AMA 15th National Conference 2003 - AMA President, Dr Kerryn Phelps - Presidential Statement, AMA Annual General Meeting 'No Mission Impossible for AMA in 2002-2003

Good morning fellow doctors, special guests, AMA staff, and members of the media.

As the video you have just seen suggests, there has been no mission impossible for the AMA.

Thank you, my friends and colleagues, for showing faith in me to represent you as President these last three years.

And thank you for the regular feedback from those members who have cared enough to let me know how you think we have been going on the many issues we have had to deal with.

At this time at this conference three years ago, I looked at the challenges ahead.

It was like standing at the base of a great mountain looking at the distant summit and wondering how I would ever get there. Unfortunately the AMA Secretariat had no Sherpas on staff at the time.

But, as with all great adventures, it began with a deep breath and the first step...and moved on from there, powered by your support and your ideas.

The personal challenge for me - and a daunting one - was how to do justice to such a diverse group of doctors - DITs, GPs, physicians, surgeons, ophthalmologists, pathologists, anaesthetists, radiologists, psychiatrists, obstetricians and gynaecologists, doctors in public hospitals, doctors in private practice, researchers, academics and students.

A key strategy to test the success of our advocacy has been to benchmark against what I'll call the three pillars:

• The welfare of our patients
• The pursuit of excellence in practice, and
• Clinical independence.

I felt early on that the key to success internally and externally for the AMA was to always reflect on that which unites us, rather than the few, usually minor issues that, from time to time, caused us to differ.

These three pillars are the greatest unifying forces for our profession. They are also the drivers of our policy development and our advocacy.

A perfect example is how we approached the medical indemnity crisis. Recent events tell us that we delivered on the three pillars.

Over the last twelve months - through Federal and State cooperation - we have very successfully presented a united front to Governments, the general public and in the media.

Federally, your team has had a huge year. And our messages have been supported and reinforced by the AMA at the State and Territory level.

It was a year dominated by medical indemnity, medical workforce and Medicare issues and major public health initiatives.

It was a year of big wins for the profession, our patients, the health system and the broader community.

And make no mistake: it was your AMA that raised the issues proactively.

It was your AMA that debated the issues.

It was your AMA that delivered positive outcomes - for our members, for all doctors, for our patients.

We put health back on the national agenda making it the Number One domestic policy issue.

We got health back on to the front pages of the papers.

We got health back into the prime time TV news.

Talkback radio across the country is full of health debate virtually every day.

And we now have the major political parties in a bidding war for the best health policy to take to the next election.

And the Australian people - our patients - are more knowledgeable than ever before about the access and affordability of health services for them and their families and their loved ones.

No mean feat in a year that featured war in Iraq, the tragic Bali bombings, the Governor-General's woes, cricket's World Cup...and the new series of Big Brother.

Let me take you through our achievements over the past year in the key policy areas.

Medical indemnity

Just over a week ago, the Federal Government put in place their final pieces of the indemnity puzzle.

The PM announced the Government would cover 'blue sky' indemnity claims and would put in place assurances that doctors would not be burdened in retirement by huge indemnity premiums.

This is what we asked the government to do because they were two of the final stumbling blocks on the path to medical indemnity security.

While some still have concerns about how far the Federal Government has come to the party on medical indemnity, let me clarify one important point: the Federal Government did not have to come to the party - they could have torn up the invitation.

You may remember the words of a certain former Health Minister. To paraphrase him: "medical indemnity is a States issue".

Yes. That was the official Federal Government line as recently as 18 months ago.

We have come a long way, and we have come a long way because the AMA ran a compelling public interest argument - an argument the Government could not ignore, and nor have they.

Today we have a Federal Government that is embedded, if you like, with the medical profession on medical indemnity.

They need a solution to the medical indemnity crisis just as much as we do, just as much as our patients do.

From our point of view it had to be a solution that left the control of MDOs in the hands of MDOs who understood the needs of doctors - while ensuring prudential regulation that provided security for our funds into the future.

Remember that with Government dollars comes Government strings. The usual formula is the more dollars, the more strings.

So Government assistance has come largely in the form of guarantees.

We would like all guarantees written into legislation. We will push for this.

There are still some crucial elements to go before we can declare the crisis solved.

We want to see a national care and rehabilitation scheme for the severely injured. Even the lawyers want this. I think it may happen. And the momentum is building.

We want all States and Territories to do their bit on tort law reform. Most have acted, some have moved slowly, and others need further encouragement.

As I told you yesterday, both Victoria and Tasmania have progressed with their tort law reform processes. The AMA will keep encouraging and assisting.

Most importantly, we need to see downward pressure on premiums.

Patients need to see downward pressure on premiums.

Otherwise, health will cost more. Otherwise, we will see doctors reviewing their plans for retiring early or steering clear of high-risk procedures and specialties.

The medical indemnity story has been a good one for the AMA over the past few years. It is a story of good strong advocacy. And by working together we will finish the final few chapters.

You will hear more on indemnity in the medical indemnity plenary session later today when Assistant Treasurer, Senator Helen Coonan, will speak on behalf of the Federal Government.

As you know, Helen Coonan is the Assistant Treasurer, and she is also the Minister the PM entrusted with the task of getting a solution to medical indemnity.

As Mark Twain said, there are only two things that are certain - death and taxes.

So, as the Minister for taxes, she averted the near-death experience of the Australian health system with some last-minute resuscitative efforts.

Senator Coonan will bring glad tidings later this morning.

Medical Workforce

The Past year has seen some truly remarkable progress on the medical workforce front.

The Federal Government now acknowledges there is a GP shortage in Australia.

They used to balance their policies on an alleged maldistribution. Now they acknowledge there is a shortage.

This change in attitude follows more than a year of campaigning by the AMA on the findings of the landmark AMA/Access Economics GP Workforce study.

AMWAC, the former champion of the GP undersupply and maldistribution theory, now accepts there is a shortage.

The Health Department now grudgingly concedes there might be a doctor or two too few out there, especially in regional and outer-urban areas.

Prime Minister John Howard recently acknowledged there is a GP shortage and that this problem must be fixed. Simon Crean agrees.

People are also now hearing the AMA arguments about participation rates.

The bureaucrats continue to count GPs as full time even when many are only working around 60 per cent of their possible patient consultation time.

The medical workforce is changing. Our message is being heard.

Thanks to vehicles such as our Safe Hours and Work Life Flexibility programs - and the work of our grassroots GP Campaign Network - the reality of the medical workforce is being acknowledged by the people who fund health and decide the number and nature of medical training places.

You will have heard some of this story at yesterday's Work Life Flexibility plenary.

You will hear more about our work in this area during tomorrow's final plenary session on the medical workforce.

GP RED TAPE

A big win this year has been an admission from Government that there is too much red tape burdening general practice and a new determination to do something about it.

The Productivity Commission assisted in extracting this admission from Government.

Prior to the Productivity Commission finding that red tape cost each GP around $13,000 a year, the bureaucratic approach to general practice could be summarised by a previously undiscovered scientific principle:

"For every action, there is an equal and opposite government program."

Red tape reduces the amount of time GPs can spend with our patients and makes the profession less attractive for new entrants.

The task ahead for the AMA is to translate the Government's 'cut red tape' rhetoric into action in the form of less paperwork and fewer hoops to jump through.

Getting rid of PIP and useless programs and rerouting the funds into patient rebates would be a good start.

Medicare

Perhaps one of our finest achievements in the last year has been sparking the Medicare policy auction.

We've even got the RVS back into the medical lexicon.

The policy debate surrounding Medicare the past few months has been nothing short of amazing.

We have not been spectators. We have been consulted comprehensively by the Coalition and Labor on their respective policies.

I had personal meetings with both John Howard and Simon Crean immediately prior to them launching their policies.

We did not get all we wanted - not even a lot of what we wanted - but they both know exactly where we stand.

They were told what the medical profession would accept in their policies and what we would not. They knew what the AMA would praise and what we would have to criticise.

We don't play favourites. We scrutinise the policies and give an honest and apolitical response.

We have achieved an unprecedented level of sophisticated advocacy that allows us to call a spade a spade in negotiations with Government.

They know we are a member organisation - now a record 28-thousand strong - and they know we have strong links with communities and voters.

Our opinion counts in Canberra. Our voice is heard. Both sides of politics may not always like what they hear from us, but they know it is in their interests to listen.

Our relationship with both Government and Opposition is built on respect and trust.

We have been invited back to the table because the major parties have come to realise that the AMA gives them the straight story based on evidence, survey work, consultation and careful consideration.

It is valuable information from the most impeccable source.

On the Medicare policy auction, the AMA looks at both contributions, so far, as a first step towards what we will ultimately see going into the next Federal election.

GP bulk billing - or 'compassionate discounting' - is now at a low of 68.5 per cent.

Neither side can or will ignore this despite different ideologies and definitions of universal health care. It's not that bulk billing rates are the problem. They are simply a symptom of the Medicare malaise.

Access and affordability are the key issues now.

The major parties know they have to address them, and they know that they cannot isolate the medical profession from any possible solution.

Medicare will be a political football this year and the AMA will be there for the pre-season, the Premiership rounds right through to Grand Final day.

Trade Practices

We made a lot of ground this year on trade practices - and I'm not talking about the retirement of Allan Fels from the ACCC.

On that note I wish him happiness in retirement looking after his family.

While we clashed on many occasions, there is no doubting he was a formidable foe who presented his arguments powerfully and passionately. It's just that all that power was misdirected.

In December 2002, the ACCC finally agreed to allow independent doctors who work together in the one practice to discuss their fees.

It was pleasing to finally see the ACCC publicly admit to the error of its ways in applying the Trade Practices Act where it doesn't belong.

Too late for some doctors. The Rockhampton obstetricians. The Sydney anaesthetists.

I can only hope that their suffering and torment has paved the way for a better deal for their medical colleagues in the future. We hope. We are yet to see the final take-out from the Dawson Review.

The Dawson Review into the competition of the Trade Practices Act 1974 (TPA) reported on 16 April 2003.

It clearly accepted the AMA's arguments for a shorter simplified authorisation process, capacity for small business to negotiate collectively with large business, and the problems we have with rosters under the existing law.

Its recommendations are likely to lead to some significant gains for the medical profession.

A possible major benefit for the medical profession and the AMA will be the provision of collective bargaining by small businesses (that is doctors) with large businesses (that is hospitals and health funds), subject to a notification process.

The Government has indicated general support for the recommendations.

If the Government accepts them, third parties, (that is, the AMA), will be able to make a collective bargaining notification on behalf of a group of small businesses.

We now have our old friend Graeme Samuel to deal with...for a year at least. His fondness for doctors and the other professions is well known to you.

Other Achievements

I want to talk briefly today on Federal-State relations within the AMA, but first let me provide a snapshot of other major achievements over the last twelve months.

• We released the revised AMA Code of Ethics.

• We established the AMA Committee on Child and Youth Health in response to concerns regarding worsening outcome measures (such as obesity and mental health) of Australia's children.

• We developed a position statement on the Developmental Health and Wellbeing of Australia's children and Young People

• We endorsed the NSW Health Guidelines for the Management of Nicotine Dependent Inpatients.

• We revised the Position Statement on Blood Borne Viral Infections.

• We developed a database on doctors' health services around the country.

• We released a Position statement on Sexual Diversity and Gender Identity.

• We convened the 2nd National Drug Summit on the theme of "Party Drugs".

• We conducted a National Environmental Health Summit on the Effects of Climate Change on Human Health.

• We endorsed the "Mandatory Renewable Energy Target of 10%" as part of advocacy work in relation to climate change.

• We produced our second Public Report Card on Indigenous Health which will be launched later this morning.

• We negotiated and implemented a new national minimum terms and conditions agreement for GP registrars which included base pay increases of 11% and various conditions improvements and an ongoing role for the AMA to update the agreement.

• We secured, through the AIRC, substantial base salary increases for doctors working in aboriginal medical services

• We achieved a $3 across the board increase in fees for GPs treating veterans. There are ongoing negotiations for improvements to the remuneration and conditions in the Local Medical Officer Scheme and we are seeking Specialist fee increases.

• We established the "Safe Staffing Taskforce" of the Australian Council on Safety and Quality in Health Care to push our Safe Hours agenda nationally.

• We defended the Federal and State AMAs' role as the premier industrial negotiator and representative of doctors against attacks from the Society of Australian Surgeons, the Visiting Medical Officers Association, the Community and Public Sector Union, and other industrial organisations.

• We renewed joint membership agreements with the Australian Salaried Medical Officers Federation to ensure AMA members have free access to a Federal union made up exclusively of doctors

• We convened in Melbourne a national Forum on Work Life Flexibility involving over 100 stakeholders from the medical and hospital sector.

• We advocated for the interests of basic surgical trainees and secured a commitment from the RACS to allow suitable trainees to re-apply for advanced training in 2004 despite the four-year cutoff.

• We successfully resisted draconian bureaucratic attempts to legislate for Informed Financial Consent.

• We persuaded health ministers to start again on their highly unacceptable national registration proposals.

• We kept the health funds honest by publishing their rebate schedules on the Website, tracked their benefit payment turnaround times, and negotiating a Code of Conduct with them.

• We participated in five of the nine Reference Groups for the development of a reform agenda for the Australian Health Care Agreements.

• We opposed Government attempts to eliminate the second tier default benefit affecting private hospitals and day surgeries.

• We kept medical prostheses available to patients and free of excessive bureaucratic control.

• We helped block the unfair increases in PBS co-payments in the 2002-03 budget.

• The AMA has been restored to its position on the Federal Health Department's key aged care consultation group - the Aged Care Advisory Committee. Key issues affecting the availability and quality of ag ed care are now starting to be addressed seriously.

• The Ageing and Aged Care Division of the Health Department has agreed to take up the issue of the inadequacy of the Medicare Benefits Schedule items dealing with residential aged care with the arms of the department responsible for the MBS items.

• As you can see, we've really been quite busy.

That is a long list but not the entire list.

We have been very active and very successful, thanks to determination, persistence and excellence...and wonderful teamwork.

AMA Federal- State Relations

Our success is due mainly to teamwork.

On a political level, the teamwork and communication between our Federal and State bodies has been unprecedented.

We have worked together to achieve great advances for the profession and our patients...particularly on medical indemnity.

The future of the AMA must be built on a solid foundation.

The Federal AMA has been working for some time on a mechanism to provide a solid financial platform for the AMA - State and Federal -into the future.

This mechanism is called AMACom - AMA Commercial.

I'm pleased to say that after a difficult gestation, the AMACom baby was delivered last Thursday at Federal Council.

AMACom sets the AMA up for the challenges ahead. It gives us a better chance of supporting our political objectives with less reliance on subscription income.

It is not about robbing Peter to pay Paul. It is about looking after all the AMA operations - Federal, State and Territory.

The AMA must be united and strong.

Our current status as the country's premier member association lobby group comes at a price.

The key to future success is for the AMA to be financially strong and independent.

We have to make membership attractive and we have done that - we now have a record membership of around 28,000 doctors.

We need to continue to strive to return value to the membership. We have to keep the members we have and attract more.

We deliver value in the form of advocacy and representation but we also supply member benefits and subscription fee relief.

Conclusion

And now, my friends, the end is near and so I face the final curtain.

It's been an absolute privilege to represent your interests. Thank you for having the faith and the trust and the belief in me to lead the AMA for three years.

John Flannery told me that my AMA epitaph should be Veni vidi nates calce concidi - "I came, I saw, I kicked ass"...and actually wanted me to mention it in this speech. But I told him I couldn't possibly do that!

But I hope my epitaph will be more than that.

Yes, I have had to be forceful at times, but to get anywhere in medical politics you have to run a strong argument...and you have to show a bit of attitude.

As I told a journalist a few weeks ago, it doesn't hurt to have a bit of the mongrel about you.

Despite this...but maybe because of this...I have for the most part established and maintained close professional and often personal links with the people who can help you get results for our members, our profession and our patients.

I think I can say with confidence that the AMA has worked well with the Prime Minister, the Opposition Leader, the respective Health Ministers and their Shadows and all the key players from the profession.

Sure, there have been the occasional differences of opinion but things had to keep moving forward.

And there were times when only we knew how desperate the situation could become with the possible loss of entire specialties if the government did not take notice and take action.

There's not always time for pleasantries when you are fighting for the very survival of the health system and our profession.

I thank my Vice-President, Dr Trevor Mudge; Chair of Council, Dr Michael Sedgley; Treasurer, Dr Allan Zimet; and Executive Councillors, Dr Choong-Siew Yong and Dr John Davis.

Thanks to all who have served as Executive Councillors, Committee Chairs and Federal Councillors these past three years.

And thanks to the Federal Secretariat whom have kept everything ticking over.

But special thanks to all the grassroots members of the AMA. It is you who give the AMA its heart and soul and the simple messages we need to pursue our policy outcomes.

Looking to the future, the keys to success will be the things that unite us.

The welfare of our patients. The pursuit of excellence in practice. And clinical independence.

You can't argue with the logic of the saying and the song - "united we stand, divided we fall".

Thank you.