Professor Dobb: Speech to the AMSA Leadership Development Seminar, Monday 12 September 2011

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Leadership in Health Reform

I acknowledge the traditional owners of the land on which we meet today.

On behalf of the AMA, I welcome this wonderful gathering of medical students to Canberra.

You are the future of medicine in this country.

You will be leaders in the health policy debate in the years and decades ahead.

The AMSA National Leadership Development Seminar has been a popular and significant event for quite a few years now.

It is an event that has some clout – just look at the list of Ministers, MPs and Senators who will be speaking to you over the next couple of days.

Medical students and the AMA

You already have influence as medical students.

You will have real influence as senior doctors.

That is why the AMA is a strong supporter and partner of AMSA.

Your members over the years have moved on from AMSA to the AMA Council of Doctors in Training and then continued in the AMA at both State and Federal level in leadership roles.

Your President is a full member of the AMA Council – our peak decision-making body that formulates and progresses AMA policy, which in turn informs or challenges Government policy on health and relevant aspects of education, training and research.

They say that politics is seductive.  Medical politics is equally so.  I became involved as a student, getting elected as President of my Medical School Student Society on a platform of having student input to key medical school committees – a totally radical position at the time!

This led to national involvement and then an ongoing commitment to advocacy on behalf of my colleagues, and for a better health service so our patients receive the best care we can make available to them. These are key roles for both AMSA and the AMA.

A close working relationship with AMSA is very important to the AMA.

Addressing issues raised by medical students is core business for us.

You can be absolutely assured that students have strong input into the work and activities of the AMA and not just on our Council.

AMSA also has nominees on a range of AMA committees, including the AMA Council of Doctors in Training, the Public Health and Child and Youth Health Committees and our Ethics and Medico-legal Committee amongst others.  We really value your input.

And that includes input on the Government’s health reform agenda.

Health reform

Many of us working in health were excited by the promise of real health reform.

The Rudd-Roxon roadshow and the recommendations from the Garling report promised much.  However, at the end of all the rhetoric, we are left with some new bureaucracies including new Pricing and Performance Authorities, more reporting, but after push back from the States it’s business as usual on the ground with no greater clinician involvement in health management than before, except perhaps in New South Wales.

Even the much-vaunted Medicare Locals at this stage appear to be nothing more than a new bureaucracy, with only their organisation being public and what they will do and how they will deliver it remaining unclear.

So any talk on leadership on these health reforms would be over almost before it began.  Instead, I will concentrate on the leadership provided by the AMA on issues that are directly relevant to everyone here.

Medical workforce training

In 2004, the AMA identified that the Commonwealth Government’s moves to increase medical student numbers would have significant ramifications for medical workforce training.

We knew that a strategy was needed to ensure that student increases were matched with similar increases in prevocational and vocational training positions.

Working collaboratively, the AMA and AMSA have delivered real outcomes for medical students.

Our advocacy for more resources and support for medical workforce training has delivered results, including significant funding increases for training as part of the COAG health funding deals.

We have seen funding boosts for clinical placements, the prevocational GP training program, the GP training program, and specialist training places in the private sector.

We have also seen Health Ministers agree to develop a national training plan through Health Workforce Australia, which will attempt to forecast the required number of medical training positions through until 2025.

We organised the medical training summit last year, which brought together all the major players in medical training in the country.

A joint statement on future training needs came out of that Summit and strong challenges were put to all governments.

It is clear that more still needs to be done.

Despite the extra investments so far, the number of prevocational and vocational training places currently fall well short of what will be required as graduate numbers grow.

The Commonwealth has invested heavily in new training places for medical graduates.

But we all know that it’s the States and Territories that look after training places in public hospitals.

Every effort needs to be made to encourage these governments to invest more money in creating quality training places.

Without it, we will waste the investment being made in medical graduates and will fail to secure the medical workforce Australia needs for its growing and ageing population.

The ability of the Australian healthcare system to provide quality clinical teaching and training to the higher numbers of medical students and graduates coming through the system will remain a key issue for the AMA.

We work constructively with the AMC, the Medical Board of Australia, Medical Colleges, medical academics and organisations, and government agencies to develop policy and projects to address these issues.

The AMA supports medical students and works with AMSA in other ways that maybe are not so obvious.

Let me give you a few examples.

Working abroad

We know medical students and junior doctors are increasingly interested in working abroad.

A significant number of trainees undertake overseas placements alongside their formal prevocational and vocational training, particularly in humanitarian or development settings.

Organising overseas work is not without its challenges, however, and identifying current and relevant sources of information can be difficult.

The AMA and the AMSA this year produced A Guide to Working Abroad in response to these issues.

The Guide is easily available through the MJA and AMA websites and provides advice about all aspects of preparing for an international experience, including managing personal and professional affairs abroad and re-integration on returning home.

National consistency in medical training

We are also working in tandem to address two other issues: national consistency in nomenclature and Australian Qualifications Framework alignment for primary medical qualifications across Australia, and the inadequate funding for higher education.

The AMA is concerned that a two-tiered system of primary medical qualifications could emerge if the MD is ranked at a higher level than the traditional Bachelor of Medicine, Bachelor of Surgery (MBBS) within the Australian Qualifications Framework (AQF), based on its status as a Professional/Advanced Masters level degree.

This would seem incongruous with the fact that all medical programs are accredited according to the same national standards, as set by the Australian Medical Council.

Perceptions of a two-tiered system would be reinforced if universities offering the MD qualification were to market it as superior to the MBBS, and there are indications that this is already occurring. 

The emergence of Masters-level degrees also creates an opportunity for universities to re-introduce full-fee paying domestic places, which has significant implications for workforce planning and postgraduate training.

Many of us have advocated strongly for equity in access to medical training places and it would indeed be a backward step if the gains that have been made in recent years were to be undone by the ability to pay becoming a major determinant of access to medical training.

There is a clear need for medical places to be linked to robust workforce modeling and there is already evidence of good work in this area by Health Workforce Australia under the leadership of its Chair Jim McGinty and CEO Mark Cormack.

This is fundamental to effective medical workforce planning, particularly in the context of escalating graduate numbers.

The AMA is concerned that domestic full fee paying places in medicine will, over time, undermine the Commonwealth's ability to match medical workforce requirements to community need.

As the Medical Deans alluded to in their submission to the Lomax review, there is clearly a complex interplay between higher education funding, fees policy, clinical training capacity and access to postgraduate places.

Obviously, the pressure to expand full fee paying places would be greatly diminished if the Commonwealth significantly increased its funding contribution to the costs of university medical school places.

The AMA supports, and is actively lobbying for, the recommendations in the Medical Deans’ submission to the Lomax review calling for an increase to base funding so it is aligned with the real cost. 

We have been actively engaged with the AMC and vocal to the Board about our position on the standards for general registration at the completion of internship.

We are particularly concerned about ensuring that the emergency medical care term proposed by the MBA is appropriately defined so that it provides genuine exposure to emergency medicine, and preserves the quality of clinical and professional experience during the intern year.

Current AMA projects

Other current AMA projects include:

• Securing funding for a pilot through the Specialist Training Program to secure funding for vocational training in overseas settings;

• Exploring the development of key performance indicators to measure the quality of training in the face of expanding graduate numbers;

• A system for national intern allocation to give graduates access to a range of internship positions across the country and to better inform the recruitment and selection processes in each State/Territory;

• Working with stakeholders to secure funding through the HWA for models that would provide support to supervisors as well as medical students and postgraduate doctors; and

• Developing guidelines for the use of simulated learning environments as an adjunct to hands-on clinical training.

Safe hours and work/life flexibility are also priorities for the AMA.

The 2011 AMA Safe Hours Audit of junior and salaried doctors has just finished.

Junior doctors were able to enter their roster details and access an instant risk assessment report, showing an analysis of the fatigue risks of their roster.

The results will be published in a nation-wide report on the working hours of junior and salaried doctors. 

The AMA will continue to strive for a balance between safe working hours, work/life flexibility, and maintaining the quality of the training experience.

We are also active in our advocacy and in the media on issues that are very important for medical students.

We have strong informed positions on anti-smoking measures such as plain packaging.

We have strong informed positions on combating obesity.

We have strong informed positions on alcohol and substance abuse.

We work with the World Medical Association to ensure there are protections for doctors working in world trouble spots.

We raise concerns about the health effects of global warming.

We are active on global health issues generally.

And we spoke out in support of the health needs of asylum seekers and refugees.

Next year is the 50th anniversary of the AMA.

Our national Conference in Melbourne will cover issues areas such as women in medicine, health workforce, and research in medicine and global health. 

It is an opportunity to launch a re-branded AMA, and a chance for students and young doctors to be actively involved in the plenary sessions and workshops.

The AMA works hard for medical students.  As I said, you are our future.

I hope the close partnership between AMSA and the AMA sees many of you here today progress to leadership roles in the AMA.

The AMA is the strongest voice in the country for the medical profession and the patients in our care.

The politicians you will meet over these two days listen to us and often take our advice.  When they don’t, we make a noise.

I wish you every success for this Seminar and every success in your careers.

Thank you.

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16 September 2011

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