A President’s perspective

The Gala Ball in May will mark the end of Dr Michelle Atchison’s term as President of AMA(SA). Here, she reflects on a period of challenges and crisis - and incredible teamwork.

As I write this, there are a very few weeks remaining in which I can introduce myself as ‘President of the AMA in South Australia’. It is astounding how quickly my two-year term has passed, and I will vacate the chair knowing much was achieved – and there is much for my successor to address.

As I’ve said many times in the past 20 or so months, there really is no way of knowing what it is like to be the President of the Australian Medical Association in South Australia. In my experience, there is nothing like it. And you can’t know what ‘it’ is until you’re there.

When I was elected President in May 2021, I had on my CV terms as President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in South Australia, Vice President of AMA(SA) and Chair of the AMA(SA) Council. I thought I knew what intense advocacy looked and felt like. But as President. I became the face and voice of an organisation with the enormously responsible role of translating and influencing government policy so South Australia’s doctors are best able to do their jobs and support their patients and communities. I went from needing to know a little bit about everything in psychiatry to needing to know a little bit about ALL of medicine, including ‘superior’ skills in COVID.

And I was in a unique position where governments, media and the public turn to us, with me as that face and voice, for the knowledge and advice to help the people of this state with some of the most serious issues in their lives.

That much I knew, or could predict. What I couldn’t predict until I sat in the President’s office was how the trust in our voice translates to a volume of work that is both challenging and extremely rewarding.

Of course, the timing of my presidency was impeccable. COVID. Ramping. GPs and Medicare. Everyone turned to us for help, guidance, information and answers. Sometimes the answers aren’t palatable to one or more of our audiences. But I’ve learned to keep sending the same message and to keep chipping away.

During my four years as Vice President and President, the landscape in which we practise medicine has been transformed. But while many aspects of the care we have provided has changed during the pandemic, there is much that holds true in the practice of medicine. The knowledge and training that prepares us to be doctors continues to increase and develop, thanks to colleagues here and around the world. The human body and mind, to which we apply our knowledge, have changed little over thousands of years. But the toll has been and is heavy.

In the first year of my presidency, the AMA federally and at state level were vocal in our efforts to protect specialists in private practice, to push for telehealth and electronic prescribing, to seek adequate compensation for providing COVID care, and to support doctors in training and medical students. We sought regular meetings with government and urged them to ‘follow the science’ – and in South Australia we were fortunate that for nearly two years, this largely occurred. We reinforced that by prioritising health care, the economy would be better placed to recover. We advocated for general practice to lead the vaccination drive, and helped our patients understand what vaccinations they should receive and when. We helped doctors understand exposure protocols and testing procedures. We held regular webinars for our members to keep them up to date with the many changes to their practice. We called for urgent, easily available stocks of PPE to be provided to doctors on the COVID frontline. Towards the end of 2021, the wrecking ball hit again with the Omicron variant. As the world has been forced to adapt, so have we.

COVID-19 was not the only issue on my agenda. During 2021, AMA(SA) worked closely with the Rural Doctors Association of South Australia to negotiate for working conditions for rural doctors that adequately recognise the time and commitment they give to the patients and communities that rely on their care.

In late October 2021, we visited members and colleagues in the South East, and heard first-hand of the challenges the hospitals and practices face in attracting and retaining GPs and organising specialist appointments. I believe it is important for future presidents to continue these rural visits, it is too easy to be city-centric in our work and advocacy.

That trip coincided with the announcement on 26 October that South Australia’s borders would open to the eastern states,. And we have been battling the challenges of wave after wave in the 16 months since.

While case numbers increased exponentially in early 2022, we – along with politicians and voters – prepared for the election in March. It became obvious that health, and particularly ramping, was the key issue of that election. Yet despite the commitments that – along with the impacts of the border opening - possibly swayed voters to elect the Malinauskas Labor Party into office, there is little evidence the health system is in any major way any better off.

In relation to COVID, for example, the past year has been characterised by a political approach that has been a shrug of the shoulders. Politicians talk of COVID being ‘over’ – despite case numbers in the thousands and many deaths recorded every week. Road statistics remain in the headlines, but COVID data rates barely an occasional reference in the media.

Otherwise, the past few months have also been dominated by major issues that threatened, and may continue to threaten, doctors’ livelihoods and their capacity to practise. With Dr Williams and AMA(SA) Committee of General Practice Chair Dr Bridget Sawyer, we have argued vehemently against ‘scope creep’ – particularly pharmacy prescribing of UTI medication in South

Australia. In this, we have been able to draw on the campaigns of interstate AMA colleagues, as we have in supporting our members against any introduction of payroll tax for specialist contractors in private practice. These battles are not over.

We are also taking every opportunity to inform politicians and the media of the dangers of vaping. As I write this, we are awaiting the tabling in parliament of a Bill to ‘regulate’ the sale of vaping products, and are explaining to members of parliament the evidence indicating that the sale of vaping products must be limited to those for whom other methods to stop smoking have been unsuccessful.

While some issues have required intense but brief focus and responses, others have remained ‘on my desk’ throughout my presidency. COVID is, of course, one of these; looking back from where we are, with the impacts of the virus still very much with us the pandemic appears as series of health care crises within one mountainous emergency. Issues such as finding suitable PPE and planning how we physically manage patients within our clinics and rooms have largely been overcome. But then there are those issues that continue to plague us: for example, concerns related to vaccinations, where to find them, who should and must have them, and overcoming hesitancy; responses, even among clinicians, to Long COVID symptoms and care; and how we can be best prepared for the next wave, or the one after that, any of which could be caused by a variant worse than any we’ve seen.

The status of rural health services is another unsolved problem that has continued through my presidency. The increased reliance on locums, the generational loss of rural GPs (as seen recently in the South East), the lack of access to both GP and non-GP specialists in regional areas, and the loss of maternity services are among the features of a real crisis in rural health across the state.

Back in the city, AMA(SA) has commented on plans and designs for the new Women’s and Children’s Hospital (WCH) many times over the past two years. As mentioned to the Select Committee on Health Services earlier this month, we must have a hospital that is fit-for-purpose for generations – and at the same time we must be able to provide world-class care, at the existing WCH until the new one is built.

The importance of hospitals such as the WCH and their role as teaching hospitals was pointed out when the WCH lost accreditation in some of its departments late last year. We must be able to train tomorrow’s doctors – which means providing them and their supervisors with ‘quarantined’ research and training time, even when the system is crashing around us.

We also have given advice to policy makers to ensure proposed Termination of Pregnancy and Voluntary Assisted Dying legislation meets the needs of South Australians and their doctors. These legislative reforms have enormous ramifications for South Australians, and we have reinforced to the relevant government and SA Health representatives the need to provide access to treatment emanating from them to all South Australians, as safely and effectively as possible.

Meanwhile, AMA(SA) has continued to plan for an economically sustainable future. After consultation with AMA(SA) Council, the Executive Board decided to sell AMA House, and we look forward to investing the capital to benefit members of today and tomorrow. I have also advocated for a climate sustainable AMA and began discussions, along with Doctors for the Environment representatives, about developing a Sustainability Unit within SA Health.

Leaving the presidency is bittersweet. I feel am now across most of the health issues South Australia and the AMA are facing, and it’s time to depart. I have been so impressed by how our opinions and advice are valued, and I truly believe we give the best evidence-based guidance we can – guidance that is also based on the wisdom of those around me. Thank you to everyone who has supported me.