Reorganisation: Clash of Strategies
Dr Nelson had reported an improvement in the AMA-Government relationship back in 1993. But there were influential members who were not happy when, in the 1998 Annual Report, Dr David Brand talked in his first Presidential Message of his ambition for a fresh approach to its role by the AMA, turning it “into a more professional lobby group – one that . . . avoids the conflict and marginalisation of the past”. Support for this new approach had been very gratifying, Dr Brand said. “It is the approach that will lead the AMA into the next century.” Early in 2000, when Dr Brand composed his last Presidential Message for the 1999 Annual Report, he defended his policy “of constructive engagement with government without compromising our principles”. Members had had the chance to reject this approach in 1999, he said. “In the end, you made a clear decision and supported dealing with government in a professional and constructive manner rather than returning to the unnecessary confrontation and marginalisation of the past”. Those few words did not quite adequately describe probably the most turbulent period for the AMA in its 50 years.
Dr Shepherd’s period as President had ended five years before but his interest in the directions that the AMA was taking had never waned and his influence was as active as ever among influential senior members. During 1996 and 1997, he says in his book Shepherd: Memories of an interfering man, he had been dismayed by what he considered to be “a steady drumbeat of doctor bashing” by Dr Wooldridge. Late in 1997, in a letter to all Coalition MPs, he warned that the Government’s health policies, particularly its retention of Medicare, would cause it to survive only one term. Dr Wooldridge responded in a letter, also circulated to all Coalition MPs, stating that Medicare would be retained “because it ensures universal access, does not discriminate or ration services based on a patient’s capacity to pay and actually helps contain expenditure on health”.
Dr Shepherd responded in a letter (to the Prime Minister but also circulated to all Coalition MPs) that “if you are content with the accelerated removal of a profession’s independence under your regime, a profession whose abilities and ethics you and your family will need at some time in your lives, so be it”. It was shortly after this that Dr Brand was elected President with a policy that the AMA could do better with less confrontation. It was not long before the forces for and against this policy hurtled into battle. Dr Shepherd’s forces believed that engagement with government led to surrender to government; Dr Brand’s believed that engagement got results. The argument dogged almost the entire Brand Presidency.
An early battle was joined between those (the Brand school of thought) who supported the AMA’s agreement with the Government over no-gap health insurance and those (the Shepherd school) who believed that no-gap insurance would result in high premiums and reduced health insurance cover. The two points of view came to an especially virulent clash over a draft Memorandum of Understanding in 1999 between the AMA and the Government in which the Government would allow fees for medical services to rise a certain amount over a certain period in return for the AMA’s agreement that outlays on Medicare rebates would be held to certain levels. The idea had aroused strong opposition among members all over the country. The Brand forces argued that the AMA had not actually accepted the MOU but decided only that it was serious enough to be put to members. The Shepherd forces asserted that the AMA had indeed accepted the MOU and had decided to put it to members only after being shaken up by members’ protests about it. In Western Australia, there was even talk of secession if Dr Brand continued as Federal President, and the Branch Council there resolved that, if the Federal AMA signed off on the MOU, it would, in the words of the then WA Branch President Dr Rosanna Capolingua in a radio interview, “have to reconsider our relationship with the Federal AMA”.
The controversy had grown to the point that the Shepherd forces produced enough members’ votes to force an Extraordinary General Meeting in June to debate a motion of no confidence in Dr Brand. The motion was carried, by about 54 per cent of a little more than 9,000 votes. But Dr Brand, who had recently been easily re-elected by National Conference, refused to resign. Executive Council called another EGM in August, this time to debate its own motion for a spill of all Executive Council positions. Dr Shepherd organised his own ticket for all Executive Council positions but Dr Brand and his Council colleagues were returned. The Shepherd forces had been gazumped. Some senior figures in the AMA (not necessarily Shepherd supporters) said later that Dr Brand should have resigned after the first EGM. Dr Brand told the ABC after the second EGM that he had thought “very long and very hard” about resigning alone after the first EGM. But, “even if I resigned, [Vice President Dr Sandra Hacker] would become President and Dr Shepherd said that wouldn’t stop him. He wanted to get rid of all of us, so that was why the Executive in the end said ‘well, look, it’s one in or all in . . . it’s either all of us to chart a course for the AMA that will take us into the future or it’s back to the past with Dr Shepherd’.”
It is not clear what this episode proved. Dr Shepherd’s argument prevailed heavily in one EGM and lost heavily in another. Dr Kerryn Phelps from the Shepherd side of the argument was elected President in 2000 to succeed Dr Brand. Under Dr Brand, AMA membership levels were increased. Before it was over, AMA members had resoundingly rejected the draft MOU proposal and the AMA had announced that it would not sign it. The AMA could now get down to preparing to deal with some really serious threats heading its way.