Presidential Statement - AMA Annual General Meeting

The first thing I'd like to say this morning is thank you to the AMA membership for having the confidence and trust to have me as your President for another year.

I thank you also for the huge vote of support for the whole leadership team.

I believe we are right on target.

While at times, especially this week, it may have seemed like the year of living dangerously, I prefer to think of it as the year of lobbying decisively.

I'd like to now look back on some of the highlights of the past year, then set out some of the challenges ahead of us.

Let me just say that my first twelve months in this job have not been dull.

Far from it. There has been action aplenty. Lots of issues. Lots of battles. But above all - effective advocacy.

The AMA has stood up for what is best for doctors and our patients, what is best for the Australian health system.

We wrote letters, we sent faxes, we polled, we had meetings, we held focus groups, and we even used the phone to get our messages across.

We met with backbench groups, frontbench groups, cross bench groups - if there had been a park bench group we would have met with them, too - and we had a Parliamentary Breakfast.

We spoke to the Prime Minister, the Opposition Leader, the Democrats Leader, the Shadow Health Minister, and we even had a chat or two with the Health Minister - and what chats they were.

And we engaged the media - media releases, doorstops, media conferences, radio interviews, talkback, TV shows, magazines, Internet news, the all-important medical press, and the letters pages.

Our messages, responses, opinions and advice got wide coverage.

If feedback from members is any indication, we're on song. If feedback from non-members is any indication, we're singing in tune. And if public opinion is any judge, we have a chorus with orchestral backing.

Just how did we fare on the major issues?

RVS

The RVS has underpinned much of our activity over the past year.

After seven years of painstaking work by the AMA and the Government - of both political hues, I remind you - the RVS was completed.

And what happened to it?

Our Health Minister, Dr Michael Wooldridge, disowned it. He stuck it in a bottom drawer, locked it, and threw away the key. He hoped it would go away. Even the 'too hard' basket was too close for comfort for the Minister.

Then what did he do? He set out to plot against it. The Budget outcomes for Health this week are proof positive of this strategy.

The RVS - warts and all - is the key to the survival of the Australian health care system for at least the next twenty years or so.

The RVS produces a defensible outcome if looked at in terms of the impact of the RVS on fees charged.

RVS fees are 48% above current fees charged by GPs.

They are 22% above what Consultant Physicians currently charge, and 4% above what Surgeons charge.

The approach of some GP groups has been monumentally disappointing with respect to the RVS.

They failed to show commitment to RVS implementation.

They succumbed to the Minister's predictable divide and rule strategy.

And they echoed the Minister's GPs versus specialists lines.

Like the Minister, they completely miss the point.

It's all about our patients' rebates - whether they see a GP or a specialist to whom they are referred. It's all about the size of the gap now and into the future. As this week's Budget shows, the gaps are getting bigger and will continue to get bigger, because nothing is being done to address the problem.

The RVS will continue as an issue until well after the election. We will make the Health Minister wear the RVS and the responsibility for the future of Medicare.

Implementation of the RVS is essential to believability on the question of commitment to Medicare.

Dr Wooldridge failed miserably in this department on Budget night.

Fortunately, it is not the Health Minister who has the final word. We will continue to work and consult cooperatively with those in the Government - from the Prime Minister down - who understand the significance of health issues this and every year.

To quote former AMA President Brendan Nelson from this morning's newspaper…"I think if you asked members of the Government what the AMA was currently concerned about, they'd be able to tell you".

Within the medical profession, it is not the grass roots doctors who are wavering over the RVS, it is the leadership of some groups, particularly the RACGP and the ADGP.

They have no mandate to pursue GP financing matters with Government through the MoU or any other process. Their members want the RVS implemented.

Poll after poll and survey after survey have shown that doctors - more than 90 per cent of GPs across the board - members and non-members - want the AMA to lead in negotiations on their behalf.

The AMA gladly accepts that role.

Hard-working doctors don't want the MoU or blended payments or fundholding or scraps ripped from specialist rebates. We want suitable and appropriate reward for our work, and accessibility and affordability for our patients.

Nor will they fall for the oldest trick in the book - doctor against doctor, GP against specialist. That doesn't work anymore.

And nor will doctors and the AMA stand accused by the Minister as having a secret plan to destroy bulk-billing. Bulk-billing is in decline, Dr Wooldridge, because you have abandoned the RVS and you have neglected Medicare and the Medicare Benefits Schedule. The fault is all yours. And the patients know it.

The AMA will not be put off by the disappointments for doctors and patients contained in the Budget. We will fight on. We will get the best deal for ALL doctors - for the future of Medicare and the health system - and the RVS is the basis of our evidence-based medical politics.

At the same time, we will resist and oppose every step of the way any attempts to introduce by stealth elements of managed care US-style - the sort of thing you see on Chicago Hope.

We know that some want to do it. We won't let them.

There will be more discussion on the RVS after my speech.

Medical Indemnity

While the Government's rejection of the RVS is all about denying doctors what we deserve, the medical indemnity crisis is all about taking away what we already have - particularly for obstetricians and, more particularly, those in country areas.

The AMA has made strong headway on indemnity this year, but there is still a long way to go.

At the very least, we can say that we have made medical indemnity a major public interest issue.

More Australians can say and spell obstetrician than ever before..

But if things don't change soon, you won't be able to find an obstetrician in rural, regional and remote Australia.

And my colleagues in urban general practice agree it is getting harder to book our pregnant patients into their obstetrician of choice.

The medical indemnity crisis - heightened by the demise of former insurance giant, HIH, and the threat of medical services being lost to many communities - has caught the attention of many politicians, too.

The NSW Government has been quickest to respond with legislation on tort law reform.

This is a good start but more needs to be done if premiums are to fall and medical services are to be preserved.

MPs and Senators from all sides of politics are hearing the message from their electorates that medical services are threatened unless there is urgent and decisive political intervention at State and Federal levels.

The message, thankfully, is starting to filter up, and the AMA has received direct positive feedback from Ministerial and Shadow Ministerial level.

Our call for structured settlements is getting a good hearing in political circles but, as usual, there is precious little coming from the Health Minister.

Our lobbying of politicians and health bureaucrats and insurers has been non-stop this past year and it will continue until we have a substantial outcome - an outcome that keeps doctors in work and maintains important medical services, locally, for all who need them.

Trade Practices Act

Someone who could do with some important medical services is ACCC Chair, Allan Fels. He needs reconstructive surgery on his Trade Practices Act - and fast.

Along with boxing, Mr Fels should be banned - banned from persecuting doctors with outdated and inappropriate legislation.

The Trade Practices Act 1974 is based on US anti-monopoly laws that were aimed at railroad and petrol monopolies.

Now, here we are in 2001 and the Trade Practices Act - like the Sword of Damocles - is hovering over the heads of doctors as they try to set rosters or negotiate with hospitals or cooperate in the time-honoured way to deliver quality care and training.

Rather than sit down and talk openly and honestly with the medical profession as a whole, Mr Fels cherrypicks doctors or groups of doctors and menaces them with the TPA.

He's had a go at the anaesthetists in Sydney. An out of court settlement by the anaesthetists to get the ACCC off their backs has been hailed by the ACCC as a great victory. A victory over what? There was NO finding of wrongdoing by anaesthetists in regard to the TPA in that case.

The anaesthetists had legal opinion that f they fought on they would most likely win. They made a commercial decision to settle. It is a disgrace.

Then there is the Royal Australasian College of Surgeons. They have to pay large sums of money and divert their energies from education while they get ACCC authorisation to continue their role in surgical training. Another victory? I think not.

And over in WA, the Joondalup case is nearing its end. When it is completed, you will be amazed and angry at the outcome.

Once again, a commercial decision to settle because, after $400,000 in legal costs, it is just too expensive to keep fighting this war of attrition.

The AMA agrees that doctors should not be allowed to form large monopolies and hold patients to ransom, but we should be allowed to cooperate to deliver quality care and training.

We support the appropriate application of the TPA to genuine breaches of the spirit of the law within our profession.

But the current approach to trade practices in health is all about misplaced ideology, not well placed policy.

The legislation is so non-specific the only way it can be applied is for the ACCC to amass case law against the profession. This would explain the virulent attacks against various groups in recent years.

The AMA believes the TPA, as it is currently being enforced, is anti-doctor and anti-patient.

We will continue to contest its application where it unfairly restricts and hinders doctors in caring for their patients. We will continue to educate our members about the TPA and keep them informed of the debate.

And we will continue to press for an independent inquiry into the unintended consequences of the TPA to health, and the activities of the ACCC.

And let me state for the record - the AMA is not advocating blanket exemption from the TPA, just common sense.

Corporatisation

Many of our members have this year had first hand experience of corporate medical practices.

Corporatisation has gained a level of momentum that none of us could have predicted.

With the viability of private general practice under greater threat than ever before from higher costs, an outdated MBS, more red tape and the GST, many doctors are joining the corporates.

For those making the decision, it is the job of the AMA to inform, educate and advise our members. They need to be able to make informed decisions about their future. It is not just a career choice, it is a life choice.

Our workforce policy team has been in discussion at both ends of the corporate equation - with the employers and the employees, including potential employees.

We released a Doctors Information Kit to help the doctors make the right decision, and we will shortly release a code-of-conduct to ensure the employers protect the rights and conditions of these doctors.

Corporate medical practice will continue to grow and spread in Australia.

It is our job to ensure that quality of care is enshrined and clinical independence of doctors is maintained - and look after our members and their patients.

Public Hospitals

At a time when corporate medical practice is thriving, our public hospitals continue to be overused, under-funded and under-resourced.

I have visited quite a few around the country and it's the same story wherever I go - long waiting lists, longer working hours without a break for doctors, ambulances doing laps of the block, and low staff morale.

There is also a brain drain from the public hospital system with senior consultants moving over to the private sector.

We don't have a national policy on public hospitals in Australia. There is no national set of standards for our public hospitals.

But we do seem to have a national set of problems.

The AMA has been lobbying and will continue lobbying all the political parties to ensure public hospitals are at the top of the list of policy announcements for the next federal election.

Despite our calls - and the calls of the Senate Community Affairs References Committee - for an extra $225 million in public hospital funding in this year's Budget, it has not been delivered.

Public hospital funding is not the sort of problem than can be put aside and put aside again. When the system breaks, lives are at risk.

The AMA this year, next year and every year will make public hospital

funding and the pursuit of national standards a priority.

The Prime Minister is on the record as saying public hospital funding is one of the toughest policy decisions facing any Government. Perhaps that is why the Queensland Government has been so concerned about our TQA survey that they have gagged their employees.

Private Health Insurance

On the other side of the coin, we maintain our support for responsible, affordable, value-for-money private health insurance.

But, while we welcome the no-contract aspect of some no-gap products, we would like to see less coercion from the funds with these products, and we have yet to see a no-gap product which satisfies AMA criteria.

At the very beginning of my Presidency, legislation was passed by the Parliament to provide for Gap Cover Schemes without individual doctor/fund or doctor/hospital contracts.

It did not replace the dreaded Lawrence contracts but was intended as an alternative to it.

A negotiating group was formed to discuss with health funds the AMA expectations of Gap Cover Schemes. Headed by Dr Wainwright, this group included Dr Brazenor, AAS, Dr Westhorpe, ASA, and Dr Rosenberg, Special Interest Group of Surgeons and Opthalmologists.

Executive Council approved a set of key principles for the negotiating group.

Most of the major health funds (except AXA) have now submitted - and had approved - a Gap Cover Scheme.

The one that most closely matches our core principles is the Australian Health Services Alliance product. AHSA represents a collection of small funds covering more than 20% of the private health insurance market.

The negotiating group has recently developed a ranking and rating instrument that is about to be sent to the health funds for comment. If the AMA produces a ranking and rating instrument, some fund will come first and some fund will come last. Those coming last may see commercial sense in moving closer to AMA principles.

It is vital we get this right. The huge increase in the level of participation in private health insurance will only survive if the health funds offer products that contributors and providers are happy with.

Public Health

While we may be in the headlines and giving politicians an earful over the RVS, Medicare, the TPA, indemnity, corporatisation, and public hospitals, our commitment to public health issues remains rock solid.

I'll run through them briefly.

Indigenous health is always high on the list of AMA priorities.

Indigenous Australians remain the poorest of any group in Australia with lower life expectancy, higher infant mortality rates, and a host of other problems.

I visited a number of communities in the Kimberley and the Northern Territory last year and I'll see more soon. I would have hoped to do so with better news from the latest Budget, but that was not to be.

We called for an extra $245 million a year in funding to be reached in stages over several years as suggested by Dr John Deeble in his report on indigenous health. It was not forthcoming.

The AMA will not be silent on indigenous health issues. We will pursue fair and reasonable outcomes to stop the downward spiral.

We remain one of the Australian community's loudest critics of smoking with regular calls for more funding to combat the habit and educate the public, particularly kids. The AMA is supportive of moves to introduce so-called cigarette 'shock packs' to Australia.

Tobacco, alcohol and illicit drugs were the focus of a very successful roundtable convened by the AMA this year.

All the major players joined the AMA in calling on all governments for more funding and better programs to combat these social and health problems.

Our work in this area is tireless and ongoing.

We have a full-time dedicated youth health adviser who is funded by the Commonwealth Bank.

Under this program, the AMA has conducted campaigns on body piercing safety and youth depression, and a comprehensive policy agenda for youth health is nearing completion.

Our views on boxing have this year been canvassed widely. Ban it.

We came out in support of an Australian study into DVT. Fund it.

We said the Government's IVF Bill was ill-conceived.

We had a view on PBAC.

We led the debate on privacy.

You may have noticed we had a lot to say about the alleged Budget leak on cholesterol drugs, diabetics, GP finances and specialist rebates.

And this week we maintained our strong line on cholesterol-lowering drugs - a clinical opinion, not an economic one. And I must thank Dr Paul Hemming and the Royal Australian College of General Practitioners for their strong public support for the AMA's stance and my medical qualifications.

We had a view - or I should say I had a view - on the Government's new GP Education and Training company.

We sought to address the gap between orthodox medicine and complementary medicine and will continue to do so at this Conference.

Aged care is an issue championed by the AMA. Our ideas and policies are respected and acknowledged by the major parties and the patients and the operators of aged care facilities.

Yet funding for aged care places actually went down at the recent Budget.

We are outspoken on contentious issues such as medical records, ethics and mental health.

And on the industrial front, the AMA has run a successful Safe Hours Campaign for junior doctors and we generally seek better work conditions for all our members. We expressed support for the ACTU's Reasonable Hours claim for all workers.

Amusingly, the Health Minister likes to dismissively refer to the AMA as 'just a union'.

Well, Minister, the AMA may be just a union to you but we have 27,000 members and membership continues to grow, and we have direct contact with millions of patients every year. I think many unions would envy that membership and that growth.

We represent the whole of the medical profession and we are the public face of Australian medicine. Ignore us at your peril.

The year ahead

So, where to from here?

It is clear that the main items on our agenda will remain much the same, at least until the Federal election expected later this year.

Health will be the BIG election issue.

The RVS is still the big ticket item for the whole medical profession, for patients, for Medicare, and the health system generally.

The job this year is to maintain the profession's unity behind the RVS in the lead-up to the election.

We will work to have the other GP groups realise the error of their ways and walk away from the MoU - especially now in light of the Budget's failings. Their members won't be happy with MoU scraps any more. And our patients will not be happy whwn they see their gaps increasing for GP and other specialist services.

The AMA will seek cooperation from the other groups about defining our roles.

We must be at the forefront of negotiations with Governments on industrial, medico-political and financing matters. That's what doctors want.

The RACGP should endeavour to regain its role in GP training and education.

The ADGP is best at local support for GPs.

And the RDAA's role is clearly defined and its political effectiveness heightened due to the political focus on rural and regional services.

Despite the ACCC's assertions we are not competitors, we are colleagues.

With each group sticking to its strengths and not doubling up or opposing the activities of the others, the best interests of all GPs - of all doctors - will be served.

This is what grass roots doctors want. Polls show it. Research shows it. Focus groups show it. Direct contact proves it. And common sense demands it.

The winners will be the medical profession, the patients, Medicare, and the broader community.

There is strength in unity that Governments cannot ignore.

The AMA will continue to pursue positive outcomes on medical indemnity.

When the smoke settles from the HIH 'bushfire', we will be in better position to assess the state of play and our next moves.

As I said earlier, the public is now well informed of the problem and governments are now more prepared to act. We will keep them up to the mark.

Once our code of conduct for corporate medical practice is out and about, we will step up our dialogue with the corporate employers to ensure security and peace of mind for our members.

We will continue our calls for better funding for our public hospitals.

I will spend a lot of time over the next year on public health issues.

We need to ensure that strong and responsible long-term public health policies are on the table at the Federal election. The parties must plan for the longer term, beyond the next electoral term.

And, no doubt, my duel with Mr Fels and the Trade Practices Act will continue until the Government - this one or the next - calls an independent inquiry into the TPA and doctors.

With a bit of luck, common sense will prevail sooner.

But, above all, the AMA's agenda in the coming year must involve better outcomes for patients, the revival of Medicare, ongoing viability and professional independence for doctors, and the securing of a health system that will serve the Australian community beyond this generation.

The medical profession is fundamental to the Australian community. Doctors - all doctors - are important and valued members of their local communities.

The AMA values greatly its role as the peak body representing health professionals in this country, and I am especially proud to be its President.

Thank you all for your hard work and your support.

The last year has been big - big issues and big successes. With your support, the next year will be even bigger.

Thank you.