Address to Brisbane Local Medical Association

One of the things we often say is: “We don’t know what we don’t know.” And that is why we, at the Australian Medical Association, try to visit as many Local Medical Associations as we can.

I have been in this role for six months. I’m a Brisbane GP and practice co-owner.

I know the pressures that my practice, my staff and my patients are facing.

I speak every day with colleagues in other specialties, working in hospitals, in emergency departments, in our cities and regional and rural areas about the pressures affecting them

But I may know all that you know.

And AMA Queensland can’t know until you tell us what we need to know and we need to fight for.

So that’s why I’m here tonight – to hear what you need to tell us.

I’d like to start by telling you a bit about myself.

I’m from Central America. I grew up in a tiny country called El Salvador. It’s a country of extremes – poverty and wealth, , corruption and good people.

My family decided to leave during the civil war - we weren’t safe anymore.

We arrived in Brisbane on the 7th of March 1990. To be honest, I was a little disappointed as I expected to see kangaroos jumping around everywhere and there were no koalas in any of the trees.

But I got over this initial disappointment and achieved my career dreams by becoming a doctor, and my personal dreams of raising my own family.

For me, balance is not just about having a happy family and a fulfilling job, but also giving back to the community and the profession.

Healthcare in Australia is at risk.

We all know that Medicare rebates and hospital funding are woeful and have not kept up with the cost of providing medical services.

We have seen distressing media reports recently claiming that doctors are rorting Medicare. We know nothing is further from the truth. In all honesty, we and our patients are the ones being rorted.

We all know that our hospitals are stretched beyond breaking point.

The only reason our system hasn’t collapsed is the altruism of doctors and healthcare workers. That is why we advocate so passionately for our profession.

The people advocating on your behalf are the people in this room – members of the AMA and your LMA. The more members our organisations represent the louder our voice. Imagine how powerful we would be at stakeholder meetings if we represented 100 per cent of our profession?

AMA Queensland is a grassroots membership organisation. We advocate on issues that our members raise with us.

One of the things we have been hearing from members and non-members alike is about payroll tax. This is actually the most important issue affecting most of our GP members and can also affect everyone in private practice. In fact, as I explained recently to the Queensland Revenue Office, the Health Minister and the Opposition, this issue affects every Queenslander. Why? Because it will force general practices to close and patients will then overwhelm our emergency departments. And we know that everyone at some stage will need medical care.

My practice is in the process of redoing our room service arrangements for the second time in 12 months. Because, no matter what the Treasurer and the Queensland Revenue Office say publicly, the way the law is being applied to medical practices has changed since a New South Wales tribunal hearing in 2020.

We know that most GPs work under room service arrangements. They are not employees or contractors. They are customers of the practice. They use the premises and administrative support. But they bill their patients independently, under their own ABN.

Practices employ receptionists and nurses and admin staff, and we pay payroll tax for our staff. We comply with the law in every way. We couldn’t afford to have schools, universities, universal healthcare, roads and police if we didn’t all pay our fair share of tax. It is not fair to expect us to pay payroll tax for people whose wages we don’t pay.

AMA Queensland and our state AMA colleagues around the nation have been advocating behind the scenes for months on this. We hoped a quiet approach might get us the best outcome behind closed doors. But it became apparent that we needed to go public.

I find three things truly astounding.

First, the Premier, the Treasurer and the Health Minister insist there has been no change to the way tax laws are being interpreted since the NSW tribunal ruling. But we have a letter from the QRO confirming changes are being made in the interests of “tax harmonisation” between the states since that fateful Tribunal decision in 2020. We have further proof in that our members are being targeted, and lawyers are telling us they have never seen the number of cases they are seeing now.

Second, the Treasurer insists he has no ability to question how the tax laws are interpreted, let alone direct how they should be applied. I’m sorry, what do we elect politicians for, if not to make laws and determine how they are applied? They are legislators, after all.

Third, and most astonishing, the Premier, the Treasurer and the Health Minister all claim doctors aren’t being targeted by Queensland Revenue Office. We have about 1,400 general practices in Queensland and many more specialist consultant practices. That’s about 0.3 per cent of taxpaying businesses in this state. But so far this year, on the Treasurer’s own figures, we make up 5.6 per cent of businesses audited by the Queensland Revenue Office.

We are hearing from doctors who have been hit with retrospective tax bills of anywhere from a few hundred thousand dollars to $3 million. We are hearing from doctors who will have to close their practices for good.

We tried the quiet approach. We thought the government would be reasonable. They weren’t. We had a meeting with the Qld Revenue Office to discuss a way forward. We asked for clarity as to what makes a practice compliant and non-compliant. Their response was that they couldn’t provide us with a document with details as tax law is complex and ever changing. Thus, they cannot tell us how to comply with the law but they can interpret it in any way they like to raise revenue. And they cannot guarantee that what is deemed compliant now will be compliant in five years.

So we are going loud. And can I say, public opinion is with us on this one. I wouldn’t normally recommend reading the comments on an online story, but the day we went public with this in The Courier-Mail, the over 400 comments were overwhelmingly on our side. No-one wants Queenslanders to pay for a payroll tax which practices cannot afford to carry and will become a patient tax.

We will continue to be as loud as we can be on this one. We have the support of the opposition and the greens as we push for a payroll tax exemption for private practices. There is a precedent for this as public hospitals and most private hospitals are exempt.

We are hearing a lot about medical workforce shortages, and we know this is a real issue.

We know what we need. We need to invest in our health workforce. We need Medicare rebates to be dramatically increased to come anywhere close to meeting the costs of providing quality healthcare. We need to make general practice more attractive to medical students, and we need to make regional practice more attractive to all specialties.

What we don’t need are the short-term approaches that state governments are taking. We don’t need pharmacists being allowed to diagnose and prescribe antibiotics without any medical oversight or consultation. We know this leads to adverse outcomes.

We have been fighting hard against this in Queensland. We are dismayed to see New South Wales and the Northern Territory following in our State’s flawed footsteps.

The urinary tract infection pharmacy prescribing pilot was disastrous for women’s health. The Government’s own evaluation, conducted by QUT, did not even follow up 65 per cent of women who took part. We will never know what happened to those 4,000+ women.

We do know from the QUT evaluation that at least 270 of the women who were able to be contacted by the pharmacist needed further medical treatment, and that four of them needed hospitalisation.

We know from our AMA Qld survey of doctors that there were missed cancer diagnoses, missed sexually transmitted infection diagnoses and pregnant women who were prescribed the wrong antibiotic.

Yet the Queensland Government has declared it a success and has now made it a permanent part of our health system, and plans to extend it to a pilot in North Queensland allowing pharmacists to autonomously diagnose, treat and prescribe for 17 serious conditions.

So, having started with women’s health, the Government now plans to experiment on North Queenslanders, where we have significant and vulnerable Aboriginal and Torres Strait Islander communities.

We continue to ask Queensland Health for the evidence-based reasons for this trial.

The recent changes to the National Law are concerning.

In June, I personally fronted the Queensland parliamentary committee, with then federal AMA President, Dr Omar Khorshid, to argue against these changes and stated that if they proceeded they would have blood on their hands

We are still angry that both sides of Queensland politics accepted these changes without any argument.

Naming and shaming doctors before an investigation has been finalised goes against natural justice. Ahpra and the medical boards already have powers to stop a doctor practising if they present a genuine risk to patient safety.

I encourage everyone to contact their local member of parliament, both state and federal, to tell them why this law change is wrong.

We know from our most recent survey that junior doctors are burnt out and worried about making clinical mistakes, and don’t think they are getting the training that they and their patients deserve.

As someone who went through this system two decades ago, I find it incredibly frustrating that nothing has been fixed.

In my visits to hospitals in Brisbane, Rockhampton and Gladstone, I have seen first-hand the stress and issues affecting our colleagues. AMA Queensland pushed hard for the state government to hold a Mental Health and Wellbeing Summit for healthcare workers. This was held yesterday and resulted in the sharing of ideas which we will push to be actioned.

The Health Minister acknowledged the stress healthcare workers are under and AMA Queensland’s role in bringing the idea of the summit to her. She also stated she is considering legislative amendments similar to the ones enacted in South Australia which will make Hospital and Health Service Directors accountable for the health and wellbeing of their staff. This has had a positive impact in South Australia. This was AMA Queensland’s suggestion in the first place.

Maternity services in Queensland are in crisis.

The maternity bypass in Biloela and Gladstone has placed additional demand on Rockhampton. Obstetricians who would offer help and locum services can’t, due to Queensland Health not allowing their employees to locum for Queensland Health hospitals. After discussions with Queensland Health and the Minister, we are confident that this rule will be removed.

We continue pushing for long term solutions to this issue and the workforce issues affecting almost every area of the health system.

In response to feedback from our members about the lack of supports for International Medical Graduates, AMA Queensland established an IMG working group, chaired by Dr Emilia Dauway, originally from the USA. The IMG working group recently conducted a survey that will form the basis for our advocacy work. We are very excited to support IMGs, who make up a large proportion of our medical colleagues in Queensland.

In conclusion, it has been a busy first six months as AMA Queensland President. I am fortunate to have an amazing team of colleagues who serve on our Board, Council, Committees and Working Groups as well as the AMA Queensland team who are passionate about supporting us achieve our goals. Thanks everyone.