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03 Dec 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA   

I get the impression that AMA leadership for decades has always felt beleaguered with threats to independent, viable medical practice. It is perhaps worse than usual lately. The catalogue of significant threats to our profession include escalating, costly over-regulation with the recent, enervating COAG decision to consider publishing the identity of doctors going through regulatory investigations even if complaints relate to minor matters.

Claiming dwindling private health insurance rates is due to excessive doctors’ fees is patently false, but a diversionary conversation health insurers and Government have fostered. General practice remains woefully under-funded and by extension this threatens non-GP specialist practice. The MBS review is slowly taking its toll with the disturbingly dormant timed-specialist consultation issue possibly yet to be resurrected. Scope of practice remains under siege from several quarters. Medical leadership is being devalued and ostracised in the entire health system. Mandatory reporting – what a disappointment.  Unfortunately, I could go on….

It is not all doom and gloom. Recently, the AMA was successful in ensuring the future integrity and viability of our medical indemnity system. Unfortunately, many in the profession remain unaware of this. But it has significantly helped every single doctor in this country. This feels like a relatively small win, however, compared to the challenges facing the profession.

It is sobering to consider the efficacy of other advocacy organisations. Pharmacists have dangerously encroached on the role of general practitioners in recent times with initiatives that are clearly unsafe and designed to predominantly fortify the waning retail pharmacy market. Despite the ACSQHC clearly indicating that expanding prescription of antibiotics to non-doctors is misguided, some politicians think the problem would be improved if others were able to prescribe because the genesis of the difficulty relates to undisciplined prescribing by doctors. Clearly ridiculous, but how can such a nonsensical idea even be genuinely entertained? The largest out-of-pocket cost for patients (at 31 per cent) is non-PBS medications and therapies – principally, all of the non-evidence based detritus that help retail outlets make money. But they do not genuinely improve anyone’s health (more than any other placebo perhaps would). Government seems blind to this and happy to continue to blame doctors whose contribution to out-of-pocket costs is only 13 per cent! PBAC recommendations are always followed by the Government – it is an independent advisory group. It makes no sense then that the Government has not enacted the change to dispense more than one month of drugs at a time in order to improve convenience and reduce cost for patients. Take also the archaic, protectionist ownership rules that remain in place for pharmacies.

I do believe the brand and voice of the AMA carry weight with the public and Government. Perhaps, however, we need to recognise that this influence has suffered some diminution and dilution in recent years. Our daily discussions between the Secretariat and the Department of Health (and other Government departments), complying with submission requests, media engagement and representation on numerous committees and other forums, has encompassed our traditional methods of advocacy. I do think it is overdue to consider what aspects of this remain effective and what components might be less useful and able to be substituted with new advocacy methods.

At the recent Federal Council, it was suggested that we perhaps need to consider making political party donations. It is not uncommon to see the Pharmacy Guild logo prominently placed at Government events, and the public register of political donors indicates the handsome payments made by the Guild to various political parties. Presumably, this is all part of the Guild strategy to have influence. The key question is should the Federal AMA do the same? I know we never have, and we should not ever. Nor should any member advocacy body. I feel really strongly that you should not need to buy access, but instead argue on merit. If you can’t argue on merit, your argument is flawed.

Perhaps easier for us all to contemplate is an evolution of how we lobby politicians. In all of the eight AMAs, we propel Presidents between various meetings but are tending to concentrate on departments of Health (and Government and shadow health portfolios). Decision-making is clearly, however, collective in Cabinet and in the party rooms. So our more focused, time-intensive approach, is perhaps not the optimal strategy. I wonder if we should develop a lobbying group within the AMA, both professional and co-opted from the various councils and general membership, so we can have proficient lobbyists meeting with every single politician who accepts a meeting from us, several times a year. I like the prospect for every politician walking into a party room or cabinet meeting to have been converted to the AMA way of thinking. Methods to widen and enhance our political lobbying efforts and influence should be a conversation we have.

Our AMA Secretariat does a superlative job in responding to the various requests for submission to committees or in regard to planned legislative change being enacted by Government. This is, however, a very time-intensive undertaking and the thought has uncomfortably occurred to me that the effort required perhaps produces only a very modest benefit, as opposed to widespread lobbying across parliament – which other groups do more effectively than the AMA. As we all enter more stringent financial times, at the very least we must consider what effort is going to produce the greatest benefit for members. I would be very interested to hear what members think on this issue, so please send me an email on czappala@ama.com.au and let me know.


Published: 03 Dec 2019