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Independence: Agreement, but not Peace

On that same day, Prime Minister Hawke held talks with COPS representatives that proved unproductive, Mr Hawke stating afterwards that “it became apparent during the discussions that the specialists had no real intention of reaching an agreement. They came to Canberra simply to tear up Medicare.” Mr Hawke also contacted Dr Thompson after his talks with the COPS to suggest a meeting with the AMA on the following day. That meeting reached agreement on negotiations on the basis of a call by the AMA to doctors to return to work, though not to withdraw their resignations, which could be reactivated if necessary, and an undertaking by the Government not to advertise specific specialist vacancies pending an assessment of the extent to which normal duties were resumed. The return-to-work call was made in newspaper advertisements in which Dr Thompson cited the deep concern felt by most doctors about the effects of the dispute on patients. “I share the frustration and anger of the profession regarding the damage done to private practice in NSW hospitals by actions of the NSW Government and by Medicare,” he said. “Nevertheless, I believe with the strongest conviction that the path down which the profession has been proceeding will lead to disaster.”

The COPS reacted with hostility to the advertisements, urging doctors to maintain their resignations. In a move led by doctors in the ACT, a group of AMA members requisitioned an Extraordinary General Meeting to consider a vote of no confidence in the Federal President. The EGM was arranged for 11 May. In the meantime, the negotiations agreed with the Prime Minister on 21 February proceeded until, on 2 April, agreement was reached, which was widely interpreted in the media as a victory for the AMA and a backdown by the Government. The COPS, as anticipated, rejected it.

The basic elements of the agreement were that, within four weeks if possible:

  • the Sec. 17 powers would be rescinded;
  • the Commonwealth would withdraw from the regulation of private hospitals (control by the state governments to continue);
  • VMOs in NSW metropolitan and large regional hospitals would be able to choose between fee-for-service or sessional payment arrangements and the Commonwealth would fund an increase in sessional payments (with the NSW Branch having the option of going to arbitration for more);
  • an improved hospital insurance package estimated to be able to achieve a 10 per cent increase in the number of private patients in public hospitals; and
  • privately-insured hospital admissions would be automatically classified as ‘private’ unless they chose otherwise.

The AMA strongly recommended a return to work, but it also decided on a plebiscite through which members nationally could express their views on the agreement, particularly since the association at the national level had come under such challenge. The result of the plebiscite was that, of the 40 per cent of members who returned their completed plebiscite forms, 75.6 per cent supported resuming normal hospital services. The only sub-group that did not support the agreement were NSW surgeons, 57 per cent of them being opposed.

Early in May, the Government accepted that the return-to-work condition in the agreement had been met. On 15 May, it introduced enabling legislation into the Parliament, which quickly passed through both Houses. On 25 May, Federal Council advised the NSW Branch that the association had no further role to play in resolving the dispute. There now being no need for it, the consultative committee recommended by the Penington Committee was disbanded. Some procedural surgeons objected, but the dispute had ended. The EGM would be their last hurrah.

It took place in Canberra on 11 May – that is, only a few weeks before Dr Thompson’s term of office would expire. With the notice of the meeting, all members received a letter from Vice President Dr Trevor Pickering in support of Dr Thompson’s record of service to the AMA and two proxy voting forms for those who could not attend: one authorising Dr Pickering to vote against the motion and the other nominating any other officer of the association to vote how he or she wished. According to members who were there, the meeting of 116 members was not pleasant. Dr Pickering led the argument against the motion because Dr Thompson was refused the right to speak. The motion was carried on the floor but thumped on the proxy votes: 7,232 votes to 1,196. The entire episode – involving organising the meeting, preparing and sending out the paperwork, arranging an extraordinary meeting of Federal Council – cost the AMA nearly $50,000. After the meeting, Dr Thompson called the result not just vindication of him personally but that it also preserved “the honour, stability and credibility of the association . . . I deeply regret the divisions that have occurred,” he said. “The task now is to heal the rifts and restore unity.” Part of this task would need to be to tackle the structural problems shown up so harshly in the doctors’ dispute, when separate professional groups had gone their separate ways and when the federal AMA had to be asked to find a solution but not given the authority to do so. As outgoing President, Dr Thompson issued a plea for change at the Federal Assembly a short time after the dispute had been settled. As incoming President, Dr Pickering decided to take up the challenge.