Dr Kerryn Phelps, AMA President, Radio 3AK, with Nick Papas,

PHELPS: Hi Nick.

PAPAS: Everywhere I turn, there you are making policy pronouncements and being on … what was it? This is your Life, and it must be very difficult to try and keep on top of the important issues of the day?

PHELPS: Oh no. I read the media clippings every morning at about 6.30am and we're on top of it all the time.

PAPAS: Oh well that's great. Now, today it's an important announcement, 'your prescription for votes' is how it's described. And it's good to see that the AMA has got on the front foot early, and saying this is what we want so there's no doubt.

PHELPS: There is no doubt. The AMA released today key health issues for the 2001 election, and this is so that the politicians and the prospective politicians can be in absolutely no doubt about what the medical profession and the patients of this country believe are the priorities for the next election term and beyond. And I think it's very important that our prospective legislators understand what we perceive to be the problems in the health system so that when they are in a position where they are making decisions about the health system, they understand what they're doing.

PAPAS: Now, the key issues, of course, are numerous, and there's no way we can go through them all. But, the point of them is that at any time, you can discuss in detail the policy perspectives that you have in relation to each of the issues?

PHELPS: That's right. We've also established a network of doctors around the country, in every electorate, who will be making it their business to go and visit all of the politicians who are putting their names forward before the next election. To ensure that they are well aware of these policy areas where there is unmet need, and what we believe can be done about it, by whichever party is in power after the next election.

PAPAS: Now, the easy criticism that both politicians and anybody who's opposed to what the AMA is standing for will be, of course, you're just being the peak body or the union for the doctors, and it's all about improving doctors' working conditions and incomes?

PHELPS: Well, if you have a look at the policy document you'll see that it's no such thing. What we're trying to do is to preserve what we believe is the basis of the best health system in the world, if only we look after it. And at the moment, we believe that it's been sadly neglected and patients are coming out the poorer for it.

PAPAS: Hmm.

PHELPS: If you look at areas, for example, such as public hospital funding, our concern is that there is a drain of not only the top doctors out of the public system and over to the private system, because they just don't like working in those conditions anymore and having to struggle with inadequate budgets and inadequate resources. But, the nurses are also voting with their feet as well and we're seeing a loss of nurses from the system, and that urgently needs to be addressed for the sake of our patients. When we look at the issue of the Medicare Benefit Schedule (MBS), while on the surface of it, that may appear to be there should be more money for doctors' fees. In fact, what we're saying is that the MBS has been grossly inadequate, has been neglecting its duty to the Australian people for a long time now. And that the result of that is that households are having to pay much more out of their budgets to prop up Medicare.

PAPAS: Well that's … I mean, that's the reality - you go to your doctor now and unless they're bulk billing, and very few of them are nowadays, maybe sometimes for kids and some of these bigger practices - everybody's paying more. I mean, the doctors are charging what they have to, to make a living …

PHELPS: Yes.

PAPAS: …in what the market bears.

PHELPS: That's right.

PAPAS: Medibank - Medicare, should I say, is nowhere near it now. It's only $23 I think, the rebate.

PHELPS: Yeah, $23.45 and that's the doctors who are what we call vocationally registered. The ones who are not vocationally registered, the patient's rebate is only $17.85 for a consultation and that's supposed to cover all of their costs.

PAPAS: Yeah, well I mean…

PHELPS: It's impossible.

PAPAS: I have no problem with accepting the MBS is out of step, especially when I see what doctors are charging just to make ends meet and to run the practice. And people, of course, forget. And I don't need to you know, get behind you, because I know you argue this well enough. But, the expenses, the nursing staff in the practice, the records being kept, the whole ability to keep the place open and funded is what has to be paid for out of these fees.

PHELPS: That's right. And you know, things like mortgages and you know, being able to buy your equipment and ensure that your equipment is kept up to date. GST costs have been a great impost on doctors over the last 12 months, and there are a lot of hidden costs as well, and that all has to be factored in. So you know, there are a tremendous number of areas that we're dealing with, rural and remote health, of course, we need to really make some special efforts in rural areas. And then when we look at some of our most disadvantaged populations. I believe, at the moment, we have a crisis in aged care, and one that I don't believe is being adequately addressed by the current government and needs to have some urgent attention and increased funding to make sure that we are accounting for our ageing population into the future.

PAPAS: Now, what about some of the qualitative issues? You're also raising general practice training and junior doctor working hours, they're both areas that I think most people would be very concerned about.

PHELPS: The AMA has completed a safe hours survey, which has found that there are a large number of junior doctors working in the hospitals who are working unsafe hours.

PAPAS: Yes.

PHELPS: Now, we really have reached the stage where it is inappropriate for any professionals or any workers to be working unsafe hours. And yet this survey found that 54 per cent of junior doctors were working at significant fatigue impairment levels.

PAPAS: I had Dr Mukesh Haikerwal on earlier in the week, as we regularly do on this program, and jokingly suggested to him that I'm glad he didn't look after me when he was in training at a hospital because of the number of hours that he was working, and he agreed.

PHELPS: Well, we all did it, and the fact that we all did it doesn't mean that we should continue to do it because that's how you pay your dues.

PAPAS: Yeah.

PHELPS: We really need to be looking at contemporary work practices and working hundred-hour weeks and 36-hour shifts is just simply no longer acceptable. I mean, we used to … in Britain they used to send children down into the coalmines. They don't do that anymore, and for good reason.

PAPAS: Yes. But we do, somehow, still seem to expect our young doctors to have to work in coalmines.

PHELPS: In the coalmines.

PAPAS: Hospitals, yeah.

PHELPS: And, not only do we expect them to be there, but we expect them to perform at 100 per cent accuracy and efficiency for the whole time that they're there.

PAPAS: And then one of my mates, a lawyer, because I'm still a lawyer, even though I'm on air nowadays rather than being a lawyer, will issue writs when something goes wrong. And who are we suing - the hospital, the management? We should be suing those who make the doctors work the hours, rather than the poor old doctor who might make a mistake, and the problem is the mistake can be fatal.

PHELPS: That's right, and it's not only devastating for the family of that patient, but it's similarly devastating for the doctor and any of the staff who are involved. Because really, the people who have the highest expectations of doctors are doctors themselves.

PAPAS: Well, that can only be encouraged. Dr Kerryn Phelps, as usual, very helpful and always willing to talk to us, President of the Australian Medical Association, thank you for talking to us this afternoon.

PHELPS: Thanks, Nick.

Ends