medicSA Winter 2024

medicSA Volume_38 Number_02 | WINTER 2024 | AMA South Australia

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V O L U M E 3 8 _Number 02

15 System critical

— AMA(SA) responds to code yellows and the State Budget — D-Day comes for payroll tax

18 On the road

— President Dr John Williams embarks on his state-wide road trip

AMA(SA) President Dr John Williams and Doctors in Training Committee Chair Dr Hayden Cain in the Riverland

CONTENTS

Winter 2024

07 President’s column

09 From the Medical Editor

10 The CEO’s report

11 Meet the AMA(SA) team

12 A duty of care

— Wrapping up the AGM — Our new AMA(SA) Councillors — Honouring our Life Members

25 Up in smoke

— AMA campaign instrumental to vaping overhaul

28 Carbon conscience

— How low-carbon practices can improve patient care

31 Training grounds

— Medical school leaders outline their visions — AMA(SA) findings call for improved workplace culture

44 Compassionate cause

48 Theory

— South Australian research grants — Research briefs

52 Vale

— Remembering members Dr ‘Fred’ Gilligan, Dr Firoze Narielvala and Dr Noel Hutchins

LEADERS IN ORTHOPAEDIC CARE ORTHOPEADIC SURGEONS BENJAMIN ALLEN BEN BEAMOND COLLIE BEGG SAMUEL BENVENISTE SCOTT BRUMBY DAVID CAMPBELL NICHOLAS CHABREL RICHARD CLARNETTE ANDREW COMLEY WILLIAM DUNCAN CHI KANG GOOI PETER LEWIS BASEL MASRI RORY MONTGOMERY MARK RICKMAN MICHAEL SANDOW CHEN TU ARTHUR TUROW

Wakefield Orthopaedic Clinic has provided high-quality, specialised orthopaedic care in South Australia since 1991.

We specialise in prevention, treatment and rehabilitation of orthopaedic conditions and work alongside sports medicine, physiotherapy and rehabilitation specialists to get you mobile again.

CONTACT US

Level 2, Consulting Suites, Calvary Hospital 120 Angas Street, Adelaide, South Australia 5000 (08) 8236 4100

woc@woc.com.au

woc.com.au

medicSA is produced by the Australian Medical Association (SA)

AMA(SA) COUNCIL & EXECUTIVE BOARD President: Dr John Williams

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

Vice President: A/Prof Peter Subramaniam Immediate Past President: Dr Michelle Atchison Chair: Dr Hannah Szewczyk

Ordinary Members Dr Vikas Jasoria

PO Box 685, Fullarton SA 5063

Dr Emily Kirkpatrick

Telephone: (08) 8361 0100

Dr Bridget Sawyer

Email: medicsa@amasa.org.au

Dr Nimit Singhal

www.ama.com.au/sa

Dr Krishnaswamy Sundararajan Dr Hannah Szewczyk

Membership: membership@amasa.org.au

A/Prof William Tam Dr Isaac Tennant

EXECUTIVE CONTACTS President Dr John Williams: president@amasa.org.au CEO Nicole Sykes: nsykes@amasa.org.au

medicSA Editorial Medical Editor: Dr Roger Sexton Editor: Karen Phillips editor@amasa.org.au Advertising medicsa@amasa.org.au Design & Layout Olivia Fantis ISSN 1447-9255 (Print) ISSN 2209-0096 (Digital)

Specialty Group Representatives Anaesthetists: Dr Louis Papilion Dermatologists: Dr Karen Koh Doctors in Training Representative: Dr Hayden Cain Emergency Medicine: Dr Cathrin Parsch General Practitioners: Dr Chris Moy Intensive Care: Dr Raj Ramadoss Ophthalmologists: A/Prof Michael Goggin Orthopaedic Surgeons: Prof Edward (Ted) Mah Paediatricians: Dr Patrick Quinn Pathologists: Dr Shriram Nath Physicians: Dr Andrew Russell Psychiatrists: Prof Tarun Bastiampillai Surgeons: Dr Christopher Dobbins

Regional representatives Southern: Dr Jerida Keane Northern: Dr Alice Fitzpatrick Public Hospital Doctors Representative: Dr Clair Pridmore

Student Representatives Adelaide University: Hannah Kieu Flinders University: Lydia Smalls

AMA(SA) Executive Board Dr Michelle Atchison, Dr Guy Christie-Taylor,

DISCLAIMER: Neither the Australian Medical Association (South Australia)

Inc. nor any of its servants and agents will have any liability in any way arising from information or advice that is contained in medicSA. The statements or opinions that are expressed in the magazine reflect the views of the authors and do not represent the official policy of the Australian Medical Association (South Australia) unless this is so stated. Although all accepted advertising material is expected to conform 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.

STAY IN TOUCH

@ama_south_australia

A/Prof William Tam, Ms Megan Webster, Dr John Williams (Chair), A/Prof Peter Subramaniam

SA members of AMA Federal Council Prof Edward (Ted) Mah Dr Clair Pridmore Dr Hannah Szewczyk Dr John Williams

AMA(SA)@AMASouthAustralia

Australian Medical Association (SA)

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President’s Report Dr John Williams

I

t’s always a valuable learning experience to listen to our elders.

And when you’re treading in the footsteps those elders first walked five or six decades ago, it’s more than valuable – it’s critical. In the same way as Roger Federer has always publicly praised and lauded Australian tennis veteran Ken Rosewall, so too should we doctors recognise the legacy of those who paved the way for our own careers. The technology has changed, but our approach to providing patientfocused care must not.

So it was wonderful to meet the doctors who have most recently been awarded life membership of the AMA during the presentation ceremony staged as part of our annual general meeting (AGM) event on 22 June. In preparing for what was my first opportunity to present the certificates to our life members, I was gratified to learn how these newest life members have served their patients and our profession. I sincerely thank psychiatrist Dr Prudence McEvoy and GPs Dr Dennis Ankor, Dr Thomas Klaveniek and Dr Geoffrey Martin for a combined 205 years of contributions to the AMA. Similarly, the obituaries we publish in each issue of medicSA make for instructional and inspiring reading. The fact that many are written by doctors who take the time to honour their mentors demonstrates how lasting is the imprint of their first teachers on their lives and the development of

the doctors they become. In this issue, we recognise Dr Firoze Narielvala, who was himself awarded life membership only three years ago – and who said at the time the ‘precious camaraderie and enduring friendships’ he made were among the highlights of a long career. There’s Dr Noel Hutchins, who seems to have epitomised all that is good about the rural ‘family doctor’, and there’s Dr Fred Gilligan, who we have to thank for the MedSTAR retrieval service, which as a rural GP I am grateful for every day. We do try and honour all former members – if you know of anyone whose life we haven’t covered and about whom you can help develop an article or provide images, please let us know.

The life members’ ceremony and AGM provided important moments in the AMA(SA) year – and, for me, a chance to mix with and hear from members in an environment a step removed from the crises and chaos that characterise so much of our health system today. As I write this, our public hospitals have been in ‘code yellow’ emergencies for four weeks, with the ramifications for patients on ever-lengthening essential surgery waiting lists yet to be fully understood. Journalists have sought AMA(SA) comments about an advertisement from SA Health that I described as ‘risky’ as it could lead people to delay seeking urgently needed treatment.

If we’d been asked, we could have helped develop an ad that urged people go first to their GPs and other frontline providers before heading to EDs, but to please go to an ED if necessary – a patientfocused, clinically sound recommendation to patients in need of care. That’s what the AMA has always done, and what we do best. president@amasa.org.au

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Join AMA(SA) Community and Make a Difference in Healthcare AMA(SA) is seeking dedicated individuals who share our commitment and passion for driving positive change in the healthcare sector.

We’re excited to offer a range of positions that will help us achieve better outcomes for patients and doctors.

If you have an interest in shaping medical editorial content, contributing to improving general practice, driving strategic initiatives, or leading our Council, we have a role for you.

AMA(SA) is stronger, louder and more effective when doctors stand together. Explore our open positions and learn how you can make a genuine impact.

1. m edicSA Committee - Member Join the editorial committee for medicSA and play a crucial role in disseminating pivotal information to the medical community. An enjoyable creative outlet with an important purpose.

Commitment • 4 planning meetings annually • Proof-reading 4 editions annually

2. C ommittee of General Practice –

Regional Member

We have a vacancy for a rural General Practitioner to join our Committee of General Practice. This position plays a pivotal role in providing a platform to influence and support general practice in regional areas.

Commitment

Requirements

• 6-8 meetings annually • Pre-meeting preparation

•A n interest in helping bring to life the stories and content that engages and informs the medical community

Requirements

3. Board – Directors

4. Council – Chair

Take a strategic lead in shaping the future of AMA(SA) by joining our Board and assisting in driving our new strategic plan forward effectively strengthening our position.

This role offers a unique opportunity for an existing Council member passionate about making a difference with a vision to guide our council towards achieving its goals.

Commitment

Commitment

• Minimum 6 meetings annually • Pre-meeting preparation

• 8 Council meetings • 8 agenda-setting meetings • Ad hoc as required

Desirable

Requirements Essential

Essential

• Working as a rural GP

Requirements

• Minimum of 2 years served on either AMA (SA) Council or a committee • Continue to serve on an AMA(SA) Council or a committee

Essential

Desirable

Desirable

• Seeking a range of skills inclusive of leadership, strategic growth and governance • Passion for helping to deliver the strategic plan and engage with our future members

• Governance

and chairing experience If you are passionate about making a difference and have the vision to guide our council towards achieving its goals, we encourage you to apply

How to Apply

Application Deadline: 8th August

If you are motivated to contribute to any of these roles, please express your interest by sending your application to suzanne.roberts@amasa.org.au.

Join us in our commitment to enhance healthcare and professional standards across South Australia.

Both online and in-person attendance options are available.

•M inimum of 1 year of experience on AMA(SA) Council

From the

Medical Editor

A

Dr Roger Sexton

cknowledgement of the work of our rural colleagues and the impact of their skills and dedication on local communities is timely and welcome. As a rural GP myself for many years, it can be a professionally isolated job, without recognition until an afternoon tea is staged in the local RSL Hall when you leave.

The AMA(SA) President’s Tour is a very important and positive initiative that will have our President, Dr John Williams, CEO Nicole Sykes and others visit groups of rural doctors in their locations over the coming few months. The tour allows AMA(SA) leaders to acknowledge and meet members, and hear about their work, successes, concerns and solutions to health system problems.

Our medical training as problem-solvers is underused and we must be at the forefront of offering solutions to improve the health system and patient outcomes. AMA(SA) can condense and distil these ideas into positive proposals to take to government.

On a related note, we are a cautious profession when it comes to the widespread adoption of changes to our clinical practice. The consensus around new clinical guidelines and practice takes time, expertise and a solid evidence base but ensures that we minimise harm to our patients, maintain treatment consistency and retain trust in our profession. However, this caution may constrain us in how we organise the delivery of medical care to the community. The high standard of medical care is one thing; our capacity to offer timely patientcentric medical care is another.

This has been too slow to change. Delays in obtaining appointments for preventative, urgent and after-hours care at the primary care practice level are widespread and unacceptable. When others step up to offer a solution, we are reacting critically to such a change rather than leading it.

Consider the rapid changes to the scope of practice of other health professions such as nursing, midwifery, optometry and pharmacy practice. Immunisation in pharmacies has been rapidly accepted by the community, due to a focus on service and convenience.

We are seeing private health-fund forays into the

establishment of new primary care clinics with salaried multidisciplinary care practices, along with out-of-hospital care models that aim to prevent hospital admissions and solve the government’s problems.

This is an entirely sensible and innovative business model for a hospital insurer but risks leaving established general practices out of the equation.

Where does the medical profession sit in all of this?

I suggest that we are treading water while the tide of innovation and problem-solving opportunities pass us by. Others are filling the void and solving the bigger health system problems in their own ways.

In my social networks and rural travels, I hear constant frustration about this and the loss of traditional continuity of care and, along with that, a palpable sadness. I see the despair at the demise of a local medical service and the lack of access to a much-loved family doctor. Comments such as ‘I don’t bother any more’ and ‘I just see anyone’ are depressing to hear and I find it harder to defend the system and such limited access to world-class care.

The way we market ourselves now is both dated and ineffective. We see pharmacists wearing white coats and looking professional. We see other health professionals wearing stethoscopes and adopting medical symbols that we appear to have given up.

GPs, especially, have been portrayed for years as tired, overburdened and in need of help. The marketing of our profession in my view has been, frankly, awful.

This does not inspire hope in the community. If they can’t find what they want, need and expect from us, they will search for alternatives.

Let us all be bolder and step up to rescue the health system.

Thank you to our valued contributors to this edition of medicSA.

‘Our medical training as problemsolvers is under-used’

roger.sexton@bigpond.com

From the

CEO Nicole Sykes Celebrating one year: reflections and milestones As I mark my first anniversary as CEO of AMA(SA), it feels timely to reflect on all we have achieved together. This past year has been a whirlwind of activity and progress, and I am proud to share a few key highlights that underscore our commitment to enhancing our member value proposition through continuous improvement.

Membership engagement and response

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AMA(SA)’s vast and diverse membership across the medical profession is what gives our association its strength and purpose. Our unity has been and continues to be what sets us apart; it’s why health decision-makers give us a seat at the table.

Ensuring we speak from an informed position for all doctors takes significant work behind the scenes. There are so many important conversations that happen every day which allow us to better understand members’ concerns and work together to chart a way forward. Those conversations empower us to advocate from an informed and tactical position so we can drive genuine improvements which benefit members, the wider medical profession and our community.

In today’s complex world, where there are many competing interests, effective advocacy and leadership is characterised by the ability to build relationships and strategic partnerships, demonstrate resilience, and consistently engage in difficult conversations with determination and grace. Our President Dr John Williams exemplifies these characteristics in everything he does. His personal approach, his ability to truly listen to members and his quietly collaborative and strategic leadership breathes life into our values of Trust,

Collaboration and Inclusion.

Building a strong team Our team at AMA(SA) continues to evolve as we welcome new staff members who bring fresh energy and perspectives, vital for delivering our mission. We are pleased to introduce our team in this edition of medicSA, so our members can become familiar with their names and faces and engage with them more personally. These are the dedicated individuals working diligently, ensuring our association continues to thrive and serve the community effectively.

medicSA

Amnesty for medical specialists AMA(SA)’s advocacy work on payroll tax has been persistent and strategic and has not ceased. While acknowledging we did not get the outcome we sought, it is important to recognise and celebrate our ability to secure a last-minute amnesty providing retrospective protection for non-GP medical specialists in private practice. This is a national first and a significant achievement that underscores our commitment to safeguarding our members and ensuring they can practise without the looming threat of unforeseen liabilities. I encourage all members to visit the member portal on our website for full details.

A milestone AGM AMA(SA)’s Annual General Meeting held on Saturday 22 June was the first delivered by John and me and marked another significant milestone in the evolution of our organisation. At this event, we approved a new constitution which has been years in the planning, establishing a more contemporary governance structure. These changes are designed to strengthen our operations and ensure we are well-positioned to meet the challenges of the future.

Engaging with regional members One of the year’s highlights has been kicking off our rural tour. Meeting with our regional members face-to-face has been exceptionally rewarding. This initiative, strongly advocated for by our first regional president, underscores the importance of a robust rural health network. The feedback and insights gained from these visits are invaluable, helping us to better understand and address the unique challenges faced by our rural colleagues. Please keep an eye out for the dates when we will be visiting your region and register to catch up with us. Your voice helps guide us as we strive to enhance healthcare across South Australia.

As we look forward to another year of growth and achievement, I am filled with gratitude for the hard work and dedication of our AMA(SA) team, including our extensive network of volunteer members. Your engagement and feedback propel us forward, and I am excited about what we will accomplish together in the coming months.

Thank you for your continued trust and collaboration as we advance the interests of the medical community in South Australia.

Meet the team

K AT E F U S S

KAREN PHILLIPS

BEN TERRY

Business Development and Operations Manager

Senior Policy, Media and Communications Advisor

Media and Communications Advisor

With a background in business strategy, marketing, events and operations in Australia and the UK, Kate brings a wealth of experience in driving strategic projects and initiatives to completion.

Kate joined AMA(SA) in May 2024 and it was the prospect of making a meaningful contribution to the health system, given AMA(SA)’s reputation for influence and advocacy, that was a key driver in her decision to join the team.

Kate is looking forward to delivering the Strategic Plan, as well as continuing to find innovations and efficiencies for AMA(SA) and its members.

Since joining AMA(SA) in 2019, Karen has helped Presidents Dr Chris Moy, Dr Michelle Atchison and Dr John Williams develop and explain policies ranging from the reasons for COVID-19 lockdown restrictions to the importance of conscientious objection provisions for doctors, to politicians, clinicians, media and communities.

She is also the editor of medicSA. A former journalist for newspapers including The Advertiser and Independent Weekly, Karen has post-graduate qualifications in communications – completed at the University of Florida – and psychology.

Ben Terry joined the AMA(SA) in May 2024 after almost 20 years as a television news journalist. He has held senior editorial roles with broadcasters across Australia, the United Kingdom and Ireland.

Ben believes in the power of the AMA(SA) to drive positive change through its collective advocacy work and is excited to help execute the new Strategic Plan as part of the AMA(SA) team.

Ben hopes to help the AMA(SA) become an even louder voice for the doctors it represents and their patients. He’s also seeking to boost meaningful interaction through social media and other means.

SUZANNE ROBERTS

SHARYN KERR

O L I V I A DAV E Y

Executive Assistant to AMA(SA) President & CEO

Administration Officer

Membership Liaison Officer

Suzanne has had a long career as an executive assistant in corporate, legal and not-for-profit industries. She also trained in project management to practitioner level and looks forward to using these skills and a focus on continuous improvement with AMA(SA).

Suzanne was motivated to join AMA(SA) in March because of the many changes taking place, including a change of constitution and the implementation of a new strategic plan.

Sharyn joined AMA(SA) in February 2020, just before the COVID-19 pandemic brought enormous change to the organisation and its members.

She has also worked in leadership and administration roles in the banking, finance and retail sectors.

Sharyn’s friendly approach is at the foundation of her efforts to support members and others seeking AMA(SA) support and services.

Olivia comes from a retail and design background, having completed her graphic design degree in late 2022.

She joined the AMA(SA) because it presented an opportunity to diversify and grow her skillset. She aims to help AMA(SA) members have valuable and positive experiences with the association and its services.

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AMA(SA) President Dr John Williams and Executive Board member A/Prof William Tam

Quinton Robinson of the South Australian Business Chamber leads the WHS traini

PLANNING FOR GROWTH

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Dr Williams with former AMA(SA) Presidents Dr Chris Moy (left) and Dr Patricia Montanaro (right) and AMA President Prof Steve Robson

Executive Board members A/Prof William Tam (left) and Dr Guy Christie-Taylor (right) with Dr Chris Moy

Prof Steve Robson and Dr Williams

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AMA(SA) is embarking on a new, more efficient governance path with the approval of a new strategic plan and constitution.

The AMA(SA) Annual General Meeting (AGM) on Saturday 22 June marked the completion of pivotal initiatives for the organisation, setting the tone for how AMA(SA) operates and supports members.

Members who gathered at the offices of Norman Waterhouse Lawyers approved a new AMA(SA) constitution, a document crafted to reflect the interests and objectives of the specialties and practice groups within the association.

AMA(SA) Executive Board member and former AMA(SA) President A/Prof William Tam, who was instrumental in rewriting the constitution, told members it was the culmination of five years of work.

‘Our main aim was to modernise how the AMA(SA) operates,’ A/Prof Tam said. ‘There has been a real need to

Dr Williams with new Life Members Dr Dennis Ankor and Dr Geoff Martin

A WONDERFUL LIFE

ing module at the AGM

re-examine what a Board should look like in a corporate setting.’

Under the new constitution, the Executive Board is now responsible for all financial duties and organisational governance, allowing the AMA(SA) Council to concentrate on policy development, review and promotion.

The Board will be appointed by and provide regular governance updates to the Council.

CEO Nicole Sykes also introduced a new strategic plan, describing it as a significant milestone for the organisation.

‘We aim to ensure our purpose remains relevant and our vision contemporary,’ Ms Sykes said. ‘The strategic plan is designed to engage members meaningfully, ensuring they derive substantial value from their association with AMA(SA).

‘It’s about delivering that value as effectively as possible.’

AMA(SA) President Dr John Williams expressed his support for the strategic plan, emphasising its focus on member-oriented goals.

‘This plan will help us support you, deliver value and expand our membership so the AMA in South Australia can continue to be a strong, unified voice for all doctors across this broad profession,’ Dr Williams said.

Members at the AGM also participated in a Work, Health and Safety training module and officially welcomed the 2023 Life Members.

Another notable highlight was a brief visit from AMA Federal President Professor Steve Robson, who stopped by to enjoy morning tea and connect with attending members.

Dr Dennis Ankor and Dr Geoff Martin graduated from the University of Adelaide in the same year. It was 1974, Gough Whitlam was Prime Minister, and back then they say joining the AMA was almost standard procedure for young doctors.

‘It was just something you did’ recalls retired Morphett Vale GP Dr Ankor. ‘I can’t believe it’s been 50 years since I joined.’

Dr Ankor and Dr Martin were awarded AMA life membership at the AMA(SA)’s Annual General Meeting in June, along with Dr Thomas Klaveniek and Dr Prudence McEvoy who could not attend.

Although Dr Ankor can’t remember his specific reasons for joining AMA(SA), he certainly knows why he stayed a member.

‘The AMA covers all doctors of all disciplines,’ he says. ‘It’s also trusted by the general population. That’s a very good position to be in for a professional body.’

Dr Martin, a GP based in Hazelwood Park, has similar reasons for retaining his membership.

‘What sets the AMA apart is its ability to represent all doctors and not just one element of the profession,’ he says. ‘It has to try to keep everybody happy, which is not always easy.’

Both doctors have witnessed major changes to the profession over the past 50 years and agree much of it hasn’t been positive.

‘We’re in a position now where general practice has been squeezed almost to death,’ Dr Martin says.

‘On the one hand, we have underfunded and struggling general practice which is not providing good quality of care to Australian people.

‘We also have crowded emergency departments which are failing, and I think they’re failing because people can’t access good primary care.’

Both men agree AMA(SA) advocacy has an important role to play improving outcomes for future generations of GPs. ‘The corporate model clearly isn’t working. You can’t practice good general practice on a six minute turnover,’ Dr Martin says.

‘The only glimmer of hope probably involves the AMA and the work it’s doing to shift the focus back onto patient care.’

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AMA(SA) Council News

Welcome new Council members Three new members of Council were elected during the AGM. They join two specialists who joined to represent their craft groups in the early months of 2024.

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Dr Alice Fitzpatrick is a GP registrar practising in Port Lincoln who graduated from the University of Notre Dame in Fremantle. Spending extensive periods in the Kimberly region of WA inspired in her a passion for rural and Aboriginal health, and she also has a special interest in women’s health.

‘I believe that advocacy is a powerful tool for change not only for my medical colleagues, but ultimately the communities we live in,’ she said.

Dr Jerida Keane is an Australian College of Rural and Remote Medicine (ACRRM) registrar who was one of the first interns to benefit from the Riverland Academy of Clinical Excellence (RACE) program and its single employer model.

She is the South Australian representative on the (federal) AMA Council of Rural Doctors.

‘I aim to further facilitate communication through my appointment to the state Council,’ Dr Keane said.

medicSA

Dr Isaac Tennant graduated from the University of Adelaide in 2023 and is a first-year intern at the Royal Adelaide Hospital. He was the university’s representative on AMA(SA) Council and on the AMA(SA) Doctors in Training Committee last year.

‘I firmly believe in the role of the doctor as an advocate for both their individual patients’ health outcomes as well as broader public health awareness,’ Dr Tennant said. ‘I am convinced that the medical profession achieves best outcomes for patients and practitioners alike when we are united in our advocacy, advice and demands.’

Associate Professor Michael Goggin has been working in the field of ophthalmology since 1984, training in Ireland and Australia. He is a consultant and supervisor of training for RANZCO-accredited ophthalmology trainees at The Queen Elizabeth Hospital in Adelaide and an Associate Professor at the University of Adelaide. He has a sub-specialty interest in cataract and refractive surgery and is an authority on the analysis and surgical management of astigmatism. He has a private cataract and refractive practice in Ashford.

A/Prof Goggin’s research in laser vision correction earned him the degree of Master of Surgery at the University of Adelaide.

‘I see the AMA as a key body representing all types of doctors together and the interests of our patients,’ A/Prof Goggin said. ‘I’d like to play my part in keeping it serving these functions.’

Dr Chris Dobbins is a general surgeon who works as a staff specialist at the Royal Adelaide Hospital as well as consulting in Port Augusta and Whyalla Hospital.

He graduated from the University of Adelaide in 2000 and completed his fellowship with the Royal Australasian College of Surgeons in 2012.

He has interests in rural surgery, trauma and emergency surgery and has been heavily involved in the training of junior surgeons through various roles within General Surgeons Australia and the Royal Australasian College of Surgeons (RACS).

AMA(SA) Council News

May 2024 The May 2024 AMA(SA) Council meeting was a long meeting dominated by federal AMA constitutional reforms and the state government’s new interpretation and implementation of payroll tax. Vice President A/Prof Peter Subramaniam expertly chaired the meeting, filling in for Dr Hannah Szewczyk.

It was a pleasure to have A/Prof Michael Goggin attend his first meeting with the Council as specialty representative of ophthalmology. We are delighted to have him and his wealth of experience on board – even though he forgot to bring a cake.

Federal AMA President Professor Steve Robson and Vice President Dr Danielle McMullen joined us online to outline the Federal AMA ‘Vision for Health Strategy 2024-2027.’

The strategy is impressive, and an email has been sent to members so we can understand the direction in which our AMA is heading.

The proposed constitutional changes for the federal AMA were discussed at length at the meeting following our Q&A with Prof Robson and Dr McMullen. Members were told we would have the option to vote on each of the changes individually. AMA(SA) is committed to working with a united

June 2024 We welcomed as guests in the Dulwich offices Federal AMA candidates for the presidency and vice-presidency, Dr Danielle McMullen and Associate Professor Julian Rait. Dr McMullen, a GP and currently the AMA vice-president, and Dr Rait, an ophthalmologist and academic and former President of AMA Victoria, are currently standing unopposed for the positions that will be voted upon at the National Conference in August.

Dr McMullen and A/Prof Rait outlined their priorities for an AMA under their leadership. Among them were general practice funding, scope of practice, payroll tax, the lack of capacity in our public health system, the need for a private health insurance regulator and the ongoing requirement to hold governments, state and federal, to account.

Dr McMullen brings a sense of optimism to the task of ensuring access to high-quality health care for everyone; she is adamant that if she is elected, the two years of her presidency will bring action. Dr Rait said he would be a strong advocate for mental health, general practice funding and a more sustainable health system. Both candidates are highly motivated to work effectively with state AMAs, while acknowledging that different approaches are required in different places and that different groups (DiTs, GPs and non-GP specialists among them) have different priorities that often require tailored communication. They also

federal AMA for all medical professionals while ensuring the South Australian voice is heard. Our commitment to our members receiving all the information about these changes, both potential pros and cons, was unanimously agreed upon.

Payroll tax was again on the agenda. It has been a frustrating series of discussions for our CEO Nicole Sykes and President Dr John Williams, who have worked hard for members to ensure the Treasurer understands potential ramifications of the tax on patient care. Negotiations are ongoing. AMA(SA) has clearly outlined how further cost impositions will affect our health care system, which is already under extreme stress. The Council is in agreement to change tactics to achieve a fair result for our health care system and our patients. Our members have made it clear to us that this issue is extremely important to their future and their capacity to deliver timely care to their patients. It appears this issue will not go away quickly.

After a long and productive meeting we reflected on the excellent manner in which alternative views were expressed, passionately but always with respect.

Dr Louis Papilion Practice Group Representative: Anaesthetists

recognise the dual roles of the AMA and its leaders that demand a balance in effort and attention: advocacy for doctors and public health advocacy.

In South Australia, it is anticipated that the plan for transition to the new constitution will be approved by the Executive Board at the annual general meeting on 22 June 2024 (two days after the Council meeting). Work is in progress regarding other governance issues, including clarifying the opportunities and pathways for member involvement in AMA(SA) Council and committees.

Our president, Dr John Williams, accompanied by CEO Nicole Sykes, continues to personally engage with regional doctors across the state, to better understand their challenges as well as the opportunities they identify. They most recently met with clinicians in the Riverland. Dr Williams reported a high level of engagement, frank discussions and interested local media.

We had a robust discussion about how best to continue to advocate for all private medical specialists after the new interpretation of payroll tax is applied from 1 July. The enormous amount of time and effort already expended

by Dr Williams and many others was acknowledged.

Dr Clair Pridmore Practice Group Representative: Public Hospitals

15

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03/24 (MIM-378)

Yellow card for public hospitals

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s South Australian hospitals continue to confront a perfect storm of illness, AMA(SA) President Dr John Williams says the South Australian Government is not listening to warnings about the impacts of its inaction from frontline medical specialists.

17 NEWS

SA Health CEO Dr Robyn Lawrence was prompted to call a ‘code yellow’ on the evening of 30 May – news that emerged a few short hours after Health Minister Chris Picton warned Vice President A/Prof Peter Subramaniam, CEO Nicole Sykes and me about the serious circumstances within the state’s public hospitals.

We learned over the coming hours that an ‘unprecedented’ surge in COVID, flu and RSV was pushing the hospital system to breaking point. Hundreds of staff were afflicted, intensifying the effect on capacity. Almost all essential surgeries were cancelled and beds opened for priority cases.

These ‘code yellow’ emergencies demonstrate that the hospital system is constantly at capacity. Patients are concerned that they will be denied care or spend hours ramped outside our major hospitals.

Two weeks later, the ‘code yellow’ was still in place. As I write this, a month later, some ‘code yellow’ practices and policies remain in force, and the state government’s own agency SafeWork SA has issued an ‘improvement notice’ on South Australia’s flagship hospital, indicating there is a safety issue for workers.

Meanwhile, patients are being told in a very expensive advertising campaign to ‘Ummm think’ about whether their illness or injury requires emergency department treatment.

The ad encourages South Australians with ‘Ummmergencies’ to call a health direct hotline before going to EDs, with a nurse directing them to the appropriate level of care.

In media interviews I pointed out that the ad, with the

slogan ‘Umm – mergency’, could be seen as blaming patients for the crisis in our hospitals.

I said the ad could be seen as placing the blame for the catastrophic state of our health system at the foot of those who need it most. I said the ad could leave vulnerable people at risk; that I was concerned older people who already worry about putting pressure on the system may be persuaded not to seek care.

I told reporters my major concern is for the silent generation, our elderly population who already worry about putting pressure on the system. So many patients I see in their 80s and older have symptoms they’ve been putting up with for days, and they really should have sought care for much sooner. It’s not their fault the system is at capacity and can’t cope.

Our members know that the overcrowding in our hospitals is not caused by some people seeking treatment in EDs. The government needs to keep people out of hospital, by providing the primary care that stops them seeking the treatment they need from hospital EDs. The cancellation of planned, essential surgeries adds to the burden of illness in our communities and to the inadequacies of a health system already suffocating.

And, of course, we now have a state-based payroll tax that will compound existing problems.

Despite some recent concessions from the state government, the tax on private medical specialists will add prohibitive costs that could lead patients to avoid important private consultations with GPs and other specialists.

At a time when the system is under significant pressure it is counterproductive to forge ahead with a tax that will put further specialist services at risk.

In the midst of an escalating crisis in our public hospitals, AMA(SA) clinicians implore the Health Minister and the Premier to listen to our concerns and urgently explain its strategies to ease the pressure on patients and doctors across the state.

Checks and balances AMA(SA) President Dr John Williams and Council detailed members’ priorities and reasons for State Budget health funding priorities before the lock-up on 7 June.

18

The Australian Medical Association in South Australia told politicians it expected to see spending to alleviate ramping and reduce essential surgery waiting lists in the State Budget handed down on 7June.

Instead, President Dr John Williams said after the Budget lockup, South Australians were provided with a Budget that promised extra beds but little information about who will staff them.

‘Extra beds are great, but we need evidence that the government has strategies in place to staff them, and we don’t see that detail,’ Dr Williams told media.

‘There is more than $700 million in this Budget for addressing “activity demand pressures in our public health system”. We want to know what that looks like.

‘And as doctors, we want to keep people out of hospital so they won’t need beds. It means more investment in connecting hospitals with general practice, which is the cheapest form of care, to keep people out of hospital and to provide care afterwards if they need to go to hospital.

‘It means removing the barriers to GP consultations, not adding to them.

‘It means using technology to collect and analyse data on system use and spending, to know where the money is spent and whether it’s spent wisely and effectively to improve patient

South Australian Government State Budget health spending From State Budget 2024-25 Budget Overview – Budget Paper 1

Dr John Williams answers media questions after the State Budget lock-up

outcomes. There’s a lot of data available, but it’s not linked between the systems – we hoped to see funding for this in this Budget.’

The 2024-25 Budget was handed down in the midst of one of the longest ‘code yellow’ emergencies in South Australian history.

Dr Williams said that while the state’s hospitals shuddered under the impact of winter viruses, doctors were bracing themselves for a wave of worsened conditions and chronic illness caused by cancelled and rescheduled essential surgery lists.

‘While emergency department staff try to manage overwhelming demand, other staff are taken from treatment duties to reschedule surgeries for upset and increasing ill patients,’ he said.

‘Outside the hospitals, GPs are doing their best to keep their patients well so they can avoid having to wait long hours for care in EDs. Nursing homes are managing mounting COVID and flu outbreaks.

‘All this on top of what have become everyday issues involved in the delivery of clinical care.’

Sustainable and efficient health system $1.6 billion over five years to recognise the higher cost of service delivery and recent increase in the national efficient price, and support SA Health as it progressively increases the efficiency of its services over the forward estimates.

Additional hospital activity $742.3 million over five years to meet activity demand pressures in our public health system and to ensure the health system is appropriately and permanently resourced to meet higher levels of demand moving forward.

Additional renal haemodialysis services in northern Adelaide $17.1 million over four years to expand renal haemodialysis in the northern

medicSA

metropolitan area, providing an additional 21 chairs and supporting an additional 84 patients to receive services in the area.

Port Pirie Hospital upgrade additional funding $11.5 million over four years to support the Port Pirie emergency department upgrade and provide for a multiprofession simulated training and development service, including a clinical simulated training laboratory.

Ambulance stations – additional funding $24 million over three years to support the government’s ambulance station boost strategy – new stations in Whyalla, Marion and Two Wells.

The AMA(SA) priorities for South Australian Government funding for health in 2024-25 focus on access, equity and improving connections between primary and tertiary care.

A. Keep people out of hospital – increase system efficiency and eliminate barriers to connected primary and hospital care 1. Boost connections between general practice and hospitals •T hrough Preventive Health SA, explore and implement ways to support general practice as the foundation of healthy people and communities.

• Examine opportunities to expand virtual and telehealth services across the state, to care for people in their homes, reducing the burden on emergency departments.

• Capitalise on emerging IT systems and tools and maintain up-to-date patient records from hospitals, Urgent Care Clinics, testing service providers, pharmacies and other health services in My Health Record.

• Through the Commission on Excellence and Innovation in Health (CEIH), use AI and other tools to improve data collection, analysis and sharing in relation to access to system capacity, including private/public system use and LHN-based and statewide approaches to delivering care.

• Reduce short-term reliance on private hospital beds and the impact of this on private health by providing more public infrastructure.

• Increase resources in public hospitals and Local Health Networks to cut essential surgery waiting lists.

• Reduce the pressure on the Royal Adelaide Hospital by delivering long-awaited upgrades in the Northern Adelaide LHN (NALHN) – i.e., Lyell McEwin Hospital.

2. Reduce inequities in access to world-class care •P rovide the same access to hospital and community health services – including after-hours care, hospital beds, surgical services, telehealth, acute and sub-acute mental health support

Tuberculosis strategy

and addiction treatment and care – for all South Australians.

• Invest in rehabilitation, respite and step-down care beds around the state.

• Require all LHNs to develop, maintain, measure and report on indigenous health policies and outcomes.

• Increase palliative care services, including for the aged and for children and adolescents, linked to primary care providers and in line with community demand.

• Expand access to chemotherapy and other treatments in regional hospitals, reducing the burden of travel for regional residents and reducing the PATS budget.

• Monitor the impact of pharmacy prescribing of UTI and other medications on individuals and community anti-microbial resistance.

B. Build a sustainable health workforce •A ttract talent through making South Australia a leader in ‘sustainable health’, including the implementation of ‘green’ builds, systems and practices.

• Roll out the single employer model in all local health networks to attract medical students and trainee doctors to and keep them employed in regional medicine.

• Increase the number of clinical academic positions/ appointments in public hospitals and invest in research activities to attract and retain world-class talent.

• Research and implement evidence-based models to prevent bullying, harassment, sexism and racism and their impacts on junior doctor health and safety.

• Work with AMA(SA) to identify the needs of international medical graduates and implement a state-wide system to support and retain them across the state.

• Support new training positions in psychiatry, especially child and adolescent, to provide a pipeline for more psychiatrist in the state.

South Australia Regional Integrated Cancer Consult Suite

Additional beds at Lyell McEwin Hospital

$4.3 million over three years to build an integrated cancer consult suite at Mount Gambier Hospital. (This initiative is funded by the Commonwealth Government.)

$16.5 million in 2024-25 for 20 additional general inpatient beds at Lyell McEwin Hospital.

Youth mental health support

SA Ambulance Service (SAAS) Electronic Patient Care Records

$5 million over four years to support youth mental health services, including an expansion of child and adolescent virtual urgent care services, mental health workshops, and to support carers and families of those with eating disorders.

$23.5 million over two years for the SAAS electronic patient care record system, enabling rapid access to clinical information and live sharing of clinical information with hospital clinicians and the State Health Coordination Centre.

$13.7 million over two years for 36 additional surgical and general inpatient beds at the QEH.

$15.2 million over three years to respond to and manage tuberculosis outbreaks across South Australia, and support the delivery of improved detection, monitoring and treatment of tuberculosis transmissions in Aboriginal communities.

Additional beds at Queen Elizabeth Hospital

SAAS Clinical Assessment Service expansion $10.7 million over four years for additional staff for the SAAS clinical hub’s clinical telephone assessment service.

19

President’s Rural Tour 2024

The AMA(SA) President’s rural tour is enabling him to hear first-hand from members the challenges and rewards of regional medicine.

20

AMA(SA) media advisor Ben Terry helps President Dr John Williams prepare for media interviews

(Above) Dr Williams with CEO Nicole Sykes and (right) with (from left) Lisa Hickey of Hood Sweeney, Avant’s Tim Hall, Rachel White of Australian Medical CPD Standard and Leigh McMahon of Hood Sweeney

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r Kevin Stanton doesn’t have a lot of downtime at his Berri practice. He’s booked up with patients six weeks in advance and sometimes the work even follows him on holiday.

He recalls a recent long-haul flight to the United States when a familiar call came over the plane’s loudspeaker.

‘We were four or five hours into an 11-hour trip to Dallas when the pilot got on the PA and asked if there were any doctors or nurses onboard,’ he remembers.

His wife gave him a nudge and Dr Stanton pushed his call button. He says the flight attendant couldn’t have been more relieved to learn he’s a rural GP. ‘It’s not the first time I’ve had the call-up.

You’re always half expecting it,’ he says. ‘We’re well-trained in emergency medicine, but a lot of people don’t really understand what we do or what we’re capable of. It was nice to be acknowledged.’

Dr Stanton has been based in Berri for 36 years and was among the clinicians who met AMA(SA) President Dr John Williams during the Riverland leg of his rural tour in June.

Dr Williams aims to cross the state in the coming months to hear first-hand the concerns, challenges and expectations of AMA(SA) members and colleagues. In the Riverland, he met clinicians at a dinner at the Hotel Renmark on 12 June.

Dr Stanton told clinicians at the dinner that doctor retention is his biggest concern for the region.

‘A lot of GPs here, the older guys like me, we look at the younger GPs and they only seem to be here for a short amount of time,’ Dr Stanton says. ‘To actually get them to stay is going to be a big challenge.’

Dr Hayden Cain, a young registrar working in Renmark and the Chair of the AMA(SA) Doctors in Training Committee, has a more optimistic take on doctor retention.

Adelaide Hills Thursday 23rd of May 2024

Riverland Wednesday 12th of June & Thursday 13th of June 2024 Dr Williams with Professor Paul Worley, Dr Kevin Stanton and AMA(SA) Councillor Dr Hayden Cain

Limestone Coast Thursday 29th of August & Friday 30th of August 2024

Kangaroo Island Monday 24th of October 2024

Eyre Peninsula Monday 4th of November 2024

Iron Triangle Tuesday 5th of November 2024

7 Murraylands 2025 Dates to be confirmed

8 Fleurieu Peninsula 2025 Dates to be confirmed

Clare 2025 Dates to be confirmed

platform from which to emphasise AMA(SA)’s Dr Cain was one of the first trainees to advocacy to improve outcomes for regional benefit from the Riverland Academy of Clinical doctors and residents.

Excellence and its single employer model ‘One of the achievements I’m most proud (SEM) of training, which has been lauded for of during my first 12 months as president is my its success in attracting and retaining young work with the Rural Doctors’ Association of SA doctors. negotiating the rural generalist agreement,’ he ‘The SEM basically allows doctors who says. go into GP training and rural ‘I am also working with our generalist training to remain junior doctors and others to linked in with the hospital system,’ improve the work culture in Dr Cain says. hospitals across the state.

‘It means they maintain all their ‘This tour is a chance for me benefits, educational perks and to explain that work and is an social connections which they’d opportunity for regional clinicians otherwise have to leave behind to shape our advocacy. It allows when moving around for different me to say to the decisionplacements.’ makers, “this is what I heard”.’

Dr Williams says hearing such Dr Stanton says Dr insights from those delivering Williams’ visit was an invaluable care in South Australia’s regions experience. is the main objective of his rural ‘I joined the AMA when I tour. graduated in 1979 and have stuck with it since,’ ‘I want to personally engage with doctors on he says. ‘(The tour) has helped us see what the ground, to understand their concerns and they’re doing behind the scenes and hear what they see as the way forward,’ he says. about how it benefits us.

‘There are so many issues they’re dealing ‘We need a united organisation to make sure with, including CPD training, payroll tax, policy makers listen to us and I’ve always felt the cyber security, the list goes on, and it’s really AMA was that organisation.’ important I support them as they work their way through these minefields,’ he says.

Dr Williams’ tour started in the Adelaide Hills in May and rolled into the Riverland three weeks later. It will cover significant ground in the coming months, including the Limestone Coast, Kangaroo Island, the Eyre Peninsula, the Iron Triangle, Clare, the Barossa Valley and the Fleurieu Peninsula.

Dr Cain is encouraging other regional clinicians to meet Dr Williams on his travels.

‘This trip is extremely important,’ he says.

‘By having the President go to the country, it’s showing regional doctors they aren’t forgotten about. It’s showing the AMA isn’t just for inner-city surgeons, it’s for everyone.’

Dr Williams hopes his tour will give him a AMA(SA) Vice President A/Prof Peter Subramaniam (front)

‘I WANT TO PERSONALLY ENGAGE WITH DOCTORS ON THE GROUND.’

and guests at the Hotel Renmark dinner

Important Payroll Tax Update for Medical and Dental Professionals Are you aware of the recent shift in interpretation of payroll tax legislation by RevenueSA? The classification of independent contractors as employees is changing, and it’s crucial to stay informed and be prepared.

Medical Professionals have recently been granted an amnesty to protect them from retrospective payroll tax assessments. This may shift the planning you have been doing with your financial advisors. Do you know how the amnesty works and how to ensure you are covered by it?

Lisa Hickey, Director and Head of the Health team at Hood Sweeney has been working closely with the AMA(SA) throughout this process and is up-to-date with the most current information coming out of Revenue SA and what is being worked on behind the scenes in this evolving tax landscape.

Hood Sweeney’s Payroll Tax Assessment Given the potential financial implications for patients and practices alike, Lisa Hickey, Director and Head of the Health Team at Hood Sweeney, is offering a Payroll Tax Assessment to ensure your practice is fully compliant and prepared for the 1July deadline.

To book a payroll tax assessment for your practice, please contact Lisa on 1300 764 200 or lisa.hickey@hoodsweeney.com.au.

1300 764 200

www.hoodsweeney.com.au/industries/health

Losing patience on payroll tax New payroll tax costs have been added to private practices’ operations in South Australia, but there is no end in sight to AMA(SA) advocacy on the issue.

23 previously imposed on contracted GPs and other physicians in private practice,’ he said.

‘Those GPs who are employees have paid and will pay payroll tax, as they must. Similarly, practices pay payroll tax as it applies to admin and other staff who are clearly employees of their businesses.

‘But most GPs are not employees, and our members and other colleagues have worked closely with legal and financial professionals for some time to ensure they do comply with the law as those professionals have interpreted it.’

While dissatisfied at the State Government’s insistence on applying the tax, Dr Williams says South Australian doctors should recognise that AMA(SA) has secured a significant concession from the Treasurer in the form of a retrospective amnesty for both GP and non-GP specialists in private practice.

‘This is a national first that brings non-GP specialists into line with GPs,’ Dr Williams says.

‘It is a significant safety net that will save practices, including general practices, as much as hundreds of thousands of dollars in back taxes.’

Dr Williams said the fight against the payroll tax continues.

In the meantime, AMA(SA) has made available for members’ information advice from RevenueSA about how the tax is being applied. The guidance – a summary of which begins on page 24 – came after a meeting between AMA(SA) representatives including CEO Nicole Sykes.

‘The AMA is one of the country’s most trusted organisations and that gives us a powerful platform from which to lobby our leaders,’ he said.

‘Along with AMA(SA) Council, our Committee of General Practice and all our members, I will continue speak on this issue, on behalf of all doctors and the patients whose care may be affected.’

A M A ( S A ) A DVO C AC Y

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s the deadline for the implementation of payroll tax loomed, AMA(SA) president Dr John Williams continued to vigorously advocate against the application of a tax with severe implications for doctors and their patients.

Dr Williams has repeatedly warned the Premier, Treasurer and Health Minister, in person and publicly through the media, that the tax is reckless, short-sighted and will add more pressure to a health system already in chaos.

‘This is a change to the interpretation of existing legislation with which our members have always complied – a change that is now adding hundreds of thousands of dollars to their practices’ costs,’ Dr Williams said of the tax.

‘The reality is most practices simply can’t afford the additional burden. To keep treating our patients, we’re having to raise our fees. It’s that or close down and let our patients down.’

On radio on 1 July – the ‘D Day’ for the tax in South Australia - Dr Williams reiterated his serious concern that – in the midst of a cost-of-living crisis - the increase to GP fees could result in patients delaying essential care.

‘We know if people don’t receive primary care when they need it, they become sicker and have no choice but to seek desperately needed treatment from emergency departments,’ he said.

‘This will exacerbate ambulance ramping and create even more delays to essential surgeries.

‘The system is already cracking under immense pressure and the payroll tax risks making a bad situation much worse.’

Dr Williams says he is disappointed the Treasurer Stephen Mullighan has ignored AMA(SA)’s concerns and has repeatedly framed doctors as tax dodgers.

‘Doctors are understandably incensed at repeated comments from the Treasurer in the media that they have been “avoiding” the tax, when this specific tax was not

Payroll Tax AMA(SA) has successfully advocated for provisions to help private medical specialists understand and navigate their new payroll tax obligations, but many questions remain.

24

After months of determined advocacy by AMA(SA), a meeting with RevenueSA officials on 19 June answered important questions about how the payroll tax would be applied for private medical specialists from 1 July.

The meeting was convened following persistent efforts by AMA(SA) CEO Nicole Sykes to seek clarification about many aspects of the new cost for private practices.

During the meeting, which included tax experts from AMA(SA)’s preferred legal provider Norman Waterhouse, detailed discussions addressed the complexities of payroll tax implications for members and colleagues.

Some of the answers below are general in nature.

AMA(SA) members are encouraged to contact the AMA(SA) membership team with ongoing queries. For additional assistance with specific contractual or financial concerns related to payroll tax obligations, Ms Sykes recommends seeking legal advice from Norman Waterhouse and financial guidance from preferred financial advisor Hood Sweeney.

My practice is not currently registered for payroll tax. What steps should I take?

You are advised to register with RevenueSA by the deadline of 30 June 2024. It is important to proceed with registration regardless of whether your practice’s taxable wages appear to fall below the threshold or if you have lodged an objection to RevenueSA’s ruling on relevant contracts.

How can I confirm if my practice is already registered for payroll tax?

To verify your practice’s registration status, contact RevenueSA directly at (08) 8226 3750. Keep in mind that prior registration does not necessarily mean your practice remains registered.

I have received legal advice indicating that my practice is not liable for payroll tax. Is there any action I need to take?

Despite the legal advice, RevenueSA advises registration to benefit from the retrospective amnesty. This proactive step is crucial as it protects your practice in the event of an audit where undeclared wages might be discovered. Registering for payroll tax does not constitute an acknowledgement of liability for the tax.

QA &

What is the payroll tax amnesty?

AMA(SA) has successfully secured a retrospective amnesty for all medical specialists in private practice, ensuring they will not be assessed for payroll tax for the past five years.

This amnesty aligns non-GP specialists with GPs and was achieved through extensive lobbying efforts with the government.

What do I need to do to qualify for the amnesty?

Medical practices with contracted non-GP specialists need to have registered with RevenueSA by 30 June 2024.

Registering for payroll tax by this date will have automatically qualified a practice for the amnesty. Those practices with contracted GP specialists that missed the earlier deadline of 30 November 2023 may appeal to RevenueSA under “special circumstances” for late registration, though these cases require extenuating circumstances due to the elapsed time.

I was already registered and paying payroll tax – am I still covered by the amnesty?

If you are already registered and have been paying payroll tax, there are no refunds for previously declared and paid taxes related to medical specialist contractors. No further action is required if you are already registered.

How does payroll tax registration work?

Initially, you must register for RevenueSA online. Following this, you will receive a link to register for payroll tax. During the registration process, you’ll enter your practice’s wage data for the previous five years, excluding wages paid to contract medical specialists due to the amnesty conditions. However, you will need to report wages for other staff members. If combined wages exceed $1.5 million in any year, a liability will arise.

What happens after I register?

Upon registration, you will typically be placed on a monthly return schedule. If an annual registration better suits your circumstances, RevenueSA will review and advise accordingly.

In July 2024, you will need to provide an estimate of your total practice wages for 2024-2025, which will be reconciled in July 2025.

Why do I need to provide five years’ worth of practice data when registering?

RevenueSA requires this as a part of its record-keeping requirements starting from when you first become liable.

What happens if I didn’t register for payroll tax by 30 June 2024?

Failing to register by 30 June 2024 will exclude your

medicSA

practice from the amnesty for prior years’ payroll tax and leave you unprotected against audits for undeclared wages.

AMA (SA) has requested an extension to register due to the short lead-in time provided.

After registration, what is the penalty for incorrect payroll tax reporting?

Penalties will vary based on the level of culpability and whether the incorrect reporting was deliberate.

What are the grouping provisions, and are interstate practices assessed for payroll tax in South Australia?

What are the implications for federal tax, leave, superannuation, etc., for self-employed GPs? These matters fall under separate regulations by the Australian Taxation Office (ATO) and do not pertain to RevenueSA. For detailed guidance, further advice should be sought from the ATO.

Will the SA Health exemption apply to payments under contracts with local health networks?

Clarification on this matter is pending. Further updates will be provided as they become available.

AMA(SA) requested that South Australia remain harmonised with QLD. Why won’t the Queensland model be considered in South Australia?

What is the 90-day exemption, and how is it calculated?

What happens if a test case challenging the application of the payroll tax is successful?

This exemption applies if a relevant contract involves the provision of services by a person to a principal for no more than 90 days in a financial year. Any work performed on a given day counts as a full day, and the days worked do not need to be consecutive.

Am I liable for retrospective payroll tax payments if I am now retired?

The practice for which you worked holds the responsibility for any due payroll tax. If you were an owner, it’s crucial to consult on your specific contractual obligations. You are advised to contact your former practice to determine if they have registered for the amnesty, as this would exempt them from retrospective payroll tax liabilities.

How does the 90-day exemption apply to medical specialists who predominantly work out of hospitals and spend less than 90 days in their rooms but still pay service fees to the service entity?

Advice from RevenueSA regarding this specific scenario is still pending.

If I am liable for payroll tax on the income I receive from patients minus the service fees, are the costs of tools of trade, such as Ahpra fees and medical indemnity, also deducted?

This is pending further investigation by RevenueSA.

RevenueSA does not support the approach taken in Queensland, citing practical issues with its implementation in South Australia.

Should a test case be won, the tax assessments affected would be reassessed and impacted parties receive refunds.

However, the timeline for such processes remains unclear.

How can a specialist practice agree to an amnesty when we have not received the wording of the amnesty?

RevenueSA has updated its website to officially confirm the amnesty protection for non-GP specialists following discussions with AMA(SA). For more details, visit RevenueSA’s website.

Is it lawful to agree to an amnesty when the bill to legislate it has not yet passed parliament?

RevenueSA confirms that it is not unlawful to agree to the amnesty; however, the most secure approach is to formalise the amnesty through legislation.

Can the timeframe to register for payroll tax and the amnesty be extended?

RevenueSA has agreed an extension would be helpful.

AMA(SA) has submitted a request to the Treasurer for an extension to allow time to educate the medical network. The response is pending at press time.

25 A M A ( S A ) A DVO C AC Y

Each medical practice that is part of a group with other wage-paying entities, whether in South Australia or interstate, must report wages on this basis. Payroll tax is assessed only on wages paid to employees who perform services within South Australia, and the $1.5 million South Australian threshold considers Australia-wide wages and adjusts deductions proportionally.

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Plus earn 1 Qantas Point per eligible $1 paid to MIGA for your medical indemnity insurance2

Offer of bonus Qantas Points not available to doctors insured in some categories, including GP Registrars, GP Rural and GP Obstetrics, refer to Ts & Cs and MIGA’s Categories of Insurance Guide.

Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website. 1 Offer only available to registered Australian medical practitioners who first insure with MIGA in an eligible fully insured category, as a doctor in private practice, for cover commencing during the period 1 July to 31 July 2024, and who pay in full or enter into a direct debit arrangement by 31 July 2024 and pay at least one instalment by 24 August 2024, who have not exercised their rights to cool off nor had their insurance cancelled, as per the terms and conditions of the Policy. Eligible categories are Allergy, Anaesthesia, Cardiology – Non-Interventional, Dermatology, Endocrinology, Gastroenterology, General Medicine, General Practice (excluding GP Registrars, GP Rural & GP Obstetrics), Genetics, Geriatric Medicine, Haematology, Immunology, Infectious Diseases, Intensive Care – Excluding Neonatal, Neonatal Intensive Care, Nephrology, Neurology, Nuclear Medicine, Occupational Medicine, Oncology, Ophthalmology, Paediatrics – Excluding Neonatal Intensive Care, Pain Medicine, Palliative Care, Pharmacology, Psychiatry, Public Health & Preventative Medicine, Rehabilitation Medicine, Respiratory Medicine, Rheumatology, Skin Cancer Medicine, Sports Medicine, Surgical Specialties – Office Pract Only. Full Ts & Cs at www.miga.com.au/qantas-bonus-tc-pp. 2 A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions at www.miga.com.au/qantas-tc. Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance For Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing clientservices@miga.com.au. © April 2024

NEWS

Prescriptive practices Changes in the prescribing landscape have prompted Ahpra and the Medical, Nursing and Midwifery, and Pharmacy Boards of Australia to release a joint statement on the professional responsibilities for prescribing and dispensing medicines, which Ahpra state manager Pat Maher believes will be of interest to South Australian clinicians.

The emergence of services designed solely to provide customers with access to a predetermined medicine raises concerns that some practitioners may be putting profit ahead of patient welfare.

The Medical, Nursing and Midwifery and Pharmacy Boards of Australia and Ahpra are focusing on concerns that practitioners are cashing in on rising demand for the prescription and use of medicinal cannabis, bulk-produced compounded medicines, or soon to be banned compounded semaglutide and related products.

Practice models of concern often feature clinics that treat a single disorder and prescribe and dispense a single medicine in response to patient demand. Some focus on a high volume of telemedicine consultations or computer or algorithmbased prescribing of medicines, and some businesses also offer direct supply of unapproved medicines to patients.

New models of healthcare, including the use of telehealth, are important enablers of greater access to health services.

The Boards and Ahpra support the responsible and safe use of telehealth. The development of new medicines also plays an important role in improving the health of many patients.

Ahpra and the Boards’ concerns focus only on health services and practitioners seeking to take advantage of consumer demand for certain treatments in ways that sidestep their obligations to provide safe and appropriate care.

We are also concerned that some of these emerging practices are dangerously disrupting the traditional therapeutic relationship between a patient and their doctor.

Ahpra and the National Boards are seeing evidence that some health services are being set up specifically to cater for patients who contact them seeking access to a single pre-determined medicine. Prescribers in these businesses may not be turning their minds to whether the medicine being offered is a safe or appropriate option. These medicines are then typically provided directly by a pharmacist linked to the same business.

There have also been claims that medical certificates are being issued without appropriate real-time consultations, which may leave practitioners in breach of their professional standards.

These business models are structured in a way that rely on restricted medicines being prescribed and billed privately in ways that mean authorities are not informed of how many people are receiving them. Sometimes, the authorities cannot determine exactly what substance is being provided.

Ahpra and the Boards have urged patients to consider the following questions when seeking care.

• Does the service provide you with the opportunity to have a real-time interaction with the practitioner?

• Is a telehealth appointment appropriate for the health service you are seeking?

• Have you checked that you’re speaking to a registered health practitioner?

• Is this health practitioner registered in Australia?

• Has the practitioner gained your informed consent in relation to your consultation?

• If you are consulting virtually and haven’t previously consulted in-person, has your practitioner conducted a full assessment?

• Has your health practitioner explained to you their clinical findings, the reasons for certain treatment and any potential side effects and risks?

To read the complete Ahpra statements on professional responsibilities and for more information, go to the Ahpra website: • Read the joint statement on professional responsibilities for prescribing and dispensing medicines, in full • Information for people about virtual care

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Advocacy

Federal

Understanding the Ahpra process AMA advocacy has led to important improvements to the Ahpra notification process, but it’s still not perfect, writes AMA President Professor Steve Robson.

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hen an Ahpra notification is made against a medical practitioner, it can understandably be an extremely distressing and confusing experience.

The whole process is often described as a ‘black box’ a vacuum of information and transparency about what happens with each notification.

It can also be a very lengthy process, leading to significant mental health issues for a doctor who feels they have a dark cloud hanging over their head for an extended period.

It is important to realise that most doctors will receive at least one notification against them during their careers; each year, about 5% of doctors receive them. While more than 60% are resolved with no findings against practitioners and only 0.7% result in cancellation of or restrictions to registration, the uncertainty and lack of understanding about the process can be frustrating and distressing.

Limiting the impact of the notification process is one of the AMA’s main goals in our advocacy and work related to Ahpra. Improving understanding by shining a light into the black box is one of the ways we aim to do this.

In March, the Federal AMA hosted a member-only webinar with Matthew Hardy, Ahpra’s National Director of Notifications.

Mr Hardy pointed to several improvements to the Ahpra process that he directly attributed to the AMA’s long-standing advocacy and continued engagement with Ahpra.

For example, having a single case manager assigned to each case, having more doctors involved in assessing notifications, and placing a greater focus on practitioner health and wellbeing throughout the notification process are all direct results of AMA advocacy.

Mr Hardy said more than 80% of notifications are made by patients or their relatives or advocates and just 7.2% by fellow practitioners. Of all notifications made, just 10.4% are mandatory, which may arise out of concerns about a practitioner’s health status, drug or alcohol

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misuse or sexual misconduct.

Ahpra takes ‘no further action’ in 70% of cases it deals with, Mr Hardy said.

In its most recent reporting period, Ahpra resolved 78% of cases in less than six months, which is a considerable improvement on where things were before, and it aims to resolve most cases within three months.

Vexatious notifications accounted for less than 1% of all notifications.

In March last year, an Ahpra-commissioned study identified 16 deaths and four instances of attempted suicide or self-harm among practitioners who were subject to regulatory notifications within the four-year study period from January 18 to December 2021.

This is 20 cases too many. Strong actions are needed to address the distress and harms caused by the notification process.

Following the release of this study, the AMA wrote to all health ministers to: •m andate, either through a Ministerial Directive or changes to the National Law, that Ahpra has a duty of care to the registrant and in particular a duty to minimise the mental health impacts and financial effects on a health practitioner who may be subject to a notification • r equire Ahpra and the Medical Board of Australia to offer confidential support by an independent mental health professional to any health practitioner under investigation • r equire all investigations to be completed promptly – with an average target of less than six months except in exceptional circumstances •e nsure that a practitioner has the right to be personally present and legally represented during all stages of the investigative process – with the practitioner or their legal representative having the full and unfettered right to support their case.

If you do receive a notification, it is important to note there is help available. The Drs4Drs service is available 24/7, providing free, safe, supportive and confidential assistance.

The AMA’s advocacy on vaping reforms has been extensive, especially in the past six months as we ensured the media, MPs and senators continued to consider the impacts of vaping on all Australians, including children. It includes: a letter to all MPs and Senators on 27 March a letter to National Party leader David Littleproud to denounce his ill-conceived decision to oppose the government’s reforms and instead pursue an excise on vapes, and to cut the cord with the National Party’s ‘big tobacco’ donors and stand up for all Australians in early May, AMA Vice President Dr Danielle McMullen standing with Health Minister Mark Butler, RACGP President Dr Nicole Higgins and Pharmacy Guild of Australia President Professor Trent Twomey to call for action on vaping at a press conference in Brisbane in May, a joint press conference with some of the country’s leading education and school parent groups and co-signing a letter with 11 of these groups to all federal MPs and senators signing the Australian Council on Smoking and Health’s open letter published in The Australian and The Canberra Times, calling for legislators to be on the right side of history and support the vaping bill. This open letter gained even more signatures in a second run on Monday 24 June – just before the historic vote. providing a written submission and appearing before the Senate Community Affairs Legislation Committee’s inquiry on vaping reforms.

Stopping the rot he new national vaping reforms aren’t perfect, but the alternative is unthinkable.

As is often said, perfect is the enemy of good. This was proved true as the federal government’s vaping legislation was passed with notable amendments in late June.

Instead of moving to a full prescription model, which would have been the perfect outcome, the legislation allows adults to buy plainpackaged vapes from pharmacies without prescriptions from 1 October as schedule 3 ‘plus’ products. This was a key concession to the Greens to ensure most reforms passed.

This will not turn pharmacies into vaping shops. Significant restrictions will be attached to the supply of a schedule 3 ‘plus’ vape and pharmacists will need to have a conversation with the consumer that addresses professional guidelines currently in development.

Under the amended legislation, many legal loopholes now exploited by the tobacco and vaping industry will be closed. No more fruity flavours; no more marketing to kids. The supply of a vape will be possible only through healthcare settings and guidelines will focus on cessation rather than recreational use.

This is a fantastic result and we commend Health Minister Mark Butler and the federal government for putting this issue firmly on their agenda. Mr Butler did what had to be done to ensure these world-leading

reforms passed largely intact. The alternative would have been to do nothing, leading to several more years of Australians suffering the health consequences of toxic vapes and nicotine addiction.

The AMA has played a significant role in ensuring these world-leading reforms became a reality. It has taken many years of advocacy at federal and state levels. In the lead-up to the Senate vote in June, we had state and territory AMAs helping execute a fullcourt press to achieve this outcome.

Now that therapeutic vapes will be more accessible for adults in pharmacies, we must monitor the situation closely. We will work with the government and pharmacists to ensure these arrangements provide guidance on other nicotine cessation tools that are backed by sound evidence.

Mr Butler made it clear pharmacists would not be forced to sell vapes, and reports are already emerging of pharmacy chains refusing to sell the vapes without GP prescriptions.

GPs have been helping patients with nicotine dependence for decades and are best placed to support patients quitting smoking and vaping.

There is plenty of work ahead to ensure these reforms are implemented and enforced properly.

Yes, there were some amendments to the original legislation, but these reforms are world-leading and can be seen as a major turning point in the fight against the insidious vaping and tobacco industry.

Professor Steve Robson

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Digital efficiencies boost care outcomes South Australia is in a strong position to lead the expansion of digital technology into new areas of health care and system efficiency, writes Dr Emily Kirkpatrick.

The Australian Government Productivity Commission report published in May 2024, Leveraging Digital Technology in Healthcare, emphasises the transformative potential of digital technologies in the healthcare sector. The possibilities examined in the paper are endless in improving healthcare efficiency, and South Australia is well established to take a leading role in several of the new and expanded initiatives reported.

The report highlights that integrating digital tools such as electronic medical records, telehealth, remote care, and artificial intelligence (AI) could save more than $5 billion annually, easing pressures on the healthcare system. As ‘code yellows’ in health services and access to care challenges continue in South Australia, the PC provides interesting emphasis on opportunities where wastage reduction can occur with the substantial benefits of digital technologies.

Reducing hospital length of stays, avoiding duplicate tests, and automating up to 30% of workforce tasks are critical by freeing up time for patient care. Consumers benefit significantly from innovations like telehealth, which saves approximately $895 million a year in travel time. While we saw rapid adoption during the pandemic, it’s the expansion into virtual wards and hospitals that will enable optimal utilisation of this technology.

Despite significant advances in digital integration, the report points out that there are still many gains to be realised, particularly in the effective use of data from electronic medical records. The report highlights the example of CareMappr, a South Australian development that serves as an automated risk monitoring tool using AI to analyse patient data and manage the risk of readmission for specific patient groups, drawing data from multiple sources.

While the adoption of digital records by general practitioners has reached about 90%, and hospitals are increasingly embracing them, the My Health Record (MHR) system still grapples with fragmented data and usability issues. The report underscores the potential benefits of improving information sharing and data management, which could unlock substantial savings and enhance the functionality of digital health tools. It

also calls for better incentives for software providers to ensure seamless information sharing across different healthcare systems. The report aligns with SA Health’s shift towards e-referrals and secure messaging, enhancing connectivity in our complex health ecosystem.

Remote patient monitoring and digital therapeutics have revolutionised healthcare delivery, especially during the COVID-19 pandemic. However, the report points out that using these technologies in our hospital systems to improve efficiency and support in-home care remains limited. The rapid growth of virtual wards in specific specialties in the UK’s NHS emphasises the conveniences offered for patients and the cost savings for the system.

However, the report also notes that funding for remote care must be more consistent and it underscores the need for greater guidance from governments to ensure the effective and equitable use of these technologies, particularly in aged care settings. The ‘rpavirtual’ model, which expands across acute and sub-acute care, has led to incredible cost savings, particularly in outpatient care-delivered encounters. The role of LHNs in supporting interconnected care across acute and sub-acute that is digitally enabled cannot be underestimated, with the cardiac rehab digital example explored in the report.

AI holds promise for enhancing almost every aspect of healthcare, from decision-making to automating routine tasks, potentially saving significant time for healthcare professionals.

However, using AI comes with risks, including a lack of trust among users, bias introduction and regulatory challenges.

The Productivity Commission calls for more robust regulatory frameworks to build confidence in AI applications, ensure data quality, and safeguard privacy. It underscores the importance of facilitating appropriate data access for AI developers while maintaining adequate privacy protections.

Access to health data in South Australia is necessary to achieve efficiency gains and optimise workflows, such as automated AI case notes and discharge summaries. Diabetic retinopathy detection and melanoma screening are examples of how AI can support care outside metropolitan areas. The potential returns from investing in digital healthcare strategies are substantial, offering significant savings and improved patient care outcomes.

Dr Emily Kirkpatrick is an AMA(SA) Councillor, SALHN board member and managing director of EKology Health.

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HIGH VALUE, LOW CARBON In the second of her articles on health’s impact on climate change, Dr Kimberly Humphrey argues an emphasis on ‘low carbon’ can often result in ‘high value’ treatment and care.

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s the health sector contends with an expanding array of challenges – such as overcrowding, climate change and the equitable delivery of quality care – the concept of high-value, low-carbon health care is emerging as a transformative approach. This approach not only aims to enhance patient care and streamline healthcare efficiency, but also significantly reduces cost, environmental impact and carbon emissions.

Traditionally, discussions on the environmental footprint of healthcare systems focus on waste reduction, electrification and infrastructure considerations. However, it is essential to underscore the carbon emissions directly linked to clinical care.

According to a recent study published in the Medical Journal of Australia (MJA), a significant 80% of carbon emissions from Australian healthcare originate from care provision. Of this care, only 60% is deemed effective, highlighting a substantial opportunity to simultaneously improve care quality and curb emissions. Within the remaining 40%, 30% is classified as low-value care, and 10% as potentially harmful to patients. Addressing these inefficiencies presents a dual opportunity: enhancing care quality and achieving significant emissions reductions through targeted interventions.

The challenge ahead is two-fold. The decarbonisation of high-quality care is critical, necessitating shifts towards low-carbon alternatives for medications such as metered dose inhalers (MDIs) and reducing reliance on anaesthetic gases with significant carbon footprints

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such as desflurane. Moreover, healthcare systems wield considerable purchasing power that can be leveraged to drive upstream decarbonisation in supply chains, including medication and equipment.

Equally critical is the imperative to minimise lowvalue and unnecessary care, which can potentially save about 8000 kilotonnes of carbon dioxide equivalent a year. Clinical decisions heavily influence the provision of such care: choices in pathology and radiology tests, procedural necessity and medication prescriptions all play pivotal roles. By reassessing clinical practices and prioritising evidence-based care, significant reductions in carbon emissions and costs can be achieved, alongside improved patient outcomes.

Delivering high-quality, safe patient care doesn’t always align with current practices. Australian research suggests that at least 150 common tests and procedures are not linked with significant evidence of benefit.

Examples include arthroscopic knee debridement for uncomplicated osteoarthritis, routine vitamin D tests, and CT scans for back pain, all of which carry a

HEALTHCARE SYSTEMS WIELD CONSIDERABLE PURCHASING POWER

lack of evidence and significant doubts as to their benefit to patients. Improving care quality is crucial and can be achieved through understanding the interconnected potential between high-quality care, patient safety and decreasing carbon emissions. The interrelation of these concepts is demonstrated through initiatives such as the formation of an Environmental Sustainability and Climate Resilience Advisory Group by the Australian Commission on Safety and Quality in Healthcare, along with the development of its associated Healthcare Module.

Pathology and radiology services contribute notably to healthcare-related carbon emissions. For instance, the carbon footprint of an MRI scan equates to driving a new European car 145 km, while a CT scan is akin to 76 km, with an USS only equivalent to 4 km. While energy use from CT and MRI particularly can be reduced by decreasing standby use, overuse of inappropriate radiology must also be addressed. A recent Australian study indicates that a significant percentage of imaging procedures, such as CT pulmonary angiography evaluating for pulmonary embolus, and imaging for lower back pain and for abdominal pain, may be unnecessary, contributing to both financial burdens and environmental harm. It is crucial to carefully assess the appropriateness of imaging and explore the potential for less carbon-intensive alternative modalities such as ultrasound, advocating for their increased availability where feasible.

Primary care vital Educational reform is also pivotal. Traditional biomedical education often emphasises interventions over thoughtful inaction, neglecting the therapeutic value of conservative management and patient-centred care. Promoting evidence-based, judicious use of healthcare resources can drive substantial improvements in patient outcomes while reducing carbon footprints. Sometimes, doing nothing at all is the right remedy.

The best long-term outcomes for patients and communities occur through the provision of preventive care. The use of primary care – general practice, as the cornerstone of healthcare delivery – offers a vital avenue for reducing carbon intensity. Effective chronic disease prevention embodies high-quality, low-carbon care. For instance, individuals managing diabetes with glucoselowering treatments produce fewer carbon emissions than those whose condition remains untreated.

Despite this, current funding models and support structures often undermine the work of general practitioners. The work of general practice has grown significantly more complex over the past two decades but consultation times have remained unchanged, broader team support has not been adequately provided and funding has not aligned with the evolving needs of GPs. The current payment model also supports shorter consultations and does not compensate for the time needed to provide optimal care, particularly for patients with chronic disease and complex needs. Reforming Medicare reimbursement strategies to align with modern healthcare needs, including longer consultation times and team-based care, is essential to strengthen primary care and reduce unnecessary hospital admissions, and associated carbon emissions.

Climate solutions are inherently linked to healthcare system improvements. This is a pivotal moment in which

BY EMBRACING THESE PRINCIPLES...

WE CAN IMPROVE PATIENT OUTCOMES we can use the lever of climate change to rethink what constitutes effective patient care and to challenge the binary thinking of care provision that says it is provided either through a GP visit or in a hospital bed. The evolving landscape presents an opportunity to reimagine clinical delivery – from bolstering preventive care and primary care to embracing innovative models already underway, like virtual care pathways and hospital-at-home programs.

Implementing these alternative care pathways, including virtual-first care when suitable, can greatly benefit patients while reducing carbon emissions, as attending a hospital is significantly more carbon intensive than receiving care in the community. By employing effective risk stratification, high-quality patient care can be provided outside traditional hospital settings, resulting in cost savings and environmental benefits.

Evidence from other countries supports this approach.

For instance, a 24-hour chronic disease outpatient clinic in Denmark reduced acute admissions among patients with heart failure and COPD. In the UK, a falls specialist response car model effectively managed falls in the community, leading to a 66% reduction in emergency department visits. Similarly, a physician response unit, comprising an emergency specialist and a paramedic equipped with advanced diagnostic tools typically available in hospitals, achieved a 67% rate of community-based management, saving substantial costs and reducing carbon emissions.

Ultimately, embedding sustainability into healthcare leadership and organisational culture is paramount.

Redefining quality care through the lens of environmental impact, economic viability, and patient outcomes requires strategic alignment across clinical practices, regulatory frameworks, and reimbursement policies.

Clinicians, as stewards of patient welfare, must lead efforts to identify and eliminate low-value care, thereby promoting sustainable healthcare practices that prioritise patient well-being while mitigating environmental harm.

By embracing these principles of high-value, low-carbon healthcare, we can improve patient outcomes and healthcare efficiency and contribute significantly to environmental sustainability, ensuring a healthier future for both patients and the planet.

Dr Kimberly Humphrey is Climate Change Lead at SA Health.

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grounds The health, safety and resilience of South Australia’s future clinical workforce are the foremost priorities of educators and mentors in the state’s education and training institutions. In this issue, we ask the leaders of the University of Adelaide and Flinders University medical schools how they view the future of medical education, and the Chair of the AMA(SA) Doctors in Training Committee, Dr Hayden Cain, provides an overview of what junior doctors are experiencing in the state’s public hospitals. As Dr Cain describes, there is much work being done to support junior doctors – and much more to do.

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Flinders University

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Educating the next generation

ALIGNING STUDENT SUPPLY AND DEMAND he quality of medical graduates from Flinders University and their capacity to meet the needs of the community is secure, says the Dean of Medicine and Public Health at Flinders University, Professor Jonathan Craig.

Yet providing the quantity, specialty needs and locations of the future medical workforce needed remains a challenge, he says.

Currently there are major gaps between the intern and junior doctor positions required and the number of domestic medical graduates, particularly in areas of need such as rural and remote settings.

That’s why the Flinders University College of Medicine and Public Health has successfully applied for an additional 20 Commonwealth-funded medical student places for a new medical program in rural South Australia. With Northern Territory and Commonwealth Government support, it has also expanded its Northern

Territory (NT) Medical Program to almost 40 students.

This includes a record number of Aboriginal and Torres Strait Islander students.

It’s only by retaining students from rural areas in rural settings that the maldistribution of medical practitioners will ever be addressed, says Prof Craig.

‘Historically we’ve had about 30 students spend their entire third year in the eastern half of the state, from Mount Gambier to the Barossa,’ Prof Craig says. ‘From next year we’ll have a cohort of about 40 students spend their entire four years in rural South Australia.

‘That’s a substantial increase in number, but more importantly the entire cohort will be in rural settings, with the expectation that this will in time address some of the medical workforce needs in rural areas.’

Yet the mismatch between the demand and supply of interns and the maldistribution of doctors leaving a shortfall in primary health care and rural areas remains a vexed issue. Structural issues such as the tight Commonwealth control over domestic student places, college training positions and the lack of indexation of training payments to general practices remain.

In the NT – unfortunately, the middle ear disease capital of the world – graduates who want to train as ear, nose and throat (ENT) specialists must leave the NT for a major city to join an accredited training pathway.

By the time they have finished their training, many have too many community and family ties in their new environment to return to the NT where they are most needed, he says.

‘We’ll continue to advocate – we will do what we can do; we’ll expand our programs where we can.

‘We can do so much but this is a whole-ofgovernment matter, this is a specialist College matter, this is AMA, this is everybody working together, collectively, to address this.’

Nonetheless, says Professor Craig, Flinders University is firmly focused on producing graduates that meet the needs of the community.

Ella, a medical student based in the Riverland

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Medical students training in the Barossa simulation centre

Career planning is a central component, particularly in relation to opportunities in rural and remote settings and in primary health care where the needs are greatest. This is reflected in data that shows the Flinders program outperforms the national average in retaining students in primary health care in SA and NT, with retention rates of 30% and 60% respectively, compared to the national average of 10%.

The graduate medical degree has a range of strategies in place to support mature-aged students from diverse backgrounds in a bid to ensure diversity and to provide graduates suited to the job market.

The program offers individual and group tutoring and an academic learning coach for students - invaluable for graduate students who may have backgrounds in careers as senior midwives, paramedics or other health professionals but have not studied for some time.

‘It’s the one-to-one interaction over and above the class and tutorial teaching – personalised care and attention that many of them feel has been a very important part of their medical training,’ Prof Craig says.

‘Often our students are mature age, they have family responsibilities, they might be working part-time to support families. To have that individual support is a really strong element,’ Prof Craig says.

‘We also have a regional training hub – which is funded through the Commonwealth grant – to support students from interns through to their registrar years to help them in understanding what the options are for specialisation and to facilitate those activities.

‘It is the role of medical school to ensure workforce readiness – that’s core to us. We want to make sure our students are fit for practice, albeit in that first year in a supervisory capacity, so we have spent a lot of time and effort in the past few years with a pre-internship module, particularly in the fourth year.

‘The feedback from hospital employers is that it has worked well. We work very closely with the training units of each of the hospitals, so we understand

To have that individual support is a really strong element. whether any of our graduates have any issues that need to be addressed.

‘And if there are concerns, don’t worry, we know about it. They (our partnerships and students) let us know,’ he says.

The same care is taken to support students in primary health care placements, and there is a recognition by many in the sector of the need to commit the time and energy into training new cohorts. GP educators are deeply committed to developing the next generation.

The new single employer training model such as that on trial in the Riverland offers hope to smooth the path for primary health care trainees with entitlements that are traditionally limited to hospitals. The priority is to produce medical generalists who address the diverse needs of diverse communities, says Prof Craig.

Ella and Darren, medical students in the Riverland

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Collaboration and coursework the keys

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reater collaboration among universities and a focus on outcomes is the key to producing medical graduates who meet the needs of the community, says Dean of Medicine at the University of Adelaide, Professor Danny Liew.

Universities could work more with each other and share resources and strategies, he says. This would be the efficient way of meeting new standards set by the Australian Medical Council to improve teaching in Indigenous health, for example.

‘Why can’t the same people teach both groups of people across Flinders and Adelaide Universities? We need to be focused on outcomes, not process,’ Prof Liew says.

Thus far, he says, feedback suggests the six-year degree with a focus on a pre-intern sixth year has been successful in preparing students for future work.

In the latest available ‘Preparedness for Internship Survey’ (2019), University of Adelaide graduates ranked second in terms of feeling prepared for internship.

With the first group of students about to step into the clinical part of the new University of Adelaide MD program, there is excitement about fresh ways of approaching courses and engaging with the health sector, he says. Meeting community needs is a priority and will be an ongoing process.

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Against this backdrop, the merger between the University of Adelaide and UniSA has few short-term challenges for the Adelaide Medical School, and in the long term provides opportunities to implement new strategies.

These include options to change the intake of students into the medical program, increasing the number of students from rural areas, and providing greater exposure to areas of medicine outside hospitals.

‘There’s a big gap between training in hospital environments versus work available across our whole profession,’ Prof Liew says. ‘You look at the surveys of where the students want to go in their career, the bulk of it is specialties – to become surgeons, anaesthetists, etc. That’s no surprise because of their greater exposure to hospitals during training.’

The Adelaide Medical School this year introduced clinical placements in general practice for third-year medical students. Despite challenges including GPs’ capacity, he says the program has been a success overall. The school is extremely grateful for the many GPs who participated as role models, says Prof Liew.

He says many other issues need to be addressed to increase the generalist workforce, such as expanding the Riverland trial of the single employer model of training for rural generalists to build demand for this pathway.

Expanding entry pathways into the medical program may also help. ‘Post-graduate entry may include students who have a broader view of what the

profession is and how it should evolve to meet community needs,’ he suggests.

Prof Liew says the Adelaide Medical School is looking for new ways to collaborate with both public and private sector organisations to provide greater teaching opportunities and to mirror the breadth of opportunities in the health sector.

‘We have SA Pathology and SA Radiology colleagues who teach our students, but we could do more to build formal partnerships at an institutional level. We do place students in private hospitals, but that’s another area with potential to expand.

‘We will need to navigate bureaucracy and manage risk, but maintaining that “outcomes focus” is key,’ he says.

The Adelaide Medical School is reliant on the health sector to deliver quality teaching, and clinical engagement continues to be a priority for Prof Liew.

Key initiatives in the past two years have been the appointment of three Clinical Deans at Central Adelaide Local Health Network (CALHN) and Northern Adelaide Local Health Network (NALHN), with another planned for the Women’s and Children’s Hospital Network (WCHN); and the creation of the formal Clinical Titleholder Committee.

The University of Adelaide’s health and medical science degrees provide a strong start to a career in health

In addition, the Derek Frewin awards (named after a notable former Dean) aim to recognise excellence in clinical teaching and a database has been established to provide evidence of titleholders’

The University of Adelaide’s health simulation facility, Adelaide Health Simulation

WE COULD DO MORE TO BUILD FORMAL PARTNERSHIPS AT AN INSTITUTIONAL LEVEL contribution to academic activities that can be used in CPD documentation.

‘We are fortunate in Adelaide – and in Australia generally – that the teaching culture is strong.

There is a duty, desire and purpose that most clinicians have; they want to teach and they enjoy it,’ Prof Liew says.

Maintaining an authentic connection with students is also important for a strong teaching culture. The Adelaide Medical School encourages feedback and open communication with students and the Adelaide Medical Students’ Society.

But the first step towards additional tailoring to meet community needs might be a basic one: getting students back to the classroom after the Work From Home revolution of COVID. ‘Our craft is not learned online so we do need to get them back,’ Prof Liew says. ‘I obviously understand the reasons: cost of living, petrol prices are high, sometimes they have one tute that is displaced, and there is the convenience factor.’

Making the course relevant, engaging, not didactic and conveniently timetabled is a key part of the strategy, he says.

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Action sought on workplace conditions

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The latest Medical Training Survey reveals there is still much to be done to support junior doctors in their hospital workplaces, writes Dr Hayden Cain.

Introduction In September 2023, the Australian Health Practitioner Regulation Agency (Ahpra) conducted its now-annual Medical Training Survey (MTS).

Across Australia, more than half (54.4%) of all doctors in training (DiTs) responded. Of those, 1,550 were in South Australia, a slight decrease from the 1,583 who participated in the survey the previous year.

In recent years, the AMA(SA) DiT Committee has used the MTS data to explore the prevalence of cultural and safety issues affecting junior doctors in South Australia’s training hospitals. The annual reports provide self-reported data to increase awareness of these issues and their impacts on individuals and their capacity to provide best-practice care, and to support AMA(SA), the DiT Committee and our partners in working to improve conditions for junior doctors. This year, for a hospital to be included and identified in the report it needed to have at least 10 respondents working predominantly in that hospital for the period being investigated.

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Dr Hayden Cain Chair of the AMA(SA) Doctors in Training Committee

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Workplace culture Overall, 80% of DiTs in SA reported a positive workplace culture, a significant increase from 74% last year and now equal with the national average.

As was the case nationally, a higher proportion of South Australian DiTs reported feeling their hospitals support their wellbeing - 78% compared to 76% last year - and that their workplaces support work/life balance - 69% compared to 65%.

The highest levels were at the Lyell McEwin Hospital (LMH) and Queen Elizabeth Hospital (QEH) with 83% and 81% respectively reporting a culture of supporting staff wellbeing, 73% and 71% reporting support for work/life balance, and 67% and 66% reporting having a good work/ life balance.

The Women’s and Children’s Hospital (WCH) performed worst in all areas, with only 45% of DiTs stating their work supported work/life balance and 40% reporting they do not have a good work/life balance. The latter result was 17% worse than the next worst hospital.

Bullying, harassment, discrimination and racism Bullying, harassment, discrimination and racism are still significant issues for DiTs in South Australia, with 20% of respondents reporting being victims of at least one of these forms of unacceptable workplace behaviours in the past 12 months, compared to 21% last year. However, this apparent stagnation hides some worrying results, with some hospitals performing worse than last year. At Modbury Hospital, the rate of reporting of these incidents increased from 21% to 33%, while at the WCH it increased from 21% to 25%. Only at the LMH was there a significant improvement, with the proportion decreasing from 23% to 18%.

When reporting of experience of any of these behaviours is combined with reports of witnessing them, the proportion increases to 32% across all hospitals. Nationally, the MTS data indicates that senior medical staff are the most common perpetrators of bullying, discrimination,

Bullying, harrassment, racism, discrimination

41 H O S P I TA L H E A LT H C H E C K

Workplace Culture

harassment and racism (45%). In South Australia the level of reporting has improved significantly over the past year, from 52% to 42%.

There has also been a significant improvement in bullying perpetrated by direct supervisors: 25% this year compared to 38% last year, and a marked difference from the national average of 42%. Flinders Medical Centre (FMC) increased from 35% to 44%.

Last year’s Hospital Health Check noted the high incidence of non-reporting of bullying, discrimination, harassment or racism in South Australia, often due to fears of repercussions or that no action would be taken.

This year, 68% of DiTs said they did not report bullying, discrimination, harassment or racism after the event, a mild improvement from 71% last year and similar to levels nationally but still unacceptably high.

QEH and FMC showed the greatest improvement in this area.

At the RAH, 47% of DiTs stated it was not the accepted practice to report bullying, compared to a state average of 24%. At the WCH, key reasons were a lack of processes (40%) and a lack of support (33%) compared to state averages of 17% and 24%.

This year, 49% of respondents stated they did not report due to concerns for repercussions while 45% that nothing would be done.

The rates of follow-up in South Australia provide an unsatisfactory picture. The proportion of reports that were followed up dropped from 47% to 38%, well below the national average of 49%. At the RAH, the rate of follow-up dropped by more than half, from 72% to 31%. FMC’s rate also decreased, from 46% to 37%.

Only 50% of victims reported being satisfied with the follow-up, a significant drop from 59% last year and 62% nationally.

Statewide, 79% of DiTs stated their workplace does not tolerate bullying, discrimination, harassment or racism, slightly less than the national average of 80%. However, the feeling of the workplace not tolerating this behaviour was only 56% at Modbury and 63% at the WCH.

Bullying, harrassment, racism, discrimination

With so many DiTs working long hours it is pleasing to note that the proportion of trainee doctors being paid for unpaid overtime in South Australia increased again, from 73% to 76%.

Work facilities

Reason for not reporting after experiencing bullying

Having appropriate working environments with access to computer desks has been a consistent issue for DiTs around Australia. There has been no overall improvement in this, with 63% rating their workspace as excellent or good in 2023 compared to 62% last year.

However, individual hospitals had improved.

The issue of inadequate workspaces and internet access will become even more significant after the rollout of the electronic medical records (Sunrise) program to all SA Health sites is completed. Without access to computers, desks and fast internet, doctors will no longer be able to offer high- standard care while working in a system that is increasingly dependent on technology.

Workload

Negative impacts on wellbeing

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Training and career development

Workload As well as an improvement in culture there has been a 5% reduction of DiTs reporting a very heavy workload in South Australia – from 14% to 9%. There was also a decrease in the proportion being asked to perform work they are not confident performing, from 11% to 8%.

These factors probably contribute to the drop in the proportion of DiTs who said their workload negatively impacts their wellbeing, from 30% to 24%.

However, 50% of South Australian DiTs still report a heavy or very heavy workload and 24% work more than 100 hours a fortnight. At the WCH, 66% of DiTs said their workload was heavy or very heavy and 30% reported working more than 100 hours a fortnight. At the RAH, 58% described their workload as heavy or very heavy and 36% said they worked more than 100 hours a fortnight.

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In general, satisfaction with education in South Australia is at a similar level to the rest of the country; 87% of interns state that their education program is aiding their development, significantly higher than the national average of 81%. FMC (86%) and QEH (85%) had the highest rates of DiTs rating their overall education as excellent or good compared to a state average of 82%.

Only 2% of DiTs rated their education as terrible or poor.

The proportion of DiTs supported by their employers to attend formal and informal training across South Australia increased from 74% to 78%. Individual hospital rates ranged from the WCH (67%) to the QEH (83%).

LMH had the greatest level of DiTs’ satisfaction with hospital-wide teaching (74%), bedside teaching (91%), formal education (89%) and online modules (67%).

FMC (86%) and QEH (85%) had the highest rates of DiTs rating their overall education as excellent or good compared to a state average of 82%.

Only 67% of respondents in South Australia stated they had access to study leave, ranging from 72% at the QEH to 59% at WCH and 61% at Modbury.

The report once again highlighted the huge training

DiT training recommendation

In conclusion The MTS survey of junior doctors indicates South Australia’s hospitals have again performed satisfactorily when compared with their national equivalents, with a few exceptions.

Sadly, both nationally and in South Australia we continue to have unacceptable rates of reporting of bullying, harassment, discrimination and racism.

Overall, there has been some improvement in workplace culture. AMA advocacy has highlighed the impacts of systemic cultural issues on doctors and their capacity to provide best-practice care, and to important legislative changes regarding the entities ultimately responsible for doctors’ psychosocial safety.

However, it must be noted that the WCH was again the worst performer in South Australia. The issues are broad and include cultural and workforce issues, workload and systems concerns, and less-than-ideal

facilities. Among WCH DiTs, 14% described their workspaces as poor by 66% of WCH DiTs, the highest in the state. Other negative results included the highest rates of unpaid overtime and workload negatively affecting wellbeing.

While the new WCH will improve facilities, these results demonstrate how junior doctors at the WCH feel about issues such as workload and wellbeing.

Finally, the report once again highlighted the training bottlenecks in Australia. As AMA DiT committees have noted, there is a need for significant workforce reform across the country, with changes in university and hospital-based training systems, improved data collection, and changes to perceptions of specialties currently being seen as being less desirable.

Recommendations The AMA(SA) DiT Committee offers eight recommendations to improve working conditions for junior doctors in South Australia. AMA(SA), the DiT Committee and individual trainee doctors welcome opportunities to work with SA Health and LHNs to consider how these recommendations may be enacted to improve workplace conditions and safety and ultimately improve health outcomes for staff and patients.

1. SA Health establish statewide, uniform, evidencebased bullying, harassment, discrimination and racism reporting pathways with education during orientation on their use.

2. The systems, culture and workload at WCH be reviewed and improved before operations and staff move to the new site.

3. State and federal governments provide modelling to determine future population needs for non-GP and GP specialists across the country, to improve workforce planning and training bottlenecks and help students determine viable career paths.

4. NALHN examine the vastly different rates of reported bullying, harassment, discrimination and racism between the LMH and Modbury over the past 12 months.

5. SA Health explore and introduce means to support the increasing numbers of and cultural diversity among IMGs in South Australia 6. CALHN continue to monitor the outcomes of the Vanderbilt model in addressing bullying and other issues at the RAH. 7. CALHN increase training and development opportunities for GP registrars.

8. SA Health improve access to acceptable working spaces (i.e., desks and computers) to ensure all doctors at all locations can deliver the best care to patients.

The complete Hospital Health Check report is available on the AMA(SA) website.

43 H O S P I TA L H E A LT H C H E C K

bottlenecks affecting the medical training system in Australia. This is highlighted by 36% of the DiTs in South Australia not currently on training programs wanting to pursue careers in surgery or anaesthetics, while current trainees in those fields only comprise 11% of all trainees. On the other hand, specialities such as GP (both the Australian College of Rural and Remote Medicine and Royal Australian College of General Practitioners), physician, emergency and psychiatry have higher proportions of current trainee roles than the number of DiTs interested in them across the country. This mismatch between desired career paths and opportunities led to 36% of DiTs being concerned they will not be able to enter or complete their chosen specialities, and 37% were concerned about finding jobs in Australia after training.

There is also decreasing interest in working rurally, with 42% of DiTs in South Australia reporting they are interested in rural medicine and 46% nationally.

Almost all (99%) interns reported undergoing an endof-term assessment, with 90% stating it was relevant to their training and 88% finding the feedback useful, significantly better than the national average of 84 and 81% respectively.

Carpe noctem reflections from internship Dr Isaac Tennant (left) with RAH intern colleagues Dr Harry Martin, Dr Justine Li and Dr Oliver Marshall

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It is widely known that there are three certainties in life: death, taxes and your friendly local council worker deciding to use the ride-on mower outside your window while you are trying to sleep between night shifts.

My current rotation – RAH nights – sees me working a seven day on, seven day off roster as the sole overnight doctor for a little over 100 inpatients across two floors of the building, alongside a small team of interns and RMOs each with their own inpatient wards to cover.

Alongside nurses and select other health industry professionals, working nights – whether that be on a dedicated rotation such as the one I am now on, as part of an emergency department roster or via the on-call responsibilities of registrars and consultants – is an experience undertaken by almost all doctors at some point of our careers.

I am sure many of you recall your own experiences and can attest to the unique work/life balancing act that it creates.

The complete reversal of routine is certainly obvious – awaking in a fog of confusion to the final colours of sunset; not knowing what to eat for (or even what to name) my first meal of the day*; then watching the sun rise over the foothills as I draw to the end of a shift and wishing away the smell of coffee in the food court as I scurry home in the morning – each of these experiences scaffolds the microcosm of the night shift.

The nature of my clinical work itself differs significantly from my previous rotation’s daytime responsibilities. With no patients to round on and only a few time-bound procedural

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responsibilities to enact during my shift, each evening begins in a rather relaxed fashion. However, this calm before the storm belies the flurry of messages and calls I receive over the next few hours, as my night fills with unexpected tasks and deteriorating patient reviews. As the early morning approaches, the backlog of tasks begins to clear and by 8 am I can begin handing over to the incoming day teams.

While gruelling for a week, the week off certainly has had some upsides. In a bid to catch up on all the vitamin D I missed on the previous week, I enjoyed the chance to go on more long runs, take a few weekend trips away and play an increasing amount of golf – the former two great for my mental health, and the latter more questionably so.

To return to my experience inside the hospital, however, one thing I have certainly appreciated about this rotation is the increased exposure to critical care that it has afforded, even at the intern level. Not only was I able to bear witness to a rapid-sequence intubation on the ward and CPR + ALS following a cardiac arrest, but I was able to actively contribute to the patient’s care in both situations – obtaining IV access in the former and a secure airway in the latter situation. It was gratifying to see the skills practised in simulation teaching and in controlled anaesthesia environments could be translated to the arrest setting, and this made me appreciative of clinical teachers in the past who had taken the time to provide me with these skills.

Outside the learnings from the clinical work itself, I have found myself with a newfound appreciation for the camaraderie and positive relationships with my colleagues through this time. Good relationships with my fellow nights doctors has been instrumental in allowing me to digest and learn from stressful situations rather than merely experiencing

My night fills with unexpected tasks

them and moving on. Whether through more formal situations such as post-ALS debriefs or case discussions, or more light-hearted situations such as enjoying Uber Eats McDonalds together, I have been so blessed to enjoy spending time with people whom I have learned so much.

In many ways, my life during this rotation serves as a caricature of the wider experience of working as a health professional. Working odd hours, experiencing the stress and excitement of caring for critically unwell patients, bonding closely through shared experiences with colleagues and watching the outside world go by are experiences every doctor can resonate with, whether they have recently worked overnight or not.

This profession reminds us not only that illness has no predilection for business hours, but also of the physical and emotional sacrifice we make to care for patients in their hour of need. In return for the forfeiture of our time and energy, we are awarded a special window into the vulnerability of our patients, a strong bond with our healthcare colleagues and a true sense of the purpose of our work. Whether it be in the adrenaline of caring for a cardiac arrest, the profound thankfulness of a patient or the satisfaction of a difficult diagnosis, our toils are not without reward.

I’m happy to work a few nights for that.

I also hope that my positive experience with my fellow nights doctors also serves as a reminder to us all to take the opportunity to appreciate both the professional ability and

the unique personality of each of our colleagues. Good relationships at work, like those in one’s personal life, are not to be taken for granted, and it is worth taking the time to experience and express gratitude for those colleagues who make our working days just that bit easier.

Finally, I will also take away the importance of spending time doing the things I love outside work. Both passive rest and active rest are so important to my ongoing energy levels at work and in my personal life, and it has been great to use my weeks off to engage in both these types of activities. Even though this will be harder in the future as the responsibilities of life continue to grow, the importance of exercise, rest and deliberate fun is self-evident and important to incorporate into our lives. *I was recently informed by my high school-aged little sister that it is in fact breakfast, as I am indeed ‘breaking my fast’ in the evening. Does this logic extend through to an early morning dinner too?

Please let me know if you can enlighten me on this topic!

Dr Isaac Tennant Medical intern, Royal Adelaide Hospital

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Phone 08 8267 8267 Fax 08 8267 2007

Student news

Flinders University

Triumphant first years at the MD1 V MD2 sports night, and (right) students participating in the AUSLAN workshop

Students eager for AUSLAN learning 46

The Flinders Medical Students’ Society (FMSS) has been kept busy in recent weeks with our Junior Committee elections.

Each portfolio has appointed a first-year student to help with event coordination and advocacy, while also integrating the first years into committee retreats and meetings. Our committee is now complete, with more than 50 students across a range of portfolios keen to make this year one of our best.

Some of our annual events have ensured the year started with a bang. Following a hugely successful medcamp, involving more than 120 of our first years, we held our MD1 V MD2 Sports Night to encourage some friendly competition. Congratulations to the first years on winning the evening. We hope to see our students at our upcoming inter-year debate to see if they can hold on to the trophy.

We also found success in our Annual AUSLAN workshop, where more than 30 students were introduced to sign language, including common greetings and words and some terms relating to the healthcare field. This event is a newer one on our calendar but we find so many of our peers eager to learn different ways to engage and interact with patients and other healthcare professionals.

The success of our events motivate us to sustain our efforts. As we prepare for upcoming major events such as Medball and our Annual Mental Health Seminar, I am excited to work with my team in delivering exceptional social and educational opportunities.

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Our relationship with the Adelaide Medical Students’ Association (AMSA) continues to grow with national advocacy and the launch of the 2024 Vampire Cup. We are proud to watch our student body become involved in the blood drive, helping three lives with every donation.

While we are currently trailing behind our rivals at Adelaide University, the gap is small and we hope to close it in the coming weeks. We continue to support AMSA in national initiatives including Paid Placements and conversations with Ahpra about registration fees.

As our graduating class prepares for internship applications, we extend our gratitude to South Australian Medical Education and Training (SAMET) for its invaluable support and guidance throughout this process. We recently organised two live-streamed informative sessions aimed at equipping our cohort with insights into the internship application process, both of which were resounding successes. We wish all internship applicants the best of luck in the forthcoming weeks.

I am honored to be leading such an amazing group of committee members and to be representing our vibrant student body at Flinders. We have so much more in store for 2024!

Grace Mackenzie FMSS President 2024

Student news

University of Adelaide

EVENTS FORGE STUDENT BONDS

Students enjoying Jazz Night

In February, the Adelaide Medical Students’ Society (AMSS) welcomed our new first years to Medical School at O’Week with a barbecue, sponsor tradeshow and a handwriting exam (our annual first year prank). Soon after, they were able to meet their fellow pre-clinical students at our new Pre-Clinical Mixer event. COVID has certainly had an impact on the inter-year friendships, locking us inside for two years. Now we’re giving the new generation of MD med students the boost they need to make sure the culture of collaboration and friendship stands strong in a postpandemic era.

The AMSS has held four of our five ‘big’ events in Autumn: Skullduggery, MedCamp, Jazz Night, and my personal favourite, President’s Keg. This year, the AMSS had the goal of revitalising our events and giving them a new coat of paint.

Jazz Night was moved from the River Torrens to the South Terrace parklands and PresKeg moved from the iconic gaol to the Burnside Ballroom.

With Mad March and Active April behind us, the AMSS calendar slows down as the mid-year exam season approaches. The AMSS has been hard at work supporting the students with our 4th and 5th-year Mock OSCEs and 1styear exam forum. A big thank you is extended to the more

than 100 volunteers who helped at the mock OSCEs, which could not have been delivered without their support.

Not everything has been smooth sailing over this exam period, however. Last week the only thing on every medical student’s mind was the Australian Government’s announcement of introducing Prac Payments to tackle placement poverty for degrees with compulsory placements.

However, medical students around the nation very quickly discovered that their degrees did not make the cut. The AMSS welcomes the paid placements for our nursing and midwifery colleagues, but more needs to be done for medical students from rural and low socioeconomic backgrounds to ensure equitable access to study opportunities and the completion of medical degrees.

Against this background, the AMSS and medical students alike look towards the future, continually supporting one another where we can and keeping alive the thriving culture of collaboration.

The culture of collaboration and friendship stands strong

A colour run for the first year Med Camp

Huy On AMSS President 2024

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PATIENTS SEEK PSYCHEDELIC ANSWERS A year after psychedelic drugs were rescheduled to allow authorised psychiatrists to use the experimental medications in treating psychiatric illnesses, general practitioners (GPs) are struggling to find information to answer patient questions.

Senior Lecturer in Addiction at Edith Cowan University, Dr Stephen Bright, said while there has been a media frisson about the use of psychedelics, evidence-based advice and continuing professional development for GPs is required.

It can be difficult for GPs to find the evidence they need, he says.

This is partly due to methodological and other research challenges with clinical trials such as small sample sizes and the challenges with placebos.

‘How do you conduct a double-blind trial on a psychedelic drug, because after about 30 minutes everybody knows who got the drug and who got the placebo,’ he says.

‘The effects are magnified because those with the placebo are disappointed and they might do poorer than they would otherwise and the results of those with the drug tend to be inflated.

‘There are potential benefits of these treatments, but GPs must be careful not to jump on the media bandwagon, but be more circumspect and interrogate the issues, thinking about some of these things – sample size, lack of adequate blinding, expectancy effects.’

On the other side, Dr Bright says there may be a tendency

for GPs to overestimate the risks, after decades of prohibition of these drugs and the ‘war on drugs’.

‘There’s a lot of misinformation about psychedelic drugs,’ he says. ‘There are a lot of methodological issues that need to temper the enthusiasm of people coming in and wanting to access some of these treatments.’

GPs are likely to face two issues, he says: inquiries from patients who believe the hype and are seeking access, and patients who have accessed the drugs illegitimately and experienced a poor result.

‘There’s been so much media – people are really interested in it,’ he says. ‘I think there will be increasing numbers of patients presenting GPs who have had some kind of do-ityourself treatment or accessed an underground facilitator to provide the treatment.

Desperate people will do desperate things.’

He suggests GPs start with the best place to start in formulating an evidence-based approach to support patients is likely to be the Therapeutic Goods Administration (TGA) website, which provides regular updates on clinical trials.

Still, it remains difficult for patients to access the treatment outside the many trials underway. And the strict inclusion/ exclusion criteria mean it is difficult for patients to be accepted into trials.

‘There is a small number of people [legally] accessing these treatments outside trials, but you are looking at somewhere between $20,000 and $30,000 per treatment. It’s not really that much more accessible for the average person who is experiencing treatment-resistant depression [than it was before the TGA change last year].’

The US Food and Drug Administration (FDA) is likely to approve MDMA as a medicine for treating post-traumatic stress disorder (PTSD) in the next three to six months, and Dr Bright is predicting a corresponding increase in the number of inquiries about the use of psychedelics.

The challenge for doctors, he says, is that many patients are unaware that psychedelics are an experimental treatment.

They might not realise that, in Australia, the Therapeutic Goods Administration (TGA) has authorised MDMA only for treating PTSD and psilocybin for treating chronic depression, because that’s where there are the strongest indications for success.

And although FDA approval is likely to cause a further shift in Australian policy, access constraints are likely to remain for the foreseeable future due to the limited number of authorised psychiatrists (currently about 15) and trained therapists.

Supply of the drugs themselves is not likely to be an issue, though, says Dr Bright, as each patient only requires two or three medication-assisted psychotherapy sessions.

‘It could also be argued that these treatments are safer than medical cannabis because the patients are never given the medicine to take on their own,’ he says. ‘They have to be administered in a clinic with at least two Ahpra-registered therapists.

‘These drugs aren’t going to end up on the street.’

Access constraints are likely to remain 49

Successful bids for cancer grants

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Several cancer research projects based in or with strong links to South Australian institutions have successfully secured funding through Cancer Australia’s Priority-driven Collaborative Cancer Research Scheme.

The scheme is aimed at driving innovative cancer research initiatives.

Health Minister Mark Butler announced $5.33 million in funding for 15 projects around Australia with $3.16 million from the Australian Government’s Cancer Australia and $2.71 million from its charity funding partners.

The grants cover work in lung, prostate, brain, colorectal, breast, ovarian and blood cancers.

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Flinders University Two Flinders University medical researchers, Associate Professor Luke Selth and Dr Lauren Thurgood, were awarded more than a half a million dollars for work into targeted cancer treatments.

NEUROENDOCRINE PROSTATE CANCER - $549,583 Associate Professor Selth’s work on neuroendocrine prostate cancer will test whether a new type of hormone therapy is an effective treatment for neuroendocrine prostate cancer and determine those patients who will most benefit from it.

The project will focus on neuroendocrine prostate cancer, a specific subtype of the disease that is particularly aggressive and kills a disproportionate number of patients.

CHRONIC LYMPHOCYTIC LEUKAEMIA - $199,682 Dr Thurgood’s project seeks to overcome the growing resistance of chronic lymphocytic leukaemia (CCL) to current therapies.

While clinical trials focusing on an intracellular protein to regulate pathways promoting the growth of CLL cells have been promising, it has been difficult to target this protein due to toxicity.

Dr Thurgood’s team has discovered a new way to target the protein that may limit the toxicity and be a highly effective novel therapy in CLL.

University of Adelaide/ SAHMRI BRAIN TUMOUR - $595,467 A world-first approach to delivering a drug to treat the deadly Diffuse Midline Glioma (DMG) in children is being developed in a partnership between the Universities of Adelaide and Newcastle and the South Australian Health and Medical Research Institute (SAHMRI).

The University of Adelaide’s Dr Kate Vandyke says a new approach is needed, given the poor survival rates – less than two years – for children with the disease While there has been work on a drug that can kill DMG cancer cells in the lab, Dr Vandyke says there is not yet a way to deliver the drug across the blood brain barrier.

The project aims to build on work around drug delivery in the context of multiple myeloma. It holds promise for many brain cancers that can mainly be treated with radiotherapy or surgery, says Dr Vandyke. If successful, she hopes this approach will lead to a new treatment approach that will dramatically improve outcomes for children with DMG. The three-year project will involve about 12 researchers, leveraging work done on mouse models of DMG, led by Professor Matt Dun at the University of Newcastle; paediatric neuro-oncology, led by Professor Jordan Hansford at SAHMRI; chemotherapy side-effects, led by Dr Hannah Wardill at the University of Adelaide and SAHMRI; and research related to drug delivery led by Dr Vandyke and Dr Krzysztof Mrozik at the University of Adelaide.

‘It is always super-competitive to win funding and we were lucky that this work has been supported by Cancer Australia, the Kid’s Cancer Project and the Australian Lions Childhood Cancer Research Foundation,’ Dr Vandyke says. ‘We’re hoping we can make a real difference.’

UniSA/ Centre for Cancer Biology Three researchers working under the auspices of the Centre for Cancer Biology (CCB) from UniSA and SA Pathology have been awarded more than $1.3 million for research into bowel cancer, acute myeloid leukaemia (AML) and breast cancer.

The CCB laboratories conduct research in breast, prostate, skin, brain and colon cancers and leukaemia, focusing on the specialised areas of gene regulation, molecular signalling, translational oncology and cancer genomics.

BOWEL CANCER $573,833 A team led by Professor Michael Samuel will investigate why people diagnosed with early-onset bowel cancer have a 50% chance of experiencing a relapse after undergoing surgery to remove their primary tumours. Compared to people diagnosed with late-onset bowel cancers, it is also more likely that the cancer will spread to other organs.

‘At the moment we cannot predict whose tumours will return and whose won’t, resulting in some patients receiving unnecessary chemotherapy and others who elect not to, leading to a relapse,’ Prof Samuels says.

‘However, we have identified chemicals produced by tumours that affect the chances of cancer relapse.

If we can block these enzymes from hijacking normal cells in their environment, this could be a new way of targeting bowel cancer.’

ACUTE MYELOID LEUKAEMIA - $599,392 A project led by CCB leukaemia researcher Professor Richard D’Andrea aims to build a greater understanding about genetic changes in children with acute myeloid leukaemia (AML).

This is intended to discovery why about one-third of the number of children diagnosed with AML do not survive, despite having aggressive chemotherapy.

‘It is now widely understood that the genes we are born with can affect our risk of developing AML and influence the response to treatment,’ Dr D’Andrea says.

‘Guidelines for doctors on how to best treat childhood AML patients based on their individual genetic profile are lacking. This could be leading to suboptimal outcomes in some childhood AML patients,’ he says.

‘We will address this gap by establishing national expert guidelines for inherited genetic changes that are identified in childhood AML patients.

This will help improve diagnosis and prognostication of familial predisposition and lead to better treatments.’

BREAST CANCER - $199,883 CCB Research Fellow Dr Sarah Boyle will investigate a new way of tackling breast cancer metastasis, the most common cause of cancer-related death in women, which is attributed to rogue chemicals that are released from cancers as they grow.

‘These cancer cells influence normal cells, causing the cancer to spread to other organs. This project will focus on finding a way to block these chemicals and stop breast cancer metastasis,’ Dr Boyle says.

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RESEARCH BRIEFS New protein offers hope for new treatment of IBD La Trobe University researchers have identified a protein integral to gut health, paving the way for treatment of Inflammatory Bowel Disease (IBD).

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A study on mice published in Communications Biology found removing the protein BECLIN1 causes a condition similar to IBD. It showed removing BECLIN1 causes problems in the internal ‘trafficking’ pathways of the epithelial cells that line the intestine, leading to a disruption of the protective barrier that allows bacteria to enter the intestinal wall.

The research also demonstrates the essential role BECLIN1 plays in endocytic trafficking. The study identified the E-CADHERIN protein as being an important cargo that relies on BECLIN1 for its correct localisation within the cell.

If E-CADHERIN is not located correctly within the cell, then the epithelial barrier lining the gut breaks down and bacteria can penetrate the intestinal tissue, leading to a potent inflammatory response, the researchers found.

The discovery is expected to assist in the development of much-needed treatment options for IBD.

Sedentary children have higher diabetes risk Sedentary children are more likely to have a significant increase in blood insulin concentration, raising the risk of Type 2 diabetes, a new study in the Journal of Clinical Endocrinology and Metabolism has found.

The study, based on the University of Bristol’s ‘Children of the 90s’ data, included 792 children followed from 11 to 24 years of age. They spent six hours a day at baseline on sedentary activities, increasing to nine hours.

The increase in sedentary time was associated with continuously higher insulin levels in fasting blood, especially among youths with overweight and obesity, whose risk of excess insulin increased by 20%.

The study also found that light physical activity of three to four hours a day could reduce the risk of excess insulin and insulin resistance. Participating in moderate-to-vigorous physical activity (MVPA) showed signs of reducing insulin but to a much smaller extent.

Sedentariness should be recognised as one of the 21st century’s independent causes of excess insulin, fat obesity, high lipid levels, inflammation, and arterial stiffness, the researchers said.

Underused heart program could reduce hospital readmissions Referring cardiac patients to a specialised rehabilitation program after a cardiac incident could reduce the likelihood of being readmitted to hospital and the risk of death, according to new Flinders University research but improvements need to be made to ensure patients take part.

Cardiac rehabilitation (CR) programs combine support, exercise and education to improve patients’ overall heart health.

Published in the journal Heart, Lung and Circulation, the study reviewed 84,064 patients who were admitted to South Australian public hospitals between 2016 and

2021 with heart issues including myocardial infarction (heart attack), chronic heart disease, irregular heart rate or a pacemaker installation.

It found CR programs offer a significant benefit in reducing hospital admissions and even death, but they aren’t being used to their full potential. Delivering the program via telehealth, often to those in regional and remote areas, was strongly associated with higher completion rates.

Compared to undertaking no program at all, those who completed it were 38% less likely to die or to be readmitted to hospital for a heart related issue within the following 12 months.

NEW FOCUS FOR CHRONIC LIVER DISEASE CARE A landmark study by researchers at Flinders Medical Centre and Flinders University published in Hepatology has found that improved models of care can benefit patients with decompensated liver cirrhosis.

The randomised control trial assessed the efficacy of a chronic disease management (CDM) model to reduce liver-related emergency admissions to hospitals and to assess effects on qualityof-care and patient reported outcomes.

Lead researcher Professor Alan Wigg from Flinders University’s College of Medicine and Public Health and Flinders Medical Centre said CDM models for decompressed cirrhosis have great potential towards an improved standard of care in hepatology.

The study showed the liver-related emergency admissions rate was not significantly improved despite robust intervention, nor was any improvement in patient survival recorded.

However, it did show several significant and clinically important benefits, including reduced emergency admissions due to hepatic encephalopathy, one of the most frequent, preventable and expensive causes for admission in patients with decompensated cirrhosis.

New link between IBS and the cardiovascular system A new study in Cellular and Molecular Gastroenterology and Hepatology finds that some of the biological

Tumour cells quick to evade the immune system Tumours actively prevent formation of immune responses by cytotoxic T-cells, new studies have found, paving the way for new immunotherapies.

Two studies in the journal Nature showed tumours use a messenger substance to influence immune cells in an early phase of the immune response. Many cancer cells show increased secretion of the messenger substance prostaglandin E2. The researchers were able to show that prostaglandin E2 which cancer cells tend to secrete more of binds to the EP2 and EP4 receptors on the surface of certain immune cells.

The study found the immune response is strongly limited when tumours secrete prostaglandin E2 and this factor binds to EP2 and

mechanisms causing IBS may be in common with cardiovascular diseases (CVD).

Analysing data from two large European population cohorts — UK Biobank and Lifelines — researchers scrutinised the genetic landscapes of 24,735 people with IBS and 77,149 symptom-free individuals.

This uncovered four genomic regions, including two previously unidentified loci, associated with increased susceptibility to IBS and found IBS heritability might be higher than previously thought.

The genetic hotspots implicate pathways central to gastrointestinal

EP4 receptors. The T cell response collapses, enabling the tumour to progress.

The second study showed where researchers prevented the interaction of messenger substance and receptor in tumour models, the immune system was able to fight tumours effectively.

Current immunotherapy approaches would probably be more effective if the effects of prostaglandin E2 on stem-like T cells were blocked to enable their unhindered differentiation within tumour tissue, the study found.

‘We need to stop the effects of prostaglandin E2 - either by preventing tumours from producing the molecule or by making immune cells resistant to it,’ the researchers said.

motility, intestinal mucosal integrity, and circadian rhythm regulation.

Lead researcher Dr Leticia Camargo Tavares, a Postdoctoral Fellow at the Hypertension Research Laboratory within Monash University, said while the study did not conclusively pinpoint specific genes and mechanisms, the findings provide novel insights into IBS pathophysiology, highlighting potential therapeutic targets.

The researchers found a remarkable link between IBS predisposition and various cardiovascular ailments, encompassing hypertension, ischemic heart disease, and angina pectoris.

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CRAZY FOR YOU Crazysocks4docs Day provides an opportunity each year for doctors to remind each other in a light-hearted way to look after themselves and each other – and that a focus on doctors’ health is long overdue.

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While there was no ‘big breakfast’ at the Adelaide Convention Centre this year, doctors and colleagues continued to select their most colourful foot attire to recognise the cause founded by Dr Geoff Toogood.

This year, AMA(SA) President Dr John Williams, Vice President A/Prof Peter Subramaniam and CEO Nicole Sykes were delighted to find that Health Minister Chris Picton and Chief Medical Officer Dr Michael Cusack had donned their craziest socks for their regular monthly meeting in Hindmarsh Square. And back in the AMA(SA) offices in Dulwich, staff also put their left and right feet in and did the hokey-pokey in their brightest, boldest hosiery.

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Passion and compassion A one-person campaign to illuminate the risks and dangers of doctors’ wellbeing is having results around the world, writes Dr Roger Sexton.

Dr Geoff Toogood is a cardiologist with the power of one.

He turned a mismatching socks incident at work in Melbourne into a movement that has spread internationally and focussed attention on the mental health of the medical profession.

I am referring of course to the annual Crazy Socks events that occurred around the country again in the first week of June. Geoff Toogood went to Royal Darwin Hospital this year with the support of Doctors’ Health SA and Doctors’ Health NT, to meet and greet medical staff and administrative staff up there.

Over the past two years, Dr Toogood has attended the two largest Australian events, here in Adelaide, each of which drew a muster of 250 to the Convention Centre. Guests included interstate panellists, hospital administrators and ministers.

Each event brings doctors together to enjoy a breakfast, to wear odd socks and make a point. The point is the primacy of a well workforce and the positive clinical impact of creating a healthy and compassionate work environment in which doctors can excel.

It is still up to us to come to work in good shape. We know that and we must, often with good professional advice, take steps to optimise our lifestyle habits and life choices.

in the

LIGHT ofTRUTH

Once we arrive at work, we need and deserve to be provided with workplaces that are safe and where the work practices are legal and humane.

Whether we are employed or self-employed, the obligation on everyone to advocate for changes and bring this to bear in our workplaces is universal.

Safe workplaces mean safety in employment and from physical injury, WH&S risks and psychological duress.

Work and training practices must not jeopardise the health of doctors through such things as denial of breaks, lack of existence needs, unpaid hours and rostering that contributes to fatigue-related clinical errors and road crashes on the way home.

I was always encouraged to work hard, with fun as the antidote. Each Crazy Socks event reminds us all to consider our own current state of health and that of our colleagues.

This must not be taken for granted. Doctors are good at not showing their distress and pretending all is well. Being an inquisitive, persistent and caring colleague can save a life.

That is what Crazy Socks, for all its colour and oddness, is about.

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Crazy Socks Founder Dr Geoff Toogood in Adelaide last year

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Motoring

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A comfortable ride Honda’s flagship SUV provides an easy afternoon on the road, writes Dr Robert Menz.

Autumn in Adelaide 2024 was magnificent (unless you’re a farmer). We had seemingly endless days of clear blue skies crisp mornings and fabulous autumn colours, especially in the Adelaide Hills. It was an ideal time to spend a few days behind the wheel of Honda’s flagship SUV, the CR-V VTiLX AWD. The CR-V has been available in Australia since 1997 and is currently the second-best selling vehicle of this size in the world, only surpassed by the ‘Oh, what a feeling’ RAV4.

When it was first released in Japan in 1995, at a time when SUVs were much less popular than now, Honda said ‘CRV’ stood for Comfortable Runabout Vehicle, although others have suggested ‘Compact Recreational Vehicle’ is more apt.

This CR-V is available in a variety of two- and fourwheel-drive configurations and with either five or seven seats. The entry level VTiX is priced at $44,600 and the top-of-the-range petrol machine from $57,000.

There is also a hybrid available for just under $60,000, only available in the 2WD, five-door format.

All the petrol cars are mechanically identical, with a 1.5 L turbo four-cylinder engine producing 140Kw and 240Nm driving through a CVT gearbox.

The Honda flagship SUV is a smart-looking vehicle with a profile not dissimilar to a number of its competitors.

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However, the front grill has a very distinctive black honeycomb pattern, which is reflected in the airconditioning vents beneath the dash. For such a popular car, it is interesting that there are only six available colours: white, black, silver, blue, dark grey (as in the test car) and red.

This machine is brimming with safety technology features consistent with the price.

However, one feature I found particularly interesting was that applying the brakes hard at speed triggers a flashing of all the indicator lights, sending a clear signal to any following vehicles.

Another great feature is Honda Connect, which allows some communication with your vehicle through a smart phone. For example, you can preset the climate control temperature, lock or unlock your car, and flash your headlights and taillights (how useful if you can’t remember where in the car park you left your car!).

If there is an accident and your airbag is activated, notification is sent directly to the Honda Connect customer care service team, which will phone you to make sure you’re safe; if there’s no answer, the team will dispatch an ambulance to your location.

This feature also meant that Honda was able to monitor my driving, in particular where I went and how quickly. (I

‘THIS MACHINE IS BRIMMING WITH SAFETY TECHNOLOGY FEATURES’

think this may only apply to media test vehicles.)

I was also impressed to find a full-size spare in the boot. This is consistent across the range of the five-seat petrol cars. The seven-seaters and the hybrid use a space-saving spare.

Suburban commuting was a breeze with the CR-V easily able to keep up with traffic. The controls were all intuitive. The touchscreen worked very well and connecting my smart phone was very simple. The leather seats were heated. The windscreen washes are built into the wipers. The only annoying issue was that the radio did not seem to work much beyond Mount Lofty. Fortunately, the phone has plenty of entertainment, including several talking books such as Chris Hammer’s Scrublands downloaded from Libby (the State Library app).

I did manage to spend Mother’s Day morning at Ukaria, one of South Australia’s national treasures. We were entertained by Sharon Grigoryan on cello and Michael Ierace on piano as the ABC Classic FM brunch program hosted by Greta Bradman was broadcast live. Then, as a special tribute to Greta‘s mother who was in the audience and was granted the first request, Greta (an opera singer as well as an ABC presenter, with a quite famous

grandfather) sang Schubert’s Ave Maria accompanied by her cohost Russel Torrance on piano. What a treat - and made all the more special by the amazing location. This was followed later in the day by a trip to the newly re-opened West Beach Surf Life Saving club for a father-daughter dinner.

The next day there was no trouble fitting my bike into the back of the Honda for the drive to Stirling for my monthly Hills bike ride. The 581L boot capacity expands to more than 1600L with the rear seats down.

The Hills really were alive with wonderful autumnal colours.

After an excellent coffee at the Uraidla bakery, we took a detour into the Mount Lofty Botanic Garden specifically to visit the Chris Steele-Scott Pavilion.

In summary, a week behind the wheel certainly demonstrated to me how far Honda has come in developing its ‘comfortable recreational vehicle’. The standard five-year unlimited kilometre warranty has been extended to eight years for an end-of-financial-year special.

Car supplied by Honda Australia.

Dr Robert Menz is a GP and enthusiastic motorist.

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VALE

Dr John ‘Fred’ ‘Ted’ Eugene Gilligan 1936 – 2024

A LIFE SO FULL 60

D

r John Eugene Gilligan was renowned for his work in retrievals and critical care medicine. He was the driving force behind critical care transport in South Australia, leading to the establishment of MedSTAR. Dr Gilligan was known to his wife and family as Ted, as Dad to his children, and as Fred to his medical colleagues.

His daughter, Sarah, writes that he was a man with a life so full that he needed three names to manage it all. And yet he always made time for people – both at home and at work.

His colleague, Dr Bill Griggs, notes that consideration and genuine interest in others were constant features of Dr Gilligan’s interactions with those around him.

Dr Gilligan identified in the 1970s that sick and injured people at country hospitals often did not survive the trip to Adelaide. In the early days he would find himself in unfamiliar environments with limited resources. He applied himself to the unchartered challenges of remote country clinics and hospitals, dealing with victims trapped in vehicles, sometimes upside down and in inclement weather, and at worksite accidents. None of this was taught at medical school in those days, so Dr Gilligan had to work it out for himself and then teach others.

He was always prepared for anything, once producing a laryngoscope and endotracheal tube from his pocket to assist in an impromptu resuscitation when he observed a

person collapse in the crowd at Adelaide Oval. He usually had a biro in his pocket in case an emergency tracheotomy was needed – TV-style.

Dr Gilligan was an innovator. As Dr Griggs explained, on one occasion when an asthma patient was not responding to conventional treatment, Dr Gilligan revived an old remedy in the form of medical ether. While this method had been discontinued for a range of reasons, including fire risk, he found an old anaesthetic machine and put the patient on it, keeping her and the machine in the ICU admission bay where it would be away from other patients. This successfully turned the tide.

He was widely revered as a teacher and, in his last years in and out of the Royal Adelaide Hospital (RAH), many former students and colleagues expressed their gratitude for the impact he had had on their careers.

As one tribute observed, ‘he had a very friendly manner when it came to educating others - and did not make people feel too nervous to learn’.

Dr Gilligan’s wife, Jan, told the family, ‘all the nurses would run around shutting the bed curtains in the emergency department to stop Dad checking their patients when they knew Dad was walking through’. He may have created more work, but he saved a lot of lives on his way to the car park.

John Eugene Gilligan was born to Kapunda couple Jack and Bridget on 17 December 1936. He was the youngest

‘HE WAS ALWAYS PREPARED FOR ANYTHING’

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of three boys by 10 years. His son Simon says he grew up in Hindmarsh among the brickworks and clay pug holes and learned to play piano, – often accompanying his elder brother Arthur who was a high-profile Irish dancer.

He went to Rostrevor College where he developed an academic ability and was inspired to study medicine after being taught anatomy from a St John Ambulance first aid book. He studied at Adelaide Uni and in his first year after graduation diagnosed his father, Jack, with leukaemia.

Jack died a year later.

He met and married Jan in 1962. They spent 62 years together and they had three children: Sarah, Chris and Simon. Jan says Sarah was one of his ‘secret weapons’, providing unwavering love and energy and enabling him to tackle what needed to be done.

His other weapon was the ability to power-nap at any time – particularly handy as he often spent all night in ICU. Nonetheless, the kids found him to be a very present father, typically racing home between crises for dinner or breakfast as ‘family dad’ and supporting them in their endeavours.

As well as receiving many awards, creating new systems

and processes in emergency medicine, and saving lives, his children recall that Dr Gilligan created a wonderland to grow up in on the edge of bush. The Gilligans lived in a beautiful warm inviting home with nature, music, adventure and community.

‘I think his calmness, generosity, temperament and drive to help people are what made him so special,’ Simon says.

Like many who excel in crises, Dr Gilligan was calm and analytical and had a great sense of fun. He loved a party and was a great dancer. The word would get around RAH staff at the Austral Hotel in the early ’90s, ‘Dr Gilligan is here, and he’s buying jugs’.

Dr Griggs reports many tributes on a paramedic Facebook page. ‘A great man whose contribution to Ambulance and Emergency Health Care in our state and beyond is immeasurable. A lesser place without his presence. He was not only brilliant, but immensely decent and generous of spirit,’ was just one of them.

‘A genuine hero in my eyes,’ commented another colleague. ‘Saved countless lives; a privilege to have known him.’

He died on 13 May 2024.

- With help from Sarah Gilligan, Simon Gilligan and Dr Bill Griggs

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VALE

Dr Firoze Mancherji Narielvala 1929 – 2024

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Firoze Narielvala was born on 10 December 1929 in Bombay, India. He died in Sydney on 16 April 2024.

Firoze’s formative years, secondary and tertiary education were completed in Calcutta. His journey into the medical profession commenced at Calcutta Medical College. He obtained his MBBS in 1952 at the tender age of 23.

Venturing to the UK in 1955 for postgraduate studies in medicine, he returned to India with double MRCP degrees in 1958, eschewing a PhD to serve his homeland.

The tenure in Edinburgh ignited a passion for academia, inspired by integrated clinical teachings in gastroenterology.

Firoze’s teaching zeal flourished at Vellore Medical School, where he ascended to associate professorship, revolutionising the pass rates of final MBBS examinations and nurturing future luminaries in medicine. He was appointed Professor of Medicine at Benares Hindu University Medical College, where he established the curriculum for clinical years of medicine. He moved to Mumbai in 1967 to be the Professor of Medicine at the prestigious GS Medical and King Edward Memorial Hospital.

His unwavering commitment to honesty, integrity, and principles led to professional challenges, prompting his decision to migrate to Australia in search of a fresh start. Despite initial hurdles, Firoze’s expertise was eventually recognised in Australia, leading to his appointment as a General Physician at the Repatriation General Hospital in Daw Park. He worked tirelessly to earn the trust, loyalty and appreciation of many veterans.

Firoze’s migration to Australia and employment opportunities in Sydney and The Repatriation Hospital, Adelaide, were assisted by Sir Edward Dunlop, whom he had met in London and during a previous trip to Australia.

Firoze’s dedication to teaching was exemplary. He believed in the importance of instilling traditional methods of medical practice, emphasising the significance of thorough history-taking and clinical examination over reliance on costly investigations. He put into practice the integrated teaching methods he observed at Edinburgh by involving pharmacists and

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social workers in his ward rounds.

Firoze’s legacy lives on through the countless medical students he influenced. Throughout his career, he touched the lives of many, supporting, mentoring and nurturing the talents of young gastroenterologists. During his tenure at the Repatriation General Hospital he was also honoured to be appointed Senior Visiting Physician at the Flinders Medical Centre and Senior Lecturer at Flinders University.

He established the Gastroenterology Unit at the Repatriation General Hospital in 1982. Firoze was a visionary: even though his department was relatively small he introduced several new tools and technologies in endoscopy, placing his department at the forefront of the South Australian public system.

In appreciation of his dedication to gastroenterology services at the Repatriation General Hospital, the Endoscopy Suite was named in his memory when he retired in 1994.

In 2020, Firoze was honoured to receive life membership of the AMA from the South Australian branch for 50 years of service to the organisation, the medical profession and his patients.

Firoze’s multi-faceted persona extended beyond medicine. His love for Western classical music, global exploration and fascination with luxury cars mirrored his zest for life.

His mastery in computing in his later years underscored his adaptability and curiosity, and with failing vision in his later years he embraced novel technology to sustain his passion for reading.

Above all, Firoze cherished his family: his daughter Yasmin, son-in-law Nathan and grandsons Xavier and Ollie.

His death, following his beloved wife Manda’s departure a year prior, leaves a void in the hearts of those who knew him.

Dr Firoze Narielvala’s life epitomised dedication, resilience, humility and pursuit of excellence.

- Dr Sathananthan, Dr Hugh Harley, Dr Anil Utturkar, pharmacist David Cosh and gastroenterology nurse practitioner Joylene Morcom (retired)

My association with Firoze began in 1979, when I joined the medical team at the Repatriation General Hospital as staff radiologist.

Firoze asked whether I could conduct a weekly Xray review meeting for him with his medical trainees and students. I agreed, and so began an educational trip that lasted over 30 years.

While Firoze was principally a specialist gastroenterologist, his work at RGH at that time involved many general medical patients, requiring a broad knowledge of many specialty areas. He was an avid reader of medical literature, not limited to his own field. I recall numerous occasions during our meetings when there would be robust discussions with other specialists about patient management and treatment, during which Firoze always demonstrated his grasp of recent developments and treatments in other fields of medicine.

The Xray review meetings offered numerous educational opportunities.

Firoze used the meetings to quiz trainees and students and to educate them in his established methods of history taking and clinical examination. He frequently said that careful and detailed history taking from the patient was 80% of diagnosis.

His classical approach to medical practice did not prevent him from exploring the latest diagnostic trends; within his own field he introduced new technology and methods, placing the RGH gastroenterology department at the forefront within the South Australian public hospital system.

In his discussions with trainees and students, Firoze consistently demonstrated his vast medical knowledge together with his personal humility and humanity towards his patients.

Many graduating doctors regarded his educational methods and standards as the best they had experienced.

In his letter to the RGH administration when he retired, Firoze declared his privilege at having been a member of a medical team in a hospital with a unique character and a special culture. He had personally contributed greatly to that culture in which the medical team provided ‘a particularly high standard of patient care with good and unrivalled balance of humane and scientific medicine’.

- Dr Russell Morcom

For a common goal Dr Noel Hutchins 1935 – 2024

When Dr Noel Hutchins moved to Port Pirie with his young family in 1962 to join a two-person practice, he joined a culture of collaboration, which he loved.

It was this credo of working together for a common goal that underpinned Noel’s career as a country GP, country locum, AMA(SA) member of 58 years and Life Member, and member of the Royal Australian College of General Practitioners (RACGP).

It also inspired him to establish domiciliary care in Port Pirie, to be the divisional surgeon for St John’s, and to work with young people on the Young Adult Council, earning certificates of merit from the Port Pirie Regional Council.

Noel’s widow, Maureen, recalls that with only five doctors in town (two two-doctor practices and a solo practice) doing everything from emergencies, locums, deliveries, and palliative care, the clinicians needed a team-based approach.

The doctors regularly met to discuss appropriate treatment for difficult cases rather than sending them to Adelaide specialists and they collaborated on clinical professional development.

Even doctors’ wives were part of the team; their role was to stay home between 5 pm and 9 am every day to monitor after-hours calls for the practice and work as receptionists.

It was demanding work for the whole family, but the Hutchins family loved it, says Maureen. It was a community life filled with service, family, good friends, and sport.

It was a leap of faith and a stroke of luck that had led Noel and Maureen and their young family to Port Pirie after Noel met the man who would become his business partner, Dr Hammill, when Noel was working at the Repat Hospital and Dr Hammill was an inpatient.

Noel liked the idea of practising in the country. He had grown up in Gawler when it was a country town before moving to Adelaide to study at Kings College and Adelaide University. He graduated as a doctor in

December 1959 – a year after he and Maureen married.

Dr Hammill offered him a place in Port Pirie, where he stayed for 32 years, eventually building a new practice adjacent to the family home.

Then, as now, GP appointments were scarce – to the point where there was a two-week wait for appointments. Noel decided only same-day appointments could be made, prioritising the sick. The town’s doctors worked together though to provide overnight and weekend locums.

Noel was always available and became somewhat of a local identity, hosting a regular program with a Lutheran pastor and Catholic priest on local television. The three would meet at Noel’s house beforehand to plan the show, notionally about ‘life’, and would traditionally canvass everything but the content for the show.

‘I used to have to come out with the milk money to give them the signal that it was time for bed,’ Maureen recalls.

The life suited Noel, she says, who was not one for ‘sitting around’. He loved his garden and doing things with his five children but was always keen to take on a community project or an adventure. In 1978 this adventurous spirit took him to Antarctica, where he spent a year as a doctor at the Casey Station – a life dream.

It left a significant hole when he ‘semi-retired’ to Adelaide to embark on a peripatetic existence doing country locums as far away as Rockhampton.

‘He always wanted to do country locums because he said it was so often difficult to get them,’ says Maureen.

The biggest challenge he faced in working across the country was the variability of computer systems between practices – sometimes forcing him to resort to a pen and paper. The couple enjoyed a full and varied life, travelling around Australia in the caravan and to the UK for conferences.

Noel died at the Queen Elizabeth Hospital at the age of 88, after a brief illness – as briskly and efficiently as he had lived his life. He leaves Maureen and their five children – Merridee, John, Mark, Paul and Craig – 12 grandchildren and five great grandchildren.

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Member Benefits

BIG, BOLD AND RED Shiraz? Syrah? Which is it?

Shiraz (which is essentially syrah) is a dark-skinned grape grown throughout the world and used primarily to produce powerful red wines.

It is called ‘syrah’ in its country of origin, France, as well as in the rest of Europe, Argentina, Chile, New Zealand, Uruguay and most of the United States. The name ‘shiraz’ became popular for this grape variety in Australia, where it has long been established as the most grown darkskinned variety. In Australia it was also commonly called Hermitage until the late 1980s, but since that name is also a French-protected designation of origin, this naming practice caused a problem in some export markets and was dropped. The name Shiraz for this grape variety is also commonly used in South Africa and Canada.

It seems many of the legends of syrah’s origins come from one of its many synonyms - shiraz. Since there also is a city in Iran called Shiraz, where the famous Shirazi wine was produced, some legends have claimed that the syrah grape originated in Shiraz, and was brought to Rhône, which would make ‘syrah’ a local French synonym and ‘shiraz’ the proper name of the variety. Whatever you call it, it is one of the world’s most renowned grapes for making Big Bold Red Wine.

The syrah grape was introduced into Australia in 1832

by James Busby, an immigrant who brought vine clippings from Europe with him, and it is almost invariably called ‘shiraz’. Today it is Australia’s most popular red grape but it has not always been in such favour; in the 1970s, white wine was so popular that growers were ripping out unprofitable shiraz and grenache vineyards, even those with very old vines.

Many factors, including the success of brands like Lindeman’s (part of Foster’s Group) and Jacob’s Creek in the UK, as well as Rosemount in the US and UK, were responsible for a dramatic expansion of plantings during the 1980s and 1990s; a similar trajectory occurred in California. However, the biggest factor in this expansion during the 1990s was a federal government tax subsidy to those planting new vineyards.

Shiraz is now the most planted variety in Australia. Australia thus has the world’s second-largest plantations of syrah/shiraz, after France. Victorian regions include Heathcote, roughly 1.5 hours north of Melbourne. Cooler climate regions such as Western Australia’s Margaret River produce shiraz with marginally less alcohol content and often in a more traditional French style.

An excellent example of Australian made, French influenced wine-making. For more recommendations contact Phil Manser at winedirect phil.manser@winedirect. com.au

AMA SA MEMBERS

SPECIAL

DEALS!

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Dispatches 2024 NATIONAL CONFERENCE The 2024 AMA National Conference, AMA24, on the Gold Coast in August offers a program of issues of concern to all AMA members and opportunities to meet and greet colleagues from across the country.

It will be staged from 2 to 4 August and include presentations from Olympian Dr Jana Pittman and ‘scientific futurist’ A/Prof Catherine Ball.

The election of the AMA President will be held on the afternoon of Sunday 3 August.

Registration details are available at the AMA24 conference page.

2024 AMA(SA) COUNCIL MEETINGS The next meetings of AMA(SA) Council will be held on Thursday 22 August and Thursday 19 September 2024. There is no meeting in July.

Members may attend Council meetings as observers. If you are a member and wish to attend a future meeting, please contact Suzanne Roberts at suzanne.roberts@amasa.org. au or on 8361 0109.

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EXECUTIVE BOARD VACANCIES Vacancies exist on the AMA(SA) Executive Board for Ordinary Directors.

For more information about requirements and eligibility for nominating, please see page 8.

The Executive Board is also seeking an Independent Director with financial expertise. This position will be advertised on the Australian Institute of Company Directors portal and shared on LinkedIn. You may also contact Suzanne Roberts at suzanne.roberts@amasa.org. au or on 8361 0109.

ACCESSING YOUR MEMBER BENEFITS 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, download your tax receipts and make changes to payment details. If you have forgotten your password, you can reset it here.

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.

President’s Rural Tour 2024

Limestone Coast Please join Rural GP and AMA(SA) President Dr John Williams as he visits the Riverland for the purpose of personally engaging with his colleagues, to share insights and challenges in regional healthcare today.

The Barn, Mount Gambier Thursday 29th of August 2024 6.15pm for a 6.30pm start Non Members $99pp | Members $45pp

Includes: Two course dinner and drinks

2 hours CPD Accredited Educational Training Dr Roger Sexton AM The HighPerforming Rural GP Tim Hall Avant - support for Regional Doctors and Practices

Rachel White Australian Medical CPD Standard. Medical Board of Australia updates to 2023/24 CPD Programs.

What are the changes, and who they impact!

Q&A Panel Discussion An opportunity to engage with Dr John Williams and our speakers

Book now trybooking.com/CSECO

Hamilton House Plastic Surgery RICHARD HAMILTON MBBS, FRACS, Plastic Surgeon, wishes to notify colleagues that his private clinic Hamilton House Day Surgery is fully accredited under the rigorous Australian National Standards (NSQHS) for health care facilities and also

by QUAD A (American Association for Accreditation of Ambulatory Surgery Facilities, inc.) (www.quada.org).

Richard Hamilton continues to practise Plastic and Reconstructive Surgery at Hamilton House; 470 Goodwood Road, Cumberland Park, with special interests in skin cancer excision and reconstruction, hand surgery and general surgery.

He also welcomes patients considering cosmetic surgery, who now by government regulation, require a referral from their General Practitioner.

A “See and Treat” service is also available for urgent skin cancer patients and patients travelling from rural areas, with convenient, free, unlimited car parking at the premises.

Richard also consults fortnightly at Morphett Vale, and monthly at Penola and Victor Harbor. He is available for telephone advice to GPs on 8272 6666, and readily accepts emergency plastic and hand surgery referrals.

Referrals can be faxed to 8373 3853 or admin@hamiltonhouse.com.au For all appointments phone Richard’s friendly staff at Hamilton House on 8272 6666 www.hamiltonhouse.com.au

e v i s u l Exc MEMBERS RECEIVE

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AMA is the sole leading advocate representing doctors from all specialties.

Join AMA(SA) to play a crucial role in shaping a healthcare landscape prioritising the well-being of both medical practitioners and the South Australian population.

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Including networking events and committee participation, access to AMA fee guidelines, subscriptions to the MJA and medicSA, and an upcoming mentorship program.

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Join us and use your voice to strengthen ours. *Membership fees are tax deductible.