The EGM took place on 25 May in The University of Sydney, as arranged. Dr Pickering explained the circumstances and the agreement with the Victorian branch. The meeting resolved that, instead of the amended draft constitution being dealt with that day, it would need to be put to another EGM, which would be held within three months. In the event, it was convened on 22 July. There was minimal debate on the motion for the new constitution. Eight proxy votes were received against approval; 4,433 votes were in favour. In the words of the 1988 Annual Report, “following three years of study, debate and negotiation, radical changes to the AMA Articles of Association were adopted”.
The AMA could now concentrate for a while on another core issue that had been building up during 1988 – and another battle over it with the Federal Government. It concerned the AMA List of Medical Services and Fees, in particular to what the AMA considered to be the need for a new approach to the existing time-based system of charging fees in general practice. There had been growing dissatisfaction among GPs that this system did not reflect changes in general practice. A working party composed of representatives of the AMA, the Royal Australian College of General Practitioners and the National Association of General Practitioners of Australia had been set up in 1987 to examine the issue. It had recommended in April 1988 that all GP services in fees lists be based on descriptions of content, not on time alone. Federal Council resolved in May that the three bodies should discuss new descriptors and benefits for GP consultations with the then portfolio Department of Community Services and Health. In August, it decided to develop an action plan to “elevate the level of GPs’ items of service to reflect the worth of services rendered in general practice”, and to exert political pressure for adequate rebates for these services. In September, the AMA announced that, with effect from 1 November, its List of Medical Services and Fees would include content-based GP fees. The new descriptors would be: minor service, special service, extended service and comprehensive service. The reaction of the Minister, Dr Blewett, was not at all friendly. He said that he was not unsympathetic to the concept-based system, but he condemned the AMA for not consulting the Government before deciding on the change. The AMA responded that it had tried frequently but unsuccessfully to raise the need to restructure GP items between 1983 and 1987. Moreover, the Government had made fundamental changes to the MBS affecting GPs (removing after-hours MBS fees, for example) without consulting the AMA. In any case, the Government would never have agreed to consider the concept-based change if the AMA had not forced the issue by setting it in place from 1 November.
On that day (ie, the day that the new fees came into effect), the AMA, with representatives of the RACGP and NAGPA, met Dr Blewett to brief him on the new concept, and both the AMA and the Minister offered the idea of a joint medical profession-Government working party to explore the concept-based system. But this brief accord ended when Dr Blewett insisted that the Government would participate only if the AMA deferred the new fees for three months - a condition that was unacceptable to the AMA and NAGPA. The RACGP, on the other hand, reached agreement with the Government on the creation of a Vocational Register of GPs, which included the introduction into the MBS of content-based GP item descriptions, but with a time element. GPs choosing not to register would attract lower rebates for the time-tiered items of service. Opposition to the agreement was widespread, not only in the ranks of the AMA but also generally among GPs and RMOs. When legislation was introduced into the Senate to establish the Register, the resistance managed to persuade the Australian Democrat Senators to join the Opposition in sending it to a select committee. The Committee recommended more or less what the AMA had proposed to the Government in the first place: a standing review group that would oversee the introduction of the register and other matters relevant to general practice.
The list, with the changes, duly came into effect on 1 November. The President, Dr Bryce Phillips, said that he expected the changes would be evolutionary, rather than revolutionary. But, within a few weeks, the Federal Secretariat was reporting response from metropolitan, provincial and rural areas that the changes were gaining steady acceptance among GPs. In the meantime, the AMA continued to press the change, whether the Government supported it or not. Federal Council set up an AMA Practice and Fees Committee that would propose alterations or additions to the AMA List of Medical Services and Fees and, more generally, provide advice on the economics of private medical practice. It agreed in a meeting in October to advise GP members not to seek vocational registration because its full implications and requirements were still not available. It decided on a public campaign to explain the AMA’s decision – especially among pensioner and consumer groups that the 1988 Annual Report noted had issued “simultaneous and coordinated” media announcements criticising it - and to warn people generally of the loss of confidentiality of their patient records if they attended a vocationally-registered practice after 1 December. And it agreed on a promotional and political strategy whose objective was to secure improved conditions for GPs, including “positive promotion of the implementation of content-based descriptor reform”.
The era of great change carried over into 1989, most of it resulting from the previous year’s upheavals. In his message in the 1989 Annual Report, Dr Phillips recorded that events in that year had seen the AMA emerge “from its period of political introspection with organisational restructuring and the accompanying inertia, to a far more active engagement of the professional interests of our members”. Federal Council reformed its committee system. It broadened the scope of activities and interests in which the AMA should be involved. A corporate plan was drawn up that set out the political and professional priorities for the period ahead. A start was made to transferring the Federal Secretariat from Sydney to Canberra, where it would begin its strategy of greater and closer involvement in national health policy.
Federal Council adopted the new corporate plan that would enable the association and the profession in general to deal with approaching medico-political issues. One such issue was the MBS. In 1989, the AMA persuaded the Government to agree to set up a Medicare Benefits Consultative Committee on which the craft groups would work with the AMA in negotiating effectively the contents and structure of the MBS. Other emerging issues identified in the corporate plan included the growth of high technology, declining private health insurance, the need to develop the AMA as a union at the national level and the continuing failure of governments to include doctors on committees and other bodies with influence on health policy and practice. A particularly important objective in adopting the plan was to restore “amicable relations” with the RACGP. These had been going through a bumpy patch, as could be seen in the controversy over the Vocational Register of GPs and the changes to time-based system of charging fees in general practice.
An important change in 1989 associated with the restructure was the abolition of specific committees of Federal Council – 18 in all (though the President’s Advisory Group on Women in Medicine was retained, with its remit to advise on women’s health and professional medico-political issues that affected female doctors). The 18 were replaced by seven committees with broader agendas that reflected the new strategic challenges: public health issues such as AIDS and substance abuse, for example, and even – as the reach of public health expanded – immigration and climate change. The new challenges also included aged care; Indigenous health; medical ethics; medical science and education; and increasing calls on the AMA to protect the interests of doctors working in public practice, especially as the old Repatriation hospitals were being integrated into state hospital systems.
A start was finally made to fulfilling the longstanding ambition for a national headquarters in Canberra. The Federal Secretariat had been working out of a building in Sydney owned since 1924 by the Australasian Medical Publishing Company (AMPCo, publisher of the MJA) but which was sold in 1989 to The University of Sydney. The MJA was still published in Sydney; the new Federal Secretariat was to be in place in Canberra by the end of 1991. In the interim, Federal Secretariat staff occupied an office in Queanbeyan, on the NSW-ACT border a few miles from Parliament House, near where the new office was to be built. In synchrony with this environment of change and increasing national activity, and as part of the physical transfer from Sydney to Canberra, the AMA adopted a new national logo and launched a new national journal, Australian Medicine, which – like all these changes associated with the restructure of the AMA – exists today. The transition process was completed in March 1991, when AMA House was officially opened in Canberra by the illustrious biologist (and AMA member) Sir Gustav Nossal. In its new home, and to deal with its new responsibilities, the Federal Secretariat quickly created sections with expertise in general practice, medical fees and medical insurance, public relations and communications, public health and hospital and health funding.
This expertise was needed – and later sorely tested – by the AMA’s involvement with the Government in a process to determine MBS fees for services (other than pathology and diagnostic imaging) on which Medicare rebates would be paid. The genesis of what became known as the Relative Value Study was actually in the National Conference of 1991, which carried a motion that “the Federal AMA undertake a work value and relative value study to reassess the appropriateness of the AMA List of Medical Services and Fees”.
In the early 1990s, there were other issues to be settled – and even battles fought – over government activities and policies that the AMA judged to be inappropriate and even inimical to doctors’ interests; a mix of government attempts to exert greater control over doctors’ remuneration and government encouragement of community expectations of virtually free access to healthcare. By then, Dr Shepherd had become Federal President, and he brought to these issues all the ferocity and energy that he had shown in the NSW doctors’ dispute. Before his term of office ended, the AMA had extended it from the traditional two years to three, so that he was able to continue to lead the AMA through the problems ahead. (Ten years later, Dr Kerryn Phelps, confronting the medical indemnity crisis, was also given an extra third year in office - she and Dr Shepherd being the only Presidents in the AMA’s half century to serve more than two years.) With Dr Shepherd at the helm, and under the rubric ‘Political Control of the Medical Profession’, Federal Council discussed this troublesome political terrain at its first meeting in 1991. When discussion ended, the Council resolved (among other things) that the AMA should preserve its commitment “to the present standard of excellence required to practise medicine in Australia”, and that it plan and mount “a public political campaign to have its values made known”, in coordination with state branches and the colleges. Four government activities in particular were agitating the Council’s members at the time:
the National Office of Overseas Skills Recognition [NOOSR] which, as the agenda papers said, “many people believe will tend to diminish the standards required for recognition of medical qualifications in Australia”; an investigation by the then Trade Practices Commission “of the professions generally, and the medical profession specifically, clearly prompted by political considerations”; consideration by the Tasmanian Government of proposals to establish “minimal professional standards”; and proposals by the Australian Health Ministers’ Advisory Council to establish a national system of medical registration.
(NOOSR was established in 1989, part of the Hawke Government’s Migrant Skills Reform Strategy, to expedite the use of skills of immigrants. One of its proposed activities at the time was a review of examination procedures by the Australian Medical Council. The Trade Practices Commission had announced in 1989 that it would conduct a research study of the impact of professional regulation on competition. In December 1990, it produced a discussion paper that observed (among other things) that it was important to assess whether or not government or self-regulation of the professions provided net benefits for consumers.
Subsequently, its Study of the Professions concerned accountants, architects and lawyers, but not doctors. The national registration proposals were ignored by the Howard Government later, at the urging of the AMA, but resurrected by the Rudd Government in 2008.)