medicSA - Autumn 2024

PRESCRIPTION FOR CHANGE

Advocating against payroll tax

Challenging ‘scope creep’

A new model for a sustainable workforce

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17.

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Shaping the future

19.

GENERATION NEXT

- Meet the 2023 AMA(SA) Student Medal winners

- Congratulating South Australia’s newest doctors

- Student news – the year begins at our two medical schools

28.

A MODEL OF CARE

- Emeritus Professor Paul Worley introduces a special feature on the success of the single employer model in the Riverland and its potential for other regions across the country

34.

AMA(SA) ADVOCACY

- AMA(SA) leads work to secure rural contract agreement

- South Australian members urge governments to stop ‘scope creep’

- Legal partner Norman Waterhouse outlines the legal perspective on RevenueSA’s payroll tax

38.

FROM THE AMA

- Bulk-billing incentives, genetic discrimination and campaigning for people in care

40. WINDS OF CHANGE

- the unavoidable relationship between health and climate change

54.

VALE

- Honouring the legacies of Dr Michael Yung, Dr Thea Limmer and Dr Nigel Quadros

58.

ON THE ROAD AGAIN

- Dr Robert Menz tests a red and racy Type R Honda

60.

OUT AND ABOUT

- The ACMA celebrates Chinese New Year

(From left) Riverland Academy of Clinical Excellence trainees Dr Sinead Turner, Dr Steve Behan, Dr Josh Buchecker, Dr Kyle Selga and Dr Jerida Keane. Photos here and on page 29 courtesy SA Health

Australian Medical Association (South Australia) Inc. Level 1, 175 Fullarton Road, Dulwich SA 5065

PO Box 685, Fullarton SA 5063

Telephone: (08) 8361 0100

Email: medicsa@amasa.org.au www.ama.com.au/sa

Membership: membership@amasa.org.au

EXECUTIVE CONTACTS

President Dr John Williams: president@amasa.org.au

nsykes@amasa.org.au

unless this is so stated. Although all accepted advertising material is expected to confirm to ethical standards, such acceptance does not imply endorsement by the magazine. All matter in the magazine is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, without written permission. Images are reproduced with permission under limited license.

AMA(SA) COUNCIL & EXECUTIVE BOARD

AMA(SA) COUNCIL Office Bearers

President: Dr John Williams

Vice President: A/Prof Peter Subramaniam

Immediate Past President: Dr Michelle Atchison

Chair: Dr Hannah Szewczyk

Ordinary Members

Dr Vikas Jasoria

Dr Nimit Singhal

Dr Krishnaswamy Sundararajan

A/Prof William Tam

Dr Emily Kirkpatrick

Dr Rajaran Ramadoss

Dr Bridget Sawyer

Practice Group/Region Representatives

Anaesthetists: Dr Louis Papilion

Dermatologists: Dr Karen Koh

Doctors in Training: Dr Hayden Cain

Emergency Medicine: Dr Cathrin Parsch

General Practitioners: Dr Chris Moy

Orthopaedic Surgeons: Prof Edward (Ted) Mah

Paediatricians: Dr Patrick Quinn

Pathologists: Dr Shriram Nath

Physicians: Dr Andrew Russell

Psychiatrists: Prof Tarun Bastiampillai

Public Hospitals: Dr Clair Pridmore

Southern: Dr Richard Try

Medical School Representatives

University of Adelaide: Hannah Kieu

Flinders University: Lydia Smalls

AMA(SA) EXECUTIVE BOARD

Dr Michelle Atchison, Dr Guy Christie-Taylor, A/Prof William Tam, Ms Megan Webster, Dr John Williams (Chair), A/Prof Peter Subramaniam

SA MEMBERS OF AMA FEDERAL COUNCIL

Dr John Williams, Prof Ted Mah, Dr Clair Pridmore, Dr Hannah Szewczyk, Dr Matthew McConnell

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IPresident’s Report

Dr John Williams

t’s difficult to think of any other time in recent history when two issues have simultaneously rendered it so essential that we doctors stand up for ourselves, each other and our patients.

The first is obviously the pandemic, and the crushing toll it continues to impose on our capacity to provide the care we know has been and continues to be so urgently needed.

Now, there’s the looming threat of payroll tax.

What I find incredible is that the decision to impose this tax comes so soon after the worst of the pandemic, when our profession was that which our society and our politicians relied upon to get them through. They depended on our expertise, altruism, ethics and dedication to our profession and patients. They knew we would keep working and we did.

You’d think there’d be a little quid pro quo. You would think there would be acknowledgment from our politicians that doctors, especially those at the heart of their communities in primary care, are still addressing those issues triggered or worsened by the pandemic and ask how they can help us. You would think those politicians would recognise that a strong, viable primary care system is the most productive, efficient and costeffective means of limiting the long-term effects on hospitals, surgery waiting lists, and – yes – ramping.

Yet here we are.

For those who may not have closely followed this issue, RevenueSA announced the proposed imposition of a new payroll tax on South Australian GPs in June last year. In doing so, it joined the Queensland, NSW, Victorian and ACT governments in deciding on a new interpretation of existing payroll tax law.

RevenueSA granted general practices an amnesty until 30 June 2024. AMA(SA) was told that registration for

the amnesty would allow RevenueSA to investigate each registered practice to determine whether its contractual structure meant it was or was not liable to pay the tax on its GPs.

AMA(SA) counselled many doctors and practice staff members, recommending that they seek legal and financial expertise so they were best able to determine their individual practice contract structures before registering. We heard that many practices did register, confident their contractual arrangements meant their GPs could not be considered ‘employees’ and they would not have to pay the tax.

In recent weeks, however, many of the 283 practices we understand did register are now receiving responses from RevenueSA – identically worded, despite their differing contractual arrangements and registration details –informing them they will have to pay the tax in 2024-25.

Since then my colleagues in AMA(SA) and I have been advocating to RevenueSA, to the Treasurer and Health Minister and their Opposition counterparts, and, through the media, to South Australian users of our health system what this tax will mean for doctors, patients, hospital admissions and the future provision of primary care. We continue to call for the Treasurer to reverse this astoundingly destructive decision, pointing to Queensland, where a legal solution has been found.

I acknowledge the moral injury caused by the incredibly difficult decision doctors will face, many times a day. Will I charge this patient a gap knowing their difficult financial position or do I keep the business viable and able to pay the staff that make a good practice function?

We are here for all doctors, our profession and our patients. If you are member of AMA(SA), please contact me with your concerns. If you are not, please join us. Our voice is your voice, and is louder if we speak for you all.

president@amasa.org.au

From the

Medical Editor

Dr Roger Sexton

ou will no doubt recall the national response and reaction to the Australia II winning the 1983 America’s Cup yacht race. It was an extraordinary and truly strategic victory.

Yachts navigating their way around the racecourse can be a metaphor for competition within the health system and the importance of having a winning strategy.

Our profession is now one of a number of influential players in an expanding sector that has become very competitive. We need to recognise this and how this can contribute to inequitable outcomes and a maldistribution of resources across the sector.

Examples of this include competition for talent and finite human and capital resources, urban versus rural services, funding of primary versus tertiary care, political favour, research dollars, trials to extend scope of practice, access to Medicare, new models of clinical care delivery, broader prescribing and technological advances. The list is very long.

The strategic aim of our race is to grow in strength and size; to be a sustainable and influential competitor in the long term and positively influence health outcomes.

Strategically, Australia II succeeded through having a well-resourced campaign, very broad community support, excellent and consistent leadership, and a united crew of people who were fit and well-trained, with everyone strongly aligned to the mission. The Australia II team possessed a source of competitive advantage, the winged keel, the details of which it kept a closely guarded secret. The crew members were innovative, agile, faster and better at their craft. They were first to the post.

Where does the medical profession now belong in our ocean?

In terms of competition with other sectors, we belong at the head of the pack, well-resourced and growing both in size and influence. We

must be innovative, adaptive and agile in business. We need to believe in ourselves and the importance of our work to the community. We must protect and preserve the symbols and skills of our trusted craft that have historically been a true source of competitive advantage.  We must define and defend our scope of practice and our place in the system as healers and teachers.

This requires strong, optimistic leadership of the sort the AMA has always provided. But leadership now means not one but many generals and officers – not just in our traditional medical workplaces but out in the field, promulgating the same message at meetings, fora, parliamentary gatherings and ministerial and shadow ministerial advisory groups where solutions are offered and decisions are made.

AMA leadership is respected and listened to but is in a red ocean of competition now with others who are ambitious influencers.

It is time to roll our sleeves up.

A stronger AMA can train and recruit more doctors to play a whole range of leadership roles and provide role modelling across the entire sector. We can spread the message of hope that a healthy profession offers the broader population.

‘We must be innovative, adaptive and agile in business.’

Strategically, this is how we ‘win’.

The community and government want reliable, compassionate and trusted medical leadership across the sector. Community support for what we do is central to our own sustainability and that of the wider health system.

We don’t need to conquer waves or Olympic sailors. We must win the crowd – and thereby earn the ear of government.

Join the AMA(SA) Council and

help shape the future of healthcare

By joining the AMA(SA) Council, you can help to shape healthcare policy and make a difference. You can contribute your expertise and ideas to address pressing healthcare issues. The Council is a dynamic forum comprising member GPs, private specialists, and public hospital doctors responsible for collaborating and developing policies to advocate change in healthcare.

Casual positions in Radiology Gynaecology & Obstetrics + are available until a formal nomination and vote at the AMA(SA) Annual General Meeting in 2025. Upcoming nominations for Ordinary Members and Regional Representatives for two-year terms open in April 2024.

Your voice matters. Together we can drive meaningful change!

For more information and nomination forms, contact Ms Suzanne Roberts at the AMA(SA) Secretariat

Suzanne.roberts@amasa.org.au

CEO From the Nicole Sykes

his month, as we honoured International Women’s Day, I took a moment

to reflect on the immense privilege of collaborating with an extraordinary assembly of women on our Board, Council, committees, team, each at various stages of their careers. I want to extend heartfelt recognition of every remarkable woman within our health community whose work and commitment embody the essence of this significant day.

Unfortunately, over the past few weeks, payroll tax has taken centre stage, with RevenueSA sending generic letters to most of the 283 GP practices registered for the amnesty, informing them of their liability for payroll tax on their contracted doctors. These apparently identical letters have not recognised variations in business structures, Medicare payment flows, and clinician independence in practice structures. Our GP members are understandably incensed, enraged and distressed as they ponder their future capacity to operate their businesses and support their patients. There are also direct implications for our private specialist members.

I would like to acknowledge and commend President Dr John Williams and Dr Bridget Sawyer, Chair of our Committee of General Practice, for their efforts in navigating the many discussions we have had with government officials – in collaboration at different times with Hood Sweeney, Norman Waterhouse, RACGP and Business SA – as we have sought and recommended short and long-term solutions. This issue impacts

our GP and specialist members, and we will continue to advocate for a solution that will not add further strain to our health system.

On a brighter note, I am pleased that our Board and Council have approved our Strategic Plan for 2024-2028. This is a pivotal moment in our journey as the Australian Medical Association SA. The plan is grounded in our core values of trust, collaboration, and inclusion, serving as a roadmap for our collective efforts in the coming years. I offer my thanks to all who contributed to this plan. Your insights and commitment have been instrumental in shaping our direction and developing a plan that will be the foundation of our work to serve our members and the community. Our strategic pillars, which focus on member value, advocacy, delivering excellence and sustainability, reflect our ongoing commitment to advancing the profession while advocating for policies and practices that prioritise the well-being of both patients and practitioners.

‘Our core values of trust, collaboration, and inclusion’

It is an exciting time to engage with AMA(SA) and actively influence the future of healthcare in South Australia. If you are not a member, please consider joining our community and explore opportunities to contribute through our Council and committees as openings emerge. All members are welcome to attend Council meetings as observers, and to attend our annual general meeting in June to gain insight into our achievements, plans and what happens behind the scenes.

If interested, please don’t hesitate to contact us. There’s much to tell; much about which we seek members’ thoughts and involvement. I look forward to working with and for you in the year ahead.

ON THE TRAIL OF A GOOD NIGHT’S SLEEP

Sleep and sex are the only activities that should occur in people’s beds, says internationally known science broadcaster Dr Michael Mosley. But at least one, he says, can be hard to find.

It’s a cold winter’s evening in London when science broadcaster and journalist Dr Michael Mosley calls via Zoom to discuss the topic of his latest scientific exploration: sleep.

Sleep and sex are the only activities that should occur in bed, Mosley says.

Mosley is the international bestselling author of several books, including The 8-Week Blood Sugar Diet and The Clever Guts Diet. He studied medicine before joining the BBC, where he spent three decades as a science journalist.

Having previously worked with SBS on a successful series called Australia’s Health Revolution about how diabetes can be ‘put’ into remission, when he was asked what he’d like to explore next he quickly nominated sleep. It was, for him, the perfect subject.

Insomnia has been a bugbear for Mosley for years. He says he became a ‘chronic insomniac’ in his early 40s, waking at 3 am in what became a deeply ingrained pattern.

The result is a series in which Mosley joined 29 other participants, in the lab at the Flinders Health and Medical Research Institute (FHMRI) Sleep Health and through follow-up sessions at home, in pioneering sleep treatment program he hoped would eventually bring him that elusive dream – a full night’s sleep.

Moseley says the participants discussed each other’s symptoms and struggles with sleeplessness, which categorised each of them into one of three main groups. About one-third of the participants had undiagnosed sleep apnoea, another third had various forms of insomnia; and the remainder had a combination of the two (co-morbid insomnia and sleep apnoea or COMISA).

‘SLEEP APNOEA IS VERY COMMON AND EASILY MISSED’

The insomniacs varied between those who found it difficult to go to sleep (onset insomnia) and those who struggle with returning to sleep after awakening during the night (maintenance insomnia) or wake very early.

Sleep apnoea is very common and easily missed, Mosley says. It’s also the simplest cause of sleeplessness to diagnose and treat, he says, as evidence now indicates it is usually a problem that can be reduced or even eliminated with weight loss.

‘The only real way of getting rid of sleep apnoea is a weight-loss diet,’ he says. ‘Sleep apnoea is caused largely by too much fat around your neck and your waist.

‘In terms of insomnia, there are the insomniacs who are linked to having a body-clock that’s going too fast or too slow and you are out of sync with it. These seem to adjust best to bright light.

‘Beyond that, the classic insomnia where perhaps you are waking up at three in the morning, that can be a learned habit. And the best way of treating that is through behavioural techniques.’

TREATING INSOMNIA

A key part of the Flinders program was exploring how technology and tools people can use at home can replace some of the on-site expertise available in facilities like Flinders’ Sleep Lab – to identify whether some tools could be improved to the point that patients can work with their GPs to diagnose and manage insomnia.

‘Accessing the sleep lab isn’t always economical or feasible for a lot of people to access treatment,’ Mosley says. ‘The researchers looked at how known technology can be used by GPs and others to diagnose the problem: mats that can be placed under the bed with microphones that assess whether someone has sleep apnoea, devices to measure your internal core body temperature to assess circadian rhythms, Apple watches and rings and other “wearables”.’

‘AUSTRALIA HAS ALWAYS DONE VERY WELL IN SLEEP RESEARCH’

Other technology aims at fixing, rather than diagnosing, the problem. CPAP (continuous positive airway pressure) machines work for about 50% of cases, but many people find them uncomfortable. Less intrusive are mandibular advancement devices (MADs) that move the jaw forward and prevent the tongue blocking the airways; other devices fit around the neck and ‘buzz’ when the wearer lies on their back, which leads them to move to their side.

The Flinders team is also looking at the use of light for people who are ‘hard-core larks or owls’. A few years after the ‘Sleep Lab’ became known for the goggles developed by Professor Leon Lack, the Institute’s Associate Professor Sutapa Mukherjee says it now has as a major focus how emerging technologies such as ‘wearables’ – Apple watches and other devices – can be used and improved so that more people can treat their symptoms at home.

A/Prof Mukherjee says the exploration of so many facets of sleep has maintained the Flinders institute’s status as one of the foremost in the country, and among the best-known in the world.

‘Australia has always done very well in sleep research, which really came from our research in respiratory medicine,’ she says. ‘And more recently, because Australia managed COVID-19 differently to other countries, our research has been able to continue while other places haven’t been able to maintain their momentum.’

It made sense, then, that when the production company Artemis Media was looking for a research

(Above and opposite) Dr Michael Mosley during the sleep studies at Flinders University

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partner for Mosley’s project, they came to Flinders and FHMRI Sleep Health director Professor Danny Eckert. FHMRI Sleep Health and the Adelaide Institute for Sleep Health clinic have more than 60 psychologists, sleep physicians, scientists and students working together to explore better ways to diagnose, treat and manage issues related to sleeplessness, including sleep apnoea and insomnia.

Prof Eckert says having research findings aired in the documentary will strengthen public awareness and understanding of the importance of good quality sleep.

trying to find out what the underlying cause is, you don’t need years of analysis, what you need is to reprogram that person so through constant exposure they no longer fear the dog.’

Similarly, he says, in the end it doesn’t matter what the underlying cause of insomnia is when seeking the most effective treatment. He says even depression and anxiety, often the causes of insomnia, are helped by better sleep.

‘We wanted to unpack the science behind common sleep conditions,’ Prof Eckert says. ‘The program also highlights the shocking short- and longterm health effects posed by bad sleep – ranging from high blood pressure to increased risk of cardiovascular disease, stroke, diabetes, depression and chronic disease.’

In addition to new technology, Mosley says there is widespread use of bedtime restriction therapy (or sleep restriction therapy), which is a form of cognitive behavioural therapy and can be taught to ancillary staff rather than require a one-on-one appointment with a GP or psychologist.

‘WE WANTED TO UNPACK THE SCIENCE BEHIND COMMON SLEEP CONDITIONS’

One hope is that these sorts of techniques could be rolled out on a larger scale. It’s part of the regime recommended in Mosley’s new book, Four Weeks to Better Sleep, which he describes as a ‘practical guide’ that encapsulates what he learned during the Flinders trial and what he has discovered since.

‘What you are really trying to do is treat patients to associate bed with sleep and sex and nothing else,’ he says. ‘Everything else is associated with achieving this objective. So, sleep hygiene is about doing that. You get all the electronic equipment out of the room, you make it cool, dark, quiet.

‘It’s like treating a phobia, where you’re not even

‘Do you treat the depression first or do you treat the sleep first? The psychologists at Flinders would say treat the sleep first … that in many cases, if you treat the insomnia, then the anxiety and depression go away; that it’s a more effective way of treating it than the other way round.

‘Clearly, if you have a bereavement, you’ve lost your job, something traumatic has happened to you, that may be a case for medication for a short term. These drugs have their place. But you don’t want to be chronically on them. They’re not usually the solution over the long term.’

Mosley says he has introduced the techniques outlined in the series to his own lifestyle ‘with great success’, and believes they will be helpful for GPs and patients.

‘I don’t necessarily sleep through the night now, but when I wake up, I am not agitated by it,’ he says.

Meanwhile, A/Prof Mukherjee says the Flinders team is now writing a paper on the study in the hope it will be published. The team is also seeking grant funding for studies into the efficacy of the various technologies so that Apple watches and other wearables can reach ‘clinical grade’ and have Medicare item numbers. Australia’s Sleep Revolution With Dr Michael Mosley is available to stream free now on SBS On Demand.

Dr Mosley discusses the study with FHMRI Sleep Health’s director Professor Danny Eckert and A/Prof Sutapa Mukherjee

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Educating doctors to reduce litigation risk

The interface between medical practice and technology is the new frontier of medical indemnity insurance, says the new Board Chair of medical indemnity insurer MIGA, emergency physician Dr Stephen Parnis.

‘That’s why principles about the best-practice application of new technologies in diagnostics and therapeutic practice will be a pillar of the organisation’s new strategic plan,’ says Dr Parnis, who assumed the role in October last year.

The focus, he says, will be to expand the organisation and build on MIGA’s strong work with doctors to create a culture of continuous improvement in medical practice.

He says that while new technologies such as generative artificial intelligence (AI) offer great promise in enhancing medical procedures and reporting – as well as in MIGA’s own business in data analytics and underwriting policies, for example – a strong governance framework will be required.

‘It’s not for medical defence organisations (MDOs) to approve new clinical technologies, but more to advise on what can be done to minimise the risks of adverse clinical outcomes of any new technological applications,’ says Dr Parnis.

‘Some kind of accreditation is likely needed to make new technologies safe and defensible in medical practice.’ Ultimately, says Dr Parnis, the key is educating doctors to understand that the judgement calls lie with them, not the machines. He says MIGA has long been promoting education that reduces the risk of litigation in an increasingly complex operating environment. Topics addressed in face-to-face and online forums range from understanding privacy in healthcare to interaction with the Medicare system.

‘You need to think about the contexts in which you make clinical decisions,’ he says. ‘Even matters like diagnostic error can be better understood and overcome – the way we can sometimes kid ourselves into going down the wrong clinical path, knowing when to refer to a colleague, when to stop and ask questions, knowing what we are good at and not so good at because of our training and experience. That’s the wisdom of medical practice – that can be taught.’

in the years ahead. Helping people understand its safe and effective use is part of what we are doing,’ he says.

Equally, governance frameworks for storage and management of patient data are topics causing anxiety for medical practitioners and practice staff as they are for other businesses trying to stay ahead of the hacking curve.

Improving the culture of professionalism between colleagues as well as with patients is another important focus, given the recent emphasis on preventing bullying and harassment in hospitals and medical practices alike. Dr Parnis says the medical profession faces particular challenges in tackling workplace culture given the long working hours, the hierarchical system and resulting power imbalances, discussion of intimate topics and close proximity of the working environment.

REDUCING THE RISK OF LITIGATION

‘We’re helping doctors and other health workers understand what professionalism looks like; helping people understand that respecting boundaries is not just between doctor and patient but between colleagues,’ he says.

It’s all part of a growing evidence-based organisational understanding of the best ways to reduce the risk of litigation, Dr Parnis explains.

‘Australia has more than 120,000 doctors now and the number of complaints for the millions of consultations and procedures that occur annually is thankfully a low proportion.

‘But increasing litigation has been a feature of medical indemnity in recent years, and MIGA has never been more determined to protect doctors and enable them to practice with confidence.

‘IT’S ARGUABLY THE MOST TRAUMATIC MOMENT OF A DOCTOR’S CAREER’

Developing doctors’ skills in capitalising on telehealth and the use of newer communication modalities in medicine – which have grown exponentially since the pandemic – is also in MIGA’s sights.

‘Recognising when new ways of communicating are advantageous (such as reducing travel time or cost), and when they can increase diagnostic risk is really important,’ says Dr Parnis.

‘Telehealth will be an important part of medical practice

‘It’s arguably the most traumatic moment of a doctor’s career when they are subject to litigation – even a complaint that is quickly resolved can be traumatic.

‘When doctors are in these situations, they need an enormous amount of support and expert advice. It’s not just legal expertise, it’s physical and mental health and understanding the impact on their families. I hope knowing that five of their medical colleagues sitting around the board table with an incredibly talented, dedicated team will give them comfort and confidence.’

And to that extent, the new strategy, says Dr Parnis, is part of the evolution of the business that began in 1899 as the Medical Defence Association of South Australia.

‘I am particularly interested in making sure that doctors build on those professional skills – understanding that they are the leaders in the provision of healthcare services; leaders bring out the best in their teams and make their patients feel deeply respected. That is the message I want to get through,’ he says.

‘The focus on doctors’ health is very precious to me too. Professionalism, self care and work-life balance – they are the things I’d like to see.’

next GENERATION

Each year, the President of the Australian Medical Association in South Australia is privileged to examine the resumes and experience of some of the state’s highest-performing medical school graduates and select the winners of that year’s AMA(SA) Student Medal. It’s a difficult task but a rewarding one.

Here, we present the winners of the 2023 AMA(SA) Student Medals and continue our tradition of congratulating them and their peers for completing medical school and embarking on careers as ‘real doctors’.

We also introduce a column from first-year intern and former AMA(SA) Council student representative Dr Isaac Tennant, who will write about life as an intern in each edition of medicSA this year, and we meet the 2024 medical students’ societies presidents as they update us on the early activities at their campuses this year.

With these young people as our future, it seems the medical profession is in exceptionally skilled hands.

QWHEN DID YOU DECIDE YOU WANTED TO BE A DOCTOR?

I don’t remember the exact moment, but my mum says I came home from school one day in Year 7 telling her I wanted to be a doctor. What I do remember is the feeling of a light bulb going off and suddenly knowing that this was the path I wanted to take. Around this time, I learnt about organisations like Doctors Without Borders and was symbiotically inspired to pursue medicine and make a positive difference to people’s lives.

WHERE ARE YOU AND WHAT ARE YOU DOING NOW?

I am interning at The Alfred in Melbourne, currently rotating on breast and endocrine surgery. I have also taken up a role as accreditation co-lead for JMO Victoria this year, representing junior doctors in the roll-out of the new national prevocational framework.

WHAT ARE YOUR PROFESSIONAL GOALS?

I aspire to build a portfolio career that traverses both clinical and nonclinical spaces. My clinical interests are in paediatrics and critical care, so a specialty where I can combine the two is the dream. Beyond that, I plan to do a Master of Public Health in the next couple of years and pursue roles in public health leadership, research and advocacy.

HOW DID MEDICAL SCHOOL PREPARE YOU FOR INTERNSHIP?

Half of my degree was dedicated to clinical placements, which provided the opportunity to feel grounded and more comfortable within the hospital system. Those years on the wards and in the clinics were invaluable. Aside from that, extra-curricular opportunities created by the medical student community allowed me to foster initiative, communication and organisation skills.

WHAT WERE THE BEST AND WORST ASPECTS OF MEDICAL SCHOOL?

The best aspects started with the people. I met so many wonderful and inspiring people - my world really exploded when I started medical school. Beyond that, I was exposed to innumerable life-altering and challenging experiences that were unique to medical school – from being privy to a patient’s first diagnosis of cancer, to visiting the APY Lands to helping lead large-scale events and committees, the variety was huge.

The worst aspect was adjusting to the lifestyle of a clinical student. But it does force you to learn to prioritise time and find ways to share it with loved ones.

HOW DID YOU REACT TO BEING NAMED THE WINNER OF THE AMA(SA) STUDENT MEDAL?

I remember hearing the introduction about the recipient before my name was called out at the Declaration Ceremony, and suddenly realising they were talking about some very specific things I had done in medical school. If I could sum it up, Declaration Ceremony was one of the best days of my life.

WHAT INVOLVEMENT HAVE YOU HAD WITH THE AMA AND PLAN TO HAVE IN THE FUTURE?

I have been on the receiving end of the AMA’s advocacy efforts when I was stuck behind a locked-down border between SA and Victoria in 2020.

I have been an AMA student member throughout medical school and kept up to date with their latest advocacy and reforms. I plan to become very involved in the AMA, because I see it as a platform that not only achieves positive widespread change for doctors and patients but also gives doctors the chance to have a say on the local and national health systems we are deeply entrenched in.

HOW DO YOU BELIEVE THE AMA HELPS STUDENTS AND JUNIOR DOCTORS?

If my story of AMA support as a thirdyear medical student isn’t enough, then just look to the news. Examples of the AMA’s breadth of impact includes successful wage-theft class action awarding junior doctors tens of thousands of dollars in unpaid overtime, and national mental health advocacy for medical professionals.

The AMA’s career support and membership benefits are great for students and junior doctors on a good day, and on a rainy day, they’re the ones you want on-side.

HOW IMPORTANT IS IT TO HAVE A NETWORK OF MENTORS AND ADVISORS THROUGH YOUR CAREER?

I think it’s incredibly important to foster a network of mentors and advisors, and I have realised that these relationships are somewhat serendipitous. When you cross paths with these people, it becomes clear that these connections should be valued and respected; that these mentors and advisors could not only help you make life-changing decisions, but also open further opportunities to you. And, ultimately, you will one day have the chance to be that person to someone else too.

WHAT ADVICE DO YOU HAVE FOR NEW MEDICAL STUDENTS?

If you’re a new medical student this year, take a breath and take it all in – it’s a whirlwind of an adjustment! First year can be overwhelming (it took me the better part of a year before I figured out how to study for uni). But be open to every opportunity given to you – always consider saying yes! You will learn a lot about yourself as a person, and it is transformative.

WHEN DID YOU DECIDE YOU WANTED TO BE A DOCTOR?

From the age of 6, I was exposed to regular hospital visits to see family who required weekly infusions. I would spend hours on the wards almost every weekend, getting to know the staff and helping the nurses. I knew I wanted to work in healthcare; however, I did not have the grades to even dream of becoming a doctor until high school. Once my dyslexia was diagnosed, and I found ways to work around it, the dream began.

WHERE ARE YOU, AND WHAT ARE YOU DOING NOW?

I am currently working at Alice Springs Hospital on my general surgical rotation. I completed 14 months of placement as a student in the Northern Territory between Alice Springs, Tennant Creek, and Darwin. I loved living in Alice Springs, and it was my first preference for internship locations.

WHAT ARE YOUR PROFESSIONAL GOALS?

My short-term goals are about maintaining the values I would like to be remembered for as a doctor. These qualities are often the first to go when we are overwhelmed and busy, which is all too common starting out in this job. In the long term, I am looking at working in the critical care space, particularly anaesthetics or rural generalism with an anaesthetics focus. I hope to develop my skills through various rotations, courses and research to reach this goal.

HOW DID MEDICAL SCHOOL PREPARE YOU FOR INTERNSHIP?

Being placed in the Northern Territory as a student was the best preparation I could have asked for. The smaller

groups allowed for more one-on-one teaching and responsibilities, more hands-on procedural experience, and a diverse exposure to different pathologies and cultures.

HOW DID YOU REACT TO BEING NAMED THE WINNER OF THE AMA(SA) STUDENT MEDAL?

It was a great honour hearing my name being called out for the prize. It wasn’t until I was nominated and writing my CV for the application did I realise all that I had achieved and worked towards in the past year. It served as a great reminder that the hard work paid off, being able to give back and advocate for my peers.

WHAT INVOLVEMENT HAVE YOU HAD WITH THE AMA AND PLAN TO HAVE IN THE FUTURE?

My involvement with the AMA has been through my role as President of the Flinders Medical Student’s Society. We sat in meetings with the junior doctors-in-training representatives, feeding information to and from students about advocacy issues. I also regularly wrote articles for medicSA about various activities and advocacy wins within FMSS.

HOW DO YOU BELIEVE THE AMA HELPS STUDENTS AND JUNIOR DOCTORS?

Students and junior doctors are two of the most vulnerable groups in the profession, undertaking enormous changes in responsibility as well as uncertainty. Having representatives who understand the challenges being faced and who are happy to listen can be helpful. Knowing that your voice is making an impact, benefiting your own work and also the conditions of the future students and doctors, is empowering.

HOW IMPORTANT IS IT TO HAVE A NETWORK OF MENTORS AND ADVISORS THROUGHOUT YOUR CAREER?

A good mentor will make all the difference - not only to your day-today work but also your career choices. They are someone to talk to about a mistake you made, they can teach you something useful or help you make decisions on the direction of your career. I know when I work with doctors whose working style and patient interactions I admire, I greatly consider following in their footsteps.

WHAT ADVICE DO YOU HAVE FOR NEW MEDICAL STUDENTS?

Medical school is not designed for you to come out being an all-knowing, fully independent doctor who knows what they want to specialise in. Enjoy the process, learn about yourself, and immerse yourself in your hobbies and community during uni. Finding this balance will be essential for the rest of your career. Finally, you don’t have to aim to be a consultant as quickly as possible. You will still be working and earning money; it is okay to take time for other life priorities.

Congratulates

University of Adelaide

Georgia Anker

Nidhi Aujayeb

Vi-Seth Bak

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Lara Beltrame

Henry Bittner

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Lucy Brown

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Ho Hoi Chan

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Matthew Worley

Antonios Xenikis

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Sam Yu

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South Australia’s 2023

MEDICAL GRADUATES

Flinders University

Angelo Abdelmalek

Daniel Adair

Keshani Alagiyage

Shems Al-Murieb

Melissa Ayyildiz

Jahan Barr

Jonathan Beacham

Max Bedward

William Bessell

Sargam Bhardwaj

Kurt Bierlein

Jia Yi Alicia Boey

Samuel Bradley

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Cassie Cameron

William Cavaye

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Katherine Constance

Bianca Cottier

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Joseph Fantasia

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Lorraine Kit Ying Ho

He Huang

Moaz Ibrahim

Mary Iengo

Sahima Jafari

Navya Jain

Fatih Jamal

Rachel James

Joseph Jang

Midhun John

Natalie Kanter

Teng

Hugo Keller

Ann Michael Khoo

Shu Yan Elizabeth Koh

Michael Kolar

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R Raveen Kumar

Nathan Lang

Amy Langdon

Cassandra Larobina

Hannah Lewis

Matthias Lim

Shee Teng Lim

Zida Liu

Sean Loh

Robin Lu

Kevin Lu

Matilda Lyons

Alexander MacAdam

Maryam Mahmoud

Justin Martin

Christine Mausolf

Bahati

Mbuzukongira

Laura McEntee

Tara McFadyen

Kaelee McKay

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Alexander Mesecke

Scott Milton

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Ellen Monsi

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Elizabeth Morgan

Danielle Morris

Maxim Nagorny

Tyler-Brooke Newman

Zheng Joel Ng

Nina Nguyen

Amirhossein Norozi

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Michael Pham

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Adel Razi

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Daniel Vale

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Hanru Wang

Andrew Waters

Shannon Waters

Beatrice Webb

Madusha Weeratunga

Jeffrey Weng

Loyola Wills

Jacob Wilson

Jason Wong

Janelle Wong

Daniel Young

Jim Zeng

New leaders bring fresh ideas

The 2024 academic year has started with events to create lasting connections between colleagues of the future.

The Adelaide Medical Students’ Society (AMSS) is one of the oldest student bodies, founded more than 125 years ago and now consisting of 900 medical students I am Huy, the President of AMSS and this year I have the privilege of continuing the AMSS’s strong traditions, stellar events and advocacy for student education and well-being.

Our aim this year is to work to our strengths and what makes us great as a society: our priceless connections and bonds with each other. You’ll see us focus on new initiatives to foster these connections. Watch this space to see what we have in store for our pre-clinical, clinical and international students!

Carrickalinga as the first years create memories that I’m sure will last time a lifetime. What do you remember from your first MedCamp and your time in Med School? Earlier this month I had the pleasure of meeting

‘HOW FORTUNATE WE ARE THAT THE AMSS AND AMA(SA) HAVE SUCH A STRONG AND LASTING RELATIONSHIP’

We started this year with a bang, welcoming back our Year 4-6 clinical students at the Clinical Student Mixer at the largest aquarium in Adelaide, Atlantis. In mid-February we celebrated our 6th-years’ last year of medical school as they prepare themselves for internship and head into the workforce.

As I write this, we are excited and eager to welcome the incoming first years as the 3rd year of the new medical doctorate degree at O’Week. Following this will be our first Pre-Clinical Mixer event welcoming our Year 1-3 students back to university on Pinky Flat. We also look forward to the highly anticipated MedCamp at Camp Dzintari in

AMA(SA) President Dr John Williams and CEO Nicole Sykes to discuss how AMA(SA) and AMSS can together support medical students in their med school journey. Times like these remind me of how fortunate we are that the AMSS and AMA(SA) have such a strong and lasting relationship to collaborate and help each other.

The AMSS continues to adapt and improve to fit the current needs of medical students in an everchanging landscape and list of priorities. We are deeply thankful for the support

AMA(SA) has provided us over the years and look forward to working together and supporting and learning from those who have studied and embarked on careers in this profession before us.

Welcoming sixth-year students to the new academic year

President pledges community support

Every year, the Flinders Medical Students’ Society (FMSS) evolves with new ideas, leadership, advocacy and events. We value the great relationship between students allowing continuing growth within our roles to uphold our four domains: advocacy, culture, education and support. My name is Grace Mackenzie (she/her) and I am the President of FMSS for 2024, following the amazing leadership of Christine Mausolf in 2023. This year, the committee is committed to funneling our finances and resources into our community, the student body. We aim to provide a calendar full of events that are affordable and accessible to everybody, as well as maintain our healthy relationship with the college and wider university.

As with every new year, the first few months keep us busy! We have now welcomed a new cohort of first-year students from all over the world who are embarking on their medicine journey at our Adelaide and Darwin campuses A huge team of volunteers from our committee has developed the calendar, which includes our annual quiz night and meet-and-greet at local venues. We also published videos answering common Frequently Asked Questions and a virtual tour around campus. Students from all year levels were involved, to facilitate vertical integration

and provide some (soon-to-be) familiar faces for our new colleagues From experience, we know these first few weeks of med school can be overwhelming, with emotions of excitement but also nervousness and self-doubt. Looking back, having the support from events like these helped ease that transition, as well as set the tone of collegiality and non-competitiveness.

‘WE KNOW THESE FIRST FEW WEEKS OF MED SCHOOL CAN BE OVERWHELMING’

This year is a year of re-accreditation for our university and we are privileged to play a part in this process. With the continuing easing of COVID-19 restrictions, students have been welcomed to the wards earlier in our program. This has strengthened our curriculum, allowing students to solidify their theory by interacting and communicating with patients and clinicians on the hospital wards and in the GP setting This is a process that requires adjustment for the clinic and hospital spaces as well as the clinicians providing supervision. We look forward to assisting the college in the process and working together to continually improve the student experience.

Looking at our year ahead, I cannot wait to see what all our amazing new leaders in FMSS will achieve. They have a passion for supporting their peers and making lasting changes that will have a positive impact on many students, now and in the future. I hope we can continue to serve the students in the MD, empowering them through the many challenges they will face throughout med school.

Grace Mackenzie FMSS President 2024

From left: 2024 Senior Vice President and AMA(SA) Council student representative Lydia Smalls, 2023 President Dr Christine Mausolf and 2024 President Grace Mackenzie

EARLY WEEKS BRING MANY FIRSTS

Dr Isaac Tennant is a first-year intern at the Royal Adelaide Hospital. This is the first in a series of columns he is writing this year to highlight the rewards and challenges of life as a junior doctor.

On a brisk January morning, I arrived at the main entrance of the Royal Adelaide Hospital and made my way to the Gastroenterology unit office on level 5. It was a morning similar to any other morning from the last few years – as a medical student I had many placements at the RAH – and I strode the same corridors at the same early hour as I made my way upstairs.

The only difference – a slight difference – was that this year I had a bright blue tag on my belt – inscribed with the word ‘INTERN’ in big bold lettering.

I was no longer the student.

I was now the doctor.

Having just completed my week of orientation, it was now time to get to work – preparing the ward round and printing the list, following the team around the ward, writing my first scripts and organising patient care with nursing staff. It was certainly a fastpaced start.

Life comes at you fast as an intern –while I am undoubtedly thankful for the support of the unit’s RMOs, registrars and consultants, the step up from student is huge. Nurses, allied health staff and patients treat you completely differently as a doctor, and the change in workload, responsibility and working hours is huge.

cardinal moments in my first week – signing my first script, introducing myself as doctor for the first time, managing my first deteriorating patient, and buying my first round of coffee for the students – was such an exciting milestone, and it has been truly wonderful to see so many of these milestones in the last few weeks.

Writing this now, halfway through my first rotation, I feel significantly more comfortable with this new role and able to reflect on the experiences of this early transition to the medical profession. I still feel much more inefficient and inexperienced than my RMO and registrar colleagues, but I have already seen the growth in my ability to handle the many and varied competing tasks of inter nship.

‘THE HUMANITY OF OUR PATIENTS OUGHT TO BE TREATED WITH THE UTMOST RESPECT’

As another aside, it is also just so fun to see all my friends at work! I love the quick smiles and conversations with fellow interns –old friends and new – and seeing their names on notes written for my patients. It is great to work in this big new hospital team, and I have enjoyed seeing these people as not only fun to be around, but colleagues who I trust and respect.

While the common adage of ‘with great power comes g reat responsibility’ is certainly well known, to it I would also add that great responsibility (within a supportive environment) begets great excitement. Each of these

To finish my first month’s reflections, I would like to end on a more serious tone and describe a cardinal experience of mine over this time – one which I believe highlights the real privilege it is to work as a doctor.

This reflection comes from an experience where, early on in my rotation, I delivered the results of a CT scan to

a patient. Unfortunately, the scan demonstrated a lesion consistent with hepatocellular carcinoma, and, having been reported later in the day and my fellow doctors busy with other responsibilities, I was the one tasked with explaining these findings to the patient.

With the medical school teaching on ‘how to break bad news’ still fresh in my mind, I approached the patient’s room, closed the door, and drew up a chair as I began to explore their understanding of their situation before beginning to explain the diagnosis.

I remember vividly the reaction as my words tur ned from bright, to hesitant, to sombre. I waited for what felt like years as the patient’s eyes welled up slowly with tears and then emptied, as the patient caught their breath and asked their first round of post-diagnosis questions.

I remember with absolute clarity too how as I stood up to leave the room, the patient held me with a magnetic gaze, my eyes locked with theirs. ‘ Thank you,’ they stated, probably the most visceral and emotional thank you I have yet heard in my life.

At its core, medicine is this strange juxtaposition between a career which is essentially a service profession and a role as a healer and advisor to someone in their most vulnerable hour. Often in our busy lives we fall too easily into the former, and it can take some deliberate introspection to bring ourselves out of this first mindset and back into the second.

I am a massive advocate for being only appropriately emotionally involved with our patients – I understand that emotional burnout prohibits a longstanding deep connection with each and every patient – but the humanity of our patients ought to be treated with the utmost respect, and the opportunity to interact with this in a real and meaningful way is certainly something to cherish.

As I reflect on these key experiences from my first weeks, I encourage you to join me by reminiscing on those same early days of your own career. I hope that these reflections awaken similar memories of your own and serve as a reminder of the strong bond through common experience shared by all who work in the medical profession.

I look forward to updating you soon with my next article!

Dr Isaac Tennant Medical intern, Royal Adelaide Hospital

Valete Dinner at the Zoo

AMA(SA) was among the sponsors of this year’s Valete Dinner at the Adelaide Zoo in January.

The dinner brought together about 130 interns from across three local health networks – Central Adelaide, Northern Adelaide and Southern Adelaide – to celebrate the successful completion of their first year as junior doctors. Intern year is a major hurdle in a doctor’s life, fraught with steep learning curves as junior doctors learn to navigate the health system and learn work as effective team members and advocate for our patients in an often-stressed system. Valete provided an opportunity for this year’s junior doctors to share and reflect on the highs and lows before they diverged to follow their own unique career paths. Valete is also a time for interns to celebrate those who have supported them throughout the year: their seniors (registrars and consultants), nurses, ward NUMs, pharmacists and even friendly switch board staff, to whom we credit much of our success.

Dr Simone Jaenisch

2023 Valete Dinner Convenor, NALHN RMO Society

for

sustainable care A model solution

For too long, regional communities and the health providers that serve them have sought ways to attract and keep trainee doctors in rural medicine. In this feature, Emeritus Professor Paul Worley and colleagues in the Riverland Mallee Coorong Local Health Network explain how the ‘single employer model’ could be the answer.

As Professor Worley writes below, the single employer model is a missing link in a sustainable workforce supply chain.

The uptake of training for a career in general practice, and rural practice in particular, appears to be falling. The impacts of this are being felt across South Australia, with small remote practices being the canary in the coalmine. Of course, rural doctors in small towns work in both their clinics and their local hospitals, so this decline is also affecting the ability for hospitals to provide care for their communities. Often, a series of expensive locums is the only apparent way to fill this gap, but this is only kicking the can down the road and the escalating costs involved have opportunity costs on other required care.

Queensland Health thought it had solved the problem with its Rural Generalist Program. And it did solve the problem for the hospitals, which are now well supplied with resident and well-trained consultant rural generalists. But the general practices in the towns were left to wither on the vine.

The Riverland Mallee Coorong Local Health Network (RMCLHN), like all regional LHNs, shared the workforce

problem. It saw the value of this partial solution – but then, crucially, listened to what doctors in training were wisely pointing out was a major reason for the crisis in rural general practice: the pay and conditions discrepancies faced by GP and rural generalist (RG) trainees when, as part of their training, they have to leave public hospital employment and enter a series of short-term employment contracts with private general practices. This meant the junior doctors had to forego the security of accrued benefits that their colleagues in other specialty training continued to accumulate and benefit from.

In essence, GP/RG was the outlier for doctors in training. Most other specialties had a single employer (SA Health) for the entire period from internship through to fellowship. The hospital site at which a trainee was employed may change, but they did not need to move their family; they had access to generous and accruing annual leave, sick leave, parental leave, long service leave, professional development leave, etc., etc. Doctors in training were wisely valuing

the financial and security benefits offered by a single employer and choosing specialty training that enabled them to access this, even if they had previously been interested in careers in general practice.

One of the ‘reasons’ for the outlier status was that GP clinic training is funded through MBS billings. Section 19(2) of the Medicare Act prohibits employees of state health services from billing the MBS. Led by Dr Paul Mara and the Murrumbidgee Local Health District, and followed by RMCLHN and more recently the whole state of Tasmania, the Commonwealth Government is trialling providing an exemption to this Section of the Act to allow doctors in training for RG/GP fellowships to stay employed by the hospitals and bill Medicare when they are working and training in a private practice. This exemption is the key legislative provision enabling the single employer model.

When RMCLHN formed the Riverland Academy of Clinical Excellence (RACE), it aimed to take responsibility for training its most crucial asset –its workforce. Most of the doctors in our medical workforce must be rural generalists, so we adopted the National Rural Generalist Pathway. We created de novo Intern, PGY2, and Advanced Skills Training posts in our region so that, alongside our existing GP registrar training practices, we could offer new graduates a pathway to Fellowship based entirely in our region.

And we offered these doctors in training five-year contracts to provide security until they had achieved their Fellowship. This included the single employer model (SEM), so the trainees could move seamlessly between hospital and clinic-based training in the region. More than 30 domestically trained graduates have taken up our offer in the past three years, increasing our medical workforce (both in the

DOCTORS IN TRAINING WERE WISELY VALUING THE FINANCIAL AND SECURITY BENEFITS OFFERED BY A SINGLE EMPLOYER.

hospital and general practice) by more than 25%.

Sounds simple? In principle, yes. But it has required planning, preparation and a radical rethinking of the relationship between the public LHN and private practices. Although everything is eventually codified in various memoranda and contracts, the principal ingredients are trust, a recognition that we sink or swim together, and a preparedness to see that establishing a region as a training centre of excellence is a necessary investment, not an avoidable cost.

The details are always important. The Academy’s CEO and Executive Director Medical Services (EDMS), along with the great doctors across our region, have had to be innovative and work tirelessly to build the trust and capacity needed to implement the SEM. And the impact – well, that is a story for our RACE trainees to tell. Transformation is, after all, a team effort.

Riverland trainee doctors Dr Steve Behan, Dr Jerida Keane, Dr Josh Buchecker, Dr Sinead Turner and Dr Kyle Selga

RACE SHINES SPOTLIGHT ON THE RIVERLAND

Only two years after its introduction in the Riverland, the single employer model is gaining international attention, writes Dr Caroline Phegan.

The Riverland Academy of Clinical Excellence (RACE) was established in 2022 as an innovative, complete rural generalist training solution. Building on previous models including the New South Wales (NSW) Murrumbidgee Model and using the single employer model (SEM), RACE was established to bolster clinical training and healthcare services within the Riverland Mallee Coorong Local Health Network (LHN).

The decision was informed by the experiences of CEO Wayne Champion, LHN Board Chair Dr Peter Joyner, Executive Director of Clinical Innovation (EDCI) Professor Paul Worley, and me. It was backed by international studies highlighting the benefit of Longitudinal Integrated Clerkship (LIC) for sustainable medical education and training in rural areas. RACE aims to address the challenges of geographical narcissism embedded in medical training by providing a regionally located medical training program takes the medical student right through to a career as a

rural generalist and fellowship with either the Royal Australian College of General practitioners (RACGP) or Australian College of Rural and Remote Medicine (ACRRM).

Importantly, RACE was not initiated as a pilot but as a permanent, strategic initiative designed to provide sustained improvements in healthcare education and services in the Riverland. The SEM is a federal government initiative that through an exemption of the Heath Insurance Act (1973) allows salaried medical practitioners in an approved training program (such as general practice training), the ability to render Medicare Benefit Services (MBS) items numbers for services undertaken while employed by a state health service.

SEM is a critical component of RACE, addressing the inequities of rural generalist registrars who traditionally must give up salaried roles in the state health service, along with all the benefits, to become private employees, with new contracts every six to twelve months and no continuity of benefits or long-term employment.

RACE has significantly influenced the recruitment of medical professionals to the region, offering unique training opportunities that have attracted a diverse group of training medical officers, rural generalists and other experienced medical practitioners. The SEM has allowed the LHN to offer our trainees five-year salaried contracts for the full term of their rural generalist training. Our trainees can move into our LHN on a long-term basis, knowing they have the surety of a contract that assists them in purchasing housing, planning their families and future in our region.

We welcomed our first cohort of 10 TMOs in January 2022: five interns and five RMOs. Two years later we have more than 30 RACE trainees at various stages of their medical careers, with a retention rate of more than 98%. They are backed by a small, dedicated implementation team of educators, clinicians and administrative staff, ensuring the program’s success through rigorous planning and execution.

The quality and relevance of the training have led to heightened satisfaction among doctors, with many citing RACE as a key factor in their decision to continue practising in the region.

But the ramifications extend further than benefits for doctors. RACE has contributed to measurable improvements in health outcomes within the community, including the movement of a previously privately run, private billing Emergency Department (ED) back into SA Health governance in our largest regional hospital, the establishment of new primary and community care services including GP-led community outreach clinics, increases in other specialists’ services in the LHN and improved chronic disease management.

The program and its success have also served as a promotional tool for the LHN, enhancing our reputation as an innovative leader in rural healthcare and medical education. The RACE program has been presented at several national and international conferences, generating significant interest. There has been a surge in applications for training positions and salaried roles since 2022, and we expect this to continue.

The broader economic benefits of

RACE have been substantial. Healthcare professionals and their families have been attracted to the region, stimulating local towns’ economies, and reducing the need for patients to seek specialist care elsewhere. The initial investment in RACE is yielding a significant return through the improved quality of healthcare provided to our communities.

Looking forward, RACE is set to achieve and surpass a range of KPIs including retention, completion of fellowship, patient outcomes and development of local health services in RMCLHN. In partnership with Flinders University, we are undertaking an evaluation of the impact of RACE on our community’s health and of the RACE program itself. Meanwhile, RACE is looking to expand our educational offerings, attracting the best medical talent to the region, and further improving patient care and health outcomes.

The success of RACE is seen as a model for rural healthcare excellence, with potential implications for national and international healthcare education strategies. It has already gained significant attention from national and international cohorts interested in partnering with RMCLHN to further our success and implement similar programs in their local areas.

Dr Caroline Phegan is a Rural Generalist and the Riverland Mallee Coorong Local Health Network (RMCLHN) Executive Director Medical Services.

SEM PROVIDES EMPLOYMENT CERTAINTY FOR MEDICAL TRAINEES

The single employer model is a logical and effective ingredient in the search for regional medical workforce certainty, writes Riverland Mallee Coorong Local Health Network CEO Wayne Champion.

It is vitally important that we in the Riverland Mallee Coorong Local Health Network (LHN) invest in the development of our future regional health workforce to ensure we attract and retain skilled health professionals.

We are positioning the LHN as a centre of excellence in rural health through our Riverland Academy of Clinical Excellence (RACE).

It’s important to note that we’re a health service, not a university, so we can’t provide an undergraduate medical degree. But we can coordinate and curate the experiences available for advanced trainees.

With the single employer model (SEM), we have structured a postgraduate training program by combining experiences available in our own health services, local primary practices and other settings.

Technically, SEM refers to a funding model in the form of a Medicare billing exemption that allows the LHN to recover Medicare for primary health services provided during the GP training component.

However, the magic ingredient is the ability to provide junior doctors with a comprehensive program stretching from graduation to fellowship, with all the training, education, experience and supervision required, so they can graduate as a fully

qualified GP or rural generalist with employment certainty in the region.

This is making it possible for trainees to plan their future and put down their roots in a location of their choice. In doing so, they contribute to the creation of a thriving, sustainable, regional health workforce.

In addition to attracting new medical trainees to the region, the opportunity to be involved in training as supervisors, mentors and instructors has really reinvigorated our existing workforce, which is really exciting.

It’s taken years to get the right structures in place to properly support and supervise medical trainees and we’re very proud of what we’ve achieved so far.

Pilot program an answer to rural GP shortage

How can we boost the number of medical students and junior doctors wanting to become general practitioners, asks Dr Hayden Cain.

When comparing each state’s public hospital enterprise bargaining agreements to the National Terms and Conditions for the Employment of Registrars (NTCER) for GPs, there are obvious and significant discrepancies between general practice and other specialties, including a lack of access to study and maternity leave, a significant reduction in remuneration, and loss of entitlements.

For people entering general practice, there is also anxiety over having to learn an entire specialty in only two years of community placement at the same time as you are required to learn and understand the complexities of Medicare, ensuring you earn enough to survive in a world with spiralling costs of living.

Finally, there is the isolation of regularly moving from one practice to another for short rotations, and often with only one or two other registrars.

Fortunately, in the Riverland in South Australia, a pilot project, the second of its kind in Australia, has been established to combat these issues. The project is a version of a single employer model (SEM) and I am lucky to have been one of the inaugural trainees in this program. SEM is a system in which instead of a single general practice owning a registrar’s contract for six to 12 months during their training, the registrar is instead employed by a central body for the entire period.

The details of the model can vary in each region, and even within each region, according to its governance and the care requirements. This allows a framework to be designed to deliver flexible care to communities and bespoke supports for individual registrars.

In the Riverland, the SEM project is known as the Riverland Academy of Excellence (RACE) program and the Riverland Murray Coorong Local Health Network (RMCLHN) is the central body that owns the contracts.

The RACE program is focused on developing rural generalists to work long-term in the Riverland. The first thing the Local Health Network (LHN) did to help this was to give the trainees financial and job security by offering five-year contracts. This security was enough to convince me that it would be safe to leave the city and my well-paying job as an orthopaedic service registrar and move to the Riverland as an Australian College of Rural and Remote Medicine trainee.

During my medical school and early junior medical officer years I had dreamed of becoming an orthopaedic surgeon, but after moving to Darwin and being introduced to the life of a rural generalist a new passion was ignited within me. It was the RACE program that gave me the safety net I needed to overcome the fears and obstacles and take the leap from my previous career path to a life in rural medicine. The program meant I could retain all my previous accrued entitlements, including time towards long service leave, access to Super SA and professional development.

The long-term contract allowed me to move to the Riverland and have the financial security to buy a home during a cost-of-living crisis. I moved to the region as one of a cohort of trainees that formed a close group of colleagues and friends, instead of being isolated at a new practice whenever we rotated. It improved my confidence moving into the community, knowing I had a guaranteed wage while learning Medicare Benefits Schedule (MBS) billing.

This allowed me to change how I was remunerated as my knowledge of MBS improved, ensuring that both the practice I worked for, and I benefited financially.

It also encouraged me to maintain contact with the LHN, as the same contract allowed me to continue working in the Emergency Department, work in mentorship roles and set up a remotely supervised orthopaedic fracture clinic.

The SEM in the Riverland has been such a success that the hospital and GP services in the region are managing to expand their services after previously being an area in need. I feel incredibly privileged to have been in the inaugural RACE intake in the Riverland. Having spoken to GP trainees around Australia I can see how much I have been supported during my training. Now I look forward to seeing individualised and flexible SEMs being deployed around the country, developed by each region with its population’s needs and their trainees in mind.

Dr Hayden

Chair of the AMA(SA) Doctors in Training Committee

Cain is

RSS seeking agreement to expand SEM

The early success of the single employer model in building a sustainable regional workforce is leading to plans to roll it out across South Australia, writes Rural Support Service Executive Director Debbie Martin.

Access to healthcare in regional areas, along with more secure employment pathways for trainee doctors, are two of the key benefits of the innovative single employer model (SEM) being trialled in South Australia.

Now, only two years after its introduction on a pilot basis in the Riverland Mallee Coorong Local Health Network (LHN), the Rural Support Service (RSS) is looking to expand the program into other LHNs.

Having been implemented as a pilot in the Riverland, the SEM makes it more appealing for junior doctors to enter the rural generalist training pathway by providing continual access to entitlements under the one employer, while supporting their training in delivery of services in general practices and hospitals. The flow-on effect of this in a rural setting is improved access to local healthcare for patients, and a higher retention of doctors that limits locum and recruitment costs.

Following the success of the trial under the Riverland Academy of Clinical Excellence in the Riverland, the RSS – an SA Health business unit that supports the six regional LHNs – submitted a proposal to the Commonwealth in December 2023 on behalf of SA Health. This proposal is to expand the trial to the other five regional LHNs in South Australia, providing training opportunities for a further 60 local rural generalists and dramatically improving healthcare delivery in rural areas.

We see the SEM providing an opportunity for SA Health to deliver focused, increased healthcare delivery to regional and rural communities where patients often must travel to metro areas to access critical care. This crucial boost to services will enhance the attractiveness of sustained employment in these areas for junior doctors - a key driver of remote healthcare.

We are hopeful of working with the Commonwealth and local stakeholders to deliver an expanded trial of the SEM to build on the success we’ve seen at RACE. The end game is a committed, retained workforce that enables people to see doctors closer to home.

We have a team putting together appropriate governance, oversight and financial arrangements for the new model. We know the effect this model can have and are putting systems in place in anticipation of Commonwealth agreement of the proposal, to leverage it as efficiently as possible throughout regional South Australia.

The RSS would be responsible for the deployment of this program through our dedicated Rural Generalist Coordination Unit, in collaboration with the regional LHNs. Together, we’ll work with local GPs, junior doctors and communities to ensure the outcomes match local needs.

With 60 additional positions potentially being made available, the plan would be for an equitable distribution of trainees across the other five regional networks.

How does the model work?

Rural generalists are trained in primary care services, emergency medicine and additional fields (for example, anaesthetics) to provide critical services based on changing needs between regional communities. Under Section 19(2) of the Commonwealth’s Health Insurance Act 1973, the State Government can access exemptions for the trainee doctors to bill for eligible services under Medicare, providing a source of revenue to help offset their salary.

Currently, rural generalist and GP trainees are required to leave their public service employment during their required training periods in private general practices, meaning they lose access to entitlements such as sick, parental and annual leave. The SEM avoids this by maintaining their employment within SA Health.

Rural contract completion a boost for regions

AMA(SA)’s participation in the latest contract negotiations for rural generalists was critical to a successful outcome, writes AMA(SA) President and rural GP Dr John Williams.

The new four-year agreement for rural generalists provides certainty for GPs working in regional South Australia and incentives to attract more doctors to areas where doctors are in high demand.

The SA Health Rural GP Agreement 2024-28 (GPA) represents the culmination of negotiations that began in 2022. It was due to come into effect on 1 February 2024, with annual indexation.

The agreement forged by AMA(SA) and the Rural Doctors’ Association of South Australia (RDASA) with SA Health’s Rural Support Service (RSS) provides a significant increase of 3% to the sessional rates and a suite of attraction payments to recognise the vital role GPs play in regional and remote areas. This is on top of the more than 20% increase achieved two years ago.

It was particularly gratifying to have the collaborative and respectful nature of the negotiations acknowledged by Health Minister Chris Picton, given the protracted consultations and the complex structure of remuneration for rural doctors.

We are confident this new agreement will help to attract doctors from metropolitan areas and interstate, enabling regional and rural communities to breathe a sigh of relief after experiencing a dire shortage of doctors over the past few years.

The AMA(SA) and the RSS are appreciative that there is now a recognition and facility within the agreement to pay rural doctors to provide supervision and training for junior doctors in the regions.

Under the agreement, the $50,000 payment for new GPs who are beginning practice and providing hospital services will be expanded.

A $10,000 payment will also be offered to encourage new doctors into an additional 32 country towns including Mount Pleasant, Kapunda, Eudunda, Barmera, Meningie,

Mannum, Renmark, Waikerie, Bordertown, Kingston, Millicent, Penola, Clare, Wallaroo, Crystal Brook, Jamestown, Quorn and Hawker.

In addition, a recognition payment of $5,000 will be given to each current GP signing on to the new GPA to acknowledge their service and ongoing commitment to South Australian rural and regional communities.

A new Non-Clinical Engagement Plan (NCEP) will allow GPs to be remunerated for a broad range of non-clinical commitments such as teaching, training, supervision, regional Local Health Network meetings, and other essential hospital-based activities.

We believe the agreement represents a significant win for the more than 330 rural GPs and GP registrars currently contracted by SA Health providing care including emergency services, inpatient care, surgery, obstetrics, and anesthetics in regional hospitals.

Together with our negotiating partners, AMA(SA) successfully argued that a significant increase in the remuneration of doctors was necessary given the substantial workload many commit to in providing hospital services as well as maintaining their private practices. The collaboration with RDASA – led by former President Dr Peter Rischbieth and his successor Dr Bill Geyer – was critical to the negotiations, and the expertise of AMA Senior Industrial Officer Andrew Lewis ensured discussions focused on outcomes for doctors.

Combined with the capital works going on across regional hospitals and the For Work, For Life Incentives, this agreement demonstrates that there has never been a better time for GPs choosing to make a tree or sea change to a regional area.

A joint working party between AMA(SA), RDASA and RSS has been established to support implementation of the new GPA and dedicated regional LHN information sessions are being conducted to help ensure equity and consistency across regions.

All rural residents should expect access to reliable, expert and dedicated doctors in their communities. That was the goal of the negotiations, and our agreement is a big step towards this.

Doctors oppose pharmacy prescribing for UTIs

AMA(SA) members are urging SA Health to monitor pharmacy prescribing of medication for urinary tract infections (UTIs) and other conditions to ensure patient health and safety do not suffer.

On the eve of the beginning of the South Australian Government’s introduction of pharmacy prescribing of UTI medication on Friday, 1 March, AMA(SA) President Dr John Williams reminded journalists that pharmacy prescribing of UTIs placed the responsibility of diagnosing and treating UTIs on pharmacists who are not trained to accurately diagnose the condition.

‘South Australian doctors continue to oppose a program in which a pharmacist who has completed 2.5 hours’ of training is supposed to be able to confidently diagnose a UTI and differentiate that condition from the other conditions – including pregnancy and cancer – that may present with similar symptoms,’ Dr Williams said.

He said the SA Health advice, as outlined in its ‘UTI Management Protocol’ was that urinalysis was ‘not a part of empiric treatment’ so pharmacists were not required to undertake dip-stick tests – tests he said quickly indicate whether a UTI is present or not.

The absence of the dipstick tests meant overprescribing of antibiotics was very likely, he said.

‘We are also extremely concerned that the overprescribing of antibiotics that has occurred – up to 97% in one evaluation in Queensland – will contribute to antimicrobial resistance.’

Antimicrobial resistance is the rapidly growing resistance to antibiotics caused by their over-use in recent decades and is described by the World Health Organization as one of the greatest threats to human health.

Dr Williams questioned how many pharmacists had received the training that the Minister has deemed necessary under Regulation 21(2)(h) of the Controlled Substances (Poisons) Regulations 2011.

The regulation sets out ‘training objectives’ such as ‘classification and epidemiology’ of UTIs and ‘evidence and role of over-the-counter products’ for their treatment.

In the UK, Dr Williams said, the requirement is that a pharmacist undergo a minimum standard learning time of 26 days’ worth of structured learning and a 90-hour practical. Most of the pharmacists who undergo the training work in general practices.

The South Australian regulation requires the pharmacist to refer a patient ‘to a GP or other appropriate health service if risk factors for complicated UTI are present or a pharmacist is not confident that an uncomplicated UTI is a likely diagnosis’.

‘Of course, we want the pharmacist to refer any patient believed to be at risk – but how much time has been wasted in the meantime?’ Dr Williams said.

The health of South Australian women is at the heart of advocacy against pharmacy prescribing of medication for a growing number of serious conditions.

‘The government has introduced this program – we now urge women to continue to monitor their symptoms and seek medical help if needed,’ Dr Williams said.

‘We also continue to urge the government to immediately cease this program if it becomes apparent that what has been advertised as “easier access to treatment” leads to more emergency presentations for potentially lifethreatening conditions.’

The State Government’s decision to introduce pharmacy prescribing came after Health Minister Chris Picton accepted recommendations of a Select Committee that examined access to treatment for UTIs.

AMA(SA) voiced its opposition to the plan in a submission to the review and in personal and written submissions to Mr Picton. The Federal AMA and other state AMA branches and medical groups have also opposed similar moves.

‘Evidence in other states demonstrates that women will be prescribed antibiotics for presumed UTIs that are in fact other conditions, including pregnancies and cancer,’ Dr Williams said.

‘As we have emphasised throughout the many months of discussing this issue, GPs will find time to consult with any patient believed to have a UTI. Our focus is and always has been the health and safety of South Australian women.

AMA(SA) had earlier provided to Mr Picton, at the Minister’s request, a list of recommendations to maximise patient safety when pharmacy prescribing began in South Australia.

Among the recommendations was assurance that pharmacy prescribing would immediately cease if it was found that it led to even one adverse outcome.

AMA(SA) TEMPLATE WILL RECORD PATIENT OUTCOMES

AMA(SA) Committee of General Practice members are developing a template for South Australian doctors to monitor and record details of patients who present with complications after being diagnosed by pharmacists as having UTIs.

AMA(SA) CGP Chair Dr Bridget Sawyer said the committee is creating an easy-to-use form that will allow GPs to record the details of discussions with patients who come to them who have recently consulted a pharmacist about a suspected UTI.

The form will be distributed to South Australian GPs in coming weeks.

Dr Sawyer said the committee was also urging SA Health to ensure pharmacists record all antibiotic prescriptions, for the safety of individual patients and so impacts on antimicrobial resistance can be monitored and evaluated over time.

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Council News

AMA(SA) Council - February 2024

The general ‘poor health’ of South Australia’s health system continues to be front and centre on Council’s agenda, and was a major topic at the February meeting.

The meeting, the first of 2024, was chaired by Vice President Associate Professor Peter Subramaniam in the absence of Dr Hannah Szewczyk, who was sitting her fellowship examinations.

The ongoing issues with ramping, lack of primary care support, mental health, long elective-surgery lists, bed block and concerns regarding budget wastage were vigorously discussed. Equally important are staffing worries, with members describing how urgent care centres are taking GPs and emergency doctors from their already reduced ranks.

Embedded culture deficiencies within hospitals are an ongoing concern and Council heard from President Dr John Williams that a project is planned to address workplace codesign, governance and problem-solving to effect long-term change within the state’s public hospitals.

Our new student members were welcomed: Hannah Kieu from the University of Adelaide and, via Zoom, Lydia Smalls from Flinders University. The students’ contributions to Council are always valued.

We also welcomed first-year intern and former student representative on Council Dr Isaac Tennant as an observer. AMA(SA) is committed to highlighting issues and exerting

Council News

pressure on the government and the Health Minister to improve our system and long-term change beyond one election cycle. Council discussed ways to focus the AMA’s efforts and involve our members; further plans will be announced later this year.

Updating AMA(SA)’s Constitution has taken significant effort, particularly for our CEO Nicole Sykes. She explained that alterations have been complex but will tighten governance for the organisation as a whole.

Council has a number of vacancies, including specialty group positions for radiology, surgery, ophthalmology and obstetrics/gynaecology. Two members have offered to fill casual vacancies and Council approved the appointments of Dr Christopher Dobbins (ophthalmology) and A/Prof Michael Goggin (surgeon).

Members are encouraged to nominate themselves or their colleagues when speciality group positions and ordinary member positions are advertised. The gender balance of Council has become somewhat skewed, so I personally encourage my female colleagues to participate.

Dr

Karen Koh Specialty Group Representative: Dermatologists

AMA(SA) Council - March 2024

Council’s endorsement of the new AMA(SA) Strategic Plan and constitution was a highlight of the March AMA(SA) Council meeting on 7 March.

CEO Nicole Sykes explained that after extensive consultation with Council, Board and other members, and with the Secretariat staff, three principles emerged as the basis of AMA(SA) operations and approach: trust, collaboration and inclusion.

Ms Sykes said the plan would form the foundation of efforts to ensure the organisation is member-focused, collaborate with other bodies to effect change, and to seek and heed voices from across the profession.

However, she said, how best to engage with a membership body that includes a vast array of members –urban and rural; young, senior and retired; and in a variety of specialties – is an issue with which all AMA state bodies are grappling. She said a calendar of educational and social events is being considered, as is the use of new and emerging information platforms and formats.

The constitution has taken some time to review and is now in place, with new alignment of the role and fiducial responsibilities of the Board and Council, with the AMA(SA) president leading both.

We welcomed two new members to Council: ophthalmologist A/Prof Michael Goggin and surgeon Dr Chris Dobbins. A/Prof Goggin was absent, but Dr Doggin introduced himself with detail about his love for the piano. Reform in the AMA is ongoing and there are challenges with the federation model of the AMA especially revenue sharing between the states and the federal AMA. An external facilitator is facilitating this.

Payroll tax has been an ongoing discussion with the state government and the AMA(SA). The government is aware that pay roll tax will decrease bulk billing rates, increase ramping and hit the poorest in society.

Four years after the AMA(SA) Culture and Bullying Summit, and three years after the Summit led to new legislation about the role of LHN Boards in identifying and addressing bullying and harassment, Council approved the development of a program to support other SA Health initiatives to boost the health workforce culture in South Australian public hospitals.

Dr

Shriram Nath Specialty Group Representative: Pathologists

Taxing time for medical practitioners

With RevenueSA’s payroll tax amnesty program underway and general practices receiving notification about their eligibility, Norman Waterhouse tax lawyer Alexander Belperio examines recent developments.

In previous editions of medicSA we explored the monumental shift in the interpretation of the Payroll Tax Act 2009 (SA) (the PT Act), which was triggered by interstate tribunal and Supreme Court decisions. The decisions found that for payroll tax purposes, payments from a central clinic account to independent contractor practitioners will be taken to be ‘taxable wages’ – even if those payments are simply transfers of medical billings earned by the practitioner.

These decisions have effectively turned the general understanding of payroll tax arrangements for medical practitioners on its head – an understanding widely held throughout the medical, legal and accounting professions for decades. Acknowledging this drastic shift in the legal landscape, RevenueSA followed some other interstate revenue authorities in announcing a limited payroll tax amnesty for general practice only for the period of 1 July 2018 to 30 June 2024 (the amnesty).

Unfortunately, early amnesty responses from RevenueSA suggest that it will be issuing payroll tax determinations to medical practices irrespective of whether updated arrangements (and contracts) have been put in place –effectively ignoring any action taken to reflect the true nature of the relationship between the parties. These issues must be determined on a case-by-case basis. But given the matters we have been involved with, it is our view that assessments issued by RevenueSA in such circumstances are not in accordance with recent case law, and that the assessments are likely to be unwound on challenge to the Supreme Court.

While the Queensland Revenue Office has publicly confirmed that out-of-pocket patient fees and Medicare benefits paid directly into an individual doctor’s bank

account will not attract payroll tax (in its recently updated Public Ruling) – in line with the observations made by the Court of Appeal in Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue (Thomas and Naaz) –RevenueSA is yet to follow this approach and at the time of writing appears unwilling to do so.

PAYROLL TAX AND SUPERANNUATION

While most ‘medical clinic’ operators acknowledge that the nature of the relationship between the clinic (usually as a ‘service entity’) and doctor is one where the doctor contracts the service entity to provide services (including a consulting room, administrative and nursing services) and pays a service fee in exchange for those services, many standard contracts we see state that the service entity contracts the doctor to provide medical services at its premises.

While this distinction may appear trivial, the legal consequences can be far reaching – and despite being only somewhat at odds with the true relationship in most cases, in the eyes of the law what exists is a contract for the medical services of a practitioner, rather than for the provision of administrative services of a service entity. The result is a potential liability to payroll tax and superannuation liabilities for the service entity. This is so even where these contracts are sufficient to create a true independent contractor relationship between a doctor (as contractor) and a medical clinic/service entity.

While superannuation issues have seen less time in the sun in recent months compared to their payroll tax counterparts, the likelihood of medical clinics incurring unintended superannuation liabilities is just as great, with potential financial consequences being even more substantial (forced payment of superannuation plus interest and penalties, for which no deduction is available).

DEEMED EMPLOYEES

Like the PT Act, the Superannuation Guarantee (Administration) Act 1992 (Cth) (the SGA Act) contains provisions that expand the application of the legislation to impose superannuation liabilities on payments made to independent contractors in certain cases. While this seems

similar to the ‘relevant contract’ provisions in the PT Act, it is important to note that the legislative tests differ greatly between the two Acts. A contractual relationship may give rise to payroll tax liabilities without automatically giving rise to superannuation liabilities (and vice versa).

The definition of ‘employee’ in the SGA Act has been deliberately expanded to include certain types of independent contractors. Section 12(3) of the SGA Act provides that ‘if a person works under a contract that is wholly or principally for the labour of the person, the person is an employee of the other party to the contract’.

If a medical practitioner enters into a contract that is ‘wholly or principally’ for their labour, they are likely to be entitled to be paid superannuation at a rate of 11% of the medical billings paid to them from a clinic’s central bank account (increasing to 12% from July 2025). This additional charge must be paid by the deemed employer into the contractor’s nominated superannuation fund; the deemed employer cannot pass this obligation onto the deemed employee (that is, a deemed employer cannot pay the deemed employee a gross figure including superannuation, and expect the deemed employee to manage their own superannuation payments).

A deemed employer under the SGA Act may also be liable for civil penalties where superannuation liabilities are not paid, or where the deemed employer attempts to enter into a ‘sham arrangement’ to avoid superannuation liabilities arising. This liability can even extend to directors of the employer in their personal capacity.

In determining whether a contract is wholly or principally for the labour of a person, the Commissioner of Taxation considers that the ‘extended definition’ will apply where:

• the individual is remunerated (either wholly or principally) for their personal labour and skills

• the individual must perform the contractual work personally (there is no right to delegate or sub-contract), and

• the individual is not paid to achieve a specific result (contrasting with the provision of ongoing services).

More broadly speaking, the Commissioner of Taxation (along with Courts and Tribunals) will generally consider the totality of the arrangement between an independent contractor and the principal to determine whether superannuation is payable, including matters such as the level of control, business integration, liability to rectify defects in the work/services provided, and the provision of tools necessary to complete the work.

But all is not lost: there are ways to fall outside of the deeming rules. First, consider whether in the current environment it is appropriate to continue to engage doctors

as independent contractors, or whether it is preferred that the doctors instead enter into contracts for the provision of administrative services – which seemingly falls outside of section 12(3).

Alternatively, if a practice does prefer to engage a doctor as an independent contractor, consider engaging with a corporate contractor instead – as even the ATO accepts (in most circumstances) that a company cannot be an employee for superannuation purposes.

SHIELDING AGAINST THE TRIPLE-EDGED SWORD

In recent times, the legalities surrounding payroll tax, superannuation and employee entitlements generally have been in a near constant state of flux. RevenueSA (in our view, incorrectly) seems to have ignored Queensland’s example of confirming that diverting payments directly into the hands of doctors will be effective for payroll tax purposes, while the ATO is expected to release updated guidance on the Commissioner’s position regarding superannuation.

Due to the shifting state of play, some within the medical profession have expressed a willingness to do nothing unless there is a guarantee of success. While there may be some reason in that approach, our experience in advocating in these matters is that it is always better to have a shield from which to argue behind than no shield at all. As such, we recommend that service entities and medical clinics prepare themselves as best as possible for future audit activity by RevenueSA and the ATO, by carefully reviewing their current contractual arrangements to ensure these properly reflect the intended relationship with contracted practitioners against the current legal context.

Please contact AMA(SA) with your concerns and experiences with the new payroll tax requirements, and let us know your interest in a webinar with the latest legal and financial updates.

membership@amasa.org.au

Should you wish to obtain further guidance about your potential exposure, feel free to contact Norman Waterhouse Lawyers to speak to one of our tax law specialists:

Kale Rigano (Principal)

Marissa Mackie (Principal)

Alexander Belperio (Solicitor)

Public health leaders unite to call for health levy on sugary drinks

Leading Australian public health organisations are calling for a 20% health levy on sugary drink manufacturers in a new policy position statement released in Canberra.

The Rethink Sugary Drink alliance — including the Australian Medical Association (AMA), Cancer Council Australia, the Australian Dental Association, Food for Health Alliance, and Heart Foundation – says the policy could reduce Australians’ annual sugar intake by 2.6 kilograms per person and raise billions of dollars for health initiatives.

The alliance argues the levy could raise around $1 billion each year to fund crucial obesity prevention and other health initiatives.

AMA President Professor Steve Robson said the alliance’s modelling shows a 20% health levy on sugary drink manufacturers could raise around $4 billion over four years.

‘Research also shows there could be 4,400 fewer cases of heart disease, 16,000 fewer cases of type 2 diabetes, and 1,100 fewer strokes over 25 years if government takes this step,’ Prof Robson says.

The alliance points to success stories from places like the UK, South Africa and Mexico combined with a robust evidence base to indicate the policy has the potential make a real difference to diets and health in Australia.

Bulk-billing numbers increase in response to financial incentives

The suite of financial incentives introduced to support bulk billing has had a significant effect, leading to an estimated 360,000 more bulk-billed GP consultations since November.

The AMA says the early signs are that the measures – which include a tripling of the rebate – are working and have arrested the sharp decline in bulk billing, which is good news for vulnerable Australians.

The AMA’s Modernise Medicare campaign has argued for improved indexation of all Medicare rebates and additional funding for primary care.

Prof Steve Robson said the government had considered the AMA plan, making a significant down-payment of around $6 billion for primary care — including bulk billing incentives and increasing rebates — in last year’s budget.

The alliance’s research revealed 77% of respondents would support a health levy on sugary drinks if the funds raised were reinvested into crucial obesity prevention efforts.

‘We advocated for additional funding because we knew it would make a difference,’ he said.

While the investment in Medicare appears to have arrested the decline of bulk billing rates in general practice, Prof Robson says further reform and investment is needed to ensure the system continues to support improved access and affordability for patients.

‘It’s going to take a lot of work and it’s going to take investment to bring Medicare back to where we think it should be and to make healthcare accessible and affordable for all Australians.

‘One of the problems is that general practice has been so neglected young doctors don’t want to be general practitioners, so we’re hoping that these incentives will make that an attractive career path again.

‘When Medicare was introduced 40 years ago, healthcare was a totally different landscape. We now have robotic surgery, we have extraordinary ways of treating people, and of course, the landscape of illness has changed. We have chronic mental health problems, diseases like type 2 diabetes - the landscape has completely changed.’

The big challenge remains to adapt Medicare to fund complex, multidisciplinary care, he says.

‘If we want another 40 years of Medicare, a lot of change is going to have to happen.

‘We now have the early proof that investing in the right way in Medicare can deliver returns.’

Genetic discrimination in life insurance is a health hazard, AMA warns

Genetic discrimination in life insurance is preventing people from undertaking genetic testing that could help prevent serious disease and is a barrier to participation in genomic research, the AMA has warned.

In its submission to the Australian Treasury’s consultation on the use of genetic testing in life insurance underwriting, the AMA called for a legislated ban on the practice.

Prof Robson says consumers are discouraged from participating in genetic testing, fearing being frozen out of life insurance cover if a genetic risk is uncovered.

A Monash University study of 10,000 Australians found that a very significant proportion of people ultimately didn’t want to undergo testing because they thought it might compromise their own ability to get life insurance or that of their family.

‘People are making a choice not to have the testing — so putting themselves at risk when they could in fact get information, work with their medical team, and lower the risk, in some cases almost to zero.’

Under the current moratorium, life insurance providers are still able to ask for and use genetic test results if the total amount of cover in an application exceeds certain monetary thresholds. The moratorium is also industry led, raising concerns about self-regulation.

‘Genetic testing and genomic research have the capacity to rapidly transform healthcare in Australia, by potentially providing more cost-effective treatment options and improving patient outcomes by identifying a need for treatment before an issue arises,’ Prof Robson said.

‘The industry has placed its own partial moratorium on the requirement to disclose genetic test results, but we need a legislated ban to give consumers absolute certainty that their genetic status won’t be used by insurers to freeze them out of certain levels of cover.

‘Having a legislated ban is the only way to ensure Australians feel safe and confident their genetic results won’t result in discrimination,’ Prof Robson said.

The AMA argues that we need a national approach to the provision and regulation of genetic testing to ensure equitable access to testing in Australia.

‘We’re absolutely firmly of the opinion that the more information you have about yourself, the more likely you are to protect yourself and to work to reduce that risk, and that you shouldn’t have a disincentive,’ Prof. Robson said.

AMA CALLS FOR EQUITABLE ACCESS TO MEDICARE AND THE PBS FOR PEOPLE IN CUSTODY

The Australian Medical Association is calling on the federal government to update unfair rules that prevent people in custody from accessing Medicare and medicines subsidised by the Pharmaceutical Benefits Scheme (PBS).

In a submission to the Pharmaceutical Benefits Advisory Committee (PBAC), the AMA argues health services in custodial settings must be of equivalent professional, ethical and technical standards to the wider Australian community.

‘It is appalling and an affront to Australia’s human rights status that prisoners in this country aren’t allowed to receive the same

quality of healthcare as the wider community,’ Prof Robson says.

Under legislation dating back to 1973, people in custodial settings are not able to receive treatment under the Medicare, or medicines subsidised by the PBS.

While the legislation was designed to avoid duplication of services, with state and territory governments funding prison-based health services, this exclusion has led to significant health treatment disparities for Australian prisoners.

People in custodial settings with complex medical conditions that require high-cost drugs currently have their treatment determined by state justice health departments.

The PBAC has acknowledged the barriers and is assessing the situation.

CLIMATE CHANGE A HAZARD FOR HUMAN HEALTH AND CARE

As global heat records fall on an almost daily basis and usually dry regions are inundated with floods and summer rain, the impact of climate change on health is impossible to ignore writes SA Health Climate Change Lead Dr Kimberly Humphrey.

As an emergency medicine physician, I see the impact of climate change on the health of my patients every time I walk into the emergency department. I see it in my elderly patient on diuretics who presents with heat exhaustion and dehydration on a 45°C day. I see it in the grief and loss and physical trauma experienced by patients that I care for in the aftermath of a bushfire. And I see it in the patient who presents to my ED with Japanese encephalitis, in a location where it has never previously been a consideration.

Climate change is relevant to all clinicians, no matter our specialty. As physicians who took an oath to protect the health of our patients, it is our responsibility to both understand and manage the impacts of climate change on health, and to mitigate our contribution to the problem.

The repercussions of climate change on human health extend beyond what may initially be apparent. Rising temperatures contribute to an increased incidence of heat-related illnesses and fatalities, particularly among vulnerable populations. Shifts in weather patterns result in more frequent and severe extreme weather events, such as hurricanes and floods, leading to injuries, displacement and mental health challenges.

Climate change also adversely affects air and water quality, amplifying the prevalence of respiratory illnesses and waterborne diseases. The transmission patterns of infectious diseases, including malaria and dengue fever, are also influenced by alterations in climate conditions; locally this has manifest as outbreaks of Japanese encephalitis, and of vibrio parahaemolyticus in oysters.

One notable illustration of the impact of climate change is the intensification of heatwaves, which have become

increasingly common in Australia. In 2015, the Climate Council reported that over the previous five decades the number of heatwave days in the country had risen substantially, with certain regions experiencing an increase of more than 50%.

The Climate Council report also noted that heatwaves have caused more deaths in Australia than any other natural hazard, leading to a 10% increase in ambulance callouts and a 2.6% increase in deaths.

The health impacts of these extreme heat events can’t be overstated. Heat interacts substantially with the effect of many common medications, exacerbates chronic conditions (including cardiovascular, renal and respiratory diseases) and increases the risk of heat stroke. The most profoundly affected are often the elderly, children, and socially isolated individuals who lack the support to adapt or cope with these events.

People with underlying economic challenges are also at particular risk. No amount of education about how to stay well when it’s hot balances the inability to run the air conditioner because of cost-of-living pressures.

We also know that heat increases the burden on our healthcare system. A study published in BMJ Open found that in the summer of 2009, a severe heatwave in Adelaide led to a 13-fold increase in heat-related hospital admissions and a seven-fold increase in direct heat-related mortality. There is also evidence from a Victorian study of mental health-related presentations to emergency departments increasing by 7%.

We know, too, that incidences of domestic violence increase in number during heatwaves, as do workplace accidents.

Heat also has indirect health effects. It contributes to the formation of ground-level ozone, a major component of smog, which can trigger asthma attacks and other respiratory problems. Heat can also worsen allergies: longer warm seasons extend the pollen season, affecting those with allergic rhinitis or ‘hay fever’. A 2019 study published in The Lancet Planetary Health showed that airborne pollen counts have been increasing around the world, correlating with increased temperature and CO2 concentration.

Climate change also accentuates and worsens prevailing social disparities, disproportionately burdening lower socioeconomic communities and ethnic minorities and underscoring existing inequities in health. These communities are more likely to be situated in areas with poor housing conditions, inadequate infrastructure, or in regions prone to extreme weather events. They often lack access to adequate healthcare and the resources to protect themselves or recover from the impacts of extreme weather events.

Moreover, these communities are often underrepresented in decision-making processes, and the absence of these voices in policy discussions limits the ability to develop and implement interventions that are culturally appropriate and address their specific needs and circumstances.

What can we do to tackle this enormous challenge? The most urgent adaptation mechanism that we have is a rapid reduction in global carbon emissions. As physicians we should leverage our privilege and power to speak up for reduction of fossil fuel use as a critical public health intervention.

While emissions reductions must occur on a global scale across all sectors to ensure we limit global warming to under 1.5C, it’s also essential that we examine our contribution to this problem. The carbon emissions stemming from the healthcare system are far from negligible. A 2022 study published in the MJA demonstrated that an estimated 7% of Australia’s carbon emissions can be attributed to the health system. The Lancet Planetary Health reported in 2023 that when aggregated on a global scale, healthcare ranks as the fifth-largest emitter of CO2.

This implies that 40% of carbon emissions originate from activity that does not align with providing quality patient care, presenting a valuable opportunity to enhance clinical practices while reducing carbon emissions.

Recognising that all tests and interventions carry both a monetary and carbon cost, substantial emissions reductions can be achieved by minimising unnecessary pathology and radiology tests, and by adopting rational pharmaceutical prescribing and supporting low-carbon alternatives for high-carbon alternatives (such as phasing out desflurane). All of this can help us achieve the ‘triple bottom line’ – achieving the best outcomes in patient care quality, monetary cost and carbon emissions. Equally, investing in preventive and primary care not only decreases carbon emissions but also results in a healthier population, leading to fewer emergency department visits and hospital admissions. And the carbon impact of a primary care visit is significantly lower than a hospital attendance or admission.

WE CAN EXPECT TO EXPERIENCE MORE SIGNIFICANT HEALTH IMPACTS THAN WHAT WE SEE NOW

These emissions are categorised into three groups: Scope 1, 2, and 3. Scope 1 includes emissions directly from healthcare facilities and fleet vehicles, while Scope 2 comprises those from purchased electricity, steam, cooling and heating. The most challenging to quantify, Scope 3 emissions, primarily arise from supply chains, food use, equipment, devices and pharmaceuticals. Addressing emissions necessitates multifaceted strategies. Electrifying buildings and vehicle fleets are critical for handling Scope 1 and 2 emissions, along with energy-saving initiatives. Scope 3 emissions, driven by supply chains, benefit from implementing criteria for low or zero-emission procurement, waste reduction and considering the environmental impact of clinical care practices.

Of particular significance to clinicians is the need to reassess the delivery of clinical services. The MJA study found that while buildings, electricity, and gas contribute to 20% of healthcare emissions, clinical care itself constitutes a significant 80%. It noted that estimates indicate that 60% of these carbon emissions stem from the provision of effective care, 30% from low-value care, and 10% from harmful care.

Despite our efforts to reduce carbon emissions, we are still on track to reach a global increase in temperature of at least 1.5°C. At this level, we can expect to experience more significant health impacts than what we see now, with the current warming of approximately 1.2°C. We need to build climate resilience in our buildings, supply chain, infrastructure and communities. In health, it involves adaptation for our patients, our systems and our workforce. We need a workforce that understands the health impacts of climate change, including on the delivery of clinical care. We need policies and governance within our healthcare systems to enable workers to act pre-emptively to prepare the physical environment, equip patients with information about what to do in extreme weather, understand the intersection of climate with chronic conditions and medications, and collaborate with communities to adapt to our current and future environments. We need to invest in preparing climate-resilient health systems that can anticipate, respond to, recover from and adapt to climate-related impacts, and bring sustained improvements to the health of populations, despite our changing climate.

It is imperative that we reassess our approach to clinical practice, reconsider the structural framework of our healthcare systems, and equip ourselves to provide effective care for every patient affected by the impacts of climate change. Climate change is the greatest threat to health that we will face in our lifetime. But it also offers an unprecedented opportunity to protect and advance the health of our communities.

Dr Kimberly Humphrey

New

study lists potentially dangerous drugs in Australian healthcare RESEARCH BRIEFS

Researchers at RMIT have developed an Australian-first list of 16 potentially dangerous medications used in healthcare and their safer alternatives.

‘Potentially inappropriate medicines’ (PIMs) are medicines with risks that may outweigh their benefits. PIMs can have high risks of severe adverse effects, drug interactions, increased risk of falls and even death.

Lead researcher Dr Kate Wang said the PIMs list would help Australians clinicians identify medications that have higher risks of negative clinical

Risk of serious COVID-19 infection can now be predicted

Researchers at the Technical University of Munich (TUM) have developed a predictive biomarker for the seriousness of a COVID -19 infection.

The researchers developed a method for assessing the number and structure of aggregated blood platelets to help

Invasive fungal infections are a growing risk to human health worldwide.

Researchers at the University of NSW are studying the cell and molecular biology of the invasive Candida albicans fungi, which can be fatal to the host when it escapes the gut and invades organs.

outcomes such as hospitalisation and death.

The study produced an Australian list of medications that are used nationally where the risks outweigh the benefits for older people and where, for some, there are safer alternatives. The list includes common medications such as ibuprofen, lorazepam and codeine, some of which may be replaced by medications like paracetamol.

A total of 130 medications or medication classes was considered, including medicine classes commonly appearing in PIMs lists internationally such as benzodiazepines, NSAIDs and tricyclic antidepressants.

quantify the risk of a severe COVID-19 infection.

A study using image-based flow cytometry demonstrated a rapid rise in concentrations of platelet aggregates in patients admitted to intensive care with COVID-19 infections. This simple diagnostic method based on blood cell aggregates has the potential to identify high-risk patients at an early stage and improve their care.

The researchers investigated blood samples from 36 intensive care patients (age 32 to 83) admitted to the hospital with a SARS-CoV-2 infection classified as moderate to severe. The results showed that the number of aggregated thrombocytes in the blood samples of

At least 40% of systemic C. albicans infections are fatal despite the availability of antifungals. By comparison, a nasty bacterial infection like Staphylococcus aureus (golden staph) kills in around 25 per cent of cases.

Serious fungal infections can be difficult for medical practitioners to diagnose. Symptoms can vary drastically between fungus types and often present just like bacterial infections.

Like antibiotic resistance, there is also increasing worry over antifungal resistance. Researchers observed that when Candida auris first emerged in healthcare settings in the late 2000s, it was already drug-resistant and there

Dr Kate Wong

Researchers found that the lists in other countries were only partially applicable in Australia due to differences in medication availability, what clinicians tend to prescribe, clinical practice guidelines and the healthcare system. No Australian lists to date have made recommendations for potentially safer alternatives.

severely ill patients was significantly higher than in moderately ill patients and definitely in healthy blood donors.

The researchers found that the number of aggregates and their composition changed gradually in line with the severity of the COVID-19 infection and that these changes occurred at an early stage before complications appeared. The aggregates were typically made up of fewer than 10 thrombocytes.

The interdisciplinary team of engineers and medical researchers now plan to transfer what they have learned to other diseases, such as cardiovascular disease or cancers.

is increasing resistance in the clinic to existing antifungal treatments.

This is complicated by the fact that there are only five classes of antifungal medications for use in clinical settings –that’s compared to at least 38 classes of antibiotics to treat bacterial infections.

The World Health Organization recently released its first watchlist of fungal priority pathogens. But researchers say strengthening surveillance networks is critical to identifying any potential fungal threats before they arise and that more funding is needed for mycology to drive better diagnostics and new therapies.

New research finds placenta cells may lower blood pressure

Scientists from La Trobe University and the Hudson Institute have demonstrated that cells from placentas could have therapeutic benefits for patients suffering from high blood pressure.

The research published in Scientific Reports has passed human safety trials, advancing La Trobe’s recent studies into

Nature vs nurture: shedding light on heritable brain activity

A twin study has revealed the complex interplay between genetics and environment in how our brains navigate emotional and cognitive tasks.

New twin studies have shed light on the complex interaction between genetic and environmental factors in processing emotional and cognitive tasks.

The study published in the journal Human Brain Mapping used functional MRI (fMRI) scans to reveal that some emotional and cognitive tasks were partly associated with genetics and others exclusively with environment.

It found some of the same genetic and environmental factors can play a role in the brain reacting to two different

using placenta cells for stroke recovery.

In the next phase, this new therapy will be assessed for its efficacy at reducing disability caused by stroke, pending Therapeutic Goods Administration approval.

The study builds on previous studies that found that if placenta cells were infused within a day after a stroke, the cells target the affected area of the brain and reduce inflammation and nerve cell death.

tasks. For example, the analysis showed that some of the same genetic factors influence the way we process fear and happiness and the way we sustain our attention.

The study conducted fMRI scans on 270 adult twins – both identical and non-identical –as they undertook five tasks. Two were linked to emotional responses, such as reactions to various expressions of different faces, and the other three were associated with cognition, such as the ability to sustain attention and short-term memory.

Twin modelling methods revealed that for some brain networks, genetics plays a small to moderate, but significant role. And for other processes, it’s only the environment that determines brain function.

The second part of the analysis found that there were similarities in the genetic and environmental factors that underpinned different tasks.

The researchers discovered that the way the brain processes fear and happiness (which was measured in the emotional tasks) and our ability to sustain attention (which was measured in the cognitive tasks), have some shared genetic factors.

Research leaders: Dr Quynh Nhu Dinh & Dr Michael De Silva

Researchers tested whether similar protection could occur in reducing the damage that high blood pressure causes in the body and found that the treatment reduced inflammation in blood vessels.

The cells could target inflammation in the arteries caused by hypertension and therefore reduce the associated risks of cardiovascular disease and cognitive impairment, the researchers said.

COVID-19 restrictions and alcohol consumption in Australia

A longitudinal study of 775 participants by La Trobe researchers has compared alcohol consumption in Victoria during the COVID lockdowns over 2020 with nationwide alcohol consumption.

The study published in Drug and Alcohol Review found participants in Victoria decreased their consumption during the first nationwide lockdown while participants from the rest of Australia reported no change in consumption compared to 2019.

During the second lockdown in Victoria, there was no difference in Victorian alcohol consumption compared to the other states where participants were not in lock-down.

The six survey waves between April and December 2020 identified that pandemic restrictions had a bigger impact on consumption in high-risk drinkers than in low and moderate-risk drinkers.

Study identifies safer breast cancer treatment

Local breast cancer specialists have discovered safer treatment alternatives for patients with breast cancer.

An international study involving the University of Adelaide is highlighting the success of a less toxic treatment of breast cancer developed by South Australian researchers.

The global clinical study involving researchers at the University of Adelaide has found the drug enobosarm is an effective, less toxic treatment for breast cancer than the standard treatment that involves blocking estrogen.

The study supports pre-clinical research by researchers at the University of Adelaide previously published in Nature Medicine, which established that the androgen receptor (AR) is a tumour suppressor in both normal breast tissue and ER+ breast cancer.

The new study found enobosarm stimulates the AR, making it effective against estrogen receptorpositive (ER+) breast cancer, which constitutes up to 80 per cent of all breast cancer cases.

‘The effectiveness of enobosarm lies in its ability to activate the AR and trigger a natural defence mechanism in breast tissue, thereby slowing the growth of ER+ breast cancer, which relies on the hormone estrogen to grow and spread,’ said senior co-author Professor Wayne Tilley.

Along with investigators from the University of Adelaide, the international study included researchers from the DanaFarber Cancer Institute (DFCI) in Boston, the University of Liverpool in the UK and other experts around the world.

The team assessed enobosarm’s efficacy and safety in 136 postmenopausal women with advanced or metastatic ERpositive, HER2-negative breast cancer. Enobosarm showed significant anti-tumour activity and was well-tolerated by patients, without adversely affecting their quality of life or causing masculinising symptoms.

This discovery represents the first advancement in hormonal treatment of ER+ breast cancer in decades and offers a promising new oral treatment strategy for the most prevalent form of breast cancer. The new hormonal strategy, published in The Lancet Oncology, differs from the existing standard-of-care hormonal treatments involving suppressing estrogen activity in the body or inhibiting the ER.

It is the first time a non-estrogen receptor hormonal treatment approach has been shown to be clinically advantageous in ER+ breast cancer. The study supports further investigation of enobosarm in earlier stages of breast cancer as well as in combination with targeted therapies, such as ribociclib, a CDK 4/6 inhibitor.

‘The data strongly encourages more clinical trials for ARstimulating drugs in treating AR-positive and ER-positive breast cancer. The fact that this drug is well-tolerated also

opens possibilities for its use in breast cancer prevention,’ said co-author Dr Stephen Birrell.

NEW MODELLING MAY HELP PATIENTS WHO DON’T RESPOND TO TREATMENT

Meantime, Monash University-led research is using mathematics to predict how new combination therapies can help patients with breast cancer who no longer respond to conventional therapies.

Published in Nature NPJ Precision Oncology, the Monash Biomedicine Discovery Institute (BDI) study investigated breast cancer driven by a specific protein, PI3K, and how new combination therapies could effectively shut it down.

The study created new computational models that mimic the behaviour of the cancer-promoting protein PI3K and its extensive downstream targets. This is critical because the PI3K pathway is mutated in about 30 per cent of breast cancer patients, and contributes to resistance to primary anti-cancer treatments.

Co-author Associate Professor Lan Nuygen said this enabled the team to predict new combination therapies and confirmed through experiments in the lab that these new combination treatments are more effective at combating PI3K-mutant breast cancer cells than targeting PI3K alone.

Co-senior author Dr Antonella Papa said the study was an important step forward in understanding and overcoming breast cancer drug resistance using innovative predictive models.

‘Our study has found the way in which breast cancer cells become resistant to alpelisib, a PI3K inhibitor used in the clinic for the treatment of PI3K-mutant breast cancer,’ she said. ‘Using this knowledge, we have identified additional proteins that when inhibited, restore sensitivity to alpelisib and halt the proliferation of resistant cells.’

Associate Professor Nguyen emphasised the formidable challenge of drug resistance in cancer treatment.

‘Our study not only sheds light on the complex mechanisms causing therapeutic resistance to alpelisib, but also provides a computational approach for systematically prioritising combination therapies in an unbiased manner,’ he said. ‘This could accelerate the discovery of effective treatments, making it a valuable framework for future research in oncology and beyond.

‘As drug resistance is a common reason for treatment failure, our research could lead to the testing and approval of new therapies that maintain theireffectiveness longer, potentially improving survival rates and quality of life for patients.’

Dr Steve Birrell and Prof Wayne Tilley

New palliative care services now available

Patients’ access to a ‘good death’ should improve with a new SA Health service.

Palliative Care Connect is a new phone line for doctors and health professionals, aged care professionals and consumers that provides information and linkage to palliative care and bereavement supports in South Australia. Funding for the initiative comes from the Australian Government Department of Health and Aged Care.

Palliative Care Navigators are registered nurses and social workers who assist palliative patients, their family members, and carers, as well as general practitioners, specialists, hospital units, aged care and ambulance services to coordinate and link people to appropriate services and assist with smoother transitions between types of care and into end-of-life care pathways.

To date, navigators have helped clinicians to better understand services available to their patients, navigate complex healthcare and aged care systems, coordinate home support and collaborate effectively on palliative care and end-of-life planning. Through their expertise, navigators enhance patient outcomes and foster stronger collaboration across healthcare teams.

In addition to the phone line, the Palliative Care Connect website, developed in partnership with Flinders University, provides guidance and supportive resources for patients, loved ones and carers from the time of a life-limiting illness diagnosis through to bereavement. The website has a selfassessment tool to help people identify the support and

resources they need, and a service directory to help find local palliative care, bereavement and related community services.

A specific Aboriginal navigation service is being made available across the state during March 2024 to help consumers and health professionals access and provide culturally appropriate palliative and end of life care.

Other Palliative Care Connect services to be implemented in March include a regional model of palliative care navigation services for the Yorke and Northern region and bereavement navigation services in Adelaide, Berri Barmera, Gerard, Loxton Waikerie, Mount Gambier, Port Augusta, Renmark Paringa, and Whyalla.

Promotional materials for display in health clinics and surgeries are available at the Palliative Care Connect website.

For more information email healthcommunications@sa.gov.au.

DEnd of life option offering comfort and hope

A year after its introduction, South Australia’s voluntary assisted dying legislation is bringing comfort to critically ill patients and their loved ones, writes SA Health’s Helen Chalmers.

eath affects every South Australian. When people reflect on someone close to them having a ‘good death’, they use words like dignity, respect, and compassion. However, some South Australians have personal experience of the trauma of watching someone suffer at end of life, and this can have far reaching effects.

After many attempts to pass voluntary assisted dying (VAD) laws across 25 years, eligible South Australians can now make the choice to access VAD, supported by 70 safeguards embedded in legislation.

The introduction of safe, accessible, and compassionate VAD on 31 January 2023 has given eligible South Australians living with a life-limiting illness the choice to make a personal decision about how and when they will die within legislated guidelines.  VAD has successfully been implemented safely in South Australia, with approximately 30% of access by regional South Australians. Every VAD experience follows a legislated pathway, has a permit issued for the substance when eligible, and every case is reviewed by the VAD Review Board for compliance, and for lessons for continuous improvement.

The option of VAD as part of the end-of-life care continuum provides a sense of security and comfort for many, providing a legislated pathway, with extensive safeguards, for individuals to exercise autonomy over their lives. The impact of this has been richly expressed by family members and friends sharing has shown that it has helped many South Australian families:

‘It was a very even partnership from the first moment; by that I mean that the VAD Liaison Nurse set up a dynamic where we were all on this journey in a partnership, and that the primary person was always my brother.’

‘Establishing a VAD clinician workforce has been critically important.’

‘In the end, VAD gave my brother and myself comfort. Even though he didn’t use the kit, just knowing it was an option for him was therapeutic and life affirming.’

‘It is the humanity shown throughout that is of the foremost importance, I think: and the various legal aspects while driving the strict and necessary sequential processes are nevertheless the subordinate parts of the successful implementation of the voluntary assisted dying experience.’

Accessing a ‘good death’

In its first year of operation in South Australia, between 31 January 2023 and 30 January 2024, 195 people were issued with VAD permits by the Department for Health and Wellbeing. Of those, 140 people died, including 110 from administration of the VAD substance.

two VAD Clinical Advisors, Dr Peter Allcroft and Dr Chloe Furst. Dr Allcroft is a general medicine physician and the Clinical Lead, Palliative Care Commission on Excellence and Innovation in Health, who specialises in respiratory and sleep medicine. He has worked with the Southern Adelaide Palliative Care Service for over 20 years and was instrumental in setting up the Statewide Motor Neurone Disease Clinic.

Dr Furst is a geriatric medicine physician who also specialises in palliative medicine. Chloe currently works as the Acting Medical Lead, Acute and Urgent Care at the Royal Adelaide Hospital.

Asked what advice she’d give to medical practitioners considering adding VAD to their scope of practice, Chloe said, ‘do it’.

‘It will seem scary and strange to start with, but it is so rewarding,’ she says. ‘The assessment process becomes shorter as you become familiar with the clinical portal and there are now VAD Clinical Advisors, Peter and me, here ready and willing to support new practitioners.’

Peter echoes this view. He says that the support from the VAD care navigators, liaisons, pharmacists and operations team means that help and assistance is never far away. Peter highlights that the mandatory training course is not arduous, and the clinical assessments of patients are able to be completed within a reasonable time frame with support from the care navigator team and VAD liaisons.

SUPPORTING PATIENTS ON THE VAD PATHWAY

UNDERLYING DISEASE TABLE

Establishing a VAD medical practitioner workforce has been critically important. There has been a positive uptake in the number of medical practitioners undertaking the mandatory training, with 121 doctors registered to undertake mandatory practitioner training and 73 having completed the training, enabling them to support access to VAD in South Australia.

Of the 73 medical practitioners who completed the mandatory training to deliver VAD in South Australia, 38 are general practitioners and 35 from a range of medical specialties including oncology, general medicine, neurology, palliative medicine, emergency medicine, anaesthesia, psychiatry and surgery.

A Community of Practice (CoP) for participating medical practitioners also provides a platform for authorised VAD coordinating or consulting medical practitioners to support the safe implementation of VAD. The CoP is chaired by the

Both Peter and Chloe say it is a privilege to support patients and their families as they explore autonomous end of life journeys.

Chloe describes the transition from patient to person during discussions about VAD. Initially she encounters a vulnerable patient who is worried that their application for VAD will not be supported. When she confirms a patient’s eligibility, she sees them visibly relax and transform to a person who regains their strength and control.

Peter says providing VAD is the ultimate in offering person-centred care that continues along the full continuum of their end-of-life journey.

Chloe says a discussion of pain and suffering is a necessary part of any conversation about eligibility for VAD. She says it can be difficult to listen to how a person is suffering. As a palliative medicine specialist who is experienced in supporting people at end of life, she says the exploration of suffering reaches a new level within the context of the VAD assessment.

The Voluntary Assisted Dying Review Board produces regular reports that provide an analysis of the key activities, outcomes, and statistics of voluntary assisted dying in South Australia. These can be located at https://www.sahealth.sa.gov.au.

Helen Chalmers is the South Australian Department for Health & Wellbeing’s Executive Director, Health Services Programs.

RTWSA review aims to improve the assessment process

ReturntoWorkSA’s review of the Impairment Assessor Accreditation Scheme aims to improve the assessment process for Permanent Impairment Assessors and injured workers, writes CEO Michael Francis.

Permanent Impairment Assessors (PIAs) are doctors accredited by the Minister for Industrial Relations and Public Sector to conduct assessments that determine the levels of impairments resulting from work injuries. As a key part of the whole person impairment (WPI) process, they assess injured workers and prepare assessment reports in accordance with the Impairment Assessment Guidelines. In doing so, these doctors provide a crucial and highly valued service for injured workers and the South Australian community.

The Impairment Assessor Accreditation Scheme (IAAS) is established by the Minister under section 22(16) of the ReturnToWork Act (2014). Along with the Performance Monitoring Framework, the IAAS ensures assessments are consistent, objective and reliable. The IAAS includes essential requirements for doctors to obtain and maintain their accreditation status, including entry criteria, terms and conditions, training, and performance management processes.

In 2023, Industrial Relations Minister Kyam Maher asked ReturnToWorkSA to undertake a comprehensive review of the IAAS, with the aim of establishing a clearer and more accountable scheme that improves the WPI process for injured workers and PIAs.

Phase one of the IAAS review occurred over August and September 2023, with ReturnToWorkSA consulting and seeking input from PIAs, medical associations, claims agents, employer groups, unions and other key groups. Feedback was gathered via face-to-face meetings, email, a dedicated online portal and a PIA Forum on 6 September 2023. All feedback has been meticulously reviewed and considered.

There was consensus among respondents for reform within the existing IAAS with several consistent and recurring themes emerging, including:

advocacy for a continuing accreditation model for PIAs, coupled with ongoing training and upskilling requirements to maintain accreditation an emphasis on fostering assessor capabilities through a supportive model of learning and development a call for a peer support program for assessors engaged in assessments and report completion.

ReturnToWorkSA is drafting a revised IAAS that considers the feedback received in phase one. When drafting is complete, phase two of stakeholder consultation will commence. This is expected to occur before June 2024.

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STUDY ASSESSES INTERN HEALTH AND LIFESTYLE

A small study of final-year medical students entering their intern year has important implications for keeping junior doctors physically and psychologically healthy, writes Doctors’ Health SA director Dr Roger Sexton.

Doctors’ Health SA has completed a small but important study examining the health of 28 final-year medical students as they transitioned through their intern year.

The group underwent a two-stage assessment process that involved a very detailed, protocolised health and lifestyle assessment in December 2022 and a second identical assessment six months later in July 2023, halfway through their intern year.

The assessment was conducted by an experienced medical practitioner (GP) and an exercise scientist at an established and fully equipped executive health clinic in Adelaide.

Each assessment included full medical history and examination, body composition analysis, a treadmillbased VO2max aerobic fitness assessment, exercise ECG, spirometry, evidence-based mental health and sleep questionnaires and baseline bloods including vitamin D.

In addition, a thorough lifestyle review of their smoking, nutrition, alcohol, substance use, exercise and sleep habits was undertaken each time.

Despite the low power of this study, four statistically significant findings emerged. These were a reduction in alcohol intake, a material improvement in the aerobic fitness of unfit subjects with a below average-for-age VO2max , an increase in perceived stress levels, and improvement in low vitamin D levels, found in 80% of the cohort on initial assessment.

Other trends that were not statistically significant but worthy of further study were a reduction in fitness of the very fit subjects (which we hypothesised was due to a lack of time), an improvement in dietary balance, improved reported sleep quantity, and greater awareness of necessary age-appropriate health screenings and their current and emerging health risks, especially those deriving from their family history.

The feedback following the assessments indicated very positive regard for such an assessment and for the opportunity to discuss and modify lifestyle habits before startingwork.

We also discussed and assessed at the second assessment the impact on their health of their intern placements. Not surprisingly, the rotations that appeared to have the most negative impact on their health, as shown by the assessments, were those that involved working beyond scope, working without senior supervision, working where there was no clear endpoint to their on-duty hours, and working where there was a lack of teaching and supportive culture.

Rotations that allowed reasonable time for personal care, good nutrition and exercise after work were favoured.

Overall, the study offered the final-year medical students an opportunity to be professionally assessed by a trained general practitioner and exercise scientist using a range of parameters. For all 28 participants, this was the first time they had undertaken such a comprehensive examination.

The assessments exposed a range of health concerns and risks within the group that included risks arising from their family history, undiagnosed physical illness (such as endometriosis), latent anxiety disorders, unhealthy lifestyle habits, a lack of age-appropriate health screening (such as for chlamydia), and that many did not have regular general practitioners for their ongoing care.

Participants found the second assessment very motivating and they were keen to improve on their test scores from the initial assessment.

There is much to recommend this approach before and during the intern year. Coming ‘fresh off the paddock’ into the tertiary hospital system with varying degrees of impaired personal health, suboptimal lifestyle habits or with undiagnosed conditions is avoidable.

Prevention is better than cure. The application of good preventive medical care to the most junior and often youngest members of the profession at a critical time in their training is an ethical and moral obligation for all of us.

I strongly advocate offering comprehensive assessments of this sort to all final year medical students and mid-year interns.

A tireless advocate for critically

unwell

children

Dr Michael Yung 1962 - 2023

It is with great sadness that doctors across Australia learned of the sudden and unexpected death of Dr Michael Yung in the days before Christmas last year. Dr Yung died on 12 December 2023 as the result of injuries sustained in a home invasion at his home in suburban Gilberton the previous day. He was 61.

Michael trained in paediatric intensive care at the Royal Children’s Hospital in Melbourne in the early 1990s, subsequently working in Kenya as a paediatrician intensivist and the UK before returning to Australia. For the past 25 years, he had worked as an intensivist at the Women’s and Children’s Hospital in Adelaide, where he was director of the paediatric intensive care unit (PICU) until a few years ago.

Over the course of his career, Michael made an enormous contribution to our specialty. He was a rigorous and incisive clinical researcher, exploring multiple common PICU problems and therapies. Such was the quality of his work that a randomised controlled trial that he performed 25 years ago still influences treatment of acute asthma in critically ill children today.

Michael’s comprehensive and careful reading of the PICU literature informed his practice; he exemplified the role of the academic clinician, continuously distilling and interpreting evidence to improve care. He had recently been studying a Masters in Biostatistics, reminding his colleagues that it was important to ‘not just exercise the body but to continue to exercise the mind’.

Michael was a tireless advocate for critically unwell children and their families. A hugely respected clinician and teacher, Michael’s intelligence and careful thought made an impression on everyone with whom he came in contact. His vision and perspective on what paediatric intensive care should be was always manifest in the multiple roles that he held within the Australian and New Zealand Intensive Care Society (ANZICS). He was chair of the ANZICS Paediatric Studies Group for five years, oversaw local data collection for the ANZPIC Registry for two decades, and was a member of the ANZPIC Registry Clinical Advisory Committee from its inception in 2014. His ability to articulate his unique perspective and insights, together with his playful and quick wit, meant that he was always a joy to listen to whenever he spoke at an ANZICS meeting.

A hugely respected clinician and teacher, Michael’s intelligence and careful thought made an impression on all with whom he came in contact. He was a wise, fair and highly valued examiner for the College of Intensive Care Medicine’s (CICM) Second Part Paediatric Exam. Michael was always warm and kind to candidates, fellow examiners, and College staff alike and he will be remembered for generously giving his time to the CICM Paediatric Exam.

‘Michael’s intelligence and careful thought made an impression on everyone’

Additionally, he inspired and influenced a generation of PICU trainees and colleagues, and will long be remembered for his humility, his gentleness, and his sense of humour.

Michael was devoted to his family and a wonderful father to his sons, Ronan and Conor. Michael and his wife, Kathryn, a health policy researcher at Flinders University, were both passionate about Indigenous health. After Kathryn died tragically three years ago, Michael started the Kathryn Browne-Yung Scholarship Fund to establish an ongoing annual scholarship for first-year Aboriginal medical students to enable them to concentrate on their studies. The first scholarship was awarded this year, with the Foundation largely self-sustainable due to Michael’s tireless work.

Those who were lucky enough to know Michael have lost a humble, kind and generous friend. His too-early death leaves a vast hole in the lives of all who knew him and deprives many children and families of his care and expertise.

This tribute was written by Michael’s colleagues from across Australia and New Zealand. It is republished with permission from the Australian and New Zealand Intensive Care Society (ANZICS)’.

Trailblazing a path for female doctors

Dr Thea Limmer 1931 - 2024

Dorothea (Thea) Forgan was born to parents Dorothea and Fred on 28 September 1931. She was the eldest of three children and along with brother Richard and sister Marg grew up in Myrtle Bank in suburban Adelaide.

Thea attended secondary school at PGC Glen Osmond, now Seymour College. A good sportswoman and scholar who represented the school at senior levels in tennis and netball, she became a house captain and deputy head prefect.

She went on to study medicine at Adelaide University, completing her degree of Bachelor of Medicine and Bachelor of Surgery MBBS in 1958. She was appointed junior registrar at the Queen Elizabeth Hospital. Thea said that she was one of a very small number of female doctors – possibly two – to graduate in her year. This achievement cannot be underestimated when looked at through the lens of the challenges facing women establishing themselves in professions at that time. She was certainly an early trailblazer in championing women’s rights and remained a passionate advocate of women’s rights throughout her life.

After a relationship that began at medical school, Thea married Allan Limmer in 1958.

Life changed again with the birth of Chris in 1960, followed by Dave, Andrew, Cathy and Penny over the next eight years and she became a full-time mum. She recalled this as a challenging but fulfilling stage of her life, with the family moving first to Port Augusta to enable Allan to enter private practice and ultimately settling in Stirling in the Adelaide Hills.

In her mid-40s, and after almost 20 years as a full-time mother, Thea retrained and returned to medicine. Now

‘Dr Limmer’, she established herself in private practice with Dr Andrew Ramsay at the Crafter Medical Centre in Hawthorn, and assisted various surgeons at Abergeldie and Wakefield St private hospitals. This was a tough time for her, combining medical retraining with full time work and being a single parent to five school-aged children. It was an inspiration for us all.

Thea completed her medical career working for the Commonwealth Department of Health in Adelaide. She commented several times on how nice it was to have regular 9-5 hours for the first time in her life!

Throughout her career, Thea remained a fierce advocate of women’s rights and particularly advancing the role of women in medicine. She was actively involved in the Medical Women’s Society of South Australia for many years, including two stints as President, and in more recent years co-founded the AMA(SA) History Committee, which is dedicated to recording the important history of the Australian Medical Association in South Australia.

In her later life, she was fortunate enough to find a new relationship, and in 1993 married Gerald Reynolds. Many happy years followed with Gerald, with Mum finally being able to indulge her love of travel, art, and antiques and to have the joy of sharing them with a significant other.

A habit that caused her family no end of mirth was her tendency to describe matters in formal medical terms, rather than in plain English. Her grandchildren never had a runny nose, they had a postnasal drip.

She loved cultural pursuits and, in her retirement, had the time to indulge them with visits to the theatre, concerts and art galleries. Education was an important cornerstone to what she valued in life. She made significant sacrifices to ensure that we all had the best opportunities for education that she could provide.

Thea had a strong sense of duty. She was someone who always tried to do the right thing. She had an overwhelming sense of justice and fairness; it was important to her to treat everyone equally and with respect.

Thea died peacefully at Estia, Kensington Gardens, on 4 January 2024, aged 92.

Andrew Limmer

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AMA(SA) members are invited to attend the AMA Queensland International Annual Conference.

AMA(SA) members are invited to attend the AMA Queensland International Annual Conference

This CPD-accredited conference has a long and proud history of bringing doctors together to discuss key issues facing the profession while immersed in unique tourism destinations. We are thrilled to hold our international 2024 event in Athens, Greece, with support from our corporate partner Orbit World Travel.

This CPD-accredited conference has a long and proud history of bringing doctors together to discuss key issues facing the profession while immersed in unique tourism destinations. We are thrilled to hold our international 2024 event in Athens, Greece, with support from our corporate partner Orbit World Travel.

Athens, the historical capital of Europe, is located in Central Greece on the Attica Peninsula. The Greater Athens area features the longest coastline of any European capital, offering several beaches just 20 minutes from the historic centre.

Athens, the historical capital of Europe, is located in Central Greece on the Attica Peninsula. The Greater Athens area features the longest coastline of any European capital, offering several beaches just 20 minutes from the historic centre.

With a recorded history dating back around 3,400 years, Athens is known as the birthplace of democracy, arts, science and the philosophy of western civilisation.

With a recorded history dating back around 3,400 years, Athens is known as the birthplace of democracy, arts, science and the philosophy of western civilisation.

Athens is a gateway to so many pre- and postconference travel extensions, including more than 6,000 islands and islets scattered in the nearby seas. Also on the historical doorstep of Greece is Türkiye, steeped in its own cultural and natural beauties.

Athens is a gateway to so many pre- and postconference travel extensions, including more than 6,000 islands and islets scattered in the nearby seas. Also on the historical doorstep of Greece is Türkiye, steeped in its own cultural and natural beauties.

Join us at this much-anticipated conference destination.

Join us at this much-anticipated conference destination.

* For more details please visit our website ama.com.au/qld/events/annual-conference/athens

* For more details please visit our website ama.com.au/qld/events/annual-conference/athens

Finding his calling in rehabilitation practice

Dr Nigel Quadros 1960 - 2023

Dad was born in Patna in North India but moved to Perth with his father, mother and brother in 1971. He completed high school and went on to gain a bachelor’s degree in immunology and biochemistry at the University of Western Australia in 1981. He moved to Adelaide in 1982 for a job as a research assistant in the Faculty of Dentistry. His supervisor identified Dad’s potential, enrolling him in a project a looking at amino acids to supress the growth of bacteria causing gingivitis and Dad obtained a First Class Honours Degree in Science.

He then worked as a research officer in the Department of Haematology at Flinders Medical Centre, developing an enzyme-linked immunosorbent assay (ELISA) to detect D-Dimer Levels, indicative of blood clots.

With support from the Professor of Immunology, Dad was awarded a scholarship from the SA Arthritis and Rheumatism Foundation in 1986 to examine endothelial cell antibodies as a contribution to vasculitis in autoimmune rheumatic diseases. This work and exposure to patients with complex medical conditions sparked an interest in medicine and he was accepted into the MBBS at Flinders University in 1990. He used university holidays to write his PhD thesis and was awarded combined MBBS and PhD degrees in 1994. The friends he made at medical school remained close throughout his life.

After working for several years at Flinders Medical Centre, Dad moved to the Royal Hobart Hospital in 1997 and then to Launceston General Hospital, where he found his calling in rehabilitation. He enjoyed seeing people with disabilities going home to live as independently as possible and became very interested in neurological rehab. He returned to a training position at the Rehabilitation Medicine Department in Adelaide in 1998, becoming a registrar in rehabilitation medicine in 1999.

He married Judith in 2000. But on his first wedding anniversary, he was diagnosed with a midgut neuroendocrine tumour. The outlook was bleak with no treatment available and the expected five-year survival was 65 to 70%. He was a very strong-willed man and was determined to prove the survival statics wrong, undergoing four-weekly hormone therapy to control the symptoms. Undeterred, he completed training in 2004 and was admitted as a specialist in rehabilitation medicine by the Australasian Faculty of Rehabilitation Medicine in the same year.

In 2005 he became Head of the Rehabilitation Unit at the Queen Elizabeth Hospital. As a new consultant he overcame the challenges of no administrative training, mentorship or even an office with a characteristic methodical manner. His tenure oversaw the expansion of rehabilitation inpatient beds at St Margaret Rehabilitation hospital, development of day rehabilitation and rehabilitation-in-the-home services. He also established the only public post-polio clinic in South

Australia, as well as clinic transition services (kids to adults). He relinquished the head of unit position in late 2014 just before the amalgamation of St Margaret and Hampsted rehabilitation hospitals.

Dad loved teaching. With the support of Professor Renuka Visvanathan, he was able to develop a series of lectures on rehabilitation medicine for the 4th-year musculoskeletal courses and 5th-year geriatric medicine and general practice courses. He was involved in the Adelaide University medical student mentorship program and was a selection panel member for the MBBS course.

Dad supported the Chinese medical exchange program at Adelaide University, providing lectures on principles of rehabilitation medicine and working with a multidisciplinary team.

He wanted to promote education related to the late effects of polio in ageing polio survivors and ran many educational sessions on the topic, including to the Afghan and Sudanese communities to inform young polio survivors about the late effects of polio. Together with Associate Professor Dr Anupam and Associate Professor Dr Sivam, he looked at the risk of sarcopenia development in ageing polio survivors. He also enjoyed working in private rehabilitation at a number of private hospitals including in stroke and cardiac rehabilitation.

Dad always felt God gave him a blessed life and he wanted to return the favour. He served meals to homeless people every Saturday morning, Easter and Christmas at the Hutt St Centre. He raised money for Polio SA, prostate cancer and melanoma awareness campaigns through the Campbell Rotary club.

Dad thanked God for giving him 22 years after the cancer diagnosis to fulfill his dreams. The beauty of my father being a physician was his ability to help people, but his curse was knowing far too well how his condition would eventually progress. In late July his prognosis was poor, and despite exceptional oncology and rehabilitation he deteriorated for five weeks until 3 September. He promised he would be with us for Father’s Day, passing away that very night. He left this world peacefully, holding the hands of my loving mother and I, knowing I would one day continue his legacy to provide wholehearted and exceptional care to people on a medical and personal level.

As he wiped my first tear, I wiped his last. He toiled not to seek for rest; now he rests

Luke Quadros

BSc Hons BMBS (Flinds) PhD (Flinds) FAFRM (RACP)

Dr Nigel Quadros with Judith and Luke Quadros in 2022

EXHILARATION AND PERFORMANCE

A new Honda Civic provides an exciting drive – especially in red.

Another Honda, but this time one of the most exciting cars I have driven, and perhaps the most exciting Front Wheel Drive (FWD).

More of the excitement later, but just to whet your appetite, the latest Type R currently holds the record (7:44.881 minutes) for the fastest lap of the famous Nürburgring in a FWD car. Nürburgring is a 20.83 km race and test track situated near a medieval town in the beautiful Eifel mountains, some 60 km south of Bonn, Germany.

So, what does this mean for the Civic Type R owner?

Honda Civic was first manufactured by Honda in 1972 and introduced to Australia the same year. The original Civic had two doors and a 1.1-litre engine. Weighing only about 650 kg, it was very economical, hitting the market at just the right time given the world oil crisis in 1973.

Civic’s popularity has persisted, with total sales globally approaching 30 million, nearly half of which are sold in US where it remains the top-selling small car. Mind you, it is hardly a small car any more, having grown (much like the Corolla) from a length of 3545 mm in 1973 to 4560 mm now and gaining a ‘middle aged spread’, from 1505 mm to 1802 mm in width. And to pull all that extra bulk, more than double the original’s, now requires a 2-litre engine.

Civic’s sporting aspirations date back to the beginning, with the diminutive Honda even competing in the Bathurst 1000 from 1973 to 1976.

However, it was not until 1997 that the first Type R was released by Honda, and this was only sold in Japan. Six generations of Type R brings us to the present test car, with its ‘go faster’ looks enhanced by being finished in Rallye

Red. Other colours include Boost Blue, Sonic Grey Pearl, Championship White and Crystal Black Pearl.

My first view of this machine was from the rear, and I certainly felt my pulse quicken at the site of triple exhaust pipes appearing under the bright red livery, topped by an aggressive black rear spoiler.

Other external features hinting at the performance include an air intake scoop at the front of bonnet and air intake scoops behind front wheels.

There are red covers over the Brembo four-piston aluminium front brake calipers.

The very smart 19-inch alloy wheels are shod with 265/30 ZR19 Michelin Pilot Sport 4S that contribute to the extraordinary handling. Internal features include deep red body-hugging seats, which are quite low and not as easy to get out from as other sporty cars such as an MX5; red carpets; red stitching around the gear-stick cowling; and red ambient lighting. There is a solid aluminium gear shift (memo to driver: this becomes very hot if the car is parked in full sun), and also alloy sports pedals.

When seated, the driver can see the 10.2” LCD ‘driver information interface’ (this used to be called a dashboard) with large tachometer display and F1-inspired shift lights. There is also a mid-console infotainment touch screen.

Underneath the aforementioned bonnet sits a 235 kw 420 nM 2.0 litre DOHC VTEC Turbo in line four-cylinder engine driving through a six-speed manual transmission (no automatic available) and Helical Limited Slip Differential. Performance is stunning with a claimed 0-100 time of 5.7 seconds and top speed of 272km per hour. The very firm suspension adds to the exceptional cornering ability.

Another feature to assist in maximising the potential of the Type R is an exclusive data-logging app that monitors vehicle conditions and driving behaviour in real-time, and an auto score mode that measures and scores your everyday driving patterns. There is a data log mode that records lap times and other performance on the track, allowing the driver to share and compare with others who’ve completed the same course. (This can be seen in action on the Nürburgring online track video.)

Despite all this hoopla, the Type R can also be a very

‘A DATA LOG MODE RECORDS LAP TIMES AND OTHER PERFORMANCE ON THE TRACK’

suitable daily drive, especially with the ‘comfort’ setting engaged.

The manual gearbox is easy to use and has a rev matching function. There are only four seats, with the middle of the rear passenger area taken up with two of the eight cup holders. The boot is spacious at 410 litres, expanding to more than 1200 litres with the rear seats down.

Connecting the mobile to the car is intuitive and easy, and there is a wireless charger, although I had to remove my phone from its bulky (and hopefully very protective) leather case to enable charging.

Headlights and windscreen wipers activate autonomously, and the Type R locks itself when you walk away.

After a few days of city commuting, it was time to stretch the Type R’s legs and head north. There are many ways to get to Port Augusta and one of my favourite Friday drives is to head from the city up One Tree Hill Road through Humbug Scrub, Williamstown, Lyndoch, Kapunda, Marrabel and Auburn to Paulett Winery for a leisurely lunch. Delicious food and in this case washed down with a single glass of its sparkling Riesling, surrounded by probably the best view in Clare.

This route certainly gave a great opportunity to blow any (unlikely) cobwebs from the Type R and thrill to the exciting handling, acceleration and safe overtaking on some of these fabulous hill roads. After lunch there was a more scenic leisurely drive via Crystal Brook to my final destination.

Saturday was mainly spent entertaining my now one year old granddaughter for her first birthday party along with a number of her friends.

The return trip down Highway One was much more straightforward, although again the few occasions for overtaking were achieved with very little time across the broken white lines.

It was with some reluctance that I returned the bright red beast on a sunny Monday morning.

Anyone wanting to be the next owner should order now as there is a 20-month wait. However, the list price of $72,600 is the driveaway price and includes a five-year unlimited km warranty and capped-price servicing of $125 per service, provided it is done at 12 months or 10,000 km (at the time of writing). You will be in for a treat.

Dr Robert Menz is a GP who really likes red cars. Type R provided by Honda Australia.

With a roar of delight

The ACMA Annual Chinese New Year Dinner held at Adelaide BMW on West Terrace this year celebrated the Year of the Dragon.

The booked-out event attracted 300 guests, including sponsors of ACMA(SA) and partners from across the health sector.

VIP guests included Shadow Minister for Multicultural South Australia, Jing Lee MLC, Adelaide Lord Mayor Dr Jane Lomax-Smith, People’s Republic of China in Adelaide Consul-General Li Dong, the Executive Dean of Flinders University’s College of Medicine and Public Health, Professor Jonathan Craig, and AMA(SA) President Dr John Williams.

From left: Dr Debra Andreacchio, A Rajendra, Dr Jane Zhang, Dr John Williams, Surasen Rajendra, Lee Martin, Sharon Martin

Back (from left): Consul Yao Na, Professor Jonathan Craig, Dr Sheldon Chong, Ms Bernadine Wee, Tim Wooley, Dr Jane Lomax-Smith. Front (from left): ConsulGeneral Li Dong, Mrs Barbara Craig, Dr John Williams, Hon Jing Lee MLC, Mr Eddie Liew

Dr Sheldon Chong addresses the guests

The VIP table and other guests enjoy the entertainment

AGM! Dispatches is the AMA(SA) annual general meeting (AGM)

SAVE THE DATE FOR OUR

MAXIMISING YOUR MEMBER BENEFITS

22 June

More details will follow soon.

Please check The Pulse in April to find out more.

Have you logged in to the AMA Member Portal?

The portal is where you will also find all the information you need about the exclusive perks you can benefit from by being an AMA(SA) member. If you have forgotten your password, you can reset it here or contact AMA(SA) membership on 8361 0108.

2024 AMA(SA) COUNCIL MEETINGS

The next meeting of AMA(SA) Council will be held on THURSDAY, 16 MAY 2024.

There is no meeting in April. Members may attend Council meetings as observers. If you are a member and wish to attend the February or March meeting, please call Ms Suzanne Roberts on 8361 0109 or email sroberts@amasa.org.au.

There is an opportunity to lease Specialist Medical Rooms in Aldinga custom designed to your specifications. The site is adjacent to other complimentary properties including an Alternative Medical Centre, Nursery and a Child Care Centre. There is an adjacent 800 home new sub-division and nearby Aldinga Super School with 1,500 students. For further information please call

David Smallacombe Nathan Fox 0412 826 615 0412 818 208 das@smallacombe.com.au nathan@smallacombe.com.au

RLA 1520

ACCESSING THE AMA FEES LIST

The latest AMA Fees List is available and is under a licensing arrangement so AMA members have access at no cost. Please access the list at https:// feeslist.ama.com.au/ using your login details.

THANK YOU, DR SANAP!

We are delighted to extend our warmest congratulations to Dr. Milind Sanap, who has been awarded a $500 credit towards membership for the year 2025.

Dr Sanap indicated his support for AMA(SA) and his colleagues across the state by renewing his annual membership before its expiration on 31 December 2023. This reflects Dr Sanap’s commitment to the value he places on being an active member of AMA

ROOMS FOR RENT Waverley Vascular Group

Waverley Vascular Group has availability for a Consultant Surgeon or Physician to join our practice.

With a reputation spanning over 30 years and a close relationship with St Andrew’s Hospital, we have built a wide referrer base covering metropolitan and regional South Australia. 337 South Terrace was completed in 2023 with Clinpath and Jones Radiology conveniently located on site for patients.

Our tenancy offers 3 consulting rooms, tearoom with amenities, back office and a large waiting room, and on-site car-parking for patients and staff.

Please contact

David King or Kurian Mylankal on (08) 8232 1293 for further discussion.

Durif – just like shiraz on steroids

Durif (aka Petit Sirah) was originally something of a Rutherglen secret, with typically brilliant wines made by Morris, Stanton and Killeen, Campbells, Fairfield and others. Of late it has quickened its stride with plantings in the Barossa, Riverland and McLaren Vale. I love it and I reckon it’s got legs in the glass with its high alcohol and in the vineyard because of the stunning wines it so often produces.

Durif is particularly well suited to warm climates as it is drought tolerant and seems to avoid shrivel, even in extreme conditions. It retains acidity and bright fruit even when very ripe, minimising the chance of dead or indistinct fruit finding its way into the glass.

Handled well it makes massive, tannic wines with an inky core of bright fruits and a strong spine of acidity. Fruit tends to plum and blackberries. You might also find liquorice, blood plum, cinnamon and cloves. Andrew Seppelt from Murray Street likens it to shiraz on steroids and says it is ‘akin to eating fountain-pen ink.’ With the first vintage in barrel, we look forward to seeing what Andrew eventually does with his Durif.

Durif has often been used as a blending variety to ‘beef up’ many red wines, enjoying the anonymity of up to 15% of what is declared as a single varietal red. By this I mean, if a wine declares itself to be a single varietal such as shiraz, it can have up to 15% of anything else in it (yeah, really!). Most will add Durif in smaller measures than 15% as that’s all that would be required.

A stunning modern example of 100% Durif is made by Curtis Family Wine Makers, a more elegant example than most and packs, plums, blackberries, black cherries, black olive, vanilla, cedar, and more into a thyme spritzed package which is gorgeously sumptuous. As close to entry-level as we could recommend; otherwise the likes of Morris and Fairfield are the deep dive and give you a good benchmark.

For more recommendations contact me and I’ll send you a list of some of my other favourites, at phil.manser@winedirect.com.au

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AMA(SA) is the most influential voice on health matters for doctors and South Australia’s community.

We’re the only organisation representing all doctors from all specialties.

As a member, you’ll have the opportunity to join a powerful network of professionals who are working to improve the health system, advocate for ethical standards in the medical sector, and provide guidance on professional conduct.

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AMA(SA) membership is tax deductible. By joining, you can shape the future of healthcare in South Australia.

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