AMA 15th National Conference 2003 - Immediate AMA President, Dr Bill Glasson - AMA Announces New President

GLASSON: Ladies and gentlemen good morning. I thank you for coming along and I'd like to begin by first of all introducing firstly myself - I'm Dr Bill Glasson, the immediate president of the AMA. It's a great tribute, I suppose, to accept this position, but it's a position I accept really as part of the organisation and importantly as part of a team.

And I'd like to introduce to my right, my Vice President Dr Mukesh Haikerwal from Victoria. To my left Dr Allan Zimet who is our Treasurer, and Dr Dana Wainwright who will be our Chairman of Council.

As I've said, this is not all about me, this is all about us. It's about what we can do for not only the profession but, as I keep saying, it's about patients, it's about what we can do for the community at large.

If we keep focussing on the community, and forget about doctors and forget about any other extra player, if you just focus on the patient - 99% of the times you'll get it right.

As I said if you focus on anybody else, you'll often get the wrong solution. And so I'm asking this council and this organisation to continue as it has done to focus on that important component and that's the patient.

I'd also like to acknowledge our past president, Dr Kerryn Phelps. I feel very proud to follow somebody who's provided, I feel that this, the most significant strength unifying force leadership that this organisation has seen for a long time.

We are indebted to her, and can I suggest to you that the population of this nation is indebted to her for what she has done over the past three years, and no doubt will continue to do. And so, to Kerryn, we say thank you very much.

I will certainly be working closely with her over the next few months in a transition phase. We've got a lot to learn, and the important thing is that the transition should be smooth. It's a little bit like a horse running around a track, we change jockey's, but essentially policy will continue and continue to reflect the views of the community and profession at large. So I think that it's important that both Kerryn and I continue to liaise, as I say, on an ongoing basis.

I would also like to acknowledge two people particularly that stood against me - and that's Dr Michael Sedgley and Dr Trevor Mudge. These two people have contributed so much to the AMA over the past, I think, Trevor Mudge probably 10 years or more.

He was unfortunately not successful today, but for somebody who has so much experience, I obviously will continue to rely on their experience and this organisation will continue to rely on their experience to make sure that, you know, what we, the policies that we develop - develop as I say, really reflect the needs of our members and most importantly of our community.

So I suppose at this stage I'll say no more. Oh, by the way, should acknowledge my beautiful wife back there who will be, obviously my partner in crime, and obviously I am going to have to give up a lot to do this - both practice wise, but also family wise - and I think everybody along this table their families are the ones that actually may be the losers out of this.

But obviously with their support - and I think from Dana right through to Mukesh and Allan - know that what our spouses have to give up in order that we can actually do the job that this organisation requires.

So I'll open to any, any questions.

QUESTION:?

GLASSON: Well I suppose, I feel as though I'm probably one of the most passionate people. I do, what, the things I believe in I passionately believe in, and I passionately believe in them because it reflects on my patients.

I feel if we don't get issues of indemnity, issues of Medicare funding, issues in relation to our public health, hospitals right, then essentially really doctors aren't gonna suffer, it's our patients who are gonna suffer. And essentially you out there, when you go to access medical services, you want to be able to actually afford the doctor in the first place, and (b) it might be a good idea if you can find one.

But under the current system of indemnity and the rising costs, essentially doctors are being driven out of the profession, there have been major reforms in the area of medical indemnity, but there's still a lot of work to be done.

In a sense we need a stable industry that essentially is affordable for patients, because the message is doctors don't pay indemnity costs, patients do. And so as indemnity costs rise, patients will be more and more out of pocket. What happens then? They can't afford the service. What happens then? They go to the public hospital. They are crumbling anyway, so that's putting a pressure on a system that's already failing.

And so we must keep them a suggestion - recommendation that there'd be a new, a number of medical student places, that these would be bonded.

Now the issue about the bonding - you can argue whether students should be bonded or not bonded - but the big argument is that these are unfunded positions.

So what they're saying to these kids of sort of 17 or 18, and saying, listen you can have a medical student place and we'll bond you for six years, for six years after you finish your medical training - which may be another 10 or 15 years ahead, particularly if you do a specialty - and by the way we won't pay you a dime.

This is industrial blackmail. It's immoral, and it's one issue that I really want to take up very strongly with the government because I just think it's, I think it's unconstitutional, and our students are really ropable about it - and I don't blame them - and I think that it's the role of this organisation to get behind them and to make sure that issue is addressed. And that's probably one of the first things I'll be discussing - certainly with the Health Minister - to try and work our way through that.

The solutions to the rural problems is not conscription. There's no point in having a doctor going rurally who doesn't want to be there. There's lots of other ways we can look at to encourage doctors to go to the bush.

I was born in the bush, I service the bush, and I know what the bush needs, and it doesn't need a whole load of unfunded conscripted doctors. What it needs, an environment out there that would encourage people to actually go and want to work out, work up there.

I think the Townsville experiment - well known experiment - the Townsville situation with the JCU medical school up there, will be a very good example where most of those students will end up practicing in provincial or rural areas - (a) because they're from there, and more importantly, they train there, they marry there, their friends are up there.

There's no point in training people in the middle of Sydney and giving them little or no exposure to the bush and expect them to go out and live there for 10 years. It won't happen, because what happens these days is when I marry, or you marry, we marry a fellow - often professional - whose occupation can't be necessarily, you know, moved, position in that area. In other words I won't marry another lawyer, I marry a lawyer or something, there may not be a position out there.

So, I think essentially there's lots of other manoeuvres we can do to try and encourage doctors to go to the bush, and that's not one of them.

QUESTION:?

GLASSON: See that's an interesting, that's an interesting question. Is that supporting patients to support 100% bulk billing? I don't think that's supporting patients at all.

I mean at the end of the day, if you said to me what's an appropriate, have the government gone out and decided what's it cost to run a medical practice? Although we've done a relative value study - the AMA did that, or supported that - they do not take that into account. When they decide what the Medicare rebate is it's purely a budgetary decision - they can afford this amount of money and they divide it up.

So that doesn't reflect high quality practice. What I want to say to you is that I want to support patients by ensuring that they have (a) access to doctors - because as you know we're heading for the biggest workforce crisis this country has ever seen, particularly in both specialist and general practice. So access them first, and then be able to afford them.

As I said, the affordability issue comes down to the government who is the insurer. So the government is the insurer to you who access Medicare. And so it comes down to the government deciding how much they will fund it, and then ultimately you at the ballot box saying is that sufficient funds or not?

And so ultimately you have the power to decide what that rebate should be by simply removing them out of office.

And so I think it's important for the public out there to understand what is the role of the general practitioner or a specialist - and that is - or hospital doctor - that is to provide high quality, appropriate medical practice. It's for them, and then to charge accordingly depending on the costs.

As you know medical indemnity costs have gone up like skyrocket - everything has gone up - and so they're saying I cannot continue to provide high quality practice at the Medicare rebate which is - I don't know, 20 something, $24 or something.

It's not adequate. So to answer your questions, we're not doing the patient necessarily a service, because if you said to me what is the right rebate - depends on the practice.

QUESTION:?

ZIMET: Look I think that there have been significant strides in the last few weeks to get things right. We're not there yet. We've got a lot of work to do. The Blue Sky issue - which was concerning a lot of my colleagues. I've been approached in the corridors of hospitals - both public and private - by people who said that they were going to retire who've now, changing their minds. But if the government doesn't deliver on that issue, there will be a severe shortage - more severe than we could ever imagine. It'll be critical for our patients. We've got to solve it.

I think Helen Coonan yesterday came and spoke to us. She has some obligation - I think she has the fire in the belly almost as much fire as Bill has - oh well maybe not - but we will solve it, otherwise medical practice in this country as we know it will no longer exist. It has to be done.

HAIKERWAL: On the indemnity issue, Victoria was just on the edge of the precipice and Premier Bracks pulled something out the bag. He's got to deliver otherwise those predictions you're talking about will come true.

GLASSON: The one other area that Dana Wainwright - who's our chairman of council. Dana's from Queensland. She's a physician, and she's had tremendous experience both on State and Federal AMA's. And one of the issues that Dana has been intimately involved with over a number of years is private health insurance - particularly in relation to the issue of, of really these contracts, and I suppose that's one agenda item that I will be relying on Dana to drive and continue to drive hard. So Dana you might comment on those.

WAINWRIGHT:Thanks very much Bill. As Bill said I've been intimately involved in the private health committee for the last three years, and have been meeting regularly with the other players in the private health sector, the hospitals and the funds.

It's our, our wish that we can maintain an independent medical profession so that at we can better serve our patients. We fear the spectre of managed care, and there've been many initiatives that have been introduced by the health funds to try and introduce a form of managed care - which is just a way of interfering in our clinical decision making.

We will be ever vigilant as far as that's concerned. We see health as a complementary system between the public and the private system. It's very important we have strong private sector to take the load off the public hospital, which indeed it has been doing over the last three years since all the initiatives.

I'd like to also point out that I work four sessions in the public hospital, in a teaching hospital. I'm a specialist physician, and I see first hand every day the significant effects of the restrained resources on our hospitals.

I look after the old and the sick mainly, though the young and sick do come in as well. And every day I recognise that the restriction in resources we have in adequate number of beds because our planners have said that we're going to have a biological time to cure that's faster and quicker. Indeed we haven't.

And unfortunately we have access block - huge access block. The most important thing is, we have exit block. Unfortunately there are not enough aged care places of any kind for our elderly citizens who go into hospital with often very complex illnesses. There's not enough places that the government has provided in the community for these patients to be discharged to.

It's not good for the hospitals. It's certainly not good for the patients. They develop other diseases while they're waiting there, in limbo, waiting for their next home - or waiting for rehabilitation.

I feel very passionately about our public hospitals and the need to look at the Medicare agreement to make sure that they are adequately resources for the future.

GLASSON: Okay. Well thanks very much everybody.

ZIMET: Well done Bill.

GLASSON: Thanks Allan.

Ends