Interview - AMA President, Dr Bill Glasson, with Chris Bath and Glenn Milne, Sunday Sunrise, Channel Seven - Medical indemnity dispute

Bath: Good morning and welcome to you, Dr Glasson.

Glasson: Thanks very much indeed. Good morning to you.

Bath: It appeared that you had come to certainly an agreement with Tony Abbott on Friday. What has happened?

Glasson: Look, it really wasn't an agreement. The Government put forward a proposal on Friday to try to settle down the situation. But I have spoken with a large number of doctors over the weekend, and the perception is that this is just an olive branch with thorns on it, or the cynics amongst them feel that it might be an insurance tax that's been deferred from before the election to after the election. So what they're saying is they need to have more on the table, more concrete evidence that there is going to be change in the system before they're going to actually continue to work within the public hospital system.

Bath: But on Friday night, certainly in several news services, you were saying that this gave you somewhere to go forward from. Were you rolled on this by your membership?

Glasson: No, no, no, no. I think what I was trying to say or what I said was that the meetings we had with Mr Abbott were very congenial, open and frank. I feel that having Mr Abbott taking the new portfolio on Tuesday signals that the Government has put health on the front foot. I think with Tony Abbott at the helm, we can get some major reforms across-the-board in health that we have been asking for for a long time. I'm confident that, with Tony Abbott there, we can get the change. But what is being proposed at the moment by the Government is really not enough. In fact, it's little more than a promise. So in reality, unless we can sit down with the Government and draw up a concrete proposal to address, I suppose, the structural and financial reforms that are required in the system - and this in fact will require the Government to look at the way the system is currently being funded, and that's by the patients - and try to spread the liability, I suppose, for the system across the broader taxation base, unless we get those structural reforms and financial reforms into that medical indemnity structure, it's not sustainable in the long term, and it will continue to impact on our work force. I keep saying that this whole debate is about trying to preserve the medical work force out there. This includes in our communities as well.

Milne: On that very point - in New South Wales, 72 doctors have walked away. The papers this morning are saying that 200 will go; thousands more are "edgy". How many resignations are you expecting and where?

Glasson: Unless something is done very quickly this week, I would expect that this tidal wave of resignations will continue through New South Wales, and we know it's extended from Sydney right out to rural New South Wales, and no doubt it will impact on Queensland and Victoria.

Milne: How many in total are you expecting?

Glasson: Well, we could be up into the hundreds this week, and these are the doctors who actually provide the services to our public hospitals As I say, unless something is done to try to stabilise the situation, you will impact on the public hospitals through the whole of New South Wales and Queensland particularly. So I think that it's a clear message that it is time now for the AMA and the Government to sit down and agree on a process forward and, as I say, to sit down and essentially define what is going to allow us to have an affordable and sustainable medical indemnity system in this country.

Milne: You would have to agree that you're basically acting like a trade union here, aren't you? You're on strike, essentially?

Glasson: No, we're not on strike. Doctors are just deciding not to renew their contracts. They haven't gone on strike. They're saying they cannot continue to practise in this environment where medical indemnity costs are going up and up. When you talk about doctors paying up to $150,000 to $200,000 in premiums and then this new tax, health tax, insurance tax on top of it - the reality is that these are small businesses doctors are running, and they're saying to us that they cannot continue to practice with this ever-increasing financial burden. I keep saying: who's paying for this?

Milne: Well, who is paying for it? You do concede, however, that we wouldn't be in this situation if doctors hadn't underfunded their own public liability scheme in the first place?

Glasson: Could I answer that by a question? Why do obstetricians in Tasmania pay about one-fifth of the obstetricians in New South Wales? The reason they do is because the New South Wales system, particularly because of the judiciary and legal system there, has been out of control for the last decade or more. What we're paying for is the past sins of a legal system, a judicial system that was out of control. It's not about bad doctors. Essentially, Australia has one of the highest standards of medicine in the world and continues to do so. The reality is that what our patients are paying for today is a legal system that failed a decade ago, and we have to have the reforms in that legal system in order to move forward, because the current system is not workable, it's broken, it's unaffordable and it's impacting on you and I being able to access medical services in this country. That's across all our rural towns, our communities out there, where the general practitioners particularly provide the cornerstone, I suppose, to the community, both from the medical point of view and the support point of view, but across to all our surgical disciplines and medical disciplines as well.

Bath: Reform of the legal system is long term. In the short term, though, what would appease doctors now?

Glasson: I think what we need to do is guarantee the profession that we have a forward vision or process by which we can move forward. We need to have some funding to support, I suppose, the current structure, and that's trying to support some of the reforms that we're proposing.

Bath: So the Government should prop up the medical indemnity system further?

Glasson: Can I suggest to you it's not the Government; it's the taxpayer or, in this case, it's the patient that actually pays the fee to the doctor. You can think of it as either the general taxation base supporting part of this problem and the patients who pay a doctor's fees supporting the other part. In reality, unless we get, I suppose, a broadening of the payment base, this system is not sustainable. So we have to really try to look at a model whereby we're suggesting that, for instance, care costs be removed completely out of our current model, and also, this business that doctors can be sued for 21 years or beyond is not sustainable. So we're suggesting that doctors under the current scheme or patients under the current scheme insure for probably up to six years, and then all claims that fall outside that be funded by the general community. That would be a small impost on the general community in order to maintain medical services, and that's what this argument is all about.

Bath: So when you next meet with Tony Abbott, you will be saying: unless you can shorten the statute of limitations, unless you can guarantee that you're going to prop up the medical indemnity system further for some months while we continue negotiating - even though we have been doing it for 12 months and come to no agreement - that's the only thing that will appease doctors?

Glasson: No, I think the reality is the discussions we will have within the next week or so, particularly with Tony Abbott at the helm, will lead to some constructive outcomes. Essentially the proposals we have put forward need to be costed and agreed on both sides. But what we are asking here is for a sustainable medical work force in this country. You and I know that doctors are leaving the system in droves, both in general practice and specialty areas, such that you cannot access obstetricians or neurosurgeons or general practitioners to the level that you should be able to. We're talking about trying to maintain a medical system that is affordable and that is sustainable. The current model is not. Therefore, we have to look at a system that is broken and try to put in a model that is affordable and sustainable in the long term.

Milne: I may have misheard you earlier there. Did you suggest that patients might have to insure against malpractice?

Glasson: No, no, I'm just saying patients actually pay for the system, not doctors. Doctors simply are the conduit by which money goes from patients to what ultimately is lawyers and administration of medical defence organisations.

Milne: But why should they pay?

Glasson: They do pay. Patients pay, and they're paying ever-increasing amounts and increasing gaps. The patients out there are paying for the system, not the doctors. We're saying that patients have paid too much. We're sick of putting our hands in our patients' pockets and asking for more and more to pay for a medical indemnity system that's essentially unsustainable. We want to look at a new model whereby we can spread the risk and spread the liability for the system such that patients can get the care when they need it, but essentially it remains affordable for patients across-the-board.

Milne: I'd put it to you that patients are also taxpayers. If we're going to shift the burden, you say, from patients to taxpayers - they're probably the same people - how much will it ultimately cost?

Glasson: I would like to think that the reforms that we're putting in place, it may in fact cost them far less than the current system is. I want to remove the money essentially away from the legal system and the administrative system. If anybody is going to receive care, I would like to see that the money go directly to the patients, and the general taxation base is in the best position to make sure that those patients that need care, get care. In other words, the money is directed directly to the patient, not via the doctor, through a lawyer, through a medical defence organisation, which chews up about 80% or 90% of the funds that go into the system. We want patients to get care when they need care. We want a system that's long term affordable and sustainable. Our clear message is that the current system is broken and that doctors are suggesting that they cannot continue to function in that system and hence are simply retiring out of it.

Milne: But you must have crunched the numbers. How much will it cost taxpayers?

Glasson: We have to sit down with the actuaries and get an absolute figure. But if you said, "We're going to remove all the care costs out of the system and we're going to make sure that claims outside of six years also fall into the general taxation scheme", you may be looking at $50 million, $100 million - I can't say an exact figure.

Milne: A year?

Glasson: But the reality is that, for a small impost for us with a $7 billion surplus at the moment, if you can say to me, "Listen, we're going to put $100 million into the system. We can guarantee that you will have doctors on every street corner, you will have specialists out there who can deliver your babies, operate on your brain tumours and look after the community at large", I think you would agree that that's a small outlay for an outcome that the community demands and the community wants.

Bath: So that surplus should be spent not on tax cuts but certainly on the health system, according to you?

Glasson: Well, I suggest that some of that $7 billion needs to go into the health system, not only into this system we're talking about but the health system across-the-board. I think it's a small outlay to a community that really is screaming about the fact that they do not have doctors in their local communities. These are the rural towns, the outer suburbs of Sydney and Melbourne and across-the-board. We have the biggest fallout of specialty services we have ever seen in this country. We're 3,000 general practitioners short nationwide. We have lost more obstetricians in the last three years than we have done in the last 10 years.

Bath: If I could just stop you there. If we are so short, what impact is this walkout having on public hospitals right now?

Glasson: Huge. Essentially, what it's going to do, if it continues, it would lead to a significant scaling down of services at these public hospitals. Our concern is that it will affect the poorest and most vulnerable in the community. So we want to turn this round before it actually reaches those sorts of proportions. Our message clearly is to the Government, and certainly to the new minister, that we want to sit down with you this week, define a process that we can take back to our constituents, our members, over the next week saying, "Listen, guys, everything looks as though it's heading in the right direction. Hold any action. Go back to work. Provide those services that are really needed." But they will not do that unless there's an environment where they know that tomorrow, or next year, or in 10 years' time, they're not going to revisit this situation. The reality is that they've had enough.

Bath: Quickly and finally - doctors are certainly taking a hard line on this. It certainly would be a good opportunity for you to make this an election issue, particularly a marginal-seat campaign?

Glasson: We have clearly signalled the fact that this will be an election issue unless it's resolved. I clearly indicated that I would be going out talking in marginal electorates and indicating the concerns we had for the delivery of medical services in these areas to try to signal to government the importance of this. But let's not get to that. Let's sit down in a mature way, on behalf of the patients of Australia, and come out with a resolution that ensures we look after the people who need to be looked after, and that's you and I trying to access medical services. This shouldn't become a political campaign between the AMA and any government. It should be all about patients. It should be all about patient services. It's all about our communities out there trying to access affordable services and, importantly, have the service to access in the first place. That's the message that we're getting and I get when I move around my rural communities. I service a lot of rural areas. The clear signal is: they want their doctor there. It gives them heart, it gives them faith to know that there's a doctor there in their town who, at any time of the day, they can call upon to provide medical services across-the-board. I suppose that's the message I want to get out there.

Bath: We wish you luck in getting your message out in the week ahead. There will be a lot of talking for you down the track! Thank you very much.

Glasson: There will be. Thanks very much indeed.

Bath: Glenn, thanks for joining us. We'll see you next week from Bali.

Milne: See you then.

Ends