Australian Medical Association

The AMA has identified the medical workforce shortage as a major health issue with the overall distribution of doctors being skewed heavily towards major cities such that regional, rural and remote areas shoulder a disproportionate workforce shortage burden. There is a strong preference amongst much of the current medical workforce to live and work in major cities. So much so that attracting young professionals to rural locations is extremely difficult. The AMA believes the factors affecting the supply of medical workforce in rural areas should be viewed in the context of generalism; remuneration and incentives; hospital infrastructure; compensation and family support; costs of establishing a practice and access to community; high on-call demands and the need for rosters and locum services;and recruitment of international medical graduates (IMG) doctors.The submission makes a series of recommendations addressing these issues as well as the effect of the introduction of Medicare Locals, anomalies with the ASGC scheme and the need to extend MBS telehealth items.

Patients may be eligible to claim a tax offset of 20% of their total out-of-pocket medical expenses provided that the total out-of-pocket costs reaches the threshold of more than $2,060 for 2011-12 financial year. 

In September 2011, the AMA hosted a summit of public health and police stakeholders to consider advice to the Australian Government on reform of alcohol taxation and pricing. A Communique was issued which outlined a consensus view on options for reform.

The provision of out-of-hours care is a key part of general practice. The AMA Out-of-Hours Primary Medical Care 2011 position statement has been developed to guide the design of these services, outlining the essential feature of a successful model of out-of-hours primary medical care.

This submission responds to the HWA draft background paper - Rural and Remote Health Workforce Innovation and Reform Strategy released in July 2011 as part of the consultation process.

The AMA believes it is important that the Government gets it right to ensure that the health workforce in rural and remote areas is sustainable and that people in rural communities can access affordable, appropriate health care services when needed.

The AMA submission to the Productivity Commission outlined how the promised administrative efficiencies and economies of scale of the national scheme have not been realised for the medical profession. The scheme:

• has increased compliance costs for the medical profession;
• has introduced administrative red tape;
• lacks clarity on the handling of notifications;
• has introduced mandatory reporting requirements that must be thoroughly evaluated before its impact is properly understood; and
• requires greater transparency and accountability of AHPRA administration for each registered health profession.

The AMA Public Hospital Report Card 2011 has found that there has been little improvement in public hospital capacity and performance across Australia in 2009-10, despite extra Commonwealth funding.

It has been very much business as usual as public hospitals struggle to meet demand.

The AMA has made a submission to the Medical Board of Australia on its Proposed Registration Standard – Granting registration as a medical practitioner on completion of intern training. The Board's proposed standard includes the option for health services to provide interns with exposure to emergency medicine (EM) in a general practice context. Of utmost concern to the AMA is the absence of clear criteria about what would constitute appropriate exposure to EM under this type of arrangement. As a result, the AMA has offered to be part of the team that will prepare guidelines to better define the Board’s requirements. In the mean time, the AMA maintains that all interns should have access to a term in an Emergency Department.

The Australian Taxation Office (ATO) recently released draft addenda to GST Rulings 2006-9 and 2006-10 for comment.  These draft addenda will effect the GST status of some medical services and the AMA is seeking legislative changes to ensure that medical practitioners do not face additional compliance costs.

This statement outlines the AMA’s position on the scope and structure of prevocational medical education, which encompasses the period between graduation and the commencement of vocational training. In the case of most trainees, it includes postgraduate year 1 (PGY1), also known as internship, and postgraduate year 2 (PGY2). Doctors at this stage of their training are collectively referred to as junior medical officers (JMOs). The statement provides a position on contemporary as well as emerging issues related to prevocational medical education and training, taking into account concerns raised by junior doctors regarding quality, streaming, competencies and vocational pathways.

The AMA submission to the Department of Health and Ageing on the draft Performance and Accountability Framework which will be used by the National Health Performance Authority urges the Government to undertake a proper consultation process on the performance indicators proposed in the Framework beyond the State and Territory governments.

On 2 August 2011, the Commonwealth, State and Territory governments finalised the National Health Reform Agreement. A summary of the Agreement's key points can be found here.

‘Healthy doctors, healthy patients’ is a well-known maxim of the medical profession. Doctors need to be well to provide high-quality health care to their patients and the community, and to experience medicine as a rewarding and satisfying career. Listed here are useful resources and information on doctors’ health and wellbeing.

Interested in working abroad as a junior doctor?  "A Guide to Working Abroad for Australian Medical Students and Junior Doctors" (the Guide) has been developed by the AMA Council of Doctors-in-Training (AMACDT) and Australian Medical Students' Association (AMSA) to meet a strong demand from medical students and junior doctors for evidence based and practical information on studying and training overseas.

Written by eight junior doctors in consultation with a range of Australian experts, the 90 page Guide is the gold standard for any medical student or junior doctor seeking to organise safe and rewarding placements and rotations abroad.

The Guide is available as an electronic supplement to the Medical Journal of Australia (MJA).

The AMA has made an additional submission to the Department of Health and Ageing to raise concerns identified by AMA member junior doctors. This submission:

• emphasises the need to ensure that time-based targets do not impact on the ability of public hospitals to provide quality clinical education and training;
• calls for ongoing resources to support the ability of emergency departments, the hospital and community providers to fulfil education and training obligations; and
• recommends that the monitoring and evaluation of the impact of targets also includes the impact on education, training and junior doctor experiences.

This submission supplements the submission lodged by the AMA on 25 May 2011.

Interested in working abroad as a junior doctor?  The AMA and AMSA will launch ‘A Guide to Working to Abroad for Australian Medical Students and Junior Doctors’ at an evening seminar at AMA Victoria on Tuesday 21 June 2011.

Details are as follows:

Tuesday 21 June
1830 (refreshments) for 1900
AMA Victoria House, 293 Royal Pde, Parkville
RSVP to amclennan@ama.com.au or 02 6270 5424

As part of a service to all of our members the AMA has mediated an agreement between GP Registrars and GP Supervisors that sets out minimum terms and conditions for GP Registrars. This agreement is negotiated every two years by the National GP Supervisors Association (NGPSA) and GP Registrars Australia (GPRA), with the AMA's assistance.

The 2011 agreement applies from the start of the 2011 training year.

The AMA submission highlights that the Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010 already govern the management of health care practitioners who have blood-borne viruses and makes the point that there is no need to de-register a medical practitioner because they have a blood-borne virus.  The AMA has asked the Board to clarify its role in regulating the scope of practice of medical practitioners who are infected with a blood-borne virus in isolation from the way this issue is managed by medical practitioners and the health care organisations in which they practice.  The AMA has suggested the Board undertake a second round of consultation once it has clarified what action would constitute a breach of guidelines and that action the Board might take in such cases.

The AMA has made a submission to the Department of Health and Ageing, on the implementation of elective surgery and emergency department targets, which strongly advocates for an evidence-based approach to implementation. The AMA supports measures to improve the timeliness and quality of patient care in public hospitals but cautions against imposing arbitrary time-based targets that may carry more risks than potential benefits if they are not slowly, carefully and cautiously implemented.

Pathology services in Australia are amongst the highest quality and the most accessible in the world. However, Government funding cuts to pathology services have had an impact on the quality, accessibility, affordability and safety of pathology services. Government funding changes can also have a significant impact on the sustainability of the pathology sector including the ability to support ongoing training, research and development.

The Health and Wellbeing of Doctors and Medical Students – 2011 replaces the Health and Wellbeing of Medical Students and Practitioners – 2006.

The health and welfare of doctors continues to be a priority for the AMA.  Junior doctors continue to experience distress in their workplace.  This position statement provides a basis for future AMA lobbying and addresses a number of current and topical issues faced by doctors in training on a daily basis.

It includes details on support mechanisms that should be put in place by training providers to address issues related to doctors’ health. The revision of the document also represented an opportunity to include recent developments in doctors’ health such as mandatory reporting.

In its submission to the House of Representatives Standing Committee on Health and Ageing Inquiry into registration processes and support for Overseas Trained Doctors, the AMA calls for removal of the 10 year International Medical Graduates (IMG) moratorium and greater support for IMGs trying to achieve specialist registration through access to other GP training, courses.

The AMA has made a submission to the review of the Medicare provider number legislation. We have called for a number of measures including medical training initiatives; the introduction of a single Medicare provider number for all practice locations; and the grandfathering of pre-1996 non-vocationally registered general practitioners who were accessing GP Medicare rebates prior to 1 November 1996 and have predominantly been in general practice for a minimum of five years since that date.

The AMA Public Hospital Report Card 2010 is an analysis of the most recent publicly available national data on public hospital performance plus more recent feedback from doctors working in public hospitals in all States and Territories.

There has been little improvement in public hospital capacity and performance despite significant extra Commonwealth funding as part of the National Healthcare Agreement and specific funding for an elective surgery ‘blitz’.

AMA has supported the need for reform to Australia's health system, particularly the issue of responsibility for public hospitals and the linkages with other parts of the health system such as primary care and aged care.  The Government has said Medicare Locals are the mechanism to improve these linkages.  Our usual preference would be for less bureaucratic mechanisms than are suggested in the discussion paper.  We represent doctors who like to behave in an efficient manner, responsive to the needs of their patients, to be independent and accountable to their patients and free, to the maximum extent possible, of bureaucratic red tape.

The 2008 national partnership agreement on hospital and health workforce reform includes a specific component to expand clinical training supervision capacity and competence.  $28 million has been set aside to expand clinical supervision capacity across the health professions.

Health Workforce Australia (HWA) prepared a discussion paper to consider supervision across professions and the educational continuum from professional entry through to postgraduate and vocational training. The AMA prepared a submission to HWA on the discussion paper.

This Position Statement examines the role of general practice in the delivery of primary care services in Australia.

This position statement sets out the principles the AMA considers should underpin the national introduction of time-based targets for public hospital emergency departments (EDs) in order that patient safety and outcomes, quality of care and the training of doctors are not compromised.

State Programs for Doctor Health

The Council of Australian Governments (COAG) Agreement 2010 outlines the agreement reached by all jurisdictions, except Western Australia, to establish a National Health and Hospitals Network (NHHN). The NHHN Agreement incorporates structural reforms as well as additional investments in hospital, primary and aged care services, and preventive care in mental health and diabetes health care.

Further initiatives announced in the Commonwealth Government’s Budget on 12 May 2010 include support for practice nurses, improved primary care infrastructure and the roll-out of electronic health records, bringing the total new health investment over the next five years to $7.3 billion.