Media Conference - AMA President, Dr Kerryn Phelps, AMA Vice President, Dr Trevor Mudge, AMSA President, Mr Nick Brown, and Access Economics Consultant, Mr Roger Kilham: AMA response to the 2003-2004 Federal Health Budget

E & OE - PROOF ONLY

PHELPS: Good morning, everyone, and thank you for joining the AMA this morning for a post-budget analysis of the health area of the budget. I'm joined this morning by Trevor Mudge, the AMA Vice President, Nick Brown, the President of the Medical Students Association who obviously has a lot to do and to say about the higher education announcements that were made, particularly in relation to medical education and training in last night's budget. And, to my left, is a very familiar face to you all, Roger Kilham from Access Economics, who has been working throughout the night to analyse the announcements in the health budget and provide the AMA with expert economic commentary to analyse what this will mean to Australians, to doctors and to our patients.

The Treasurer, Peter Costello, announced in January of this year that there would be no new money for health in this budget, and it appears that that's exactly what's been delivered. We have been quite clear in our responses to the Medicare reform package that was announced by the Prime Minister in recent weeks. We have had a chance to consult with our colleagues to analyse their responses to the Medicare reform package. And, generally speaking, I'd have to say it's very unpopular. It's not seen to address the fundamental issues, particularly in general practice, which relate to access and affordability.

Access in terms of can you see a GP when you're sick? And affordability in terms of what gap might you have to pay to see a GP when Medicare and its rebates fall short of the cost of providing that service.

Now, we're happy to answer any questions that you have about the budget and the way we're viewing it.

QUESTION: Is there anything you are happy with in the health package at all?

PHELPS: We're certainly happy that there has been a recognition that there is an overall GP workforce shortage. That's a battle that we had faced three years ago. Access Economics conducted the most extensive survey ever of general practice and came to the conclusion that we do have an overall undersupply of GPs. That's been recognised with the new medical student places and the increased numbers of GP registrar training places.

What it hasn't unfortunately done is to do anything about the GPs that we currently have. They're a very valuable resource and I don't think this budget really addresses just how valuable a resource general practitioners are in the community. And that in that lies the key to the access issue.

We welcome the focus on prevention, which is what general practitioners do. They're specialists in prevention and management of chronic disease. Unfortunately the amount of money being applied to these programs is not substantial and Roger Kilham may have some further comments to make about the actual levels of funding.

QUESTION: Dr Phelps, what impact will the higher education changes have on this current under-supply of doctors?

PHELPS: What we don't need are further disincentives for people to pursue a medical career. We've had a look at the repayment schedule for, let's say $15,000 per annum for a full fee-paying student over a six year course. And, if they pay back nothing in their first two years as a resident, they would be looking for the next 10 years. So we're talking 19 years up to 20 years from when they finish - from when they finish high school and start a medical degree, would be looking at repayments on an annual basis of $11,692 per year.

Now, that money has to come from somewhere and it's going to have to come from either the employers, the State hospitals where the junior doctors are working and training, in terms of their salaries. So that would be a cost shift to the States. Or it's going to have to be applied to patients fees once that practitioner is graduated, trained and working with patients in private practice. And so the money is really - the repayments are, basically, for medical education, are being shifted a generation down the track.

MUDGE: We think there are two major problems that are coming, and they're not bulk billing. The problem really is two areas of workforce. One is the workforce shortage that we've got in general practice. And the other one is the looming crisis in workforce brought about by medical indemnity and the crisis that exists there.

Come the 1^st July we might easily see a drop of about 25% in the workforce in my particular area of obstetrics, but also other high-risk areas, paediatrics, paediatric surgery, orthopaedic surgery and general surgery. Now, there's nothing, there's no money in this package at all to address that problem.

And in terms of the GP workforce, we have a situation now where three-quarters of Australia's population can't see a GP within half a week. No matter how many extra medical student places we produce and how much we shackle them to the slavery of the government's conditions that they've put on it, it'll be 15 years before they can contribute.

We have a workforce in general practice now that isn't doing general practice. It's trying to do other things because general practice has become so undercapitalised, so full of red tape and so poorly rewarded. We have to make conditions more attractive for these GPs to work. Improving what we call the participation rate. Otherwise I think the big problem is not going to be bulk billing, it's going to be access to a doctor. And we're going to hit that wall within two or three years and hit it very hard.

QUESTION: Are you saying the necessary doctors are out there, they're just choosing not to practice at the moment?

MUDGE: That's right. The participation rate, that is the percentage of time that general practitioners are spending in general practice, is down to about 64% on our figures. We've got to improve that. I mean GPs are doing all sorts of other things. They're working for Divisions, they're selling Amway. One even became a Health Minister not too far distantly I think. And an Education Minister. And we really have to reverse that trend. They've got to go and do general practice. Perhaps not those two individuals, but...

QUESTION: Are you serious that one doctor has gone to selling Amway?

MUDGE: Absolutely. Not one doctor, many doctors sell Amway.

QUESTION: Selling Amway?

MUDGE: Yes.

QUESTION: And still practising?

MUDGE: Some. Some have given it up altogether. Basically they're looking for other areas of earning an income.

KILHAM: A Canberra GP recently gave up his practice and went back to teaching school - becoming a school teacher.

QUESTION: Teaching in Canberra?

KILHAM: Which isn't generally recognised as being highly paid.

QUESTION: How many people in this room get bulk billed in Canberra? I certainly don't and I don't know many...

PHELPS: We know the bulk billing rates are low in Canberra, yes, and they are low in a lot of areas of the country. One of the areas that we feel have been neglected, and have been recognised by the Access Economics Report to have been neglected in this budget is indigenous health. Now, the AMA's gone to great efforts to highlight the plight of indigenous people in Australia living, in many instances, in third world conditions. I've visited many of those communities, and there is nothing in this budget to give hope to indigenous Australians that those conditions might improve.

Tobacco control has not been well-funded and yet it remains one of our major public health crisis. Aged care and new ways of dealing with aged care, particularly transitional care, there's not been a lot of funding go into that.

Mental health has once again been largely neglected. And, of course, the indemnity situation which is still looming as a crisis. We certainly appreciate the efforts that the government has made, both at Commonwealth and State levels over the last couple of years, to try to stabilise the medical indemnity situation. But there is still somewhat more to do, and we would certainly like to see a recognition of the extra work that needs to be done over the next few months, particularly on the indemnity issue, because that is going to have a major impact on the workforce crisis.

QUESTION: Are you still negotiating with the government to try and win any extra concessions as part of this Medicare package? Or are you running up against a brick wall there?

PHELPS: We were hoping that the government would amend some of the less popular elements of the Medicare reform package, and they had the opportunity to do that and have chosen not to. So obviously we're disappointed that our consultations with them haven't been heeded, and certainly the unpopular measures with the public have not been addressed.

I don't believe that trying to shore up bulk billing is necessarily the best way of spending the health dollar, but I do believe that we need to ensure that there is affordability of the system. And that people, when they need to see a doctor, can get to see a doctor and it is within their means to do so.

QUESTION: How should the government have addressed the indemnity situation? What were you expecting? What would you have liked?

PHELPS: I'd have to say that we are very grateful, particularly to the Prime Minister, for the personal attention that he's paid to the indemnity situation. And Senator Coonan has also been working very hard on trying to find real solutions to this very complex problem. We are very pleased with, for example, the stability of the industry. There have been some prudential regulations that have been put in place which were necessary. We have structured settlements legislation, which has gone through. Most of the State Governments are moving towards substantial tort law reform. So there's been really massive progress on that score.

But we have to bring this across the line. And in order to do that we have to address the blue sky problem. We don't want to wait until there is one doctor who is the sacrificial lamb who is facing bankruptcy because their medical insurance, indemnity insurance, doesn't cover an award made by the court before something is done. So we need to sort out that problem. That can be solved with the long-term care and rehabilitation scheme. So we would liked to have seen more progress in developing a long-term care and rehabilitation scheme for people who are severely injured in medical accidents.

The second thing we need is some security for doctors who are wanting to retire and not having to face large indemnity premiums throughout their retirements. And in some cases in some States they can still be sued 24 years or longer after an event. And that's just an untenable situation.

So State tort law reform to have Statutes of Limitations very important. We need to look at capping of general damages and other tort law reform elements.

And we also need to look at what happens with doctors, when they do want to retire, if they die or become disabled, what happens then to the tail that develops in the time that they are still working and still has to be funded after they are finished working for whatever reason?

BROWN: If I could just say, this budget does not encourage students to pursue medicine as a career. It does nothing to enhance the attractiveness of medicine in areas where doctors are most needed. In short, it does not secure the future of medicine in Australia.

As far as the educational component of this budget goes, medical students will be hardest hit. Medicine is already the most expensive degree in Australia. Medical students have been found to be the poorest students in Australia - or among the poorest students in Australia, both financially and timewise. Adding an extra 30% onto their HECS repayments will push the cost of a six year medical degree up to $50,000 plus. And this will obviously push medicine out of the reach of most students in Australia.

On top of that, the full fee-paying student places will cost in excess of $100,000, and this is a financial burden that most students will not be able to meet.

So it is taking away the ability for students to access medicine and medical studies to pursue as a career.

We're also very, although we are pleased with the government making 234 new medical school places available, HECS funded places available, we are disappointed that the government has pursued a policy of conscription of medical students to fill the gaps in rural and remote areas.

Under the new scheme the government is launching, medical students will be contracted to periods of six years of rural service. But this does not address the main point of making rural service more attractive for medical students and for young doctors. And that's the key here. We need to make rural service more attractive for medical students and for young doctors to try and increase the numbers we can get into those areas of need.

QUESTION: Are you concerned that people are going to be able to buy their way into a medical degree?

BROWN: Absolutely. What we'll see is actually three tiers of medical students being established. You'll have your normal medical students who can meet the criterias, the entrance criterias, and gain one of the normal places in medicine. You'll have the medical students who will be able to buy their way into a medical degree, if they can afford the $100,000 plus. Now, they will still have to meet the same entrance criteria as everyone else, but not everyone's ability to pay that $100,000 will be the same.

So obviously you'll be getting students, who may not necessarily reach the standard that's needed to get a normal medical school place, being able to buy their way in.

The third tier of medical students would be those who'll be unfortunate enough to have been bonded. They'll have to sign contracts which place unfair and inequitable constraints and conditions upon their choices for the future, which will obviously restrict their options within medicine.

MUDGE: It's nothing short of conscripting our juniors. I mean long term implications for the profession of having as many as 25% of them bonded to the government, enslaved to the government really, are appalling for the profession. And I think that who will be next? Perhaps journalism degrees. Who knows?

BROWN: And can I just add to something that Trevor said before, we need doctors in the bush now. This scheme that the government is implementing will actually kick in in 12 to 15 years time once students have finished their post-graduate studies. We need the government to adopt policies that help to mobilise the current workforce to meet the short term and medium term needs of medicine in rural Australia.

PHELPS: Any further questions? Thank you all.

Ends