Interview - Dr Kerryn Phelps, AMA President with Neil Mitchell, Radio 3AW Morning Program. Discussion: Federal Government changing the rules in relation to private medical insurance and implications for medical practitioners and patients
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MITCHELL: Now, this is something which I've really just stumbled across by talking to a few doctors. It's something happening in the medical profession, and to me this sounds terrifying. It's got huge implications for patients.
Now, this is sort of sneaking through. It hasn't had a great deal of attention, but it's due to become law in a couple of months. The Federal Government's doing it.
Basically, what they're doing, the changes they're introducing, and it's in the insurance area, I'm told could lead to a shortage of doctors, particularly obstetricians, neurosurgeons and orthopaedic specialists. So don't have brain surgery, a baby or a busted leg.
It could cost you more as a patient. It could make it hard to get treatment. It could mean people suffer and, worse, I know doctors who are simply going to stop delivering babies because of this situation, because if they don't they're putting their whole family on the line, their whole future on the line every time they walk into a labour ward.
On the line is the President of the Australian Medical Association, Dr Kerryn Phelps. Dr Phelps, it sounds complex. The bottom line, I suppose, what does it mean to patients?
PHELPS: Well, what it's going to mean to patients are two things. One is that there may well be a reduction in services, particularly in the high risk procedural areas, and the second thing is that they will have to pay more for those services when they can find them.
MITCHELL: What sort of services do you mean?
PHELPS: Well, if you're looking at the areas which are most likely to be litigated, you're talking about obstetrics, so someone to deliver your baby. You're talking about neurosurgery, so the doctors who operate on spines, who might take out brain tumours; and the surgical procedures like orthopaedics.
MITCHELL: And you say that it could be, what, more difficult to get those services, and you've got to pay more, and that's fairly heavy stuff for any patient to hear.
PHELPS: I think it's very difficult, and that's why we've been at the AMA fighting so hard to make sure that not only is the medical indemnity industry stable and secure for patients and for doctors, but also so that the State Governments are prompted to, as soon as possible, put in place the reforms that they need to put into their legal processes so that not only is the system less expensive, but that there is less likelihood of litigation, and, of course, a part of that also is whatever risk management we can put in place which means reducing the risk of something going wrong in the system.
MITCHELL: Well, what will be the situation if I want ... I need a baby delivered or I need neurosurgery, I need orthopaedic work, what will I do as a patient?
PHELPS: Well, this is the real concern for us at the moment because these are specialties that you don't learn overnight and they are a very, very valuable resource to the community, and if we lose the expertise from the community of those people it can take a generation to regain it, if ever.
MITCHELL: Will I have to wait for treatment? Not much I can do if I'm having a baby, I suppose.
PHELPS: Yes, well, I think that the concern there is that if you get into trouble and there's not an obstetrician available that there could be devastating consequences for the mother and the baby.
Now, we already have towns around the country which don't have an obstetrician, and women are having to travel distances, and sometimes long distances, and are away from their other children for a period of time while they wait to have their baby in a centre where there is an obstetrician available.
MITCHELL: That sounds ... I mean, that sounds potentially dangerous.
PHELPS: Well, of course it is, of course it is, and it's no coincidence that we have one of the best safety records for mother and child health in the world, but that's only because we've got really high quality obstetric care.
Now, if we lose that high quality obstetric care, sooner or later we're going to see a reduction in the positive outcomes for mothers and babies, and that is tragic.
MITCHELL: A reduction in the positive outcomes. That means more deaths.
PHELPS: Yes, it does, and more bad outcomes, so, babies born with problems and problems for the women when they're having the babies. Now, that's obviously very serious and what we're trying to do is to keep doctors working, because doctors want to keep working.
They're in the profession because they want to look after patients and they want to provide the care, and you would know from your friends who are doctors that we are absolutely perfectionistic about our work. We want the best for our patients and sometimes things do go wrong and that's why we have this insurance in the first place.
MITCHELL: Well, as I understand it, the changes would mean that you didn't have ... you couldn't, in fact, get unlimited insurance. Is that right?
PHELPS: No, that's right. There will be a change to the way doctors can be insured which will come into legislation on the 1st of July or the 31st (sic) of June is the changeover.
So, at the moment, the way doctors are insured, they are insured for any claim that happened during the period of time that they are insured.
MITCHELL: Yes.
PHELPS: What that changes over to is what's called claims made cover, so what that means is that you can only be insured if you are currently insured at the time that the claim comes in, so that ...
MITCHELL: So the claim has to be made in the period you've insured, not just incurred in that period.
PHELPS: That's exactly right, so the difference is that whereas up until now you could afford to retire and if you were insured right the way through your career, you could safely say, well, I'm hanging up the doctor's bag next week and then you could quite safely know that your medical insurance that you paid through your career would cover you in retirement.
What's happening now is that you're going to have to take out insurance for your retirement and through your retirement. So let's say in 10 years time you decide to retire, you've got 10 years worth of possible claims that could come up, because under the laws in certain States you can still be sued for 24 years or more.
And so if you're still having to pay your insurance but you're not getting an income ...
MITCHELL: Yes, hell, yes.
PHELPS: ... and in the case of obstetricians that could be a hundred thousand dollars a year, I mean, who's going to be able to afford to retire?
MITCHELL: Well, yes, exactly, who's going to be able to afford to practise obstetrics, too?
PHELPS: That's right. Well, some doctors are making the decision to go over to the public sector, but once again they're saying, well, I don't know if I can afford to go to the public sector, because I'm not going to be making the same income, I'm not paying the same insurance, but I'm not making the same income as if I was working in the private sector, even though my claims are going to be covered, and this obviously depends on which State you're working in, and so then they are facing the situation, well, I can't even afford to go and work in the public sector and pay my insurance premiums.
MITCHELL: Is it correct, too, that it won't be possible to get unlimited insurance, so you could be ... if you've got a cover for $2 million you could be sued for three and have to pick up the extra million?
PHELPS: Yes. Well, what is looking like happening at the moment is that there'll be cover by the medical indemnity providers under insurance contracts up to $15 million, and the Federal Government as part of its rescue package has said that they will cover from two million to 15 million, half of, not the whole lot, 50 per cent of that figure.
What happens to the claim in, say, 10 or 15 years time ...
MITCHELL: Well, exactly.
PHELPS: ... that comes in at 20 million?
MITCHELL: Well, does the doctor have to pay it?
PHELPS: Yes, the doctor is liable for that amount over 15 million, so ...
MITCHELL: But that means any doctor's putting their whole family on the line, if they're practising, surely.
PHELPS: Well, they are, and certainly if they've retired they're in big trouble. So, you know, this leaves them in a very difficult position that, you know, what do they actually do?
MITCHELL: It sounds like the potential for one hell of a mess.
PHELPS: Well, it is, and we're working very hard with the Government and the Prime Minister's task force to try and address this problem, but at the moment we don't seem to be getting a lot of sympathy from the people who are coming up with this legislation, and it's coming into force very soon. It's going to be in Parliament within the next few weeks.
MITCHELL: Thank you very much for your time. I appreciate it. We'll get on to Government about it. Thank you.
PHELPS: Thank you, Neil.
MITCHELL: The President of the Australian Medical Association, Dr Kerryn Phelps. And we will get on to Government about this, because it just has been very quietly sneaking through. Dr Kerryn Phelps.
Ends