OBSERVATIONS FROM AN OVERSEAS TRAINED DOCTOR

Good afternoon, ladies and gentlemen, members of the media, and everyone with an interest in medicine and health in this country.

It is a pleasure and a privilege to speak at the National Press Club as President of the Australian Medical Association.

I speak on behalf of AMA members and all the doctors who care for patients and serve the Australian health system every day.

I welcome you also to Family Doctor Week - the AMA's annual tribute to Australia's hardworking GPs.

Good on you, GPs. Keep up the good work.

Our GPs are highly skilled, motivated and ethical health care experts who are a valuable resource to guide individual Australians and their healthcare.

To the nation as a whole, they provide an accessible and cost-effective method of providing top-notch services to the population. We must support them.

Well, the time has come, the Walrus said, to talk of many things.

But first - allow me to introduce myself.

My name is Mukesh Haikerwal.

As I have explained to radio journalists at 6.00am on many mornings over the last few years, that is:

M - U - K - E - S - H - Mukesh

H - A - I - K - E - R - W - A - L - Haikerwal

Hard to pronounce. Easy to remember.

I was born in India. I was raised in West Africa, my early years in pre-independent Nigeria.

I was schooled and nurtured in the United Kingdom where I gained my medical degree and post-graduate training.

I am an Australian citizen. I live with my wife, Karyn, and three boys in Melbourne.

I have two brothers - one a cardiologist in Melbourne, the other a computer scientist in the UK. All three of us are married to doctors.

I run a busy general practice in Melbourne's Western Suburbs.

I have a healthy complexion - tanned and ageing well.

Oh, and by the way, I am what is known as an Overseas Trained Doctor - or an OTD, for short.

In some quarters, we are known as IMGs, or International Medical Graduates. But at the moment some of our OTDs are being called far worse things - through no fault of their own.

It is because of one infamous OTD known as Doctor Death. I could not come here today without mentioning Dr Patel and the tragic events at Bundaberg Hospital.

I won't comment on the specifics of the case. There is a process in train in Queensland at the moment that is looking into it.

But those events in Queensland are reverberating around the country. There are good effects and there are bad effects.

I'll talk about the good stuff throughout my speech, but first one of the bad effects.

Australia is currently experiencing what I will call 'medical racism'.

Because of the Patel case, doctors with funny names, accents, coloured skin and different backgrounds are getting a hard time.

Some patients are avoiding them. Some patients are abusing them. It is not right. This should not be happening.

Australia is in the midst of its worst-ever medical workforce shortage. We cannot afford to lose any of the doctors we have. We cannot afford to discourage others who are considering coming here to work.

The simple facts are these. More than 20 per cent of our doctors are overseas trained. In country areas, more than 30 per cent are overseas trained. In some places, the only doctors they can get have come from overseas.

As a community, we have to value our OTDs. We shun them at our peril.

Our community and political leaders must get out there with this message as well.

Yes, the Dr Patel saga is a tragedy. Families have suffered loss of life, and loss of quality of life, due to mistakes.

The extent and reason for those mistakes will be known in good time.

But we cannot allow honest, highly skilled doctors to be made pariahs in the communities they are committed to serving.

Because of the negligence of others, they are bearing a burden that isn't theirs. They are under scrutiny for getting a medical degree from overseas. Or for having darker skin. Or a different faith. Or English as a second language.

We have to stamp out medical racism before it takes hold.

Overseas trained doctors do not practise inferior medicine. Nor are they less committed to patient care.

Remember, they are the pick of the crop - the cream of the education system in the countries from where they hail. The All-India Institute of Medical Sciences, for instance, has a competitive entry exam sat by 60,000 high-ranking students. Those 60,000 students are competing for just 45 places each year.

But we still have to fix the checks and balances so we do not have another Doctor Death situation in Australia.

The debate has to be about:

• skills
• training
• quality
• accreditation
• risk management for all
• assistance with language
• providing guidance about the Australian health system
• cultural awareness training
• recognition of qualifications
• and proper mentoring and supervision and management for those doctors we recruit internationally.

It must not be about race. That is too simplistic, divisive and wrong. It is backward-looking and would deprive us of excellent doctors should the wrong line be pursued.

There must be greater tolerance and understanding in the community.

Just look at the AMA.

My Vice President is Dr Choong-Siew Yong - Australian born and bred and educated - and proud of his Chinese heritage.

Our Treasurer is Dr Rosanna Capolingua - Italian by parentage.

Then we have Andrew Pesce - an exotic blend of Italian and Russian.

Across our Board we have a Malisano, a Maor, a Dubois, and a Gullotta.

They sit proudly alongside the Wainwrights, the Cains, the Fords, the Coopers and Thomases - names that do not cause a ripple of concern in the community.

The AMA reflects the reality of multicultural Australia. So does the medical profession.

Whatever our background or history, we are all doctors. We all studied medicine to fix people, not harm them. To do this is our privilege.

But, as I said earlier, the Bundaberg incidents can shine a light on other elements of the health system.

They give us an insight into the good and the bad - and what we have to do about them.

Medical Workforce

The biggest issue that will be with us well into the future and certainly for the life of my Presidency is the medical workforce.

There is a dangerous shortage of doctors within our system. But there is also a lack of understanding of their rigorous training and the value of a complete medical education.

The Government got it wrong back in 1996 when it cut back on medical training numbers and restricted provider numbers. They did it at precisely the time we were going into deficit supply. Now we are paying the price.

We have historically relied on OTDs or IMGs to top up our shortages and reduce the pressure on the doctors working in our system over the years. They provided a flexible way to even out the workforce supply.

But they have now become a permanent structural feature and we have not acknowledged them as such. We need to acknowledge them formally as an integral part of our medical workforce.

As I said earlier, we need to make sure that new OTDs are properly introduced and supported as they move into our health system.

It is a two-way street. Arranging a happy induction and transition to medical practice for OTDs in Australia will pay dividends.

It will make these new recruits more comfortable in their new environment. And it will encourage them to stay as a longer term member of our health system.

The Dr Patel case has also highlighted the need for greater performance in the area of prior assessment of qualifications and experience - before registration as doctors is granted.

It also highlights the need for peer review mechanisms to allow practitioners to gauge their practice with their colleagues.

We must identify serious underperformance by medical practitioners wherever this occurs - and to take decisive action to correct it and eliminate it.

A 'without prejudice' approach to aberrant behaviour - such as that seen in Victoria's Doctors' Health Program - could identify and rehabilitate those under-performing through illness.

Those who are technically, morally or educationally under-performing can be scrutinised by the Medical Boards.

Their functions must be clear, fair, timely and decisive. Their views regarding registration and restrictions must be taken as solid expert advice by governments.

The role of the specialist colleges and societies is pivotal in training, standards, continuing education and remediation, as well as recognition of prior learning and other qualifications.

Far from being seen as protectionist and aloof, they must be regarded as the arbiter of standards for their particular speciality.

If their standards must be satisfied by Australian doctors, the same standards should be adhered to across the board. If colleges have been tardy or opaque in their assessment processes, they should not be by-passed but encouraged to be more timely, transparent and fair.

Remember that the work done by Colleges and their examiners and censors is often done on an honorary basis. They do it for free. Nothing. Not a sausage.

This fact is often overlooked by governments and bureaucrats when they are seeking to criticise the Colleges about training and training places.

The apprentice model we have is that of the current generation of specialists training the next generation of their own competitors - and this they do gladly. It is the medical way.

The trainers need and deserve the time to do this important job properly and to get the recognition that goes with it. Their work in teaching, training, mentoring, credentialing and research is an integral part of the medical curriculum.

It is a vital cog in medical service delivery today and into the future.

Newer activities such as risk management, small group learning and audit go towards many features of re-validation.

Touted overseas as the great way to ensure the maintenance of current best practice and safety, re-validation has stalled in the UK. The process developed by the General Medical Council was deemed to be too lax.

This is one of the strictest codes ever developed but was insufficient to quell criticism. The UK Chief Medical Officer is personally reviewing that structure.

How does this relate to Australia, you may ask. Simple. There are so many layers of compliance and quality assurance in the Australian health system.

If these layers are co-ordinated and adopted with the profession's approval, and pursued, the new risk management regime will reap a bonus. And that bonus will be strictly maintained standards and improved public confidence.

To avoid a Shipman or a Bristol incident, or indeed another Patel, Australia must have a system that welcomes scrutiny of practice by peers…and the ability to 'whistle-blow'.

The proviso is that vexatious reports would be revealed and outed and refuted as quickly and solidly as genuine misconduct is dealt with.

Those processed need to be dealt with in a swift but fair and open manner, ever mindful of the hurt to the reputation and practice any such investigation can have.

The Dr Patel situation has cast a slur on all OTDs in Australia and we are feeling the backlash.

Bad news travels fast. Doctors considering moving to Australia to work as OTDs are hearing that the environment here is not hospitable. Given that the medical market is increasingly an international one, these doctors can choose to go elsewhere, and unfortunately they will.

The suspension, remediation and even the removal of all and any underperforming doctors is important - but we must do it and do it well.

At the same time, we have to start training a lot more local doctors to meet current and future demand. We must become self-sufficient.

Medical Advances

However, we must not focus wholly on the bad.

I just wish the good medical and health stories received as much attention and coverage as the bad ones.

The community must be made aware of just how far medicine and surgery have come in the last few decades. People have to know that today we are keeping patients alive who have conditions that could not have been treated twenty or thirty years ago.

Lives are being prolonged and quality of life improved in patients who would have died from the same conditions a generation ago.

This has been brought about by a highly trained and motivated medical workforce operating in an environment in which teaching, training and research is properly supported and encouraged.

It is in an environment where new technology, new ideas, and new enthusiasm abound.

Since the times of Hippocrates and before, the goal has been enriching the human condition, sustaining health, preventing and treating illness, and pushing back the boundaries of what cannot be treated.

We have seen great innovations:

• from Jenner and his first vaccinations
• through Lister and his new surgical techniques
• the isolation of penicillin with Fleming and Florey
• radiation for diagnosis and treatment of cancers
• highly potent cytotoxic drugs for leukaemias
• immunosuppressant drugs for multiple conditions and to allow surgical techniques such as kidney transplants.

It doesn't end there. Things we take for granted now were once only dreamt about, but they were pursued and perfected by driven medicos.

We now have:

• cataract surgery
• joint replacement
• insulin therapy
• IVF
• Pharmacology and drug therapy
• psychotherapy
• …and I could go on and on and on.

The point is that these innovations and techniques come from inspired people with commitment and compassion who are striving for the good of humanity.

That is my profession. New learning is coupled with the old, established and important to form the bedrock of modern medicine.

Reformers have introduced the newer proficiencies of psychology, sociology and communication skills to add to the all-pervasive ethics and integrity.

All these features, ladies and gentleman, are fundamental and integral to each and every doctor.

The complete medical education ensures that the patients of Australia get a full view from their doctors - not an organ-by-organ, disease-by-disease, or symptom-by-symptom approach.

Surgeons today have a knowledge of psychiatry. Psychiatrists know neurology. Physicians can spot the need for surgical intervention. X-ray and pathology specialists can light the way to a diagnosis using their medical training.

And General Practitioners…well, as you are fully aware, GPs know everything.

To illustrate how far and how fast we have come with medicine, just look at these specific examples.

In relation to heart attacks, the death rate due to heart attacks in the USA has declined from 345 per 100,000 population in 1980 - just before I entered medical school - to 186.9 per 100,000 in 2000.

You were nearly twice as likely to die from a heart attack in 1980 as you are today.

With strokes, in the US death rates have fallen from 96.2 per 100,000 people to 60.8 per 100,000 in 2000.

That is around a 30 per cent reduction in 20 years.

These rates can be roughly transposed to Australia to reflect similar successes in saving lives. We are getting better. But we must maintain an environment in which scientific excellence can thrive.

We must be sure we do not react to individual events in the health system in a way that over regulates, stifles and detracts from the profession.

We cannot allow anyone or anything to crush our desire for progress and innovation with the huge benefits to patients that flow from research and innovation.

We need more doctors and we must retain those we have. We need to lift training standards and devote time to maintaining them. We need to keep our public hospitals in a healthy state.

We need to run hard on quality and safety in medicine, which the AMA is doing.

People never know about the efficiencies or otherwise of the health system until they are personally exposed to it - through their own illness or that of a family member, friend or loved one.

The same goes for doctors.

Just before Christmas, while Bill Glasson and I shared a luncheon with many of the health writers in Canberra - I received a call telling me that my mother was to undergo major open-heart surgery 48 hours later.

Apart from the initial sheer fright of that situation, the whole process from diagnosis to discharge from hospital confirmed to me how our fantastic system must be supported, bolstered, nurtured, protected, and allowed to flourish.

My mother's treatment involved a large cast of professionals. There were:

• many doctors of various specialties
• committed and skilled nursing staff
• theatre personnel
• perfusionists
• clerks
• orderlies
• diagnostic technicians
• and physios, to name a few.

The moral of this story? Medicine is a team game.

Doctors, with their full and rounded training, cannot and do not work alone in saving lives. They work with other highly skilled and motivated people. Each member of the team has a different scope of practice, different training - but none of them is dispensable. And none is substitutable.

The work of one group may be helped by a different group, but you cannot substitute one profession with another.

When considering this issue, ask who you would like to operate on your mother, who would you like to anaesthetise your partner? Who would you like to entrust your care to when you return home after your major surgery, your heart attack or mental illness?

There are clearly defined roles for people with clearly defined skills and experience and knowledge.

There is a lot of talk and activity out there at the moment - especially at the State level - about the roles of the various health professionals in the system.

A lot of it is knee-jerk reaction to the medical workforce shortage, and some of it is approaching role substitution.

This is a debate for another day, but a word of warning.

We must never put quality of care in doubt as we search for answers to the medical workforce problems.

We have all seen what can happen when quality is compromised.

I have talked at length about medical advances with technology, but technology plays other roles in medical practice and some of it raises issues of privacy.

These issues are drawing the attention of patients and the general public, governments, the medical profession, and even the Privacy Commissioner.

Privacy

Technology in the hospital and the operating theatre has gained ready acceptance - we all like the machine that goes 'ping' and its successors. It has transformed medicine. It has saved lives.

But other forms of technology in health are getting a more lukewarm or slower response.

One such area is electronic health records or, more importantly, the security and confidentiality of a patient's medical records. And more recently we have seen controversy around the selling of de-identified medical records for commercial purposes.

It was taken for granted that patients were aware that their medical records could be passed on to third parties for medical research, or collected by the Government for statistical purposes.

But do patients know this? Do patients give their permission?

You may have seen recent news stories about a medical software program that automatically extracts de-identified patient information from participating doctors. The program conveys the information back to the software provider who may then distribute it to other organisations.

Believe it or not, this is possible under the Privacy Act because the data is de-identified. The Privacy Commissioner advised that de-identified data is outside the realms of the Privacy Act.

The AMA has a big question mark over this practice. It is such a grey area that we decided to have a closer look.

I am pleased today to be able to release for the first time the results of an AMA Health Information poll conducted earlier this month.

The poll shows that patients have strong concerns about the privacy and security of their medical records - even when they are de-identified.

Their biggest concern is that their private health information could be sold for profit without their permission.

The poll was conducted by international research company, TNS, who interviewed 1001 members of the public.

When asked should their doctor ask for permission before providing their de-identified medical information to third parties:

• 81 per cent said Yes for Medical Research -
• 78 per cent said Yes for Government purposes
• and 79 per cent said Yes for Commercial Purposes.

Asked whether they would give their doctor permission to pass on their records:

• 67 per cent said Yes for Medical Research
• 45 per cent said Yes for Government purposes
• but 62 per cent said No to their records being used for commercial purposes.

Digging deeper into the responses:

• 57 per cent said they were 'very concerned' about security of the information
• 43 per cent were 'very concerned' about the de-identification process
• 48 per cent were 'very concerned' about a doctor profiting from the records
• and 52 per cent were 'very concerned' about businesses profiting.

When asked if they would change doctors if they found out their doctor was selling their de-identified health information without their consent:76 per cent said Yes.

From my experience, I don't find the poll results surprising. They confirm the AMA's view that patients and doctors need more education and information about privacy, electronic systems and security of medical records.

But the poll has provided the AMA and the medical profession with some valuable data.

It will come in handy as we consult the Government and other agencies about the impact of electronic health initiatives on privacy, security and the doctor-patient relationship.

For many Australians their general practitioner is their physician, philosopher and friend…their confidant. He or she is someone they can talk to freely about highly personal issues such as mental health, sexuality and abuse.

They expect and deserve confidentiality. Confidentiality is the very basis of the doctor-patient relationship.

There is perhaps a perception out there that electronic health records - and who has access to them - are a very real threat to that confidentiality.

But I think the poll results we have released today will force a re-think on electronic health initiatives from Governments, researchers, bureaucrats, drug companies and other marketers.

The poll will inform debate around things like the Smartcard technology, HIC Online and HealthConnect. Indeed, the re-introduction of the Australia Card debate by the PM could be informed too.

I personally and professionally believe very strongly in the key role that Information Technology can play in health, but I want my patients to share that belief. I want them to be confident in the safety and integrity of the e-medical record.

They need to be confident about the robust nature of its content, the ability for it to be up-to-date, and that it is only accessible by the right people at the right time - as assigned by them.

The AMA is a leader in driving the e-health agenda. We promote the agenda within the profession, to our patients, to the public, and to the politicians.

It is our view that more needs to be done about privacy and security before we see a full electronic revolution in health.

Health Funding

And now for the conspiracy theory. Maybe the Government wants this data for reasons other than statistical analysis. Could there be a reform of health funding motive?

I believe the recent fuss over Medicare access to IVF treatments was about much more than Medicare access to IVF treatments. I think the IVF debate of 2005 will be later remembered for its bigger health policy implications.

Let me remind you of three significant comments by three senior players about the IVF issue.

Prime Minister John Howard said 'nothing in life is completely free, nor should it be'.

Health Minister Tony Abbott said, quote, 'there needs to be some restraint when it comes to the availability of taxpayer funds for non-essential procedures'.

And the man in charge of the Budget, Treasurer Peter Costello, weighed in with, quote, 'taxpayer funding needs to be based on the likelihood of success of medical treatments'.

Put together, those three statements provide a platform for health reform. They do to me, anyway.

But there are more palpable signs of change, especially on the general practice landscape.

A new standards framework for the Australian Divisions of General Practice, for instance, initially requests doctors - but may well require doctors - to hand over their data through the ADGP network to the Government.

The Government wants this data for health budgeting and planning.

The AMA has serious concerns and fears that the Government and some in the profession want this data in order to 'ration' the health budget to the community. They want to do this through a health financing system called fundholding.

Fundholding

The AMA identified this threat to the Australian health care system some years ago. Last year we reaffirmed a clear policy that strongly opposes this type of financing of the health system. The general public must be aware of the issues involved in fundholding.

It is a system that takes away the certainty that patients would be able to access the care they need, where they need it, from the practitioner they want, when they need it.

Fundholding is like a lottery - the luck of the draw. If you live in a well provided for area, with well and wealthy people, the choices you have will be great. But if you live where the conditions and prevailing health status of people are lower, your health choices will be limited by a finite budget.

Under fundholding, the Government determines the budget, the fundholder administers the budget, and the patients wear the consequences.

When the doctor cannot access the best care, he or she is damned by the patient. The government then blames the fundholder for shortfalls in service, as they have provided the funds. Although the initial budget may have been insufficient, problems can be easily attributed by government to inefficiency and mismanagement at the local level.

The key to getting appropriate care at the appropriate time for your particular ailment or condition is more good fortune than good planning. I think the key to getting best possible patient care under a fundholding system is to make sure that the moon is in the seventh house, and Jupiter aligns with Mars.

We know that the Government has had a peek at both the UK and New Zealand fundholding models. And we know there are people in Government with a fondness for US-style 'managed care'.

Some commentators see striking similarities between the current UK fundholding model and the US system. So, beware. Fundholding in any form establishes a platform for managed care further down the track.

Managed care is driven by dollar savings, by political convenience and by an attempt to take control of the system. It is a platform that denies excellence in favour of mediocrity and under-supply of care. It is a system where your GP - your guide and advocate through the healthcare maze - is gagged and blindfolded.

It is a foothold for change - change for the worst.

No group has the competence or mandate to be the holders of funds for individual Australians.

Not the State hospital boards, the area or regional health boards, and not the ADGP, private health funds or other collections of planners. Nor are they equipped to be the arbiter of where and when those funds can be spent.

This is all about control. Control of the health budget and control of doctors.

We would see rationing or eligibility criteria for care, especially for long term care of the chronically ill.

There would be overt discouraging of the use of certain services - this might mean shorter hospital stays or fewer speciality services. There would be less use of the more expensive technologies - even where they may provide real clinical benefits.

One of the common features of fundholding is patient enrolment - patients would have to enrol with a certain practitioner. However, the practitioner could decide whether they will take certain patients on to their register.

Selective enrolment could occur on the basis of risk.

The philosophical basis of medicine that provision of care is based on need is undermined in such a system, and doctors and the public should be very concerned.

Fundholding also incurs higher administrative costs. There are some winners out of fundholding and they are usually those entities tasked with holding the funds.

The Australian Divisions of General Practice has certainly seen the opportunities available to them in being the fundholders. They have said publicly that 60 of their Divisions are willing to take on the mantle of fundholding.

But the fact is that the higher administrative costs divert funds away from direct patient care. Top slicing of health dollars to keep alive administrative organisations with variable capabilities is a great and unsupported leap of faith.

The political push for fundholding as a new model for the Australian health care system is largely based on the drivers of cost savings.

Proponents of fundholding in Australia continually point to improved patient health as a reason for going down this extremely difficult track. But there is no evidence that fundholding models provide improved patient care.

Australia does not want or need fundholding. Let's get rid of it before it gets started.

Let's put patients first instead, as we do now. Let's build on what is an excellent system, iron out the imperfections of poor communication and inter-governmental bickering, and preserve the freedom of choice, the ease of access to a range of services.

Let's stick with the best, not settle for the average. And that goes for every element of the health system.

On that note, it would be improper for me not to say a few words about pharmacy. My predecessor, Bill Glasson, would never forgive me.

Pharmacy Agreement

As you are probably aware, the Government is negotiating the Fourth Community Pharmacy Agreement with the Pharmacy Guild at the moment.

The ink is probably already dry and they are waiting for a very busy news day to release it, but we can at least still try to influence public opinion.

The indications are that the outcome will be evolutionary rather than revolutionary, with some changes at the margin to distribution payments and location restrictions.

The AMA, as always, is on the side of the patients in this matter.

The PBS has been growing strongly and is under severe pressure from the Government. We see this in the pressure being exerted not to list new medicines, or to list medicines with extensive restrictions.

What little evidence there is would indicate that a dollar underspent on medicines leads to three dollars spent elsewhere in the health system - on hospitals, for example.

It is very important that we do not restrict new medicines finding their way onto the PBS for purely budgetary reasons.

Distribution of medicines under the PBS is expensive. In 2003-04, distribution costs were 28.5 per cent of the total cost of the PBS to the community and 33.9 per cent of the budget cost to the Government.

Given the budgetary pressures for a moderation in the growth of PBS expenditure, an efficient and cost-effective distribution system is a necessity, not an optional luxury. Ultimately, every dollar overspent on distribution is a dollar underspent on medicines.

In 2003-04, the last available year for figures, the total cost of the PBS was $6 billion. Total Government PBS expenditure was $5 billion and total distribution costs - retail and wholesale - were $1.7 billion. That is a big proportion of a big number, and that big number is growing sharply with time.

The current pharmacy agreement has restrictions on the number of pharmacies and the location of pharmacies.

A new pharmacy, if allowed, may not locate within 1.5 kilometres of an existing pharmacy as the crow flies. Many in the community want to see an end to pharmacy location policies based on ornithological transit practices.

Ownership of pharmacies is restricted to pharmacists. Pharmacists can own medical practices but medical practitioners cannot own pharmacies, for example.

That is why goodwill of $1 million attaching to the sale of a pharmacy is not uncommon. They are effective monopolies.

The Pharmacy Guild negotiates all these arrangements with the Government on behalf of the 3000 owners. The other 12,000 pharmacists are excluded.

The AMA concerns are genuine and legitimate. This is not a turf war. Local doctors and local pharmacists work well together.

We re-iterate the significant role of the community pharmacist in providing advice on medications to individual patients. We recognise the need for such local and expert advice to supplement the work of the GP.

This role will become more significant as the number in the community with chronic and complex care needs increases.

But the Government needs to get rid of the ownership restrictions and have a very good look at whether this should include supermarkets, if only to satisfy community and consumer curiosity.

Perhaps there should be a trial to ascertain the acceptability and benefits or otherwise to the community of such a move?

Whatever else happens, the Government needs to get rid of restrictions on ownership and restrictions on location - but there must be appropriate protections for rural and remote communities.

And it needs to set dispensing fees on a more competitive basis than it does now. The savings will be considerable and they can flow straight into better patient care, with more money for medicines for people in need.

There are many other issues I could have raised today, but I will certainly give them a run over the next year.

Be assured that under my Presidency, the good ship AMA will continue to steer a strong and steady course.

As you would have seen last week, we will continue to speak out on health for those who have no voice or cannot be heard.

We will always speak out on Indigenous Health. As I said in response to the Overcoming Indigenous Disadvantage Report last week:

"At a time when all the talk is about aspirational Australians, it is a national shame that many Indigenous Australians are being left to aspire to a lesser degree of disadvantage."

The AMA will fight for better mental health services, especially in the face of sad stories like Rau and Solon. We will be active in getting kids out of detention and improving health services for asylum seekers.

All Australia's public health issues are our priorities - alcohol and drug control, getting people to stop smoking, child and youth health, men's health, women's health, environmental health,and encouraging healthier lifestyle choices.

There is still unfinished business on medical indemnity. Don't get me wrong. The Government delivered a fantastic medical indemnity rescue package. It was a remarkable achievement.

But the AMA feels the implementation of a long-term care scheme for the severely injured will reduce the risk of premium blowouts in the future.

More importantly, it would provide greater fairness and equity for patients - away from the adversarial courts system.

And I will strive to continue Bill Glasson's endeavours by keeping the Government honest on health policy by applying the benchmarks of independence, quality, access, affordability and choice - IQAAC. Bill quacked, and I can quack too.

At the same time, we must retain professional standards, teaching, training, ethics, innovation and honesty. I haven't invented an acronym for that yet.

We need more doctors - and the training of greater numbers of local doctors must start now, today. More doctors are especially needed in rural Australia. The AMA has established a Rural Reference Group to make sure country Australians have equal access to quality health services.

In closing, I ask you to please spread the word to support our overseas trained doctors. Don't allow the spread of medical racism.

Urge the Government to abandon any plans for fundholding.

Keep an eye on your patient records.

And please give your GPs a big smile when you visit them during Family Doctor Week.

They do a great job in the community and they deserve your support.

Thank you.

20 July 2005

CONTACT: John Flannery (02) 6270 5477 / (0419) 494 761

Judith Tokley (02) 6270 5471 / (0408) 824 306