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Into the 21st Century

In the first 10 years of the new century, Australia had four federal elections. It can safely be said that federal elections will generate policy as well as political upheavals, a kind of rapids to be negotiated by organisations such as the AMA concerned to see consistent standards in areas in which they are interested at least maintained, if not improved. This was certainly the case for health policy, especially in the case of the third of the four elections, that in 2007, when a new government came into office with a strong ambition to reform the entire system. So the new era was going to be a testing time for the AMA as it approached its 50th anniversary. It was fortunate, therefore, that it had undergone a reform process of its own since the reorganisation of the late 1980s.

By the time Dr Kerryn Phelps had succeeded Dr Brand as Federal President, health policy and practice had become central national issues, and the AMA had evolved into a truly national organisation, ready for involvement not just in the great medico-political questions of the day, as it had for a long time, but also now ready for involvement in new, pressing and complex health issues that could not have been anticipated even as late as 1962. The AMA’s ability to carry out this wider role came about very largely from reorganisation and the consequent reform of the Federal Council committee and Federal Secretariat structures to reflect both the changes in health policy and recognition of its wider ramifications. By 2000, the AMA was more than just one of many lobby groups agitating in Canberra for a limited range of interests or a group of professionals who coped with, or managed, or cleaned up after broader health issues devised by others. It was now an accepted part of planning and helping develop the policies and programs that would deal with these issues and defend and advance the society’s health.

On Indigenous health, for instance, the AMA had followed up its internal changes with informing public debate with two position statements - on strategies to prevent chronic disease and on the links between health and education – and began its annual Indigenous Health Report Card series. Following its creation of an IT Expert Group within the AMA to consider advances and advantages in e-Health, it was represented on the National Health Information Management Advisory Council and was involved in developing good e-Health practice through the Better Medication Management System. On immigration, it had joined the medical colleges in putting a submission to a Human Rights and Equal Opportunity Commission inquiry into the conditions of children in detention. Quite early in Dr Phelps’ time, the AMA released a position statement on sexual diversity and convened influential national summits on environmental health and drug abuse, especially use of party drugs by young people. With Access Economics, it developed the GP Workforce Survey that demonstrated a severe shortage of doctors, especially in rural and outer metropolitan areas, against the Government’s continued contention that there was no shortage but only a maldistribution of doctors. This was a position that the AMA interpreted as a threat to the quality of the system (and one that was contradicted later by the Productivity Commission, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare). Significantly, it broadened its spread of contacts with government: not just the health ministers and departments but also with other ministers and other portfolios, with government and non-government members of Parliamentary committees and other backbenchers with an interest in health policy.

The AMA also pulled off some significant coups early on in the new century in influencing government policy and legislation on health. An instance was the Health Legislation (Gap Cover Schemes) Act, which was passed with the support and advice of the AMA and which more or less saw off any threat of a resurgence of managed care via the Lawrence contracts. Another was the AMA’s role in encouraging and promoting the Government’s Lifetime Health Cover scheme. All the problems of the old era had not yet been seen off, however.

Dr Phelps came into office with much unfinished business to sort out: restoring peace after the three previous tumultuous years, establishing her view of relations with a government that, in the view of influential members and supporters, sought to control doctors, implementing the RVS and, most urgently of all, dealing with the medical indemnity problem, which had become serious.

Aside from all this, one of her earliest objectives was to update the committee structure to what Federal Council considered to be the AMA’s priorities. This was when the Indigenous Health Task Force and Complementary Medicine Committee were formed, and the committees dealing with public health, aged care, medical economics and medical workforce were strengthened. To improve communications between the federal and state levels of the association, she instituted regular teleconferences with branch presidents and CEOs to coincide with meetings of the executive. “In advocating AMA objectives,” she said in her first presidential Message in 2000, “our strategy has been to give the Government credit where credit is due on health policy, but to speak out when we believe that doctors, patients and the overall healthcare system have been let down.” It was not long before the AMA felt that it needed to speak out.