Interview - Dr Bill Glasson, AMA President, with Fiona Sewell, Radio 5CK Statewide - Medical indemnity; shortage of rural doctors; bonded medical school places

SEWELL: Let's meet the new head of the Australian Medical Association, ophthalmologist Bill Glasson.

Hello, Bill.

GLASSON: Hello, Fiona. How are you?

SEWELL: I'm well.

GLASSON: That's good.

SEWELL: How's the new job going?

GLASSON: Well, it's as bit daunting having sort of suddenly been thrown into the midst of this, but obviously once I find my feet a bit we'll hopefully, you know, move ahead positively. We've got a good team I feel, and obviously following in Kerryn's footsteps is a fairly high set of stilettos, so we've just got to make sure we keep the energy that she created in the organisation and in the profession and health debate, I think, on the forefront.

SEWELL: What's the first thing you'd like to tackle as the President of the AMA?

GLASSON: Well essentially, Fiona, I know it's going around in circles, but we still haven't solved the indemnity debate and unless we get that one bedded down the rest won't matter. Because essentially we're going to have, you know, difficulties keeping people in the profession and difficulties attracting people, you know, to do medicine in the first place.

SEWELL: Are you getting any closer to solving that situation?

GLASSON: Well, I think-- well, yes, we are. It comes down, now, to affordability. There's been significant tort law reform at the state level and certainly some of the states have done a very good job in that area. The Commonwealth have come in and stabilised the medical indemnity organisations themselves and certainly removed the risk of doctors, you know, being sued personally and losing their assets.

But it comes down to can patients then afford the premium. And our concern is that we've gone through this rather complex exercise and we still may not have products that you and I can afford to pay for and that we afford-- and we pay for it in doctors' fees.

SEWELL: And this whole issue is having a really big impact in country areas, isn't it? For example in the South East of South Australia, in Mount Gambier, shocking problems at the hospital there with indemnity causing a lot of surgeons to leave.

GLASSON: Yeah, exactly right. I mean, if doctors are finding, you know, that they're subject to, oh, vulnerability I suppose from being sued all the time, then they're not going to continue to sort of work. And they really need to have a guarantee that they can, you know, work at the coalface and have full protection from-- you know, from any legal action.

The difficulty, Fiona, for a lot of doctors out there is that, you know, for the last few years we've been sued not for reasons of-- we've been sued for reasons of adverse outcome, which has not been due to negligence.

And I think that a lot of doctors are getting rather demoralised when they find themselves in legal action, when really they've done-- you know, they've done a very good job. The patient's had an adverse outcome for nothing necessarily to do with what the doctor has done; they've had in infection or whatever.

And, I suppose, most doctors are willing to accept responsibility for an adverse outcome where they are personally sort of responsible. But they're not willing to continually accept responsibility for adverse outcomes when, really, it's nothing to do with, you know, what they've done or how poorly they've done, it's just the fact it's one of those unfortunate outcomes of a procedure.

SEWELL: What have state governments done to help this?

GLASSON: Well, the state governments have introduced tort law reform. Victoria's just-- theirs is going before Parliament at the moment. South Australia's had legislation through their Parliament and, certainly, Queensland and New South Wales have.

Now, they have tried to introduce a series of, I suppose, caps and thresholds, tried to tighten up on the process by which claims are handled, trying to bring claims forward quicker. And making the system more efficient so that, first of all, patients aren't waiting around for years to get some sort of settlement.

And, second, that doctors who are supposedly, you know, before the courts for an adverse outcome-- you know, if you've got that hanging over your head for years, it can be rather daunting. And so they like the issue addressed quickly and addressed in a non-adversarial way.

And I think that what we've really been advocating is that if you've had an adverse outcome, you need to have an explanation as to why it's occurred, and so the communication between you, the patient, and the doctor is extremely important. And the so the processes at the state level tried to address that as well.

So I think there have been major reforms that will impact ultimately on not only the number of claims, but how claims are handled and hopefully on the payouts.

SEWELL: On ABC Radio I'm speaking with Bill Glasson; he's the new President of the AMA.

Bill, you've got pretty strong ideas on the rural doctor shortage, particularly, I understand, in regard to bonding students with scholarships, ...

GLASSON: Mm.

SEWELL: ... something that's just been increased in the last Federal Budget. What do you see is wrong with that system?

GLASSON: Fiona, I was a bonded scholarship holder myself; I spent a number of years in rural practice. 'Cause I came from the bush anyway, I was quite happy to go back out there.

What I've got concerns about in these 234 places that the Government's announced in its recent package is not the bonding part about it, it's the unfunded part. In other words at the moment we've got something like 100 funded scholarships in Australia, which, in principle, I support. And some of my doctors-in-training don't necessarily support that, but I suppose, in principle, I do.

Because in that situation you are being given a pos-- you have a position in a medical school; you are then offered a scholarship. You are paid so much a year, I think it's 20,000 a year, and then after the five years or six years you give your service back to areas of need.

But under this new system what is happening is that these places will be offered-- first of all, before the-- in order to accept the position they say, "Listen, you'll have this position-- you'll only get this medical place if you accept this unfunded scholar-- bond". And then once you've accepted it you receive no payment at all during your six years of medicine, so basically you're getting no money and no financial support, yet at the end you've got to give six years of service back.

Now, I think that's immoral in the sense that if they offer some financial support during the course, then that is a true, you know, bonded scholarship. But in a situation where they're offering no financial support, all they're really offering is a medical place, and of course you say well, you don't have to take it.

But, of course, you will take it. Because, if you really want to do medicine and since there are such limited places in Australia, you're really forced into making a decision at, often, the age of, you know, 18 or 19 for something that you don't have-- you know, you perceive or-- and you may have to give back for 10 or 12 years.

And can I suggest to you that after that period of time you've done your medicine, you might have become a neurosurgeon, I'm not quite sure what use that is to somebody sitting out in the, you know, back blocks of Mount Gambier.

SEWELL: How else, then, to get doctors into country areas?

GLASSON: Well, I heard you allude to the Flinders Rural and Remote Clinical School. Can I suggest to you that Flinders School and also the JCU Medical School in Townsville are two good examples of where chil-- you know-- children-- I should say young teenagers are encouraged to come into medicine from a background of having lived and worked and grown up in rural areas.

They understand rural people, they love their rural people and they want to go back and service them. And that's the reason I go back and service rural people, because I was born and bred there. So that's one of the positive ways of, I suppose, encouraging people back there and also to train out in those areas.

You've got to-- as part of your training you shouldn't sit in the middle of Melbourne or Adelaide or Sydney. Get the students out amongst the rural doctors, demonstrate to them what-- you know what, I suppose, fulfilling medicine is to practise in rural areas and the wonderful people that you actually have to treat. And it's-- really, it's a wonderful part of medicine, and I think it's-- once you share that with the students, they, then, will want to come back out and be part of it.

SEWELL: We'll hear more about it in just a moment. But where did you practise?

GLASSON: I was actually-- I was born in Western Queensland at a place called Longreach, and I practised out there before I did ophthalmology and I continue to practise out in those areas, right out as far as Birdsville and Bedourie and Boulia. And I service those areas on a regular basis and I love doing it, because I know what the people in the Bush are like and they're just great Australians.

SEWELL: Do you think this idea of having students from country areas training, you know, with practical experience in the country is the way to go, is the long-term way to go?

GLASSON: I think it's one of the ways. Obviously, there are a number of problems why-- well, a number of reasons why people don't practise in the Bush. The other one I should bring up is the issue of the spouse, Fiona. Today, most of us are in a situation where both husband and wife work and, often, in professional capacities and we've got to make sure that if we're going to attract these doctors out to the Bush that their spouse has a position.

And whether that spouse may be an engineer or a lawyer or whatever, I think it's important that when we, you know, try and find positions for these people we look for not only the medical position but we also look for a position for the spouse. Because then it's going-- if both sides are happy in their job, then they're more likely to stay there.

SEWELL: Well, Bill, all the best with the new job.

GLASSON: Thanks, Fiona. Thanks very much. I think, as I say, I'm looking forward to it; I'm looking forward to moving 'round the country. And really, as I said, I keep saying that the AMA's about its membership which are the doctors; but really, just as much, it's about our patients.

And this organisation is here to advocate on behalf of our patients, to make sure that that wonderful medical system we have in this country - and we do have you know - remains in a situation where it is financed adequately both in the public and the private system and that we can continue to have probably the highest medical care of anywhere in the world.

SEWELL: Thank you very much indeed.

GLASSON: Thanks, Fiona.

SEWELL: Bill Glasson is the new President of the Australian Medical Association; he's just been elected into that position.

Ends