie with
an obvious scar, in addition to the
radiotherapy tattoo on her chest.
“We like them,” Padmini said. “It’s
confronting, but a lifelong reminder of
all that it was.”
Sashie is now one year into remission
and is working as a doctor at Royal
Prince Alfred Hospital.
“There is something wonderful,
something beautiful about realising how
resilient, how strong and how brave your
daughter is, and how her only brother
Sajith did everything he could to keep
his sister happy. For us, as parents,
grief paved the way to hope and ability.
As her parents it was an enormous
relief to walk through a pathway with
modern technology and advances in
medicine. It eased our pain. Now we
want to plant trees for others who would
find themselves on a journey similar to
ours. We want to raise funds for cancer
research.”
Climbing Machu Picchu is very special
for Padmini and her husband Daya,
as only four months prior to Sashie’s
diagnosis she climbed to the heart of the
Inca Empire, blissfully unaware of what
was growing inside her.
Padmini and Daya will complete the
trek on Sashie’s 26th birthday.
“Such a coincidence cannot be
missed,” Padmini said. “It will be a
spiritual journey through a very sacred
area. I want to experience what she
experienced three years before –
standing in the ruins on her birthday
with the first light of the day filtering
through the mountain tops and wild
horses running below. I want to reassure
myself there is hope for Sashie and for
all of us. I want the affirmation that life
is very beautiful with my family.” dr.
To donate to the Howpage’s trek, visit
trektobeatcancer 2015.everydayhero.
com/au/Padminisadventure.
The Howpage family hopes to raise
$10,000 by June.
Member profile
Dr Breshna Zakarya
Turning Young Afghan
Australian Lives Around
Dr Breshna Zakarya, Sebastian De Brennan
and a small committee are working with young
boys at risk of violence and extreme ideologies.
Sebastian De Brennan
Dr Breshna Zakarya is familiar with the
impacts of immigration on diaspora
communities.
Born in Afghanistan, Dr Zakarya fled her
homeland in 1982, crossing the border in
Pakistan.
“We were under extraordinary threat
from the Soviet Union army as my father
was a well-known figure,” she recalled.
After spending several years as a
refugee, she immigrated with her husband
to Australia in 1986.
Shortly after arriving, she learned English
and then gained entry into medical school
at the University of New South Wales.
Dr Zakarya undertook further training
at St Vincent’s Hospital, and now works
in the emergency departments of Sydney
Adventist Hospital, Norwest Private
Hospital and Blue Mountains Hospital.
But it was while Dr Zakarya was
preparing for her emergency medicine
primary exams that she was first exposed
to the kinds of issues youth of migrant
communities face. During this time, she
started working in NSW Justice Health
Clinics – a medical service for persons in
custody.
“I met many, many young individuals
from the Middle East with great potential,
but who got tangled up in the legal system
for easily avoidable mistakes arising from
social unawareness and failure in school.”
This experience combined with her own
journey as a migrant to Australia convinced
her of the need to identify and engage with
young people at risk through an education
project and one-on-one mentoring.
More than two years ago, Dr Zakarya
teamed with Sebastian De Brennan, a
criminal defence and human rights lawyer
in Sydney to create TYAALA (Turning Young
Afghan Australian Lives Around) to offer
post crisis assistance to youth and their
families in the form of rehabilitation,
reintegration, education and employment.
Mr De Brennan explained that he was
motivated to help launch TYAALA as a result
of his own experiences working with young
men in custody.
“I had a couple of extremely insightful
but profoundly depressing moments at
correctional centres with two young men
of Middle Eastern heritage who had joined
outlaw motorcycle gangs. During those
discussions, the muscles and bravado
momentarily went away and we had some
really honest conversations. They spoke
to the contradictions of the criminal
enterprise, the fickle nature of brotherhood,
the preying on religious factors and other
influences and decisions that had led them
astray. Both males said, ‘I wish I had my
time again…I wish I could speak to some
of the younger boys and tell them the
truth about this life’. I thought wouldn’t
it be great if these individuals were given
the opportunity to tell their stories – if
some of this could be imparted to younger
generations? I spoke with Dr Zakarya and
– as a direct consequence of her drive and
energy – TYAALA was born.”
The organisation works in three areas:
prevention, crisis assistance and post crisis.
Prevention involves identifying young
people at risk, examining the risks
they face, such as disenfranchisement
and marginalisation from mainstream
communities, and looking at means
of intervention – for example, through
education and mentoring.
“The line between unpleasant social
behaviour and criminal behaviour is less
understood in new arrivals with different
ethnicity and religion,” Dr Zakarya said.
“As well, acceptable social behaviour in
Australia would be considered criminal
back in their homelands.
“I remember talking to a family which
had a son in trouble. They blamed the
authorities for criminalising Middle Eastern
youth; and they labelled the mistake of
the young man as ‘boys’ mischief’. I think
addressing such issues by educating ethnic
communities and building bridges between
community and police will reduce the level
of resentment among young Middle Eastern
men.”
TYAALA also provides crisis assistance
through psychological support and
counselling for families and those caught
up in the criminal justice system, as well
as educational assistance, legal assistance,
and support programs.
Their goal of post crisis intervention
involves: rehabilitation, reintegration,
education and employment.
“We started our work with a small
group from one community as a trial, and
if the outcome is promising, we hope to
expand and showcase the model to other
communities,” Dr Zakarya explained.
Several challenges face the TYAALA
team, not the least of which is funding. At
present, the organisation is completely
funded by its members.
Dr Zakarya said other challenges for exist
as well – such as identifying kids in need
of this program and finding an appropriate
mentor for each child and family.
For more information or to contribute to
the organisation, visit www.tyaala.com dr.
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Evan Krawitz
Business Insurance Adviser
Experien General Insurance Services
1300 796 577
[email protected]
www.experien.com.au
Why you need to have a
professional review of your medical
indemnity insurance
In the lead up to June 30, Evan Krawitz
from Experien General Insurance
Services explains the importance of
Medical Malpractice Insurance, provides
tips on ensuring you make certain
disclosures to maximise you ability
to claim on your medical indemnity
insurance policy and shares valuable
claims stories.
As you know, Medical indemnity
insurance (MII) is compulsory to have
within Australia. Yet, few are advised on
how best to set up their cover and many
have gaps and other exposures.
One large gap seems to be coverage
for the legal entities that operate the
medical practice, the beneficiaries of
those entities, the liability of other staff
and also the liability between multiple
professionals working in one practice.
A traditional MII policy works fine if
there is a sole practitioner with no staff.
But add in an assistant, add in a service
company, or other staff, and cracks start
to appear. What if an assistant loses a
blood result? Suppose a patient is seen
by one Doctor and then returns and
is consulted by another Doctor, and a
mishap happens along the way. Which
Doctor is liable?
Another exposure could arise if there
are service companies or other various
company structures with spouses and
others involved as trustees, directors or
shareholders. These individuals could
be called to defend legal complaints
brought against the practice for medical
negligence claims. The question is, who
covers them?
Most of the scenarios mentioned
above can be covered by an over-arching
practice MII policy that supplements
each Doctor’s individual MII cover. This is
where a professional insurance adviser
can help to identify the gaps and remedy
with an appropriate solution.
It is interesting to consider the
following two case studies to highlight
when practice MII cover would be
essential:
•F
ailure to sterilise instruments
correctly. An autoclave was filled
but not turned on, following which
a staff member failed to recognise
that this was the case and removed
the instruments which were re-used.
Claims made by patients that may
have been either infected or suffered
mental anguish as a result of the
testing process would be covered
under a practice medical malpractice
policy;
•A
nurse receptionist failed to advise
a patient to go to an emergency
department following description of
symptoms by the patient’s wife, saying
that there were no appointments
available with the GP’s. The patient
subsequently suffered a serious
complication and a claim was made
against the medical practice.
Another issue we have seen as MII
advisers is where Doctors incorrectly
renew their MII cover and expose
themselves by (innocently) incorrectly
advising the insurer of their category of
practice or their billings. This may leave
them exposed to claims that may end
up not being paid. The documents that
are provided to assist with this are very
lengthy and can be confusing.
Appointing a professional adviser such
as Experien to assist you through this
process and ensure that you are getting
the right cover at the right price can be
invaluable. There are no obligations or
additional costs in getting your cover
reviewed and, whilst brokers represent
you, their fees are generally paid by the
insurers.
Most Doctors will be renewing their
MII cover in the coming month. We have
seen healthy profit results in recent
years from the insurers and we are
hoping to see reductions in premiums
for the policies which are coming up
for renewal. If you are not seeing this
then you may want to have your cover
reviewed.
Events
Czech Mate
The NSW Doctors Orchestra will be presenting music by
Czech composers at their annual fundraising concert to
be held Sunday, 24 May.
Australia’s premier
Quality Improvement
Awards in Health
Now
Open!
Australia’s premier quality
improvement awards in the health
sector – the Australian Council
on Healthcare Standard’s Quality
Improvement Awards 2015 are now
open for entries.
ACHS Chief Executive Officer Dr Christine
Dennis, said that awards are an important
focus in the Australian healthcare industry,
promoting the development of excellence
in achieving quality improvement.
Travel down one of Bohemia’s greatest
rivers with Smetana’s symphonic
poem Die Moldau at this year’s annual
fundraising concert performed by the
NSW Doctors Orchestra.
Presenting music by Czech composers
including Dvorak, Janacek, Weinberger
and Smetana, Czech Mate will also
feature Dvorak’s Cello Concerto in B
minor performed by one of Australia’s
most accomplished cellists, David
Pereira.
The NSW Doctors Orchestra, also
known as Musicus Medicus, is a talented
orchestra of doctors and medical
students who come together from both
metropolitan and rural NSW and from
across the medical disciplines to share a
passion for music and to raise money for
medical charities and young musicians.
The orchestra, which includes 70 to
80 musicians is conducted by Dr David
Banney, winner of the 1995 ABCWestfield Australian Young Conductor of
the Year Award.
This year, the NSW Doctors Orchestra
is raising money in support of Perinatal
Research and Maternal Medicine
(PRaMM) at the Kolling Institute, Royal
North Shore Hospital. The purpose of
PRaMM is to find solutions to problems
in pregnancy, improve the provision
of maternity healthcare, and ensure a
better start to life for all children.
Funds raised from the concert also
support the arts. The NSW Doctors
Orchestra has an ongoing relationship
with Sydney Eisteddfod, funding the
NSW Doctors Orchestra Instrumental
Scholarship for 16-25 year olds, worth
$10,500 annually. This scholarship is a
major highlight of the Sydney Eisteddfod
program, attracting the finest talent
from Australia. Since beginning in 2006,
almost 350 aspiring instrumentalists
have performed on its stages. This
scholarship has contributed some
$90,000 to the cultural capital of the
nation by making it possible for nine
outstanding young musicians to study
abroad.
In addition, the orchestra supports
the Young Virtuosi Program run by Fine
Music 102.5FM, funding the 3rd prize in
the competition. dr.
Czech Mate will be performed at
2.30pm on Sunday, 24 May at the
Concourse Concert Hall in Chatswood.
Tickets prices are as follows: Adults
$45, Concession $35, Child $25 and
Family $95. To book tickets, visit www.
theconcourse.com.au or ticketek.com.
au. Alternatively, you can purchase
tickets at The Concourse Box Office,
9am to 6pm, Monday to Friday,
(02) 8075 8100.
“Each year the QI Awards provide a
window into the strong, innovative
thinking that is occurring across
healthcare in Australia and overseas,
as the Awards highlight the range of
advancements taking place annually,” Dr
Dennis said.
Applications for the 2015 QI Awards
are now open, and the closing date for
entries is Friday 3 July, 2015 at 5.00pm
AEST (GMT +10:00).
“For the last few years the number of
entries received has increased – with
more than 100 entries received last
year. Entering the 2015 QI Awards is
an opportunity to be recognised by your
peers, as well as being an ambassador
for quality healthcare and celebrating your
achievements,” she said.
The three main entry categories are:
• Clinical excellence and patient safety
• Non-clinical service delivery
• Healthcare measurement
Applications are open to local, national or
international ACHS member healthcare
facilities and ACHS Clinical Indicator
Program members.
For further information about the
Awards please contact Dr Mark
Burgess, ACHS Project Officer
on +61 (0)2 9281 9955
or email [email protected].
Events
High Tea camaraderie
AMA (NSW) is pleased to report its Women in Medicine High Tea events
held in Sydney and Newcastle were a resounding success. The NSW
Doctor presents the highlights.
The AMA (NSW)’s Women’s High Tea
events, held 28 February in Sydney and
21 March in Newcastle proved to be
excellent opportunities for women in
medicine to network (as well as indulge
in cake and champagne!).
The Sydney event included guest
speakers Dr Katie Ellard, A/Prof Susan
Neuhaus and Anne Trimmer, who
shared their vast experience and insight
with attendees.
Dr Amanda Badam attended the
Sydney function with her sister Dr
Caroline Badam, as well as her
daughter, Clara Badam.
“It was a pleasure meeting,
networking and seeing so many
impressive colleagues that make us so
proud to be female doctors juggling life
as well as work,” she commented.
“It is very important for women
working in medicine to network – to
learn from each other, to be mentors
and role models for the new generation
of women in medicine, to empower
and support each other and instil
values of commitment and a sense of
accomplishment that it has been done
before and can be done, even better.”
Dr Amanda Badam indicated the
event was particularly inspiring for her
daughter, who is a second year medical
student.
“For her it was an eye opener to be
inspired and gain valuable insight from
such role models.”
Dr Caroline Badam commented, “it
was very encouraging and invigorating
to see that women can achieve, be
successful and well rounded, secure
and lead a balanced life and dictate
the type of work they want to do rather
than succumb to the pressures of the
ever competitive world of medicine in
hospitals and progress up the ranks of
the academic realm to just fit in or prove
themselves, which is looked upon very
favourably albeit they fail themselves in
other aspects of their personal life.
“Also, it was very liberating to have a
women’s only forum where matters that
are essential for women in medicine are
discussed without reservation.”
Response to the Newcastle event
was equally enthusiastic. Almost 30
women attended the event – topics
of conversation ranged from how
to achieve a work/life balance, to
accusations in the media regarding
sexual harassment in medicine. dr.
Service beyond self
A/Prof Susan Neuhaus and Sharon Mascall-Dare recount
stories of women who served as doctors and medical
specialists during wartime in their book Not For Glory.
High Tea event speaker A/Prof Susan Neuhaus recently
published a non-fiction book detailing inspirational stories of
women in medicine who contributed to our nation in wartime.
Dr Kerryn Phelps commented, “I thought I knew about the
history of women in medicine until I read Not For Glory, the
compelling stories of Australian women doctors who served
our country on the battlefields of war. The battles faced by
these remarkable pioneers were not just nation against nation.
They also had to battle the dominant medical and military
hierarchies of their time for professional recognition, respect
and acceptance. Their inspirational stories exemplify the very
best of feminist and humanist principles.
Those of us who have had the
privilege of being leaders in our
profession owe so much to the
medical women in our history
who defied convention, forming
the vanguard for those of us who
followed.”
Not for Glory can bought through
ABC bookshops or ordered through
Boolarong Press: http://www.
boolarongpress.com.au. You can
also get more information from
the Facebook site: https://www.
facebook.com/notforglory2014. dr.
Golf events
2BBB runners-up Reuben Jackson and
Gary North with Dr Robyn Napier
AMA (NSW) Autumn Cup
Despite the challenging weather, the AMA (NSW) Autumn Cup was a great success.
For the superstitious among us, the
date for the 2015 Autumn Cup – Friday
13 March – might have caused some
concern. The venue, New South
Wales Golf Club, certainly lived up to
expectations. The course, one of the
most picturesque in Australia, is also
one of the most challenging and with
rain threatening and a very brisk 30 knot
south-easterly blowing it was apparent
from the start that the scores would be
less than spectacular. And so it was with
only four players returning a score of 30
or more stableford points.
Therefore, it was a magnificent effort
by Alec Harris who won the Cup with
37 points. It is rumoured that his many
supporters celebrated well into the
weekend. The runner-up was Reuben
Jackson with 31 points and third place
went to Steve Nielsen with 30 points on
a count-back. The 2BBB winners were
Alec Harris and John Grey with 44 points
and runners-up Reuben Jackson and
Gary North with 41 points. The nearest
the pins were won by Gary North and
Ross Glasson. Well done to all for
such a great effort on what was a very
challenging day. A special welcome was
extended to some first-timers including
Ian Meakin and long-time players we
hadn’t seen for some time, including
Di Hart and Roger Scurr.
Following the presentations, Dr Robyn
Napier announced the destination for the
2015 AMA International Shield would be
Miyazaki / Kobe, Japan. The full program
is now available from Claudia Gillis in the
AMA office, phone 9439 8822 or email
[email protected]
The day raised $500 for the AMA
(NSW) Charitable Foundation and the
Golf Society thanks the players for their
generous contribution.
The next event is the Presidents Cup
to be held at Stonecutters Ridge on
Wednesday, 15 July.
In the meantime, good golfing to all
our Golf Society members. If you are
a golfer with a Golf Link number, why
not join us on future events. We also
welcome partners who are golfers. dr.
Winner of Autumn Cup Alec Harris with
Laurie Pincott
AMA (NSW) Golf Society
Events for 2015
Presidents Cup – Wednesday 15th July at Stonecutters Ridge
-registrations now openSpring Cup / AMA (NSW) Charitable Foundation –
Thursday 17th September at Terrey Hills Golf Club
BMA Cup - Thursday 10th December at Concord
International Shield – Japan, 7th October to 15th October
-Bookings now open-
____________________________________________________________________
Registration Forms can be downloaded from our website:
amansw.com.au/membership-benefits/member-activities-and-groups
Or contact us directly:
Contact AMA (NSW) Golf Society Co-ordinator: Claudia Gillis
Phone: 9439 8822 email: [email protected]
_____________________________________________________________________
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Feature
A voice for women
in medicine
The Medical Women’s Society of NSW continues to seek
equity and equality for women doctors, as well as support a
range of health and welfare campaigns.
The Medical Women’s Society of NSW (MWS NSW) is a voice for medical women
advocating for, and supporting, the health and welfare of local, national and
international communities. In addition, it seeks to ensure equity and equality
for women doctors to achieve their potential throughout all stages of their
professional and personal lives.
Over the last 12 months, MWS NSW has been an active voice in a range of
issues both of national and international importance.
On the national front, MWS NSW actively campaigned against the proposed
GP co-payment. It was also a strong opponent of “Zoe’s Law,” which proposed
“fetal personhood” for unborn foetuses less than 20 weeks gestation or at less
than 400g.
On the international stage, MWS NSW supported the NSW Doctors for the
Environment Group and had a presence at the Global Climate Change Rally.
They have also supported actions to fight the Ebola crisis.
In addition, MWS NSW raised awareness of the closure of women’s refuges
due to withdrawal of government funding; and the Bring Back Our Girls
campaign, which was developed to draw attention to the kidnapping of more
than 250 school girls who were abducted in Nigeria.
The MWS NSW also passes on information to members about events that
are relevant to medical women. In the past, this has included events run by the
Royal Australasian College of Surgeons “Women in Medicine – The 21st Century
Profession”, the Australasian Centre for Leadership for Women’s Sustaining
Women’s Empowerment in Communities and Organisations Award, the
Women’s Legal Service’s launch of their new GP Toolkit to work with victims of
domestic violence and talks run by the Australian Human Rights Commission.
Members receive their e-Newsletter, are invited to a networking dinner
held bi-annually and are given the opportunity to be involved in our mentoring
program. In the future, MWS NSW hopes to arrange workshops for medical
women focusing on leadership and communication, preparing a CV, and
developing financial management skills.
To join this inspiring group of women simply
• Download and complete the membership form at
http://mwsnsw.wordpress.com/membership-information/
• Pay your annual fees ($125)
• Send your email address to Wendi at [email protected]
According to MWS NSW, involvement in the society’s activities can
encourage medical women to recognise the importance of not only working
as a good clinician for individual patients, but to also engage in creating a
better community. Membership of the MWS NSW will closely link medical
professionals to a group of women who can provide you with advice,
encouragement and networking opportunities as you progress through your
career. For more information phone 0411 22 82 32. dr.
MWS members at an open day promoting
health equity
MWS members volunteering with Rotary
International in PNG
MWS members engage in teaching and
education of local health workers in order to
ensure service delivery sustainability in PNG
Dr Brindha Shivalingam is introduced as a guest
speaker at the most recent MWS meeting
Newest members of MWS for 2015 including
international guests from China and Malaysia
Did you know 83%
of Australian’s say
they have insurance
for their car?
Yet only 31% have
income protection.
For the equivalent of an average annual car insurance premium you can
insure your cumulative loss of income to age 70 (in excess of $2,000,000).*
Experien is the preferred life and general insurance provider to the AMA
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Speak to Matt or Tracey for a complimentary consultation and review.
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financial needs, circumstances and objectives. While every effort has been made
to ensure the accuracy of the information, it is not guaranteed. You should obtain
a copy of the product disclosure statement and obtain independent professional
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Members
A warm welcome to all of our new members this month. Get more from your membership today and utilise our medico-legal
and industrial relations team for advice, our preferred partner advantages, member services and events throughout the year.
To find out more phone our membership team on 02 9439 8822.
Dr Adrian Buckley
Dr Kirby Campbell-Wood
Dr Benjamin Cheah
Dr Martin Hong
Dr Isabelle Kapterian
Dr Johnny Siu
Dr Shelley Stokes
Dr Caroline Traill
Dr Rebecca Lindsay
Dr Nicola Mason
Dr Lisa Raven
Dr Muhamed Abdul Gafoor
Dr Melissa Chin
Dr Sukhi Hegde
Dr Dumindu Katupitiya
Dr Kata Kraljevic
Dr Anthony Le
Dr Joshua Rajaratnam
Dr Mohammad Rehmanjan
Dr Natasha Devitt
Dr Susie Kwon
Dr Georgina Learmonth
Dr Linda Liu
Dr Ji Hyun Moon
Dr Bernard Myers
Dr Jessica Rainert
Dr Melinda Sirmais
Dr Samuel Vo
Dr Kellie Wallace
Dr Karen Waller
Dr Carmen Wong
Dr Peter Xie
Dr Lucinda Donlon
Dr Therese Bewes
Dr Megan MacLachlan
Dr Emma O’Leary
Dr Samuel Orton
Dr Daniella Phillips
Dr Amelia Street
Dr Linda Tang
Dr Kenneth Boldery
Dr Charlotte East
Dr Andrew McGregor
Dr Scott Simpson
Dr Sarah Andvik
Dr Sonia Henry
Dr Jonathan O’Donnell
Dr Haylee Solomons
Dr Natalia Zygocki
Dr Vivek Ashoka Menon
Dr Camilla King
Dr Amanda Penberthy
Dr Alexander Yuile
Dr William Yates
Dr Stuart Allison
Dr Kate Anderson
Dr Jennifer Brady
Dr Jeremy Crawford
Dr Alison Crofts
Dr Emma De Tassanyi
Dr Jane Friedrich
Dr Angela Gates
Dr Kristen Haeney
Dr Stephen Henry
Dr Linh Luft
Dr Dorothy MacLeod
Dr Keshia Nagra
Dr Elizabeth Northcott
Dr Leesa Osborne
Dr Elyce Rossiter
Dr Michael Russell
Dr Saipriyadharshan
Ruthirakumar
Dr Paul Stewart
Dr Theresa Stockwell
Dr Daniel Stone
The AMA (NSW) offers
condolences to family
and friends of those AMA
members who have recently
passed away.
Dr Allan Bryson
Dr Thomas Claffey
Dr Gordon Clowes
Dr Keith Feller
Dr Colin Friendship
Dr Douglas Harbison
Dr Karen Kirwan
Dr Paul Knight
Dr Thomson Leckie
Dr Montague Lewis
Dr Robert McInerney
Dr Gisele Mouret
Dr Henry Nathan
Dr Theodora Pawloff
Dr Charles Richards
Dr Douglas Stuckey
Dr Richard Wingate
Dr Gerald Wong
Dr William Woods
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Advertorial
Owning your practice property through your SMSF
Whether on the cusp of retirement or in the full swing of your medical
career, owning your practice property through your SMSF may have
savings and tax benefits.
Australians have long understood the benefits of investing in
property and for medical professionals at various life stages
there are a range of reasons that it could make sense to buy
your commercial premises.
If you are one of the many doctors transitioning from practice
to retirement, topping up your super to retire comfortably
may be your first financial priority. This may be especially
true for Baby Boomer doctors, who were working long before
compulsory super was introduced. However, it can be very
difficult to beef up your retirement savings when you are
paying a hefty rent on your practice premises. We are seeing
savvy medical professionals borrow through their SMSF to
acquire a property in a way which utilises and grows super
capital now. By using the current balance of your super as a
loan deposit you can pay the rent of your tenancy which you
would pay your landlord, to yourself.
To take advantage of these many benefits, the ownership of
the property and the loan need to be structured in the correct
way. The details are quite complex but your adviser will be
able to set up the trust that you will need to hold the property
in your SMSF.
As experts who understand your business, BOQ Specialist can
help leverage more of your super capital. We could lend up
to around 90% of the value of property that you are using for
your professional rooms and up to 80% for other property, at a
competitive interest rate.
For early or mid-career doctors, having a secure tenancy is
another very good reason for considering a practice property
purchase if it is within your SMSF investment strategy.
The certainty that you will not have to vacate your surgery
unexpectedly, perhaps leaving tens of thousands of dollars’
worth of fit-out investment behind, allows you to do what you
do with a sense of control and security.
You also don’t want to make improvements on an asset
you don’t own, nor do you want to slow your productivity
or professional development with out-of-date technology
and rooms. Owning your own premises through your SMSF
could give you the confidence to invest in the expensive
infrastructure and equipment that may help your practice to
succeed well into the future. It could also ensure continuity
for your patients, who we know take great comfort in your
convenient and consistent location.
Things to remember when considering borrowing through
your SMSF:
• It is important to have legal, tax and financial advice early in
the process.
• Ensure that the proposed property purchase fits in with the
SMSF’s strategy. It will be necessary to provide a written
copy of the strategy
• Carefully consider the loan structure (e.g. fixed rate versus
variable rate on the basis of the cashflows that are expected
through the SMSF).
• Make sure that you can manage your gearing level under the
Superannuation Industry (Supervision) legislation.
• Remember that SMSF contribution limits could change so
you need some flexibility in your approach.
• Choose your banker carefully. Refinances are possible, but
can be very complex.
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E: [email protected]
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Membership has its rewards
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your benefits call AMA (NSW) Member Services
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9439
8822
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vehicles, commercial/residential property
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Gow-Gates Group
MEMBER
44 I THE NSW DOCTOR
I NON-MEMBER
ISSUE services
I MAY/JUNE 2015
Complete
insurance and financial
with special packages for AMA members.
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discounts
to members
Disclaimer:special
AMA (NSW)
may financially
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its credit
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Products facilities.
is not affiliated with AMA (NSW) or Federal
cardsnote:
andAMA
merchant
AMA. AMA Products is a separate business entity.
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Boutique wines at specially negotiated
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
Just someservices
of the services that are available include awards advice and updates, court representation,
Member
mediation and human resource consulting. A comprehensive range of legal packages and draft contracts
Take the stress out of
buying a property.
Not happy
with your current
Property Manager?
How Prosper Group can help
with your next property purchase
Save time
We do all the searching and evaluation for you, taking you straight
to the short-list stage
Access to unadvertised property
As our client, you will have access to a broader range of properties
including off market/silent listing properties
Reduce stress and risk
We will remove the stress of dealing with pushy agents. Each property
we will short list for you must pass our rigorous due diligence process
Professional advice and support
We work for you and support you through every step of your purchase
property
management.
“
Running a busy practice leaves me little
time to look for property, I engaged
Prosper Group to source and negotiate an
investment property. They negotiated an
outstanding deal for me – almost 19% off
the purchase price.” - Dr. B Young
We are extraordinarily satisfied with the
service Prosper Group provided, and have
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Prosper Group helped us through each step
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- Dr. W Mitchell
“
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As your independent property buyer’s agent, we will find your ideal
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3 MONTHS
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Are you thinking about buying a property?
Call us now on 1300 664 373
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For more information go to
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amanswpropertybuyers
Residential Buyers Agent
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Residential Property Managers Commercial Property Managers
*This offer is not available to certain suburbs
Like fine wine, your SMSF
should get better with age
Investing in residential or commercial property within a
SMSF can be quite complex. That’s where we can help.
Our financial specialists have extensive experience in
helping clients leverage their SMSF which means that,
when the times right, you may be able to put your feet up
and enjoy some of that fine wine.
Visit us at boqspecialist.com.au/medical or speak to
our local financial specialists on 02 9293 2000.
Equipment and fit-out finance / Credit cards / Home loans / Commercial property finance / Car finance / Practice purchase loans
SMSF lending and deposits / Transactional banking and overdrafts / Savings and deposits / Foreign exchange
Financial products and services described in this document are provided by BOQ Specialist Bank Limited ABN 55 071 292 594 AFSL and Australian Credit Licence
234975 (BOQ Specialist). BOQ Specialist is a wholly owned subsidiary of Bank of Queensland Limited ABN 32 009 656 740 (BOQ). BOQ and BOQ Specialist are both
authorised deposit-taking institutions in their own right. Neither BOQ nor BOQ Specialist guarantees or otherwise supports the obligations or performance of each
other or of each other’s products. BOQ Specialist is the credit provider. Terms and conditions, fees and charges and lending and eligibility criteria apply. We reserve
the right to cease offering these products at any time without notice. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent
financial, tax and legal advice as appropriate.
BOQS001163 01/15

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