Tax changes will downskill Australia's medical workforce

AMA President, Dr Steve Hambleton, said today that the Government’s proposed changes to tax deductions for work-related self-education expenses would have a devastating effect on the ability of doctors to improve their medical knowledge and skills through their training years and with professional development throughout their careers.

An AMA online poll has received more than 4200 responses from concerned doctors, with 98 per cent stating that the changes would seriously impair their professional development as a doctor.

Hundreds of doctors have provided comments explaining how the changes would affect them personally and the impact on their patients.

Dr Hambleton said the policy is another example of the Government announcing a major change without consultation with the people affected by the policy.

“It is a matter of policy now, consult later,” Dr Hambleton said.

“I don’t think the Government has thought through the impact of these changes on doctors and a whole range of other professionals who must continually update their skills and knowledge throughout their careers, at their own expense.

“Doctors must learn new about new technologies, surgical techniques, treatments, and pharmaceuticals if they are to provide the best possible care to save lives and improve quality of life for their patients.

“Australia has one of the most rigorous systems of medical training in the world, incorporating robust accreditation arrangements.

“Doctors who are in training programs must meet strict program prerequisites including ongoing assessment, examination and participation in specific courses related to technical and professional expertise.

“Feedback from doctors shows that they can spend many thousands of dollars each year undertaking mandatory courses and professional development to equip them with essential skills in caring for patients.

“Doctors must also travel both within Australia and overseas to learn about the latest medical research and innovations, innovative surgery techniques, and advances in overall patient care.

“Rural and remote doctors will be hit hard by the changes because they are unable to access the training they need locally.

“The Government's policy will hit junior doctors, salaried doctors, GPs and other specialists alike and is simply not in the public interest.

“It will create a huge disincentive for doctors to pursue specialised education that benefits the whole community.

“The AMA is calling on the Government to reverse this decision.

“While the Treasurer has assured the AMA that there will be a consultation process, the AMA believes that the Government needs to revise its starting point for negotiation – a $2000 cap defies reality.”

Comments from the coalface – doctors speak out about the proposed changes

“As an Infectious Diseases Physician in an area that is ever changing, the proposed limits make it impossible to self-fund further education. Given the largest conferences in the Infectious Diseases area are overseas and involve travel to either Europe or the USA, there is no possibility of attendance within the proposed cap on expenses, which makes it impossible to keep up to date.  I support the AMA's campaign against this cap.  It WILL influence my vote at the next election. I will be considering all parties’ policy on this when deciding my vote.”

“I work in private practice in regional Australia in a psychiatric sub-specialty.  This is going to make it even harder for doctors in private practice who don't get paid CPD time to attend training.  It will additionally disadvantage rural and regional Australia doctors, as travel to training is the norm for us.  Training opportunities not only assist in maintaining currency of practice but also form the basis for important collegial relationships that we may not have access to in small centres.  These collegial relationships often form the basis for referral on for complex patients and informal/formal support for doctors in rural/regional areas.”

“As a surgical trainee, our training fees are approximately $6000 dollars alone.  In addition, we are required to attend numerous courses that range from $1000 - $4000 each. They are often held interstate or even overseas and the travel and accommodation costs incurred can run into the thousands.  We also have several compulsory examinations that cost several thousands of dollars each.  The proposed changes coupled with the enforced reduction in overtime will be financially devastating for junior doctors who wish to develop their skills and obtain further qualifications.”

“As a surgical trainee, $2000 does not even begin to cover the expenses associated with training.  That would perhaps cover the College fees. On top of that are 4-5 mandatory RACS courses, at about $2000 each plus travel and accommodation.  Fees to sit exams are at least $1000 each.  Registration fees for an international conference are around $2000, notwithstanding international airfares and accommodation.  Granted education reform is important but surely this is robbing Peter to pay Paul.”

“As a psychiatric registrar, my College fees, lecture program fees and exam fees far exceed $2000 a year without even taking into account textbooks, seminars, conference fees and so on.  Given that psychiatrists are in short supply already it is foolish to further increase the barriers.”

“Remote doctors are required to keep their credentialling and skills up to date in many fields.  The impossibly low restriction proposed will seriously impact remote medicine.”

“I am a junior prevocational doctor in training (PGY2).  I have already spent almost $5000 this year on just 2 courses to further upskill myself for the workplace (APLS and DCH). Each course cost well over $2000 each, plus the costs associated with travel and accommodation as I am working in a regional area!  This proposed $2000 PD cap is ludicrous and would definitely make it impossible to attain and maintain the skills and knowledge required for our day to day work, let alone the expenses involved with working towards a specialist qualification especially for doctors working in regional and rural Australia.”

“As a specialist trainee, College trainee fees alone exceed $2000 annually plus we are required to attend intensive training courses during our training, and sit multiple exams, and purchase resources to aid our study and preparation for these exams.  Annually I spend more then $6000 for training purposes and over $10,000 in a year with College exams, plus if I want to attend additional education during training such as conferences or special interest meetings this expense is even more.  This is compounded when training in a regional centre, which I was for my College’s primary examination, as there are additional travel and accommodation costs for sitting exams and preparation courses.  Even with our current system of making these expenses tax deductible, a trainee still spends a significant portion of their income on training related expenses, making this even greater with the capped PD expenses.  We will see trainees put under financial stress for the duration of their training.”

“This is terrible news for any doctor practising in a rural area.  CPD activities for specialists are usually only available in big cities or overseas.  If the Government wants to encourage specialists to move to peripheral areas then this is NOT the way to do it.  More time away from practice at a higher cost will ensure less participation in educational activities. Conference venues, hotels, transport and food and beverage industry will all suffer.  Surely this results in less tax revenue coming back to the Government in the end.”

“As an academic and specialist clinician, I take the role of undertaking cutting edge medical research and maintaining the highest level of knowledge in my field of expertise seriously.  This is only achieved by attending top rated international medical conferences and by contributing as a committee member to national and international societies and journal editorial boards.  These attendances and contributions come at a personal cost in time and effort and absence from family, and at a financial cost.  The latter includes the cost of attending international meetings plus loss of private practice income.  To cap tax deductions in this manner is basically saying that Australians need to accept a mediocre standard of medicine in the future.”

“As a GP in remote Australia, it is necessary for me to travel to major centres to be able to attend CPD/Training sessions that are of an appropriate standard to ensure my patients receive the most up to date evidence based care available.  If this capping is introduced it may be my and other remote GPs’ patients who come off worst.  A very poor decision by the Government when the remotest patients are the sickest and have a huge health gap compared with more regional people.  This is geographical discrimination.”

“We live in an environment where medical professionals are under reasonable pressure to remain skilled and educated, with discussions regarding revalidation firmly now on the table.  Thus, we need to be able to attend conferences, subscribe to journals, attend meetings and engage in peer review activities.  I thought that necessary expenses incurred in earning your income should be deductible.  How can the Federal Government demand that you spend money to remain skilled, accredited and revalidated, and then not allow you to claim these necessary expenses.”

“As a GP in remote Australia, that has recently started a new practice, CPD will become completely unaffordable.  By the time you pay travel to larger regional centres or major cities, accommodation, course costs and then add a locum fee, you come out well behind as it is.  CPD is however vital, not only to keep up to date with developments and refresh your knowledge, but also for the much needed debriefing and exchanging of experiences that remote GPs can't do at home.  The Government probably does not realise that the only way to have time off where you actually relax is to be away from your remote community, and how much it takes for rural GPs to stay up to date so we can continue to provide quality care in our rural regions!  If I reduced my training to a bare minimum, and did REST as an emergency course, and everything else as free webinars, it would still cost me $2600 + travel and accommodation!  I would also burn out and not serve my remote community for much longer. CPD away is like food, water and shelter for a remote GP.  This idea is completely outrageous, and I am disappointed that the Government has even considered it.  Forgive my ignorance, but do our Ministers do CPD?  Do they stay under $2000?  Thank you AMA for defending our basic needs.”

“Australia has a small population that is situated a long way from other countries.  The up to date information required to remain current requires attending large international conferences.  The cost of flights, registration and accommodation is far in excess of $2000.  The situation is worse for regional and remote doctors, who spend much more on international flights and frequently need to catch flights to attend local/national meetings.  A cap will act as a disincentive to maintain learning and will disproportionately affect regional and remote doctors.”

“As a surgical trainee, I have already spent $6500 for training fees to the RACS, $6400 for examination fees, and I have two interstate conferences that I am obliged to attend as part of my training - that is since January this year.  I pay approximately 20 per cent of my annual income to compulsory training fees, and now this is added to the equation.”

“I am a PGY3 surgical resident trying to develop a breadth of experience and strengthen my application to surgical training.  In order to do this, since graduation, I have undertaken a postgraduate diploma of surgical anatomy ($11000) and several RACS courses ($2500 - $3500 each), attended conferences, and completed adult and paediatric advanced life support courses ($500 & $2000 respectively).  While I don't complain about spending money on my continued education, I can only just afford these expenses with the tax deductions, given my resident salary.  I'm not sure how I will manage these expenses in the future once I add College training fees and exam fees.”

“As a registrar in two specialties (Infectious Diseases and Microbiology), I have significant costs related to self-education every year.  I estimate my costs to be over $5000 p.a. and some years this has been even higher.  2014 is expected to be an expensive year for self-education as I sit major exams in one of my specialty fields and try to complete a Masters course, which is designed to improve my research ability.”

“As a remote rural GP, my CPD expenses are in the region of $6000-8000 per year. A $2000 per year cap on this will make my training unsustainable.  I do not abuse the self-education system by claiming overseas holiday junkets, my training is critical for competence in the work I do and for regional hospital credentialing. Unhappy.”

“As trainees, our workplace simply cannot afford to fund the educational experiences that are required to keep us up to date in our chosen fields.  Therefore, work-related costs already take up a large proportion of overall income.  Any tax deduction is much needed.

If the Government decides to cap this deduction, it will force me to reconsider and therefore limit my educational experiences and will eventually impact on the quality of care that I provide to my patients.  I will not vote for any government that tries to introduce these changes.”

“As an emergency doctor in a public hospital, I attend 2-4 courses or conferences a year to keep my critical care skills up to date.  All of these cost between $2000 - $4000 each unless they are in my home town, which most aren't.  I fly economy and stay with friends or relatives if possible.  While I can understand the Government wanting a cap in this current fiscal environment, $2000 is out of touch with the cost of our ongoing medical education.”

“As a part-time GP with kids, education will have to be compromised, as it's not financially viable.  Tempting to leave the profession!”

“As a rural GP proceduralist providing ED, anaesthetics, surgery and advanced obstetrics including Caesarian sections, it will be impossible to comply with all the College and JCC requirements for accreditation within the tax deductible limit.  So I reduce my services to my rural community and who suffers...not the Federal Government, but my isolated rural patients.  Again rural Australians will be treated as second class Australians.”

“As a clinician-researcher who works part time in public practice and private practice with part of my time spent in research, this will virtually sound the death knell for my research career.  I'm currently working on a number of projects in neurodegenerative disorders that require me to travel each year to a number of overseas conferences (there are simply no local conferences dedicated to these groups of disorders), and am involved in human and animal work and drug trials.  If this goes ahead, it will make it virtually impossible to grow my knowledge in these areas, to form collaborations, and to develop joint research projects.  I see a future where the world's clinicians and researchers will be regularly meeting and swapping ideas, whereas Australian researchers will become more and more isolated, our competitiveness will drop, and our involvement in new medication or treatment trials will fade to nothing.  There will always be a need for clinician-researchers to drive clinical research.  If a government ever wanted to kill this aspect of medical research, they've found a fantastic way to do it.”

“As a teaching GP near retiring age I may be forced to work out the next triennium without much further education and then retire. I know many are of the same mind as me.”

“Working part-time as a GP trainee, with a preschooler and a baby is not very lucrative after paying for childcare!  But I want to remain a part of our profession and continue to contribute.  College membership, textbooks and exam fees will still have to be paid. Tax-deductibility was making me feel better about that.”

“As a rural based specialist it is important to maintain competence on many fronts including my specialty.  Conferences are the ideal way of doing this.  The EASD diabetic meeting is an efficient way of updating in diabetes.  Unless one is subsidised by pharma, which has ethical considerations, $2000 is not going to cover a fraction of the cost.  This does not take into account journals etc.  Rural physicians have to travel and measures like this have the potential to negatively impact on putting physicians on the ground in rural areas.”

“I am a GP registrar. It now costs over $7000 to sit all the RACGP exams in my own city.  This does not include any travel or accommodation costs.  It costs far more than $2000 to even attend courses in my own city for fundamental education and training.  A dermatoscopy or skin cancer medicine course costs anywhere between $1850 and $3000.  A certificate in Sexual and Reproductive Health costs $2500.  The proposed $2000 cap would significantly affect the ability of GPs to maintain self-education and professional development and would jeopardise the quality of primary care in Australia.

1 May 2013

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