AMA 15th National Conference 2003 - AMA President, Dr Kerryn Phelps - Official Welcome and Opening Speech

Welcome everyone.

It is my privilege and pleasure to open this 15^th National Conference of the AMA.

I am particularly pleased that the Federal Council of the AMA agreed that we could hold this year's conference in my home town of Sydney.

You may be surprised to learn this is the first time that the National Conference of the AMA has been held in Sydney since the Federal AMA moved to Canberra in 1990.

But I must say that I have become quite a fan of Canberra since that day of my election as AMA President almost exactly three years ago when heavy snow was falling outside the Hyatt Hotel.

National Conference is the high point of the AMA's year and is vitally important in charting the future course of the Association.

Over the next few days you will choose your leadership team for the next 12 months.

You will have a major opportunity to guide the Association in pursuit of the key policy goals for our members for the future and pass judgement on how we have pursued them over the past year.

Medical indemnity, the future of Medicare, the conditions facing our junior doctors, the medical workforce and the medical response to terrorism - this is the AMA roadmap for the year ahead.

The 153 delegates in the room today have been chosen to represent approximately 28,000 members.

We like to say, of course, that all Australian doctors benefit in some way from various aspects of our program - be it public health, industrial relations, medical indemnity or Medicare policy.

However, only 28,000 of them pay their dues - the rest get a free ride or are conscientious objectors.

Policy makers, politicians and the media frequently forget that the AMA is a grassroots organisation.

They are often surprised to hear the lengths to which the AMA goes to consult with its members and the extent of the internal debate around the issues.

They have discovered that the views and positions expressed by the President are based on this consultative process - and the daily interface between doctor and patient feeds AMA policy development.

The dynamic, vigorous internal processes of the AMA ensure that when your President or spokesmen and women speak, they do so with the benefit of evidence, and debate and policy analysis.

Most importantly, the Government knows that when the AMA takes a position on an issue it reflects the overwhelming majority of Australia's medical profession.

We have seen over recent years the difficulties experienced by so-called representative organisations whose leadership did not have a mandate and who did not have the benefit of the AMA's rigorous processes.

As I reflect on the relative standing of these organisations in the policy debate, I am pleased to say that for good reason, the AMA is the undisputed leader in medical politics in Australia.

Tomorrow, in my Presidential address, I will reflect on the key policy issues that the AMA has had to deal with over the past year and before, where we have got to, and what I feel that the future holds.

While the medico-political issues rightly take centre stage in any given year for the AMA, we cannot lose sight of the bigger picture.

I have spoken at times this past year about the future of Medicare and, more broadly, the future of medicine.

We must remember that our profession is timeless - we pass through and others take our place...as we took the place of others.

It is our duty to preserve and, where possible, embellish the profession - make medicine the 'holy grail' for our best and brightest students into the future, just as it was for us.

Only we in the medical profession can guarantee the quality, the respect, the esteem, the many rewards, the honour and the responsibility that medicine bestows upon us and our colleagues.

And only we can deliver to the community - our fellow Australians, no matter where they live and no matter their means - the best possible health services in an equitable and affordable environment.

Governments have their role to play in public sector funding and infrastructure but their policies must never be at the expense of clinical independence or professional excellence.

That is our job - our quest, if you like.

And, like Don Quixote, it can seem an impossible dream at times.

Take now, for instance.

The fact of the matter is that we are today in urgent need of visionary long-term reform in the Australian health system.

Both the Government and the Opposition are basing Medicare reform around bulk billing. That is dwelling in the past. Bulk billing is on a one-way trek to extinction. Short-term incentives - or discriminatory and inequitable proposals - won't save it. It is time to move on.

There is a strong move in the profession to delete the term 'bulk- billing' from our lexicon. We need a new term for 'bulk-billing'. One colleague suggested 'compassionate discounting'.

The same colleague made the point that the 'compassionate discounting' debate should not be confined to GPs. It is very much a specialists issue, too. We have made that point to Government. It will no doubt become a crusade for my successor as AMA President.

Doctors can no longer afford to subsidise Medicare and are increasingly no longer willing to. Until the Government finds a workable alternative to full funding of patient rebates, people will continue to have to spend more of their household income on health.

Those who can pay are now getting used to a co-payment to see their GP but how big a co-payment they will tolerate into the future is yet to be

seen.

The significant challenge for government policy is: what happens to the genuinely disadvantaged as co-payments continue to increase if doctors are no longer prepared to subsidise Medicare?

The costs of providing health care will rise and rise, but will the Government's commitment to Medicare and equitable access to health care rise concurrently? History would tell us that the answer is no.

We must have a workable safety net system. What we have seen so far in the Medicare policy debate doesn't even hint at a long-term solution...or even a short-term commitment.

One of the biggest problems is that there are not enough doctors in Australia.

Again, recent policy pronouncements will help but, because of the way they have been constructed, but they bring enormous potential problems for the future.

In fact, all the major parties appear wedded to the idea of 'bonding' medical students to serve six years in areas of need after they have finished their specialty training - as determined by bureaucrats in Canberra.

In this heinous example of social engineering, they want kids as young as eighteen to sign up to something that won't come into effect until ten or twelve years down the track.

This is no crystal ball gazing; this is navel gazing.

This is a big challenge for the AMA in its quest to secure a bright future for medicine...not just for doctors, for the whole community.

The desire to practise medicine is being eroded. As a result, towns and suburbs are losing their doctors.

Access and affordability have been diminishing, not improving.

At the same time, poor funding and low morale are affecting the quality of care in our public hospitals. These are our major teaching hospitals.

Our young doctors have fewer mentors, fewer teachers. Young doctors working in hospitals are working long, often unsafe hours.

Elective surgery in public hospitals is becoming much harder to obtain...with long waiting times.

This is not a vision for the future.

Problems continue to mount in the aged care sector as the Australian community confronts an ageing population that will inevitably place even greater pressure on stretched resources.

The health of Indigenous Australians is the worst in our community and among the worst of any group in the world.

Alcohol and drug abuse are still taking the lives and quality of life of too many young Australians.

Smoking is still one of our biggest killers.

There is no commitment evident to put in place a strong and fair health policy framework to serve this and future generations of Australians.

But what will we need to get us through the next 20-30 years? What changes can we expect or hope to see?

The issues, the pressures and the crises have all changed over time.

They will be different again 20 years down the track, but are we prepared? I'd say not.

Without a workable plan of action, sadly, the poorest and the sickest will be the hardest hit.

Our quest is to influence change, make things better for the future.

We need to take the best of the system we have today and go on a search for new ideas, new advice, new options and new solutions.

The AMA did that successfully with the RVS, but the Government washed it away with the bathwater.

The current Medicare bidding war gives us the opportunity to put the RVS and Medicare back into business. And we will.

We need some attitudes to change as well.

Doctors are not part of the problem: we are a key to the solution.

There are doctor shortages all over the world. Australian doctors could sit back and enjoy the economic benefits of undersupply. But doctors want to be able to provide services to patients. That's what we trained to do.

But our professional clinical independence is paramount.

Governments need to loosen the controls on the profession to ensure doctors can provide quality care, and they need to seek and value the advice of the medical profession in resolving problems.

Who knows? They just might discover that doctors know more about the issues at the coalface than the bureaucrats in Canberra.

Ministers and politicians of all persuasions should cast their net wider when seeking health policy advice and debate. This has begun to happen with the working parties on the Australian Health Care Agreements.

The Canberra gene pool of health advisers is a small pond.

But the gene pool of progressive thinking doctors is alive and kicking...and in this room today.

We have to use your brain power. Your advocacy. Your commitment to your patients.

As delegates, you represent the needs and aspirations of our members and the broader profession.

Over the next three days you will help set the direction for health policy in Australia. Your agenda is long-term.

Clearly we are going into a period when the major political parties will be head to head over all aspects of health policy right up to the next Federal election.

The minor parties and the Senate will also try to use their leverage to push the debate in one direction or another.

This provides a tremendous opportunity for the AMA if we position ourselves carefully.

It is from this organisation - the Australian Medical Association - that the clear vision for the future of the Australian health system will emerge.

The parties are intensely interested in the AMA's policies and our response to their proposals.

This is sensible because no Government policy will survive without the support of the medical profession.

The Prime Minister, Mr John Howard, and the Leader of the Opposition, Mr Simon Crean, have been in frequent contact with me.

I expect this high-level consultation and communication to continue with the new President of the AMA in the months ahead.

It has not been easy to establish this level of contact and input, while, at the same time, maintaining an independent and frequently quite critical stand on the policies and pronouncements of the parties.

Establishing and maintaining a positive and respected image for our association with the general public has been essential.

It is OK to be intensely critical on any given issue provided we are consistently pro-patient and non party-political.

The welfare of our patients must feed our policy development.

But, at the same time, we must not shy away from the fact that, in many respects, our patients' fates are linked with our own.

Apart from the obvious fact that, as doctors, we and our loved ones are just as likely to be patients from time to time as any other professional group...(just ask me!)...but a robust, positive, satisfied and forward-thinking profession is good for patient care and service delivery.

The public medical indemnity debate has not been just about whether the obstetrician can afford their medical indemnity premium.

It is a question of whether mothers can have their babies delivered by an obstetrician of their choice...close to home and loved ones.

Throughout the indemnity crisis, we have worked for certainty, security and confidence for all doctors and their patients. And we have been hugely successful at both the Federal and State level.

I pay tribute to the State and Territory AMAs for achieving significant improvements in State tort law reform.

New South Wales led the way. Victoria recently announced its intention to make significant changes. This alarmed the plaintiff lawyers...so it can't be all bad. Just yesterday the Tasmanian Premier said his Government will cover all VMOs and other doctors working in public hospitals.

These initiatives must go national...and fast.

The medical workforce and Medicare policy debates have been about ensuring that all Australians have access to a local doctor no matter their postcode and no matter their socio-economic status.

I repeat - access and affordability are now the key issues...and they will be discussed in great detail over the next couple of days.

As always, there is a great deal of interest from policy makers and the media in our National Conference.

The election of the President, of course, attracts a lot of public interest and with five fine candidates the profession is indeed fortunate.

But I can tell you there are many people equally interested in the outcome of our policy sessions.

What is the next step for the AMA on medical indemnity or Medicare? They want to know.

How will Australia's medical profession respond to an incident of bioterrorism? This is an issue of vital importance to every Australian family and it will be discussed here this weekend.

How will the medical workforce look 20 years from now? Will it meet the community's need?

All of you have given up family time, leisure time and professional time to contribute to the AMA, and, more broadly, to the future of health care in this country.

I know that many of you feel very strongly about particular issues such as Indigenous Health, Youth Health, the working life of general practitioners or the prospect of managed care.

Everyone is concerned about the security and affordability of the new medical indemnity arrangements, which commence on the 1^st of July this year.

The next few days are your opportunity to put forward your views - in the conference, in the corridors or over dinner.

Your views count. Don't hold back. Make them part of your quest to secure a bright future for medicine in Australia.

Value your role as much as your patients value your role.

Be role models to attract others to our wonderful profession.

It has been a great honour for me to lead the AMA team but the time will soon come to pass the baton.

I know five of my senior colleagues and friends have a nervous and exciting couple of days ahead of them. I wish them all well.

It is always nice to sign off a speech with a quote full of meaning and poignancy.

I think this one captures this moment:

"History is made by the people who show up".

Well, you've all shown up. Let's make a bit of history.

I declare the 15^th AMA National Conference officially open.

Now, before me move on, a couple of important duties....

First, I'd like to acknowledge our major Conference sponsor this year - American Express. Without them, it would be impossible to put on a show like this over the next couple of days.

On behalf of the AMA, I extend a warm welcome to our international guests:

• Dr David Pickersgill, officially representing the British Medical Association
• Dr Tricia Briscoe, officially representing the New Zealand Medical Association
• Dr Shrish Acharya, officially representing the Fiji Medical Association, and
• Dr Tien Yin Wong, officially representing the Singapore Medical Association.

End