The AMA – Leading from the front

I acknowledge the traditional owners of the land on which we meet, the Wajuk people, and pay my respects to their elders past and present.

And I also acknowledge the rich life and legacy of Dr Andrew Stewart.

Thank you to Dr Michael Steiner and Kerry Gallagher for their invitation to speak to you today. It is a great honour.

I am also most pleased to present in the same session today as Mrs Hayley Cormann, both a colleague from MDA National and a friend; and Professor Angus Turner, who might be the only person in the room today who is interested to know that I will be camping tonight on Roberts Oval at Guildford Grammar School with my son.

I look at Andrew Stewart’s life and relate to much of it.

He was born the same year as my father, and attended the same primary school here in Perth.

Andrew and I were both fortunate enough to be schooled at Anglican boys schools in Perth and go on to study Medicine at the University of Western Australia.

We both completed our specialist training overseas before returning home to Perth to work in both public and private hospitals in Perth and regional WA.

He contributed to his profession and his community his whole life.

Andrew packed so much into his life – not just excellence in medical practice but music, agriculture, charity, fitness, the great outdoors, family, friends, and colleagues.

I can relate to all of this. Except perhaps the fitness bit.

Andrew Stewart was a leader of the highest order. It is an honour to deliver today’s oration in his memory.

With Andrew’s contribution to medicine and society at the forefront of this meeting, it is appropriate to be talking about leadership.

The medical profession demands strong leadership.

Health policy is at the heart of this nation’s daily political conversations. It always has been. It always will be.

It was Rudolf Virchow who said that ‘Medicine is a social science, and politics is nothing more than medicine on a large scale’.

It is vital that organisations like the ASO and the AMA are engaged closely with all levels of government.

We must use our profile to influence policy, be at the centre of political debate, and achieve wins for doctors, patients, and the broader community.

We owe that to our members and our whole profession.

But above all, we owe it to our patients.

I have a question or two for members of the audience today.

Are you interested in the future of your profession? What do you want it to look like in 15 years’ time? Do you have any idea of the forces or disrupters that it will face? And what exactly are you going to do about it?

If you care about it, do something about it. Make a contribution. If nothing else, at least support your colleagues and join your College, Association, or Society. And join the AMA.

Leadership does not just happen. It needs to be earned and learned. And it needs to be valued – never taken for granted. Or wasted.

Leadership has many definitions, and it means different things to different people.

A few examples from thinkers, entrepreneurs, and motivational speakers include:

• Kevin Kruse says Leadership is a process of social influence, which maximises the efforts of others, towards the achievement of a goal.
• Peter Drucker says a leader is someone who has followers.
• Bill Gates states leaders are those who empower others.
• John Maxwell reckons leadership is influence - nothing more, nothing less.

I think that there is an element of truth in all of those, at least in my experience.

My connection to leadership and being a leader started in a room a bit like this – but at the back of the room as a wide-eyed young man, not a keynote speaker up on the stage.

As a fifth-year medical student, I was elected President of AMSA, the Australian Medical Students Association. I was 22 years old.

I got to sit at the AMA Federal Council table at an early age, and I suppose in some respects I never really left it.

The only difference is that today I sit at the head of that table as Federal AMA President.

I have also served as President of the AMA here in Western Australia.

So, today, I will share with you my experiences with leadership and the AMA.

The AMA’s mission is “Leading Australia’s Doctors; Promoting Australia’s Health”.

In regards to our media and advocacy work, that mission can be summarised as “First and Best”.

Having being a Federal Councillor for three years, I naively thought that the step up from being a State President to Federal President would be just that – a step up.

I was wrong. It has been more like several flights of stairs.

I have discovered that the political hot-bed of Canberra is broad, deep, complex, competitive – and, to an extent, addictive.

The AMA is a key player.

And the AMA President wields considerable personal influence – across the medical profession, across the political spectrum, and in the media.

Last year, The Financial Review ranked me as the 14^th most powerful individual in Australia.

This year, The Governance Institute voted the AMA the most ethical organisation in the country.

The job is highly visible. We use this influence for the greater good of the communities you serve as individual doctors.

The AMA is not just a strong and influential advocate for its members and the whole medical profession.

We are advocates for our patients and a better health system.

Our role is all about leadership.

I want to talk about specific examples of AMA leadership, and how leadership and advocacy needs to be calibrated according to the issues.

This means that sometimes you get all of what you want, and other times you get some or most of what you want.

Apologies to Kenny Rogers, but in Canberra “you’ve got to know when to hold’em and know when to fold’em”.

Success can be instant and total, or it can be incremental and partial. A win is a win.

This was clearly evident throughout the battle to get the Government to restore indexation to Medicare rebates – the infamous Medicare freeze debate.

Health Minister Greg Hunt delivered an outcome that was not 100 per cent what we wanted.

We wanted an immediate end to the freeze across the board. We achieved a staggered lifting of the freeze, which has allowed medical practices to plan ahead with confidence.

Like all major advocacy, this required walking a tight wire.

And like all worthwhile advocacy, you do not always get everything you want in one go. You have to be patient.

You have to keep faith with all your constituencies. You have to stay engaged with the Government.

But ending the freeze was a beginning, not an end. There is so much more to do.

More recently, we have achieved considerable success with After-Hours primary care services, the Private Health Insurance Review, Opioid abuse, and the appointment of a new Rural Health Commissioner.

As an Obstetrician and Gynaecologist, I am always particularly focussed on Indemnity issues.

Writing $20,000 to $30,000 cheques quarterly for Indemnity will do that to you!

I am personally particularly proud of the role I played in convincing Minister Hunt to change the focus of the Medical Indemnity review and understand better the value of the support schemes, particularly to private procedural practitioners and the patients we serve.

But we have to continue the conversation with the Government on a range of other important matters.

We are constantly advocating on public hospital funding, the MBS Review, the Health Care Homes trial, improvements to the PBS, and the My Health Record, among many other things.

We are currently engaged with the Government on medical workforce issues, including our longstanding concerns about Bonded Rural Medical Scholarships.

We have to keep working on workforce issues to ensure we have a future medical workforce with the right skills in the right numbers working where they are most needed.

We need also to build a bigger focus on prevention – to combat the harms caused by obesity, tobacco, and alcohol and drug abuse.

We must remain vigilant on Indigenous Health – to close the gap.

As recently as Wednesday, I was discussing preventable and treatable blindness and deafness in Aboriginal and Torres Strait Islander people with Minister Hunt.

The AMA must also have a view on matters that some members do not always believe we should have a view on – but we do.

As one of the most successful and respected lobby groups in the country, people look to the AMA to have an opinion on many things.

Some of these things are controversial – and often divisive.

But there is always a health component to these issues.

In recent times, we have made statements on climate change, marriage equality, and asylum seeker health.

Leadership is all about courage, but we do not go boldly and bravely into lively public debates on the spur of the moment.

We have policy. We have intellectual rigour to support our position.

Our Position Statements are developed carefully over time by working groups or committees of Federal Council. We seek input from within and outside the organisation.

These positions are not supported by all members, nor by everyone in the community. That is to be expected. That is human nature.

But our positions are always based on the evidence available. Scientific evidence backs all our public pronouncements.

That is how we, as doctors, conduct ourselves in medicine.

That is how we, as AMA spokespeople, conduct ourselves in advocacy.

The Euthanasia and Physician Assisted Suicide debate in Victoria has been emotional and sometimes heated.

The AMA has been central to the discussions.

At the Federal level, my role has been to prosecute the formal AMA position – our Position Statement which has at its heart the statement that ‘doctors should not be involved in interventions that have as their primary intention the ending of a person’s life’.

At the local level, AMA Victoria has strived to remain engaged with the Victorian Government, especially keen to see protections in-built for patients and doctors if the Voluntary Assisted Dying bill is passed.

There will be further work to do – in Victoria and nationally – whatever the outcome.

This has caused some tensions, both within the AMA and across the whole profession.

But we have tried very hard to remain respectful and united throughout. Families stick together in the tough times and the good times.

We had a similarly rocky road on marriage equality.

The AMA has stayed the course on our policy at all times. We have stuck with the evidence.

Members have disagreed with us. Members of the public have disagreed with us.

Sometimes that disagreement gets very personal. I have been called all sorts of names.

We cop a fair bit of flak on the way through. But we power on.

That has been the case for me throughout my Presidency to date.

I have not wavered. I have championed AMA policy at every opportunity. That is my job. That is leadership.

The media calls me regularly. In the summer months, it can be as early as 4.00am.

I get judged by the week, by the day, by the hour, and by the minute on what I do and say on policy.

In the era of email and Twitter and Facebook, there is nowhere to hide.

But I do not hide. The AMA does not hide. We stand by our views. We explain our views. We argue our views.

I find that even our harshest critics on any issue appreciate the fact that we remain engaged and respectful with anyone who holds a different or contrary view.

That, too, is leadership.

Not all our advocacy is external. Sometimes we need to look inward. We need to look at ourselves as a profession – take our own pulse.

We did that recently on the issue of bullying and harassment in the profession.

I think the profession responded quickly and admirably to this crisis.

I congratulate the ASO, the learned Colleges, and other medical groups for their united response to stamp out bullying.

This purge is ongoing … and necessary.

It helped put the focus on another thorny issue at the heart of our profession – our own health.

It is a topic that has gone beyond the profession and out into the community.

It is an absolute necessity for safe and effective medical practice.

Unfortunately, in recent years – and especially in recent months – we have seen tragic stories about the health and mental health of doctors and medical students.

Sad stories of suicide and despair have been all too common.

Doctors and medical students are opening up about long hours, stress, bullying, harassment, and depression.

Ours is a rewarding profession. But it is also very demanding.

We have to get better at looking after ourselves and our colleagues.

I believe that we are indeed making progress.

We are developing structures and processes to improve our understanding of, and care for, the health and welfare of ourselves and colleagues.

I think we are all aware that health for doctors, both physical and mental, is not a given.

We all have anecdotes that indicate our personal frailties.

The important thing is that more of us are now sharing them. We are not keeping them hidden.

We must encourage others to talk and seek help as well.

It is encouraging that individual doctors, as well as organisations such as hospital and employer networks, medical schools, and the learned Colleges are taking steps to support doctors to understand and adopt, as a high priority, a healthy lifestyle throughout their medical training and professional careers.

Within the AMA and the profession more generally, there has been a welcome increase in the awareness of doctors’ health issues in recent years.

Much of this is being driven by the younger members of our profession.

I join you here today instead of being with our Doctors in Training Committee in Canberra. They are a key committee of our Federal Council.

We owe them a great deal for their initiative and drive, and their courage.

But there is much more to do.

As doctors, we spend a great deal of time and effort training in the clinical aspects of our work.

I'm sure we don't spend enough time on the aspects of our work that might collectively be called professionalism - leadership, working in multi-disciplinary teams, providing feedback, negotiation and conflict resolution, and time management.

This, in turn, may leave us poorly prepared for many of the stressors of life as a doctor.

Bullying and harassment in the workplace are serious stressors, far too prevalent, and carry health implications for the profession.

The events of recent years, which started with comments about sexual harassment in surgical training, have resulted in the recognition that there are problems with some aspects of surgical culture, with implications to varying degrees across the entire medical profession.

While it will be painful for many, it is necessary that we continue to have open disclosure, a determination to educate current and future members of the profession, and to support those who have never known any other way to interact.

We must encourage an environment in the medical profession where positive approaches are taken - good role models, work-life balance, accessible care, practical education, and cultural change for the better.

As medical professionals, we have a responsibility to ensure that programs exist to assist our colleagues to access quality health care when they need it.

We need to promote good health and the adoption of a healthy lifestyle throughout a doctor’s training and career.

For the medical profession, doctors’ health services are important not only for the provision of health services, but also in prevention, education, and research.

The AMA has always had strong links to existing doctors’ health services across the country.

The AMA has now established a wholly-owned subsidiary, Doctors' Health Services Pty Ltd, to co-ordinate the delivery of the services and ensure that they are delivered at arm’s length from the regulator - that is, the Medical Board, which is funding the new entity.

This new company has its own governing Board, and is being advised by an Expert Advisory Council made up of representatives of the health services, doctors in training, medical students, and the AMA.

The implementation of the new arrangements for doctors' health advisory and referral services is progressing well.

I am confident that this service, working with all doctor health services, will help improve the level of support given to the profession.

One important piece of AMA advocacy reaching its pointy end is that imploring Health Ministers in the other seven jurisdictions to adopt the WA law where treating doctors have an exemption from mandatory reporting of doctors presenting with mental health problems.

We currently have the ludicrous situation that the very doctors promoting the benefits of early intervention to patients cannot seek help themselves without the regulator being involved.

Minister Hunt has shown leadership on this issue. I hope to see the same care, compassion, and understanding taken on by seven of his State and Territory colleagues next week.

To care for one's colleagues is not an easy thing, because it entails significant risk.

But there are real rewards and satisfaction for those who do.

We will all end up being a patient at some time in our career, and the challenge is to practise what we preach to our own patients.

We need to be honest, to be open to uncomfortable advice from our doctors, and to recognise our own limitations.

Apart from improving our own health, I am sure it will make us all better doctors.

This could be the greatest leadership lesson we ever encounter.

In closing, let me stress that AMA leadership is for all doctors.

Our advocacy delivers for your members, for our members, and more often than not for non-members.

I ask those doctors who are not members of the ASO, their Society or Association; or not members of the AMA, to look within and question their commitment to the profession.

Our leadership helps build and sustain that health system in which we work – a health system that is among the very best in the world.

Our leadership delivers for our patients and the broader community.

It is this sort of leadership that I know Dr Andrew David Halstead Stewart would be proud of.

28 October 2017

CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

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