He found that, as it stood, the report would not be accepted. There were at least three major sticking points: the proposed loss of state branch autonomy, the proposed distribution of assets and the composition of the proposed General Council. There was strong opposition among the branches, especially from Victoria and New South Wales. (Dr Pickering reports that there was even some misrepresentation of the Cotton proposals by branch officials in both these States.) One of the proposals in the report was that the General Council should in effect replace the Federal Assembly as the supreme body in the AMA: Victoria remained implacably opposed to this to the end of the reform process. He found opposition also in Queensland, though to a lesser extent. The other States were “somewhat ambivalent”, but some were prepared to accept a loss of autonomy for the sake of a unitary organisation. Dr Pickering found from his discussion that individual members were not so hostile. His impression overall was that they were prepared to contemplate loss of autonomy for state branches if that was the price to pay for a strong national organisation that represented the profession effectively. The colleges and craft groups, as would be expected, were definitely in favour of the Cotton proposals.
The two views would clash first at a meeting on 17 July between the Federal and State Presidents. Federal Council had decided in May that the Federal President should develop detailed proposals for the reorganisation “as a basis for definitive discussion by appropriate groups within the profession”. It authorised him to convene a meeting with State Presidents to consider proposals for the reorganisation. Dr Pickering has described what happened as “one of the most unpleasant and difficult meetings I ever attended” – and a graphic illustration of why the AMA needed to change its constitution. The meeting broke up after some willing but unproductive exchanges over who should chair it: the Federal President who had convened it or those who sought to run it. As soon as Dr Pickering had opened the meeting, Dr David McNicol of the ACT moved that he vacate the chair in favour of a branch President and that the agenda be set aside. Dr Pickering refused to accept the motion, deeming it unacceptable: Federal Council had called for the meeting, and as the agent of the Council he had convened it. The NSW delegates threatened to walk out. In the circumstances, the meeting was now pointless, he said, and left the room. Dr McNicol, acting as spokesman for the branch Presidents, approached Dr Pickering about an hour later to ask that he reconvene the meeting. The Presidents wanted a constructive outcome from the meeting, he said, and wanted Dr Pickering to return. But, when it also became clear that the Presidents’ terms included insistence on their own chairman and their own agenda, Dr Pickering refused. The Presidents then continued with a meeting of their own.
Later, in discussion between him and the Presidents in the Secretary General’s office – neutral ground – Dr Pickering says he expressed his disappointment and displeasure at how the branch Presidents had behaved at a time when “a difficult and unsettling time of approaching change” needed a strong sense of unity. The only point of agreement reached on the day came in this discussion, when it was recognised that the meeting had failed and that a less uncooperative attitude was needed in the future. The Queensland members’ newsletter later called the aborted meeting “a fiasco of pre-meeting deals between power brokers, clever procedural tactics to thwart the purpose of the meeting, threats to go home and pushing personal barrows. Our future is too important for this sort of behaviour. We can only hope that more mature counsel will prevail.” It would be a while before their hopes were met.
Federal Council met one week later, from 23 to 25 July. Among other things, the agenda included the Federal Secretariat’s analysis of the Cotton Report and decisions by the unofficial version of the Presidents’ meeting. The two NSW delegates had advised it on the previous day that they deemed it inappropriate for them to attend. This might have been true, but Dr Pickering pointed out to the NSW President that it meant that NSW members would not be represented at a discussion about the Cotton Report and other significant matters such as members’ subscriptions, fees under the MBS and a Senate report into the ownership and administration of private hospitals. The Council expressed grave concern about this formally, noting that the NSW delegates’ decision not to attend effectively disenfranchised approximately 30 per cent of AMA members. It agreed unanimously two other resolutions of great significance for the period ahead: that Federal Council remained responsible for managing AMA affairs during “the current period of discussion and debate” over the Cotton proposals, and that it believed that the NSW delegates’ decision, “subsequently supported by the [NSW] Branch Council, to be divisive at a time when the profession needs unity and strength of purpose”. Events over the next six months would shake the very foundations of the AMA, and at a time when the entire national health system was undergoing radical change.
Not only that, while the turbulence was continuing, there was change at the top of the Federal Secretariat. Dr Repin, who as Secretary General had led the AMA from 1973 – through Medibank and Medicare as well as the Cotton review – had stepped down, to be succeeded by Dr Allan Passmore.
On the Cotton Report, Federal Council decided to set up an ad hoc committee to provide recommendations for the reorganisation of the AMA to its next meeting in September. The committee comprised the President as chair and each State President – ie, much the same people as those who were at the “unpleasant and difficult” 17 July meeting. It was decided that the committee would beforehand put its proposals to the Executive Committee and that the President would ascertain the craft groups’ comments on the Cotton proposals. The results of the whole exercise were to be put to the September meeting of Federal Council, “with a view to the formulation of proposals to be submitted to an Extraordinary General Meeting after consideration by the Association’s legal advisers”.
Federal Council duly met in September, though not before another outbreak of hostilities during August between it and elements in the NSW branch. An extraordinary general meeting of NSW members was called early in August to consider a proposal by the Branch Council that the AMA Constitution be amended in two ways that the Federal leadership considered would in effect result in de facto secession of the branch. One change proposed was that the obligation on the branch to collect the Federal moiety on members’ subscriptions should be removed. The other was that NSW doctors be permitted to join the NSW branch only, rather than becoming simultaneously members of both the NSW Branch and the Federal AMA. The Federal leadership called for legal advice about both changes and their implications. The advice was that the actions proposed were not constitutionally possible. Dr Pickering wrote to all NSW members to advise them about this and to urge them not to vote for the changes. His view was supported by a list of past NSW presidents. The vote at the EGM, including by proxies, rejected the proposals overwhelmingly. Despite this result, the criticism of the Federal AMA out of New South Wales continued. The Federal AMA fought back, publicly and in a letter to all AMA members and all doctors in New South Wales, arguing against the criticism and accusing “the fringe group” making it as acting against the interests of the profession and the public at large. The prospects for a harmonious reorganisation were not good.
The September meeting of Federal Council – with the advice ordered by the July meeting, plus commentary from various interested parties, and this time with the attendance of the NSW delegates – took three “long and tiring” days, in Dr Pickering’s words. Apart from what could be called the normal agenda items to be discussed (eg, finances, MBS and other fees, restrictions on PBS items and health insurance) the meeting dealt with more than 70 motions and many more amendments relating to the Cotton proposals. It agreed in principle with the thrust of these proposals, though in its model members of Federal Council (other than special group representatives) would continue to be nominated or appointed rather than directly elected. Its model was to be referred to the branches for comment. Both Federal Council’s model and the branches’ comments were to be discussed at the November meeting of Federal Council (the proposed title General Council having been rejected). The restructure thus approved included that:
- the AMA be restructured as a federal organisation;
- Federal Council have autonomy to act on matters in the area of federal jurisdiction, and that the State and Territory councils have the same autonomy on state and territory matters;
- members of Federal Council be nominated or appointed annually, with no limit on their term on Council;
- the composition of Federal Council would be four Executive Officers elected from within Council (President, Vice President, Treasurer and chair of Federal Council), one representative nominated by each state and territory, one representative of each of six special interest groups: physicians (including psychiatrists); GPs; pathologists and radiologists; surgeons (including ophthalmologists, obstetricians and gynaecologists and anaesthetists); full-time salaried and academic doctors; and doctors in training. Representatives of these groups would be elected by AMA members who identified with each group;
- an Executive Council be established, comprising the President, Vice President, Treasurer and Chair of Federal Council, with two Federal Council members to be coopted if necessary;
- subscription to the AMA be dependent on membership of both the appropriate branch and the Federal body;
- with craft representation now on Federal Council, the existing system of affiliation of national bodies be reviewed;
- any member objecting to a Federal Council decision could, with the support of 500 signatories, requisition a referendum of all members on it; and
- the amended constitution be reviewed at least every three years.