Interview - Dr Bill Glasson, AMA President, with Alan Jones, Radio 2GB: Appointment of Tony Abbott as Federal Health Minister

JONES:          Well, the most significant initiative in John Howard's Cabinet reshuffle proving yet again that experience is irreplaceable in politics - John Howard has put Tony Abbott, along with Peter Costello, easily Mr Howard's most able performer, in charge of the difficult portfolio of health.

I was going to speak to Tony Abbot this morning but Mr Abbott will be making no comment - as will most of these people - until they are sworn in next Tuesday.  And I'll speak to him about some of these issues then.  But health is difficult.  Why?  Well, there'll never be enough money.

Technology is keeping people alive.  Technology builds expectation that every medical condition has an answer.  But the answers are expensive, and there isn't enough money to go around.  Tony Abbott's first concern though won't be Medicare, as the commentators are suggesting today, but rather the central instruments of good health - doctors.

And the doctor situation in Australia that Tony Abbott walks into is one bordering on crisis.  I know it's a conventional practice now to bash up doctors.  Governments seem to be into it big time.  And of course the public are encouraged to believe that doctors are ripping off and they're just whingers who all drive around in Mercedes Benz cars.

I told you earlier this is a serious issue reaching crisis proportions.  On Sunday the AMA Federal President William Glasson addressed a rally of 4,000 people at Randwick Racecourse - doctors, on Sunday morning - basically saying that doctors are going to leave the profession.

And I've said many times, who wants to be paid a Medicare fee of about 25 bucks to be vomited on in the middle of the night?  And what gynaecologist or obstetrician is going to pay ludicrous insurance premiums in a world which is extremely litigious.  Would you do it?  I wouldn't.  So they're walking away from the profession.

What does that mean for public health?  What's it mean for access to doctors in the future?  I told you on Friday I had a doctor who wrote to me who'd been insured with UMP since the 1990s, and it took over from his English insurance company.  In April last year UMP went into liquidation, so the doctor joined another association, the MDA National, in May.

He immediately resigned from UMP, in May.  He had to give a month's notice.  So the resignation should have been effected end of May.  But UMP took credit card deductions for premiums for June, July and August worth $22,000.  They sent him bills seeking payment for September, October and November worth $23,000.

The doctor never received any acknowledgment.  So his cover was terminated in January this year, only because he wouldn't pay the bills.  But the Government has sent all doctors who are members of UMP as at June 2000 a levy notice.  It's called IBNR - incident but not yet reported - and it's to prop up UMP in case of future litigation.

The levy for this doctor is $142,000.  And to that he faces an insurance bill on top of that of another $217,000.  So what do they do?  Do they put up their fees?  Who suffers then?  This is a general surgeon.  Many of his patients are bulk billed.  We are, in my opinion, in crisis - without over-dramatising it.

The AMA President, Dr Bill Glasson - good morning.

GLASSON:    Alan, good morning to you.

JONES:          How the hell can this go on?

GLASSON:    It can't, Alan.  It just can't go on and I think that's what the 4,000 doctors were signalling on Sunday at the Randwick Racecourse.  It was that enough's enough, and the reality is that every day, as you're hearing, I'm hearing more and more doctors who are just saying, "I'm out of here"- -

JONES:          And the more doctors who go out of here, the longer the queues.

GLASSON:    Absolutely.  I mean, the reality is that you will not be able to access medical services in this country, either at a specialist level or general practice level that you have traditionally done in the last 10 years because there will not be the doctors there.  And the doctors are - these are the sort of, I suppose, the people that are the hub of the community and they do not want to be leaving their patients.  But the reality is that they've been forced out by this indemnity issue that- -

JONES:          So this levy is payable for 10 years, each of the following 10 years, beginning on November 1 - even for doctors who have retired?

GLASSON:    Absolutely.  Basically, for those doctors retired, if you're less than 65 you've got this levy for ever - and most likely for ever and ever.  I mean, it says for 10 years.  But if it's not paid off by 10 years, in theory you could even be paying it longer- -

JONES:          But let me be the devil's advocate, which is what the taxpayer would want to ask you - and that is, that UMP, your own medical indemnity insurance provider, was badly run, mostly because I suppose doctors, like all of us, pretty dumb and ignorant about all of these things, and are too busy to worry what's happening.

You've constantly got a million and one assurances, 'Everything's Okay, everything's Okay' - so then they look like going belly-up.  So the Government, for the benefit of the doctor and the patient, keeps the whole thing afloat to the tune of $460 million - that's us.  And I suppose the Government is now saying, 'Well, we want our $460 million back.'  How do you answer that?

GLASSON:    The reality is that I don't believe that $460 million is a real figure.  The reality is the doctors - or the patients, I should say - are paying for that $460 million.

JONES:          Just let me take that point up, and it's a very valid point you make.  I mean, this is a dreamed up figure that somewhere down the track in the next any number of years, there are going to be a whole lot of litigations against doctors which will cost the profession $460 million.

GLASSON:    Exactly, I mean ...

JONES:          ... How the hell do you work that out?

GLASSON:    Exactly.  I think it's a Dreamtime figure and that's what the doctors are saying, is they're putting money into - or their patients' money - into this black hole that the Government says is $460 million worth.  But the reality is that we feel that figure's much, much smaller.

But, Alan, if there was some forward vision, if you say to the doctors, 'Listen, guys, hang in there.  We're going to have a forward vision for you to say we have a medical indemnity system that looks after your patients in a caring way, and it will be affordable', then they might look back and say, 'Listen, we've got a liability for this IBNR, realistically what ever it may be, then we might look at paying it.  But we're not going to pay it when we know there's no forward vision at all.'

And this is what we ask the Government to do, is give us a forward vision - and we've gone to them with a number of recommendations as to how we can move forward on this issue so that we can actually go back to the doctors and go back to the community, then say, 'Listen, we've got a system', as I say, 'that is affordable to you and that gives security to the doctors in the long term.'

JONES:          But, see, what I don't understand, I mean, those of us that have travelled overseas, you'd never think of having a medical procedure done overseas if you could get it done at home.  Here we've got one of the best medical professions in the world and we're emasculating it.

GLASSON:    You are absolutely right, Alan, we do have one of the best systems in the world and we're sitting on our backsides and letting it essentially be destroyed.

JONES:          Let's have a look at one other aspect of it because whether we think we're making this up or not is irrelevant.  I'm concerned about what it means for the people listening to me because you've done a survey of the New South Wales arm of AMA - 27 per cent of doctors are going to leave the profession sooner than they intended, 75 per cent are going to increase their fees to cover the cost, 20 per cent will cease bulk billing.  How the hell does that help health care?

GLASSON:    That's exactly right.  The whole issue, affordability in health care, will go out the door.  As you said, those people that are truly in need and can't pay any gaps will be forced out of the system and back into the public hospital system, which is obviously in crisis as well.  People will ...

JONES:          ... Because there is already a doctor shortage, even now as we speak, isn't there?

GLASSON:    Absolutely, Alan.  There's a desperate shortage.  We're probably 3,000 GPs short nationally.  We're probably at least 50 per cent short in obstetricians.  General surgeons are falling out of the system.  An example you just gave is a typical example of general surgery.  And orthopaedic surgery is another one that's absolutely in crisis situation.  They're going to drop out in droves.

So the reality is that unless we wake up to ourselves, we'll look at ourselves in the mirror tomorrow and say, 'Golly, why didn't we do something about this?'  So that's what our message has been to government.  This is not about doctors.

This is about the community.  This is about keeping doctors in their communities, providing those important services.  And so the message is, for goodness sake, let's sit down together, let's design an affordable system and make sure that we can preserve our medical work force in this country.

JONES:          Well, I think you most probably need an appointment with Tony Abbott at about 9.00 a.m. next Tuesday.

GLASSON:    You're absolutely right, and that's the one I'm seeking.

JONES:          Okay, good to talk to you - keep in touch.

GLASSON:    Thanks, Alan.

JONES:          It's a big issue, that is a crisis, believe me - whether we like it or whether we don't.  And I mean you talk about queuing up now, I said some months ago to you that it's not beyond the realm of possibility that if this keeps going, in five years' time you'll be waiting two, three and four years.

We'll become a Bangladesh.  Now, there's an election coming up.  John Howard's a smart man.  He knows this has got out of hand, and he's put one of toughest men in the business and one of the smartest in charge of it, Tony Abbott, when he is sworn in, I'll be addressing those issues to him.

Ends