Interview - Dr Bill Glasson, AMA President, with Tricia Duffield, Radio 2SM - Medical indemnity

DUFFIELD:          Well, along with our rail system, our hospital system in this state is pretty well in a shambles, some would say, when we see these cases of emergency wards being over-run with people having to wait on benches and on stretchers, and ambulances being turned away and so on.  

Most people would agree that our hospitals are in disarray.  And some of the people who would also be nodding their heads are doctors, who are facing their own crises with increases in the medical indemnity levy, which may cost some specialists more than $200,000 over 10 years. 

Now, you might say hey, I'm at the other end of the scale, as we've been talking about this morning, but that is certainly a lot for anybody, any professional, to have to cough up.  And now they're saying, well, I'm afraid we're going to have to do something about that, and it means that's we're going to stop doing some of our lower paid work, and our pro bono work for people like veterans, Australian Defence Force personnel and so on. 

Joining me on the program now to explain what's going on, is Dr Bill Glasson, who is president of the AMA.  Good morning doctor, thanks very much for your time this morning.

GLASSON:          Pleasure, Trish.

DUFFIELD:          Lovely.  Righteo, what are some of the measures that doctors are considering to try and I suppose, recoup their costs of the increase in medical indemnity levies?

GLASSON:           I mean the implication of this Trish is really such that the doctors are now feeling that, you know, enough is enough, I suppose.  This has dragged on and on, and it's been death by a thousand cuts so to speak, rather than actually getting to the root of the problem and trying to sort it out. 

This latest levy that's been put upon particularly New South Wales doctors and Queensland doctors, is the final straw that's broken the camel's back.  And doctors are saying, well listen, at the moment we're trying to sort of do the right things by a number of groups and society, just for the reasons that Helen has just outlined, because they are needy and they need to be looked after. 

The reality is that DVA patients are one group that the doctors have particularly tried to ensure that we maintain services for- -

DUFFIELD:          Right, DVA?

GLASSON:           DVA, that's the Department of Veterans Affairs.

DUFFIELD:          I'm sorry, yes, right.

GLASSON:           We've got our public hospitals where doctors service our public hospitals in a visiting capacity, and again that's subsidised largely by the doctors, in the sense the cost of running your practice is not offset usually by what you get paid to go to hospital.  But you do it for the reasons of wanting to teach, wanting to service our public patients, and making sure that those people who are in need get the care that they do need.

DUFFIELD:          Right.

GLASSON:           Plus a lot of other pro bono work, whether it be to the colleges and teaching, whether it be overseas aid work, you know, aid to East Timor et cetera, those sort of donations in time and service that the doctors give, is usually done at no charge for good reasons. 

And so on one end they're being sort of forced to pay more and more, patients are being forced to pay more and more, and my main concern is that it's the patients out there that are funding this system. And every time there's another charge put upon the doctor, then simply they pass it on to the patients. 

But the reality is you can only pass on a certain amount, beyond which patients can't afford to pay. So gaps are increasing, and patients are saying, well listen, I can't afford the private health insurance, combined with the gap, I've got to drop out of private health insurance, and fall back on the public system.

So there's this vicious cycle, a spiral of decreasing services, doctors becoming totally disgruntled with the system.  All they're saying is, listen, just fix it, once and for all.  But this has been going on now for two or three years or more.

DUFFIELD:          Yes.  Now with the medical indemnity levy, how did the government decide on what that levy should be?  How was that, and what sort of consultation was there in determining what that levy would be, and how it was worked out?

GLASSON:           Tricia, what they did, they said, what you paid for your premium for the year 2000, in June of 2000, they said, we'll charge you 50% of that premium, and we'll charge if for every year up until we recoup the $460 million.

DUFFIELD:          Right.

GLASSON:           Now the reality is, particularly for a lot of our females, who in June 2000 may have been full time obstetricians, or full time ENT surgeons, or full time specialists in whatever the field, including general practice, and now are having a family, have got children and may only be working say one or two days a week, or maybe not working at all, while they're bringing their family up- -

DUFFIELD:          Yes.

GLASSON:           - - are suddenly finding they've been hit with this bill for $200,000 odd, and they're saying, well listen, I'm not working, I'm working minimally, and so if I've got to pay the $100,000 premium, then the call which is another $20,000, and then the next levy of $100,000, they're just saying, you know, one plus one doesn't equal two.

DUFFIELD:          So was that levy imposed without looking at any sort of flexibility? Because that seems that it would take into account those who are not working the same numbers of hours or days, or whatever, that they were in 2000.

GLASSON:          That's exactly right.

DUFFIELD:          Well that's silly.

GLASSON:           So what we've said to our members is, for goodness sake, what we want you to do is don't pay the levy for the time being, just put it at the side of your drawer, put in your exceptional circumstances situation, that you've changed your modus of practice because of whatever reason.  A lot have retired or whatever, changed their practice to another region, as well as having families, and if there's a huge block out there, which I'm sure there are, that are being impacted by this, then we've got to revisit this whole thing.

And the reality as well is doctors are saying, listen, we will put our hands in our patients' pockets yet again, if we knew we could have a sustainable system in the long term.  But the current system Tricia, is not affordable, and it's not secure.  And until we have those two elements, then the profession, and more importantly, our patients, are going to be put in predicaments where they just have an unviable situation.

DUFFIELD:          Yes.  Now there's talk in some of the papers this morning about a walk out.  Would it be something organised by doctors in some sort of public display?  Like a whole pile of doctors actually walking out of Westmead Hospital, or something like that?

GLASSON:           I mean I hope it doesn't come to that, I hope the government... I'm going down to Canberra tomorrow morning, I'll be down there Thursday, Friday, I hope that common sense will prevail, because in reality the only people who end up getting hurt in this equation are the patients, and they're the last people that we want to hurt. 

And so doctors often find themselves in a difficult situation, where they want to continue to provide service, and they want to do the right thing, yet on the other hand, unless some action is taken definitely, they'll just, you know, drag this out further and further.

DUFFIELD:          Yes.  Doctor, I know I put this to you before, and I guess I'll ask it to you today because we've been talking about poverty on the program this morning.  Is it also a case though that doctors and some specialists, are perhaps wanting to hang on to a lifestyle that this country can no longer afford, that the profession itself can no longer afford?  Do you think there's any sort of attitude like that?

GLASSON:           Tricia, if I thought that was a reality across the board, then I would be getting up and making a noise about it.  The reality across the board is that the average doctor out there who's trying to provide a service, particularly in general practice, I mean, talk about a lifestyle, they have been funding a system for the last 15 years where really in reality they have been paid less than the person running the corner store, and that's not degrading the person running the corner store, but they're putting in similar hours to the person in the corner store, but can I suggest they're taking a huge amount more responsibility, have a huge amount more training, and society has not recognised that in any way in the financial recompense they've been getting.

DUFFIELD:          Right.

GLASSON:           And so the reality is that a lot of the doctors are saying, well listen, it's all very well to be noble for 20 years, but if I come out at the end with sort of nothing to fund my retirement or whatever, then it's not worth it.  So the reality is that general practice particularly, has been under funded.  But even across the special areas now, is the cost of the system, both for indemnity and ongoing sort of accreditation et cetera, et cetera.  It's an expensive small business.  And unless the returns are there in the small business, then the financial reality is that it's not worth being there.

DUFFIELD:          No.

GLASSON:           So I don't think it's really a whole... you know, across the board doctors are not... I think most of them live a fairly mediocre lifestyle, they don't really ask for a huge amount. All they really ask is something that reflects I suppose their training and their skills, and I suppose reflects their independence. 

And I think what's been happening is the government is attempting to interfere with that doctor/patient relationship more and more, and a lot of doctors and saying, enough's enough, don't tell us how to practice medicine, for goodness sake, try and fund the Medicare so that we as patients can get an acceptable rebate.  But at the moment the rebate the government's offering is unacceptable from the point of view of what it costs to provide the service.

DUFFIELD:          Yes.  And I guess as you say, what's going to happen in hospitals if a lot of these specialists say, look, I'm not going to go and do work in public hospitals and so on, I mean we're going to start seeing those queues in hospitals extend? 

Now one point that you made this morning that you - no sorry, that someone else made - but I'll get your feedback on this.  Professor John Dwyer saying that we might need to have hospitals which are exclusively emergency and some hospitals that are exclusively for the elective surgery and so on.  Do you see that as being a workable situation?

GLASSON:           That's an interesting concept.  I think we've got to start to play around with different ideas, different models, because I think the model we're using at the moment is not working.  So I agree with Professor Dwyer that we have to be a bit more innovative and interesting. 

I went to a series of lectures on Saturday in Melbourne, run by the Indigenous Doctors Association, and they've got some very interesting models of care that they've been looking at, at the moment. 

I do think we have to think laterally, we have to redesign the system, to take aboard the fact that we're dealing now with chronic disease.  Eighty-five to 90% of what we're dealing with is people that are living longer than ever before, and we're dealing here with people with chronic disease, not acute infective problems, or acute emergencies, they are there.

But the big problem is this load of chronic disease that we as a society haven't come to terms with, neither how to fund it, and probably neither looking at the best model to deal with it.

DUFFIELD:          Yes.  Interesting points, and look, I do hope that you can perhaps get some sense happening in Canberra before you have to do any sort of walk out, and affect people like veterans and so on.

GLASSON:           We hope so, because at the end of the day, only one person gets hurt on this occasion, and it's always the patient.

DUFFIELD:          Always, yes.  Well thank you very much for your time this morning. Thanks a lot.  Bye bye.  Dr Bill Glasson, who is president of the AMA. Fingers crossed about that visit to Canberra.

Ends