Ever wondered where the phrase ‘now we’re cooking with gas’ comes from? It dates back to the 1930s when gas industry experts wrote the line for comedian Bob Hope to use in radio sketches. The line also managed to work its way into Jack Benny comedy routines in the ‘40s and later into Daffy Duck cartoons.
It was an advertising sleight of hand that imprinted the idea that cooking with gas was progressive and efficient at a time when most people were transitioning from woodfuelled stoves.
Now my kids say it whenever they lace up a new pair of sneakers or witness me rev the car to overtake someone on the road.
NSW
The Australian Medical Association (NSW) Limited ACN 000 001 614 Street address
69 Christie Street ST LEONARDS NSW 2065
Mailing address PO Box 121, ST LEONARDS NSW 1590 Telephone (02) 9439 8822
Outside Sydney Telephone 1800 813 423 Facsimile (02) 9438 3760
Outside Sydney Facsimile 1300 889 017 Email enquiries@amansw.com.au Website www.amansw.com.au
The NSW Doctor is the bi-monthly publication of the Australian Medical Association (NSW) Limited.
The phrase is as ubiquitous as it is insidious.
The thing is – cooking with gas is bad for you. Gas stoves produce unsafe levels of carbon monoxide and nitrogen dioxide that contribute to 12% of childhood asthma cases.
But my kids don’t know that. And it will take many years of public health messaging to reverse a marketing catchphrase that originated almost 90 years ago.
Public health campaigns always seem to be one step behind Big Companies when it comes to educating the public about products that cause poor health. However, it’s not an impossible task and it’s one that will be made easier the sooner
Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor. The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA.
Executive Officers 2019-2022
President Dr Michael Bonning
Vice President Dr Kathryn Austin
Chair of Council Dr Brian Fernandes
Chair, Hospital Practice Committee Dr Andrew Zuschmann
Chair, Professional Issues Committee Dr Kean-Seng Lim
Board Member Dr Costa Boyages
Board Member Dr Amandeep Hansa
DIT Representative Dr Sanjay Hettige
products are recognised as harmful and awareness is raised.
This is the battle Australia also faces with e-cigarettes, which we discuss on p10. And while Big Tobacco is utilising every tool at its disposal to position e-cigarettes as fun! Colourful! And harmless! it’s the job of health professionals to educate their young patients about vaping and the risk to their health.
Andrea Cornish, Editor
Secretariat
Chief Executive Officer Fiona Davies
Director, Services Kerry Evripidou Director, Workplace Relations Dominique Egan
Editor
Andrea Cornish andrea.cornish@amansw.com.au
Staff Writer
Sophie Taylor sophie.taylor@amansw.com.au
Designer Gilly Bibb gilly.bibb@amansw.com.au
Advertising enquiries
Julia Arellano Julia.Arellano@amansw.com.au
The Premier has called on the Commonwealth to protect primary care but is ignoring other levers it could pull to ensure the sustainability of general practice.
So, while these are valuable aims, the State leaders also have an opportunity to support general practice by tackling State-based threats – and are failing to act.
AMA (NSW)’s repeated calls for the State to grant a payroll tax exemption to medical practices has, to date, fallen on deaf ears.
readily access care from another practitioner at their regular practice if their regular practitioner is on leave or otherwise unavailable.
The Premier is contributing directly to the collapse in general practice by refusing to act on payroll tax.
DR MICHAEL BONNING PRESIDENT, AMA (NSW)THE UPCOMING National Cabinet meeting is expected to focus on general practice and primary care reform. Weeks ahead of this meeting, the NSW and Victorian Premiers banded together to call on the Albanese Government to increase Medicare rebates and provide greater transparency around bulk billing.
In early January, Premier Dominic Perrottet told media: “This isn’t about a fight with the Commonwealth Government on money; this is about working together to provide better health services.”
Medicare rebates have failed to keep pace with inflation for several years and the AMA has been at the forefront of calls to increase the rebate. We also support transparency on bulk billing rates.
Meetings and letters to the Treasurer, Premier, Health Minister and Regional Health Minister, as well as discussions with the NSW Revenue Office – none of this has resulted in an exemption that would alleviate pressure on already struggling practices.
Payroll tax is a greedy state tax that effectively punishes practices for pursuing models of care that Federal Government has been encouraging doctors to adopt.
Over the last two decades, regulatory bodies, professional and accreditation bodies, and governments have all encouraged medical practitioners to move away from models of solo medical practice. In general practice, practitioners are rewarded for doing so in the form of incentive payments.
Practitioners conducting their medical practice from a common location is seen as beneficial for patients and for practitioners. It also ensures there is professional support available to medical practitioners, and patients benefit from the opportunity for colleagues to confer with one another, and they also benefit by being able to
The other opportunity the State has at its disposal to support general practice is to address scope of practice. The NSW Government’s plan to expand pharmacist prescribing undermines general practice and the provision of quality care.
We support clinician-led teambased care with the doctor at the centre and know access is important. That’s why GPs have been at the forefront of adapting to new technology. Telehealth has transformed healthcare and should continue to do so.
However, healthcare access should not come at the expense of derailing a well-established, safe and rigorous system, that separates prescribing from dispensing.
So, whilst we appreciate the Premier telling the Federal Government what it can do to support general practice, we suggest that it behoves the State to also take some action dr.
Recognised for their experience and expertise, our over 300-strong* medical defence law team provides members with on-the-ground support across Australia.
Members have access to our medico-legal experts, 24/7 in emergencies, risk advisers and a comprehensive library of online medico-legal resources.
Interns should be proud they are joining a profession that has such a profound and important impact on people’s lives and it’s up to the profession to stand up to attacks that would suggest otherwise
CEO Fiona Davies
IN JANUARY, we welcome interns as the newest members of the medical profession. While many aspects of internship have changed for the better, the fundamentals remain the same. Internship is the gateway through which the next generation of doctors gain the wisdom, skills, and expertise of those who have come before them.
Every year, I get to speak at Orientation sessions across the State and I always start by saying what I believe, which is that they have joined the most exceptional profession, a profession in which they will have the chance to change not only the lives of the patient in front of them but influence the lives of hundreds, if not thousands of people. I remind them that doctors are respected, trusted and influential.
However, this may not feel as true today as it once was. As we discuss in this edition, it feels like doctors are under attack. Undermining trust and respect in doctors is not only distressing for medical professionals, it has real-life implications – as we can see from events in the UK.
As an Association, we have been vigilant in defending the profession, in standing up when the profession is attacked. As doctors, we want everyone to be considerate of the profession and equally defensive.
One of the most concerning aspects of these events is ‘othering,’ in which certain segments of the profession are called out and demonised. High profile doctors,
cosmetic doctors, those who have billed Medicare inappropriately. In some instances, those doctors have done the wrong thing and have brought the profession into disrepute. However, the overall tactic of othering – of “well, not you of course, but them,” undermines the whole. The most recent example of this was the suggestion in the HSU attacks that they were targeting locums, not doctors. While this claim is false in any event, the move to start “othering” locums is further evidence of the insidious nature of this campaign. Doctors locum for many reasons: burnout, desire to support rural communities, flexibility, and because we have an industrial system that allows for modern terms and conditions if you are a locum, but not if you live and work in a community.
We can’t control what others say about the profession, but we can control how we respond and how we stand together. This is why I will be encouraging our newest members to stand together and to be proud of the profession they are now part of. dr.
fiona.davies@amansw.com.au
@FionaDavies8 www.facebook.com/amansw
Once lauded as protagonists during the pandemic, recent media reports paint a poor picture of the profession. Has public opinion of doctors shifted?
REMEMBER THE 7pm cheer? People in cities around the world would stand on their balconies clapping, yelling, blowing horns, and banging pots and pans – a sonic salute to the men and women saving lives while risking their own as they worked on the frontlines of healthcare.
If the medical profession had a popularity meter, that might have been the peak.
Two years on, after borders reopened, case numbers dropped,
and self-isolation rules were scrapped, public sentiment appears to have changed. By October 2022, the once saints were now sinners.
For weeks, stories emerged of doctors defrauding the system. Dr Margaret Faux claimed her PhD into Medicare billing uncovered rorting to the tune of $8bn – an allegation that was immediately rejected by the AMA and later refuted by senior health officials before a Senate Estimates hearing in Canberra a month later. Health officials highlighted that while the PhD examined potential noncompliance, it was of a much smaller estimate, and was attributed to issues such as complex Medicare requirements.
“So, the narrative in the media is quite different to what is actually in the PhD, Senator,” said a senior official in response to questions by opposition health spokeswoman Senator Anne Ruston.
But the damage was done – not only in the minds of patients, but also to practitioners.
Senator Ruston told the inquiry she had heard the media allegations had a “significant impact” on medical practitioners, especially general practitioners, and the Department committed to investigating this issue further and reporting back to the Committee.
Meanwhile AMA President Professor Stephen Robson acknowledged, “this trial by media has led to increased doctor distress at a time when the profession is
under continued pressure. What has been completely overlooked is the incredible amount of unpaid work doctors do due to the underfunding of Medicare, and the immense benefit this goodwill provides to the community and the health system.”
And then came the attacks from within the health profession. The Health Services Union launched a campaign calling for a Royal Commission into the NSW Health Budget and featured ads depicting a doctor pocketing wads of cash and driving away in an expensive car.
AMA (NSW) President, Dr Michael Bonning responded publicly to the attacks calling the HSU’s insinuation that doctors are getting rich while patients suffer as “disgusting and unjust.”
“The campaign undermines public confidence in all health services by attacking doctors and questioning their commitment to patient care,” he said.
“Healthcare professionals should be on the same team – not fighting for scraps from the Government. This outrageous campaign pits healthcare workers against each other and does more harm than good.
“We fully support all frontline workers in their campaign to receive a fair wage, but these tactics are completely disingenuous.”
While media beat-ups and socalled ‘greedy doctors’ stories do surface occasionally, the timing of these attacks left many medical professionals feeling particularly wounded.
After the sacrifices many health professionals made during COVID, “it was like a slap in the face,” said Dr Rajiv Rattan, a radiologist who has been working in health for almost three decades.
He added, “The currency of healthcare is trust – reports like this erode that significantly.”
Dr Jill Gordon, who co-authored the article “Doctors on Status and Respect: A Qualitative Study” was less worried by the recent reports and pointed out that surveys continue to find health professionals rate “at the top of the tree for respect from the public.”
The Governance Institute of Australia published its Ethics Index 2022 in November and did find the health sector was rated among the ‘most ethical’.
Governance Institute CEO Megan Motto stated that in the Ethics Index 2022, ‘Your doctor’ (GP) scored 70, tied for first place with pharmacists for the most ethical profession in Australia, but noted that public trust in GPs has dropped 9 points since 2020.
The Governance Institute also found 2022 results show a downward trend in trust overall.
“The softening in ethical scores since the beginning of the pandemic is consistent with a decline in ethical perceptions across all sectors (except charities) and is indicative of a change in mood in our society, as we look beyond COVID-19 and concentrate on other challenges facing our society,” Ms Motto said.
GPs’ ethics scores may have dipped in the years since 2020; however, the occupation consistently ranks in the top five, revealing Australians feel GPs behave ethically, particularly their own.
This ethics perception is mirrored across the health sector. Findings from The Ethics Index 2022 revealed the health sector has the smallest gap (11 points) between the perceived importance of ethical behaviour (76) and their actual ethical behaviour (65) scores.
“The COVID-19 pandemic – and the highly ethical responses of frontline workers and society at large – raised our ethical perceptions, but as the COVID-19 pandemic dragged on and fatigue set in, these perceptions in society began to slide,” Ms Motto said.
A BMJ study from 2002 reflects the idea that respect for doctors does dip on the back of negative publicity, but it’s likely to rebound.
It cited annual polls on ‘most respected professions’ and found doctors’ ratings dropped in Australia three percentage points in 2000 from the previous year and rebounded again the following survey. These findings were generally in line with similar studies in other countries.
In Dr Gordon’s opinion, the recent attacks were unlikely to deter people from choosing medicine as a career or force some out of the profession.
“There are far more powerful factors, such as the poor remuneration for GPs and the unnecessary complexities of Medicare.”
On that front, the AMA has long advocated for changes to Medicare and is continuing its Modernise Medicare campaign, which calls on Government to address the urgent need for reform and investment in Australia’s general practices. The plan is focused on ‘more care,’ ‘more time’ and ‘more health.’
We hope this resonates with Government and just as importantly with patients – ultimately leading to ‘more trust.’ dr.
Bubble gum and blueberry ice – how Big Tobacco is using lax laws to target a new generation (and what medical professionals can do about it).
IT’S A SATURDAY night on a sunny December evening and throngs of young people are gathered in Manly Beach, Sydney. In between drinking cocktails on an outdoor deck and eating plates of food, diners take out slim looking devices that look like highlighters and smell like fruit. In less than five seconds, the vape is back in their pockets and no one – certainly not the busy servers – bat an eye.
Like other tobacco products, the use of e-cigarettes is prohibited in smoke-free areas, such as commercial outdoor dining areas. However, unlike cigarettes – which emit a pungent and distasteful smell – no one seems to notice or
even mind that diners around them are inhaling nicotine from these devices.
The difference in reaction quite possibly speaks to the public perception of vaping.
“There is a view among young people that because it’s vapour, that it’s just water,” said Carolyn Murray, Director of Public Health at NSW Health. “What we know is that the majority of vapes that we see have nicotine in them and also contain chemicals which are harmful and can have large, long impacts.”
While there has been a decline in cigarette smoking rates among young people 16 to 24 years, there
has been significant and dramatic increase in e-cigarette use among young people in this age demographic.
In 2019/2020, 1 in 5 in this age group reporting using e-cigarettes, by the following year this had risen to 1 on 3.
Why are e-cigarettes so popular?
E-cigarettes are battery operated devices that heat a liquid to produce a vapour when inhaled. The design of these devices has changed dramatically to appeal to new users. In 2019, new generation compact disposable e-cigarettes entered the market in NSW.
These devices contain anywhere
from 300 to 10,000 ‘puffs’ and high concentrations of nicotine.
These disposable devices are easy to use and come in a variety of colours and flavours. They are small enough to conceal in a pocket and could be easily confused with a highlighter or a USB stick. Flavours include watermelon ice, blue raspberry, energy drink, passionfruit mango, cola lemon soda, to name a few. One online shop advertises the ‘Dinner Lady Disposable Vape’ – which is a very sleek vape pen that is “ideal for new and experienced vapers alike.”
A Generation Vape study, which looked at vaping product access and use among 14- to 17-yearolds in NSW found teenagers are readily accessing and using illegal, flavoured, disposable vaping products that contain nicotine.
Among the 700 teens surveyed, 32% had ever vaped, at least a few puffs. Of these, more than half (54%) had never previously smoked.
Of the teens who had ever vaped and reported the type of device they used, 86% had used a disposable vape. Disposable vapes don’t require re-filling (unlike tankstyle devices) and are activated by inhaling on the mouthpiece.
In addition to being easy to use, they are easy to access.
Disposable vapes containing nicotine can only be legally sold in Australia by pharmacies to adult users with a valid prescription. And it’s illegal to sell vapes containing nicotine as well as those purporting to be ‘nicotine free’ to under 18s in Australia.
Despite this, teens are finding ways to get their hands on them. The Generation Vape study found almost two-thirds (70%) didn’t directly buy the last vape they used. The vast majority (80%) are obtaining these from friends. Of
the 30% who did buy their own vape, almost half (49%) bought it from a friend or another individual and 31% bought it from a retailer – commonly a petrol station, convenience store or a tobacco shop. Teenagers are also sourcing vapes from online sites and social media platforms such as Snapchat, where people advertise ‘Vape drops.’
They are sold at retail shops for $20 to $30 and can be sourced online for $5.
In the Generation Vape study, more than half (53%) of the teens who had ever vaped said they had used a vape containing nicotine, while 27% were unsure whether they had used a vape containing nicotine.
Even vapes claiming to be nicotine-free have been found to contain nicotine. The TGA tested nicotine vaping products and found of the 214 products recently tested, 190 contained nicotine. Disposable vapes can have
high concentrations of nicotine. Unlike cigarettes which contain free base nicotine, manufacturers use nicotine salts which allows for higher concentrations of nicotine without causing throat irritation to the user.
The Australian National University published a key evidence report Electronic cigarettes and health outcomes: systemic review of global evidence (Banks et al. 2022), which found that the use of e-cigarettes can be harmful to health, particularly non-smokers and young people, and when used for purposes other than smoking cessation. While the impact of e-cigarettes on cancer, cardiovascular disease and mental illness are yet to be established, it is known that there are hundreds of chemicals in e-cigarettes including formaldehyde, heavy metals, solvents, and volatile organic compounds, in addition to nicotine which is highly addictive and can change the structure and function of developing brains in young people.
Vapes are now manufactured to deliver nicotine deep into the user’s lungs, which allows the nicotine to quickly get into the bloodstream and go straight to the brain –much faster than a cigarette, where it interacts with nicotinic acetylcholine receptors.
Other harmful impacts include seizures, nicotine poisoning and E-Cigarette Associated Lung Injury.
One teaspoon of liquid nicotine can cause irreversible damage or death to a child. NSW Poisons helpline reported that in 2021, more than 170 children in NSW were exposed to nicotine after puffing on a vape – including a four-week-old baby. Three out of four calls to the helpline concerned children aged between one and four. This was triple the number of calls made about children under the age of 15 in the previous year. Children often pick up the vapes, which are brightly coloured and attractive, and mimic the actions of their parents.
E-cigarettes are also a gateway to smoking tobacco. Non-smokers who vape are three times as likely to take up regular smoking as non-
smokers who don’t vape.
Not only are e-cigarettes harmful to humans, but they are also harmful to the environment – designed with single use plastics and lithium batteries, they contribute to pollution.
The evidence that e-cigarettes are effective smoking cessation tools is limited.
E-cigarettes are a tobacco issue – studies reveal that those who use e-cigarettes are three times more likely to go on to tobacco smoking.
What can doctors do? NSW Health’s Ms Murray recommends health professionals familiarise themselves with the resources on the NSW Health website.
“The materials are designed for use by teachers, parents and young people and they provide a lot of current information for medical professionals to use in their discussions with young people.”
She also suggests that general practitioners broach the subject of vaping with patients who are under 18.
“It might be around what they
Similar to a nebuliser, which is highly effective in delivering medicine to your lungs, vapes are designed to allow nicotine and other chemicals to penetrate deep into the lungs. More than 200 chemicals have been detected in e-cigarettes, such as acetone (used in paint thinner), acetaldehyde and acrolein. Other common substances include:
• Diacetyl: a buttery-tasting food additive that is used to complement and deepen e-cigarette flavours. It is known to damage small passageways in the lungs. (see Popcorn Lung)
• Formaldehyde: a toxic chemical that is also used in fertiliser and pesticides – it can cause lung disease and contribute to heart disease.
• Acrolein: Often used as a weed
killer, this chemical can also damage lungs.
Reference :
Broderick, S. What Does Vaping Do To Your Lungs, Johns Hopkins Medicine, Accessed 13.12.22, https://www. hopkinsmedicine.org/health/ wellness-and-prevention/ what-does-vaping-do-toyour-lungs.
are seeing at school, checking in whether they are being offered vapes, helping them find the language to say no to vaping and just being clear around what the evidence is showing us – because that is what young people ask us for.”
The AMA’s Federal Council passed the following resolution in December 2022:
The AMA demands enhanced regulatory measures to curb the proliferation of recreational nonnicotine vaping products, which include, but are not limited to:
• Implementing similar regulation to tobacco products, such as health warnings, better labelling, plain packaging and tobacco licences.
• A targeted Federal response to monitor and act on illegal advertising and promotion of vaping products, particularly online and on social media.
• Better enforcement of existing State and Territory regulation to help block illegal vape sales both online and through shopfronts.
The AMA had also previously called for the following measures:
• reducing the concentration limit from 100mg/ml to 20mg/ml, and introducing limits on the flavours and volume of nicotine that can be prescribed or ordered,
• banning the importation of nicotine vaping products through the Personal Importation Scheme,
• adding Nicotine Vaping Products to Real Time Prescription Monitoring programs,
• restricting the use of Medicare smoking cessation items to a patient’s usual doctor, consistent with previous advice provided by the AMA. dr.
Popcorn lung, or bronchiolitis obliterans (BO), is a rare condition that results from damage to the lungs’ airways. It was originally discovered after popcorn factory workers were getting sick from breathing in a food additive, diacetyl, which was used to simulate butter flavour in microwave popcorn. Inhaling diacetyl causes inflammation which can lead to permanent scarring in the branches of the airways, which makes breathing difficult. There is no treatment.
This additive is also added to e-cigarettes to enhance the flavour.
Lipoid pneumonia develops when fatty acids enter the lungs. Vaping-related lipoid pneumonia results from inhaling oily substances found in e-liquid, which causes an inflammatory response in the lungs. Symptoms include chronic cough, shortness of breath, coughing up blood or blood-tinged mucus.
Also known as a collapsed lung, this occurs when oxygen escapes through a hole in the lung. It can result from an injury such as a gunshot or when air blisters on top of the lungs rupture and create tiny tears.
Vaping is associated with an increased risk of bursting these blisters, leading to lung collapse.
It has not been established that vaping causes lung cancer as vaping products have not been around long enough to prove there is a link.
Reference : Broderick, S. What Does Vaping Do To Your Lungs, Johns Hopkins Medicine, Accessed 13.12.22, https://www. hopkinsmedicine.org/health/wellness-and-prevention/whatdoes-vaping-do-to-your-lungs.
Recent decisions have raised concerns that a broader interpretation of payroll tax will mean more medical practices will be liable for payroll tax. How did we get here?
Payroll tax is governed by the Payroll Tax Act (2007) (‘Act’). Under s32 of the Act, payroll tax may be payable if there is a ‘relevant contract’ in place for services in a financial year, and if those services/ related wages are obtained and paid ‘for or in relation to the performance of work.’ This test is very broad. However, there are key exceptions to payroll tax set out in section 32(2) of the Act.
public by consulting patients at different locations or working in a hospital may apply for this exception.
PAYROLL TAX liability has been a prevalent issue for medical practices for some time. A medical practice will be liable for payroll tax if its payroll exceeds a threshold of $1.2 million in a financial year. Recent case law has made it clear that payroll is not just payable on employees but may also be payable on ‘contractor’ doctors. Revenue NSW may consider a contract to be a ‘relevant contract’ for the purposes of the Payroll Tax Act (2007), and their wages will count towards a practice’s overall payroll liability.
If an exception applies, then the contract is not a ‘relevant contract’ for the purposes of the Act and payroll tax does not apply. Key exceptions that may be relevant in a medical context are:
(a) Where a practitioner has worked in the practice for less than 90 days in a financial year; or
(b) The services are performed by a practitioner who ‘ordinarily performs services of that kind to the public generally in that financial year.’ For example, a medical practitioner that provides services to the general
Historically, if a medical practice had independent contractors working at their premises, no payroll tax was payable on monies paid to them. This was turned on its head in Commissioner of State Revenue v Optical Superstore Pty Ltd [2019] VSCA 197 and Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2021] NSWCATAD 259. Here we focus on Thomas and Naaz.
• Thomas and Naaz (the applicants) were directors operating multiple medical centres.
• Doctors entered into written agreements to use rooms, access shared services, and see patients.
• Patients did not pay the doctors directly, but assigned their medical benefits to the doctors, and the applicant submitted the benefits to Medicare. The
applicant then retained 30% as a service fee, and the remaining 70% was remitted to the doctors.
• Revenue NSW considered these doctors were employees and issued notices of assessment for five years including the 70% remitted to the doctors, amounting to over $795,000. Further penalties of 30% and interest were applied.
The applicants objected on two grounds.
First, on the basis that they were not relevant contracts under the Act.
Secondly, they argued that even if they were relevant contracts, an exception should apply, specifically the s 32(2)(b)(iv) exemption that a large proportion of the doctors were providing services to the public each year. The doctors were “free to provide medical services and other clinics, and many of them do so.”
Evidence provided to support this included:
• a spreadsheet listing doctors who provided medical services at other practices;
• printings including details of income earned by those doctors; and
• letters of practice letterhead detailing where they consulted and details such as ABN.
The Commissioner rejected their objection, and Thomas and Naaz subsequently applied to the NSW Civil and Administrative Tribunal (NCAT) to review the objection decision. NCAT upheld the NSW Revenue assessments, including the application of penalties and interest. In their view, the contracts were relevant contracts, and no exemptions applied.
The contracts were ‘relevant contracts’ within the meaning of s32 of the Act as:
• the doctors were not just providing services to the patients but also the practice and its goodwill – factors contributing to this were that the doctors worked on a roster, had an obligation to promote practice interests and were subject to a restrictive covenant; and
• the contracts were clearly ‘for or in relation to the performance of work,’ with a clear reasoning for this being the payment arrangement, providing a clearly indirect relationship.
In terms of whether an exemption applied, NCAT found that the evidence was not sufficient to negate their findings and prove that the doctor’s earnings were not relevant for payroll tax.
Thomas and Naaz appealed the decision, contending that NCAT incorrectly applied section 32 and 35 of the Act, however NCAT reaffirmed its decision (Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2022] NSWCATAP 220).
The appeal means that the Thomas and Naaz decision (and Optical Superstore) are still applicable law, and if a medical practice cannot establish that the doctors working in their practice are independent contractors, the money paid to them may be deemed wages for payroll tax purposes and will contribute to the practice’s overall liability. If a practice exceeds the threshold of $1.2 million in payroll for a financial year, they will be liable to pay 5.45% in payroll tax for all monies exceeding that threshold.
Consequently, the Court may take a broad view of what constitutes a
‘relevant contract’ and can apply this to contractors. It is important to be aware of the specifics of your contractor agreement and whether certain provisions indicate a doctor may be an employee, such as dictating leave entitlements.
If attempting to rely on exemptions, particularly the 90 day or providing services to the public exemptions, clear records should be kept that indicate the number of days a doctor has worked in a financial year, and written evidence should be kept showing they also work elsewhere.
All agreements with contracting doctors (and other allied health) should be reviewed and advice sought from accountants or lawyers. Revenue NSW did indicate that it would issue a Practice Note providing guidance about its approach; however, that has not been forthcoming, and we recommend that advice be sought now from accountants and / or lawyers regarding contracting arrangements. dr.
Contributed by Romy Sirtes, Solicitor and Scott Chapman, Partner at HWL Ebsworth.
Developments in payroll tax in recent years have made it clear that contracts with contractor doctors may be deemed a ‘relevant contract’ under legislation, and money paid to the contracted doctor may qualify as ‘wages’ for the purpose of payroll tax, with payroll tax payable.
Medical practices should:
• review their arrangements;
• be aware of their potential liability; and
• consider whether changes need to be made.
Several changes have been made to requirements for CPD for medical practitioners this year. It’s time to select your CPD home.
THE MEDICAL BOARD of Australia has amended the requirements for Continuing Professional Development (CPD) for medical practitioners.
The new Registration Standard which applies from 1 January 2023 provides that medical practitioners must:
• Complete a minimum of 50 hours of CPD activities per year,
• Complete a yearly written Professional Development Plan, and
• Join a “CPD Home” by 1 January 2024.
What is a CPD Home?
A CPD Home is an organisation that is accredited by the Medical Board of Australia’s accreditation authority, the Australian Medical Council (the AMC), to provide CPD programs for medical practitioners. A CPD Home may be an education provider, another organisation with a primary educational purpose
or an organisation with a primary purpose other than education. All AMC-accredited specialist medical colleges will be CPD Homes.
What is a Professional Development Plan?
A Professional Development Plan is a written plan that outlines a medical practitioner’s learning goals relevant to their current and intended scope of practice and how they will achieve their goals. It consists of self-evaluation and reflection on learning goals and progress made in the CPD cycle, as well as the planned CPD activities to achieve learning goals in the current year. CPD homes may provide you with PDP templates or structures to construct your plans and the specific requirements around PDPs may differ slightly with each home.
What changes have been made? The changes to the Registration
Standard are designed to assist medical practitioners to maintain professional currency and support their ongoing development through progressing personal and professional qualities necessary to their scope of practice. CPD Homes will assist medical practitioners to tailor CPD to their learning needs and instill a sense of confidence in the community to know that doctors are consistently improving their practice in an ever-changing field.
The CPD homes will be created and accredited in 2022 and 2023 with a grace period of a year for doctors to join a CPD home by 1 January 2024.
What does this mean for medical practitioners in 2023?
• Medical practitioners must complete a CPD program of an accredited CPD home or for doctors who have not selected their CPD home for 2023, continue
their self-directed CPD under the existing 2016 CPD standard.
• For medical practitioners with specialist registration, their specialty College may be their CPD home or they can join another CPD home that is relevant to their scope of practice and meet its CPD requirements, the self-directed CPD they have been doing and find a CPD Home that offers CPD Programs relevant to their scope of practice.
Medical practitioners with more than one specialty or scope of practice are required to meet the CPD registration standard in each of their specialties or scopes of practice. If possible, practitioners can complete their CPD within a single CPD Home; however, if this is not possible, practitioners may need to partake in more than one program.
• Medical practitioners with general registration (no specialist registration) should continue the self-directed CPD they have been doing and find a CPD Home that offers CPD Programs relevant to their scope of practice.
• For doctors-in-training PGY3+, if they are in a specialist training program, their CPD requirements are covered by their training. If they are not in a specialist training program, they should undertake self-directed CPD and find a CPD Home that offers CPD Programs relevant to their scope of practice.
• For international medical graduates
- With limited registration in the specialist pathway: their College will be their CPD Home and the College CPD Program will meet their CPD requirements;
- With limited registration not in the specialist pathway: continue current arrangements and find a CPD Home that offers CPD programs relevant to their scope
of practice;
- With provisional registration and not in an accredited intern position: continue current arrangements and find a CPD Home that offers CPD programs relevant to their scope of practice.
The Registration Standard does not apply to:
• Medical students
• Doctors-in-training who are in their intern or postgraduate year 2 positions participating in a structured program or accredited intern program
• Medical practitioners who have limited registration in the public interest or limited registration for teaching or research who have been granted registration for no more than four weeks
• Medical practitioners who are granted an exemption or variation from this standard by their CPD home
• Medical practitioners with nonpractising registration
What are the CPD requirements under the new Standard? Medical practitioners must complete a minimum of 50 hours of CPD each calendar year and distribute these across three different CPD activities. The CPD must be relevant to their scope of practice, and it is important to note that doctors will need to meet the specific requirements of their individual CPD homes which may differ slightly. The CPD activity time requirements are as follows:
• Education activities: minimum of 12.5 hours annually
• Reviewing performance and measuring outcomes: minimum of 25 hours annually, with a minimum of five hours in each category
• The remaining 12.5 hours can
be allocated to any type of CPD activity of the doctor’s choosing.
Each CPD home will publish guidelines and examples of the types of activities that will constitute CPD.
Medical practitioners will have to selfevaluate their CPD activity at the end of each year as they prepare their Professional Development Plan for the next year and retain records of their annual CPD activity for audit by their CPD Home and the Board. Records must be kept for three years after the end of each year.
dr. Contributed by Dominique Egan, Director of Workplace Relations and Kristin Kendrick-Little, Paralegal
If you have any questions about how the changes apply to you, please contact the AMA (NSW) Workplace Relations team at workplace@amansw.com.au or on +61 2 9439 8822.
Support and guidance whenever you need it, from the experts in medical indemnity insurance. For assistance call our friendly team on 1800 777 156 or visit www.miga.com.au
Changes to family and domestic violence leave will take place this year. What will it mean for your private practice?
behaviour by an employee’s close relative, a current or former intimate partner, or a member of their household that both seeks to coerce or control the employee and causes them harm or fear.
• Up until an employee becomes eligible for the 10 days of paid family and domestic violence leave, they will still have access to their current entitlement of five days of unpaid leave.
AMA (NSW) SENIOR WORKPLACE RELATIONS ADVISOR
PROGRESS WITH respect to family and domestic violence leave has seen the Labor Government follow through with its promise to legislate paid family and domestic violence leave for all workers through the National Employment Standards. Currently the existing entitlement sits at five days of unpaid leave for all employees.
On 1 February 2023, and 1 August 2023 for small businesses (less than 15 employees), this entitlement will increase to 10 days of paid leave for all full-time, parttime, and casual employees under the Fair Work system.
• The legislation defines family and domestic violence as violent, threatening, or other abusive
• Employees will have access to 10 days of paid family and domestic violence leave each calendar year, with the leave renewing on their work anniversary. This leave will not roll over or accumulate if it is not taken.
• The leave will be available for those who need to deal with the impact of family and domestic violence, and they are unable to do this outside of their current working hours. Examples of reasons an employee might be eligible to access this type of leave include to make arrangements for their own safety or the safety of a close relative, attend court hearings, access police services, or attend appointments such as counselling, medical, financial, or legal.
• For full-time and part-time employees, the payment for the leave is to be worked out based on their ordinary rate of pay for the hours they would have worked if they were not on leave for those days. For a casual
employee, they are to be paid their ordinary rate of pay for the hours they were or would have been rostered to work during that period if they hadn’t taken the leave.
• Employers are allowed to ask their employee for notice and evidence when they access this new leave entitlement, and this will work much the same way as when an employee takes personal / carer’s leave. An employee needs to let you know as soon as possible when they are taking a period of family and domestic violence leave. However, given the nature of this leave it may sometimes be after the leave has commenced.
• When you are asking an employee for evidence that they are entitled to access a period of family and domestic violence leave, you can only use this information to satisfy yourself of the entitlement. This information needs to be kept confidential unless the employee consents to disclosure, or you are required to deal with the information by law, or the employee or another person’s life, health or safety are in danger.
• Pay slips cannot disclose an amount paid to an employee is a payment for paid family and domestic violence leave, the period of leave that has been taken or the family and domestic leave balance. This is to protect the employee’s safety. dr.
Practices have a responsibility to keep patients’ healthcare information safe. Here are a few tips to strengthen your cyber security.
IN RECENT MONTHS, several highprofile cyberattacks, such as those suffered by Optus and Medibank, has drawn greater attention to cyber security, particularly when it comes to healthcare information.
In NSW, all private health service providers must comply with both Federal and State privacy laws when handling health information. This legislation includes:
MELANIE FAYAD
AMA (NSW) WORKPLACE RELATIONS ADVISOR (LEGAL &POLICY)
Changes to the way medical practices manage information, such as migration to cloud based technologies, have made health information more vulnerable to security breaches. In fact, for the 2021-22 financial year, the Australian Cyber Security Centre (ACSC) reported that, aside from government sectors, the healthcare and social assistance sectors reported the highest number of cyber security incidents.
Cyber security breaches can cause financial loss, reputational damage, and possible legal liability, all of which can be devastating for a medical practice where privacy is key to the doctor-patient relationship. According to ACSC, the average financial loss for a small business per reported cybercrime incident was $39,000 in 2021-22. This figure does not capture the cost to customers or patients, nor the capital and recurring costs of cyber security incident remediation, nor the reputational damage suffered.
We know cyberattacks are on the rise – up by 13% in 2021-22 from the previous financial year (ACSC). So, what are medical practices required to do to protect health information and what steps can be taken to manage the risk of a cyber security incident?
• The Privacy Act 1988 (Cth) (“Privacy Act”), which outlines 13 Australian Privacy Principles (“APPs”) that regulate the handling of personal information by APP entities, which includes private health service providers.
• The Health Records Information Privacy Act 2002 (NSW) (“HRIP Act”), which outlines 16 Health Privacy Principles (“HPPs”) that govern the handling of private health information.
With respect to security of personal information, both the APPs and HPPs state that health service providers must take ‘reasonable’ steps to protect the information from misuse, interference, and loss, as well as unauthorised access, use, modification or disclosure.
To understand what steps are ‘reasonable’ for APP entities to secure personal information, the Office of the Australian Information Commissioner (OAIC) has developed a ‘Guide to Securing Personal Information’ (“Guide”). Although the Guide is not legally binding, the OAIC will refer to the Guide in investigating and assessing whether an entity has complied with its personal information security obligations.
In the event personal health information is compromised,
health service providers are required under the Privacy Act to notify individuals and the OAIC of ‘eligible’ data breaches. A data breach is ‘eligible’ if it is likely to result in serious harm to any of the individuals to whom the information relates.
There are a few steps you may consider taking to strengthen your practice’s cyber security.
1.
Promote a culture of cyber security awareness through appropriate training, resourcing, governance, and management. Cyber security is no longer isolated to the control of IT specialists but is a shared responsibility amongst all members of the practice.
Personal information, privacy and security should be an integrated component of the business and should be reviewed regularly and reinforced as technology advances.
Limit internal access to health information only to those staff members who require access to do their job.
Appropriate authentication should be used to gain access to networks, systems and the information within it. This should include the use of complex passwords and passphrases for each authorised individual (no sharing of login details) and, where possible, two-factor authentication for additional protection. Importantly, all staff should log off software and systems at the end of each day.
As the sharing of health information is now often done by electronic means, strategies should be implemented to ensure such information is shared securely. For example, email is not a secure form of communication and additional security measures should be put in place to protect this information from cyberattacks including, but not limited to, password protecting files attached to emails, encrypting emails and/ or attachments, and using secure file-sharing services to link to secure files.
Third-party software is commonly used in medical practice to optimise practice and clinical processes, to transfer and communicate health information and, more recently, for electronic prescription exchange. The use of this third-party software can expose a practice’s networks and systems to cyberattacks, so it is important to ensure it is secure by using antivirus software and updating software when required. Your IT provider should be able to assist with this.
In the event of a cyberattack or breach of personal information, ensure the practice has a response plan that is understood by all staff. This plan should outline the procedures and line of authority for containing the breach or attack, reporting details of the incident, managing the practice’s response, and accessing IT and legal advice when required. AMA (NSW) can assist you with a Data Incident/ Breach Report Form template if
required. It is also important to ensure that frequent and off-site backups are kept of all critical information and systems, should a cyberattack prevent access to the practice’s systems and files. dr.
The information provided in this article is necessarily general in nature and should not be regarded or relied upon as legal or IT advice.
Should you require advice and support regarding risk management strategies for your practice, please contact the AMA (NSW) Workplace Relations Team at workplace@amansw. com.au or +61 2 9439 8822.
What happens when a community is denied access to general practice? Dr Sue Velovski argues that if the Government’s failure to support Lismore health providers is a social experiment, then the results are in.
MOST OF US BORN after 1970 in Australia do not know life without the privilege of universal healthcare – the ability to see a doctor irrespective of our financial status.
Our healthcare system ranks as one of the best in the world and is praised by the citizens of many other countries… even Presidents. I recall being at a conference in San Francisco in 2011, when the then President Barack Obama spoke to a group of Aussies about our experience of healthcare.
I was fortunate to be born in this country, a first generation Australian. This allowed me access to free healthcare and the ability to complete public high school, and with the benefit of scholarships, complete university. In a world
where one-fifth of all girls are denied an education, this is not something to be taken for granted.
My parents had immigrated from the former Yugoslavia as children. One of six kids, my dad came on his own as a teenager, while my mother came when she was 14, emigrating with her family from Macedonia in the 1960s.
In three months upon arriving in Australia, mum learnt to speak fluent English. She became the unofficial interpreter for many Macedonian immigrants in Newcastle and beyond.
In the 1970s, my parents married and settled in Newcastle where they continued to help those in need in of a translator.
Consequently, as a child I would spend many afternoons after school sitting in little chairs in corridors at Royal Newcastle Hospital with my twin brother doing our homework, whilst Mum and Dad attended various clinics with their friends, work mates and family. I would watch the young doctors come in and out of consulting rooms, call out names, and wonder what happened behind closed doors. I would see patients in gynaecology clinics, surgical clinics and even patients admitted to hospital. Some happy patients, some scared, and some sad. Trips to GP practices were different, however; we were allowed to sit in the doctor’s office. The ‘family physician’ knew all of the patients’ families and would ask about them by name… he would even ask about us.
Why do I recall this now? Because I have never lived a life without a GP in Australia. Because my community has never been without a GP.
And even when I’ve travelled or lived in other parts of Australia, my family physician has always been
there to keep me healthy and safe. My family doctor provided health checks, vaccinations, shared in the ups and downs of my schooling, my university training, and then my medical school life. My family doctor was also there throughout my parents’ health journey – the good, the bad… they helped with it all.
So, what would life be without a GP? I have never had to ponder that question… until now.
When Lismore sustained two life threatening and damaging floods in the space of 28 days in February 2022, never would I have thought that our community would still be looking for help and answers from our elected leaders almost a year later.
Most Australians would be aware of the impact of the floods, the loss of homes and of jobs and job security, and the financial strain. But perhaps many are unaware of the anxiety and constant concern we face in trying to get through the next day, week, month.
And like everyone else in the community, our rural and regional GPs face similar stressors. Many are affected by personal loss, the loss of their medical practices, and the loss of their ability to work, on top of the increased pressure to see and treat their long-standing patients, as well as new ones.
What happens when a patient with high blood pressure or irregular heartbeat who usually sees “Dr Jo” in Lismore for their medications cannot not do so? Days, weeks, months later, they
develop the complications of not seeing their GP – mini strokes, vision loss, heart attacks. They end up in a State-funded hospital for major interventions, which may or may not restore the better life they had before they developed these complications.
What happens when a patient with diabetes in Lismore cannot see “Dr Lisa” for their regular diabetes checks? High blood sugar, changes in vision, car accidents, increased risk of foot ulcers, infections, amputations, strokes and heart attack. They end up in a state-funded hospital for major interventions, which may or may not restore the better life they had- before they developed these complications.
What happens when a patient was booked in eight weeks ago with “Dr Liz” in Lismore for a skin check but rings to say that a new skin cancer has grown rapidly from 1cm on the arm to 4cm? Dr Liz schedules the patient for an emergency GP visit, but soon realises this cancer is now well beyond being treated in her GP clinic. “Dr Liz” rings her local on call specialist surgeon and is advised that there is a three-month wait. The emergency surgeon recognises how dire situation is and has no other choice but to bring the patient to hospital. The patient ends up in a state-funded hospital for major interventions, which may or may not restore the better life they had.
When happens when a patient cannot see their GP for their regular bowel screen? Months pass, then
“So, what would life be without a GP? I have never had to ponder that question… until now.”
bleeding, constipation, abdominal pain and then vomiting. They end up in a state-funded hospital for major interventions, which may or may not restore the better life they had.
What happens when a community surviving a natural disaster cannot clean their houses or get help from their long-time insurance companies? Like good hardworking stoic citizens, these community members do it themselves.
The consequences being work injuries, falls from scaffolding, lead poisoning, anxiety, depression, and a feeling of hopelessness.
Not just adults, but young people as well are facing increased mental health issues. Many young teenagers did or will be doing their HSC from caravans. How can these young men and women possibly compete with the rest of their peers to reach the goals they held before February 28, 2022? Should their future be determined by their postcode and Mother Nature’s rampage on that area?
What happens when all of these patients who face complications because they were unable to see their GP end up in state-funded hospitals? The hospital system gets overloaded and cannot provide high quality, safe care. Bed block, overcrowding in emergency departments, lack of beds for cancer surgery, delayed surgeries, expensive surgical and oncological treatment, increased numbers of patients experiencing physical and mental breakdown, doctor burnout – all of which could have been avoided if our patients had only been able to see their family GP.
In my not so long life, I have experienced and lived through earthquakes, cyclones, bushfires, and now floods.
In response to other natural disasters, the recovery started
quickly and occurred rapidly.
But the response to floods has been different. Lismore is still not “in recovery”.
We cannot change what has happened to Lismore in the last 12 months. But we must make changes so that that no other community in NSW or Australia experiences the same lack of access to their general practitioners and specialist services due consequences of a natural disaster.
The Commonwealth and the State must take responsibility, which at this point neither level of Government appears willing to do so.
The inaction of leaders on this matter defies Article 25 of the Universal Declaration of Human Rights that we, as Australians, hold so close to our hearts – that people have a right to medical care. That we boast to former Presidents about… Resolving this issue would save our Commonwealth and State Governments money, not increase it.
We need a coordinated response from State and Commonwealth Health Departments, so that no other community in Australia experiences the social injustices of natural disasters, and the social injustices of the inability to see our GPs when we need primary care… care that keeps patients out of hospital, and keeps residents healthy.
We cannot leave our communities with the belief that our elected leaders do not care. As a first-generation Australian who has benefited from public education, scholarships, public healthcare and now working in the public healthcare system, I cannot sit silent on the health and wellbeing of our communities. We are a nation that allows free
speech, without detriment or harm to our constituents, but for that privilege, we must speak up when it is needed, for those who feel they cannot.
We must resolve this impasse between Commonwealth and State Health leaders for our community, our patients and all those who have previously considered rural Australia a great place to work and live. These people, and these GPs, are the backbone of our communities.
If our elected leaders want to see what life is like without GPs, then Lismore is the “social experiment”.
I call on Prime Minister Albanese to put an end to the Lismore experiment and prevent it from ever happening in any part of Australia ever again. dr.
Dr Sue Velovski is a Specialist General Surgeon in Northern NSW – Lismore / Ballina. The Rural Doctors Association of Australia awarded Dr Velovski the Rural Doctor of the Year Award in 2022.
GP and former world-class cricketer Dr Olivia Magno spent 10 years working in some of Australia’s most remote communities.
OVER THE past decade, anyone asking Dr Olivia Magno about her day would be unlikely to hear her utter the word ‘relaxing’.
Take the time she stayed back late in her clinic in West Arnhem Land because she had a “very sick” patient with pneumonia.
“I just couldn’t get his blood pressure up even with fluids, so we did an ECG and troponin. He was infarcting and septic, probably a type 2 because he was just so sick,” she said.
“So we’re trying to support his blood pressure, with a nurse’s help and there’s a guy sitting outside, a young 21-year-old who had just been playing footy, went to the kitchen, got some food and they said he started fitting.
“I ran outside. It wasn’t a seizure. It was death.
“He had hypoxic type of twitches, so I had to jump on his chest and
start CPR in the driveway of the clinic and yelled at the nurse to get the defib.
“We shocked him twice in the driveway, then dragged him inside and called more people in and shocked him twice more and he came back, he sat up and said, ‘get the f*** off me’ and we were so relieved, we said ‘ok great’.”
Eventually, CareFlight arrived on the scene, but they were only prepared to take the septic patient.
Dr Magno convinced them to also take the second man when she said she would accompany and look after him, while they could watch the first patient.
She flew back the next day on a charter plane, but when she returned, there was a woman in labour, giving birth to a preterm baby.
“That was an interesting weekend,” she said.
‘I
Dr Magno is reflecting on her time working in remote Aboriginal communities across the NT.
She and her partner, Elizabeth Hall, started in the coastal community of Maningrida, 500km east of Darwin in West Arnhem Land, before moving to Milingimbi Island in East Arnhem Land.
Her work then took them to Wurrumiyanga in the Tiwi Islands, followed by Gunbalanya, a town located just east of the sprawling Kakadu National Park.
Dr Magno said they loved it and had embraced the people and various cultures, considering it a “privilege” to see a part of Australia most wouldn’t.
But after 10 years, and concerned about their elderly parents in NSW, the pair decided they were done.
Dr Magno now works as a fly-in fly-out doctor for Borroloola, a NT mining town located 200km from the Queensland border.
She leaves every four weeks, returning back to her home on the NSW far north coast, just south of the Queensland border.
She says it has been much better for her mental health, as she can “cope with working hard and doing lots of overtime” knowing that it allows her to see her family more frequently.
But she said Aboriginal communities fared better when doctors lived where they worked.
“Aboriginal culture is all about learning to trust you, because their health literacy is so different,” she said.
“Especially in places like Maningrida, they don’t trust Western health, it’s all black magic and that sort of stuff.
“Getting them to take medicines to help their diabetes or heart disease is all about trust. If they don’t trust you, they’re not going to take any of the medicines you
prescribed.
“It takes a while to build that trust, at least six to 12 months. When you fly-in, fly-out, you never really get to the point where you’re part of the community, you’re just a visitor.”
A former world-class cricketer, Dr Magno became a GP because it gave the flexibility to continue playing cricket at a state and national level — and compete in two indoor cricket world cups.
But doctoring in her NSW town of Tamworth after her cricket career ended didn’t suit her.
“Being a GP five days a week, seeing a patient every 15 minutes just became really draining,” she said.
She describes her first stint in remote general practice, in Maningrida, as both “life-changing” and “eye-opening.” While the population was small, 3000, morbidity levels put it on par with a town with 10,000 people.
“It’s so busy, so many sick people with completely different diseases to what I’d seen before, such as acute rheumatic fever and poststreptococcal glomerulonephritis and melioidosis, all this stuff that you don’t see in Tamworth,” Dr Magno said.
“It was almost a vertical learning curve.”
Dr Magno added that patients would commonly be flown out as many as three or four times a day.
“People get really sick, especially in the wet season. There’d be melioidosis boils, massive cellulitis, heart attacks, snake bites, crocodile bites, box jellyfish stings, or all of the above,” she said.
“On good days, you may not have anyone or just one flown out, but on busy days, I can remember sending out five or six patients on one day, but three or four was not too unusual.”
While the challenges eventually
pushed Dr Magno into her new role, she believes rural GPs have it tougher in one regard.
“I work for the NT department, so I’m on a salary. If I was a GP, in a rural community relying on Medicare, oh my god I don’t see how they could actually have a viable business unless they were charging a private fee,” she said.
“Now with GPs resigning or doing other stuff in droves, I think it’ll be easier for us to get people remote, because there’ll be salaries; you don’t have to worry about negotiating with a patient how much they pay you.
“Even when I was in Tamworth, having those conversations was difficult because we want to provide really good value healthcare, but people don’t want to pay for it.
“I don’t want to be in that situation, I don’t have to think about money, and I can just see patients and do what I think is best for them.” dr.
Doctors’ Health NSW has provided confidential support for the medical profession for almost 50 years, but the current stresses facing doctors has made its service more important than ever.
DOCTORS ARE GENERALLY highly resilient, solutions-focused, caring, and autonomous professionals. This is how we manage the many responsibilities and demands of our training and careers and continue to provide a high standard of care to others, even during difficult times. However, as a result doctors may resist the idea of reaching out for support, even at times when it might make a huge difference. We often try to manage everything on our own, even if we are struggling with issues at work or in our personal lives, are unwell or generally feeling exhausted or overwhelmed. Intent on caring for others, doctors may also neglect aspects of self-care or preventative health measures, sadly sometimes resulting in significant negative impacts on our own health.
Often, we may not consider the value of support until the need arises, and then don’t necessarily know where to turn. If you were
worried about a health issue and it wasn’t getting any better, would you have someone to talk to? Would you confide in a friend, a partner or a close colleague? Better still, would you see your GP like “normal” people do? Do you even have a GP? But perhaps it’s not that simple…
We know that doctors face significant barriers when needing to access healthcare for themselves. As well as significant time constraints, other barriers include concerns about lack of confidentiality, fears about mandatory notification, worry about impact on career, a sense of embarrassment or failure that they are not coping or perhaps not wanting to trouble a colleague. For these reasons, the Doctors’ Health Advisory Service NSW was started by a group of concerned doctors in 1975, aiming to ensure that all doctors can safely access the care and support they need, whenever
Doctor to doctor - we understand
Confidential, independent, free support for doctors and medical students
they need it. Nearly 50 years on, it’s clear this service is needed more than ever.
Now known as Doctors’ Health NSW, our continuing purpose is to make sure doctors and medical students are able to access confidential support from another doctor at any time. Callers to this free service can remain anonymous, to combat any lingering concerns about reaching out. This trusted source of support is independent of regulatory bodies, employers and other professional institutions and is completely confidential.
The phone service is run by experienced, non-judgemental doctors, available anytime to talk to doctors, medical students, or anyone else, such as a colleague or family member, concerned about a medical practitioner.
Doctors’ Health NSW provides quick access to support from another doctor. The confidential service can be contacted 24/7, every day of every year and callers can expect a call-back from a doctor within four hours of their call. This is not an emergency service however and 000 is still the correct number for individuals needing urgent care.
Every year, Doctors’ Health NSW receives hundreds of calls from other doctors and medical students covering issues such as burnout and mental health, work-related stress, career concerns, substance abuse, medico-legal issues and complaints, impairment, exam stress, loneliness and relationship problems – nothing is too trivial or too serious. Doctors taking calls on the phone line have many years of experience, with the benefit of additional training in doctors’ health. They understand the complexities and issues specific to
the medical profession.
Doctors’ Health NSW also works with organisations within the medical profession to provide educational presentations and workshops for doctors and students, centred on supporting their own health and well-being, as well as training to assist them to look after their colleagues when required.
Doctors’ Health NSW Medical Director, Dr Kathryn Hutt, encourages everyone to keep the organisation’s contact details handy.
“You never know when you or a colleague might need a doctor to talk to – someone experienced who has time to listen and will understand your concerns, so you can work things out together.”
Doctors’ Health NSW Board Chair, Dr Ameeta Patel this sentiment.
“The last few years have seen such an increase in the stress of
my colleagues, the need for this service has never been greater and I am very pleased to be involved in the valuable service Doctors’ Health NSW provides.” Call 24/7 (02) 9437 6552 or go to doctorshealth.org.au
Doctors’ Health NSW:
• Advocates for doctors’ health and wellbeing
• Operates a free and confidential 24/7 phone service for callers to speak to a doctor
• Run by experienced GPs and other specialised medical practitioners
• A safe space to talk, independent of all regulatory and professional institutions
• Connected with a network of doctors, specialists, and other services. dr.
We know that doctors value our free and confidential service and we welcome all donations to help us keep our phone line running 24/7, every day of the year. If you would like to donate to Doctors’ Health NSW, please go to www.givenow.com.au/doctorshealthnsw or use the QR code or contact admin@dhas.org.au
Doctors’ Health NSW is a registered charity and donations over $2 are tax deductible.
Dr Lachlan McIver’s memoir Life & Death Decisions is an account of his experiences providing care in some of the most remote and neglected parts of the world.
DR LACHLAN MCIVER decided to become a doctor after his father died of a heart attack. He now specialises in rural & remote medicine, tropical medicine and public health, and did his PhD on the health impacts of climate change. Originally from Millaa Millaa in Far North Queensland, his travels have spanned almost 100 countries. He has co-authored many articles in medical journals and textbooks on topics ranging from environmental health and infectious diseases to anaesthetics and emergency medicine.
He is an adjunct Associate Professor at James Cook University in Australia and the co-founder of the international non-profit organisation Rocketship Pacific Ltd, which focuses on improving health in Pacific Island countries. He
currently lives in Switzerland, where he works as the Tropical Diseases & Planetary Health Advisor at the Geneva headquarters of Médecins Sans Frontières (Doctors Without Borders). Dr McIver’s memoir, Life and Death Decisions, provides perspectives on matters ranging from international health systems to personal grief.
What prompted you to put pen to paper?
I’ve devoted most of my career to trying to tackle complex problems like Indigenous health inequities, the health impacts of climate change and the rise of drugresistant infections. Along the way I’ve also led a pretty wild life, so I’m using stories of the latter to deliver serious messages about the former.
Does the writing process reflect advice given to you by other doctors? Would you recommend it?
I’ve definitely benefited from the guidance of other doctor-writer colleagues, and writing can be a very cathartic process, as I discovered when scribbling poetry by the light of my headtorch sitting on the floor of my mud hut in a civil war zone in a swamp in South Sudan!
It’s pretty obvious in reading your book that your career hasn’t followed a plan. Is this a ‘path’ you’d recommend to today’s junior doctors?
Strangely enough, the steps I’ve taken over the years do appear to make some sense in retrospect, but that’s more by accident than by design! I would encourage junior colleagues to keep an open mind and try to soak up the broadest possible range of experiences before making decisions about how to spend the rest of their lives and careers.
When you took a ‘break’ after fourth year of medical school, did you really think you’d go back? It was touch and go for a while there, but I think I made the right decision. I eventually found my calling within medicine and I daresay I make a better doctor than I would have been a scuba divemaster or a hostel manager in Dubrovnik.
What did you like about rural and tropical medicine that made you keep going back to remote areas of Australia?
Variety, community and adventure!
You talk of the ‘psychological shift’ necessary to accept that your patients die ‘on a near-daily basis’. Is this conscious? Is it a shift that occurs once, or repeatedly or
continuously over your career?
I imagine it’s a little different for all of us, and probably evolves over time. I find myself much more conscious of death these days, particularly given I’ve officially hit middle age.
You’ve worked with many different population groups. Which issues do you think lead to the most stigma and discrimination and impacts on health and wellbeing?
Is the situation improving?
Poverty is pernicious and racism is sadly very widespread. The former is slowly improving at a global scale, but I’m not so sure about the latter.
Your career has taken you from PNG rainforests to the Swiss Alps. What are the biggest similarities and differences between approaches to health care you’ve encountered and had to overcome? Humanity is a shared experience the world over, but one of the issues I struggle with most is inequality, particularly when it comes to the gap between rich and poor, and those who can access quality healthcare and those who can’t.
What do you consider the biggest ramifications of climate change on health – and vice versa?
It’s essential that we recognise climate change as one of the defining challenges to health in the 21st century. Both the current and previous WHO Directors General have defined it in precisely these terms, but paradoxically the level of awareness of the scale and scope of the threat is troublingly low on the part of health professionals, politicians and the public. So I’ve written a book about it!
Australia is experiencing a critical shortage of GPs. Do you have any answers?
I’m a passionate advocate for rural generalism as a specialty discipline and rural medicine as a core component of any medical school’s curriculum. The more we can expose and support our junior colleagues to and in the practice of rural generalism, the more likely they are to see the appeal and commit to the specialty. This is not just my opinion; it’s a fact supported by a wide range of evidence.
What are the most immediate impacts of climate change and the ones we could address the fastest? The health impacts of climate change are all occurring simultaneously I’m afraid, so we can’t afford to be choosy. Immediate, effective and sustained action is required to slow, halt and reverse carbon emissions and global heating if we are to reduce the expected burden of millions of avoidable deaths every year due to climate change.
You’re now in a non-clinical role. How long do you think it will be before your love of clinical work draws you back to that side of medicine?
I remain happily and actively engaged in clinical work as a rural generalist in Australia, both through the Virtual Rural Generalist Service in NSW and rural hospital locums wherever there’s a need for a rural generalist with anaesthetics skills when I’m back in the country. South Australia is one of the few states where I haven’t worked yet, so I’ll definitely be making that a priority! dr.
This article was originally published in medicSA and has been reprinted with permission.
Doctors have an important role to play in educating patients about the potential harms of heatwaves and what can be done to keep safe during extreme temperatures.
DR KIM LOO AMA (NSW) COUNCILLOR & GENERAL PRACTITIONER
More people die from heatwaves than all natural disasters combined – yet there is no portfolio in State or Federal politics with a Minister in charge of this area. It’s an issue that cuts across health, housing, urban design, industry, climate adaptation, and mitigation.
Industries who do not traditionally work together will have to. The end point is that our population can live and thrive in safe communities where they are protected from temperature extremes.
Outdoor workers, pregnant women, young children, babies, isolated people, those aged over 65 years, disabled people, and those with chronic diseases such as diabetes, obesity, heart failure, respiratory failure, and kidney failure, are all at high risk of heat stress.
As we heard towards temperatures over 40 degrees Celsius, everyone is at risk –especially if it is humid as it’s hard to cool down.
So, how do we advise people to keep them safe during heat waves? There is no unified approach within Australia as this involves different Government departments and NGOs, so it’s different in each State.
As doctors where public health advice is not present, it is incumbent on us to deliver the advice to our patients, and to the general public. This is advice I give my patients.
1. Water gardens in the morning and mulch around plants. This aides in cooling. I have planted trees over the years around my house specifically for cooling.
2. Seal all gaps in the home including windows, walls, and floorboards. This can be done with old socks or stockings.
3. Turn off all power points when not in use.
4. Create a cool room – find the coolest room in your house and use fans and air conditioners in this room.
5. Insulate the house.
6. Convert to solar energy.
1. Check the temperature for the day on the BOM website and listen to emergency warnings.
2. Check that fridges and air conditioners are working. Make sure there are ice bricks and towels in the freezer.
3. Keep out of the heat by closing your curtains or blinds inside and having awnings open outside.
4. Find a cool place to visit if you cannot cool down your house.
5. Make sure your mobile phone is charged.
6. Wear light clothing.
7. Cool down with wet/cold towels and showers.
8. Have fans and air conditioners on at around 23 degrees (not any lower to save energy).
9. Cook cool meals so you are not heating up the house.
10. Drink plenty of water even if you don’t feel that thirsty. Try to avoid tea, coffee, sweet drinks, and alcohol as this can make you more dehydrated.
11. Wear a hat or sunscreen if going outside.
12. Make sure you have an esky for any food and medications in case of a blackout.
1. Check often that children are not too hot and use the same cooling techniques for adults mentioned above.
2. Make sure when you are walking with a stroller to take the cover off so there is adequate air flow for your baby.
3. Offer children milk or water to drink. No sweet drinks as this can make dehydration worse.
4. Dress children in loose lightcoloured clothing.
5. Drink plenty of water if you are breast feeding.
6. If you go outside to a playground, make sure the play equipment is not hot as there are many playgrounds that
are made from materials that absorb heat.
1. It is important that patients over 65 years old and/or those with chronic health conditions have a plan with their GP and pharmacist for a heatwave.
2. It is crucial that there is a next of kin or friend that people can connect with and look out for them on hot days.
1. Many pets are vulnerable to heat. I have chickens and I make sure that there are multiple sources of cool and clean water, and cold food on hot days.
1. Heat waves are deadly for outdoor workers if they don’t take adequate rest breaks and rehydrate. Use the above tips and take plenty of breaks in the shade. A straw poll of my own patients working in private companies tell me there is no heat policy that guides them. This needs to change.
It’s important that our community understands the dangers of heatwaves. Heatwaves are changing and becoming more dangerous and need to be effectively communicated by the health sector as we bear the brunt of this in primary care and our already overloaded hospitals. dr.
Contributed by Dr Kim Loo, general practitioner at Riverstone Family Medical Practice, AMA (NSW) Councillor, and the NSW Chair of Doctors for the Environment. Dr Loo is a passionate advocate for the environment determinants of health.
“As doctors where public health advice is not present, it is incumbent on us to deliver the advice to our patients.”
Activists peer leadership program empowers students to become leaders and make better choices for their health.
CHILDHOOD OVERWEIGHT and obesity is a significant public health issue in Australia and is associated with higher risks for the development of cardiovascular and metabolic diseases in adulthood. Major factors for the development of overweight and obesity include energy-dense diets, physical inactivity, poor sleep, having family members who are overweight, and exposure to marketing of unhealthy foods. These factors are compounded in western Sydney by lower socio-economic status which is associated with lower education levels and a reduced awareness of what constitutes a healthy lifestyle. Schools are effective settings for promoting physical activity
and nutrition in adolescents and provide the opportunity for adolescents to improve healthrelated behaviours amongst their peers. Efforts to promote physical activity and nutrition in adolescents through school-based programs is one way to ensure that students have the opportunity to be active and gain the skills required to choose healthy foods. However, this is challenging in the absence of environments, including infrastructure, which are supportive of and important for the use of those behaviours at school, home and in the community. The SALSA Youth Voices (SYV) program aims to bridge this implementation gap by empowering high school students to design and implement
solutions. This helps to ensure a well-rounded and holistic approach.
The Students As Lifestyle Activists (SALSA) peer leadership program and the SALSA Youth Voices is supported by a unique coalition of health, education, and sport communities who are strongly invested in the promotion of health in young people in western Sydney.
The program applies a systemsbased approach to address the socio-economic determinants of health by building the capacity of students to advocate for changes in their schools and create healthy supportive environments.
SYV is an extension of the Students As LifeStyle Activists (SALSA) peer-leadership program, which is designed to motivate students to increase physical activity and healthy eating. The program applies a systemsbased approach to address the socio-economic determinants of health by building the capacity of students to advocate for changes in their schools and create healthy supportive environment.
The concept of Youth Voice is about considering the perspectives, ideas, experiences, knowledge, and actions of young people. The cornerstone of Youth Voice programs is to create leadership opportunities for all young people – especially among those from socially disadvantaged communities whose voices are not heard often enough. When young people are given a voice through school-based programs like SALSA, it makes them feel they belong, their contributions matter and they are valued. Schools that incorporate Youth Voice programs help young people develop a range of social and emotional skills that prepare them for adulthood.
In 2022, SALSA organisers held
the SYV Leadership Day workshop at the Department of Education, Parramatta. The workshop comprised of a combination of presentations, group discussions and interactive games/activities which addressed topics related to the importance of Youth Voice; identifying barriers and enablers to physical activity and healthy eating; and identifying skills required to develop a School Action Plan. Students were provided with resources to guide the planning, delivery and evaluation of their school interventions. Following smallgroup brainstorming, students presented their ideas at the end of the workshop to their peers.
Following Leadership Day, the organisation held SYV Action Day at Westmead Hospital for students to showcase their School Action Plans. At this event, students presented their proposed actions to an audience of invited health and education professionals to receive feedback and support for their ideas to improve opportunities for physical activity and/or nutrition within the school environment.
To read the full report of this story and the action plans developed by the students – look for the complete unabridged version at amansw.com.au/SALSA-2022. dr.
For more information and assistance please call one of our membership team on 02 9439 8822 or email members@amansw.com.au. Visit our websites www.amansw.com.au or www.ama.com.au
Cutcher & Neale’s expertise is built on an intimate understanding of the unique circumstances of the medical profession. Our team of medical accounting specialists are dedicated to helping you put the right structure in place now to ensure a lifetime of wealth creation and preservation.
Alfa Romeo® Program allows members to take advantage of incredible discounts across the Alfa Romeo® range. Go to www.alfaromeo.com.au/fleet or and use your Preferred Partner Login.
Doctors’ Health Fund aligns to the values of the medical profession and supports quality health care. The Fund was created by and is ultimately owned by doctors. Contact the Fund on 1800 226 126 for a quote or visit the website: www. doctorshealthfund.com.au
At Tyro, we are the champions for better business banking. We’ve grown to become the largest EFTPOS provider outside of the majors. AMA (NSW) members receive special merchant service fee rates with Tyro’s fast, integrated and reliable EFTPOS for business.
Australia’s largest independently- owned online bookstore. We stock over 650,000 items and have over 5 million titles for purchase online. Booktopia carries a wide range of medical books in stock, including textbooks that are prescribed across all medical faculties in NSW and essential texts used by doctors.
AMA Training Services offers HLT57715 Diploma of Practice Management for current and aspiring practice managers. Receive the member discount for yourself or nominated staff off the first ASP term, valued at $500. Three scholarships valued at up to $2,000 each are available for current and future students.
Members can enjoy the benefits of this Programme which includes complimentary scheduled servicing for 5 years/80,000 km, preferential pricing on selected new vehicles and reduced dealer delivery charges.
Doctor-in-training members of AMA (NSW) are covered by our accident journey insurance policy if they are injured travelling to or from work.
AMA (NSW) members can now save on Dell’s outstanding business class technology products! Through the partnership of AMA and Dell Technologies, members have access to an array of valuable benefits.
Emirates offers AMA members great discounts on airfare around the world: 8% off Flex Plus fares or flex fares on Business and Economy. 5% off Saver fares on Business and Economy class. The partnership agreement between Emirates and Qantas allows codeshare.
As an AMA (NSW) member, receive the below exclusive rates and benefits when you rent with Hertz in Australia.* 10% off the best rate of the day on weekdays and 15% off the best rate of the day on weekends.
AMA (NSW) Members can now enjoy the benefits of the Jaguar Land Rover Corporate Advantage programme, including: Free scheduled servicing for 5 years/130,000 kms, 5 Year Warranty, reduced new vehicle delivery costs, and more.
Jeep’s® Preferred Partner Program allows members to take advantage of incredible discounts across the Jeep® range. Go to www.jeep.com.au/fleet and use your Preferred Partner Login.
Make your flight experience more enjoyable with access to the Qantas Club Lounge. AMA members save on Qantas Club fees.
Lexus Members can enjoy the Lexus Corporate Program Benefits including 3 year/60,000kms complimentary scheduled servicing, reduced delivery fee, priority ordering and allocation, complimentary Service loan car & complimentary pick-up/ drop-off, Lexus DriveCare providing 24hour roadside assistance.
We’ve teamed up with our partners Samsung to give you access to incredible savings across the Samsung mobile and wearable range. Members of the Australian Medical Association are entitled to amazing offers, limited time deals and great perks through an exclusive AMA / Samsung online portal.
• Deakin Medical Precinct.
Solahart do Solar Panels, not just Solar Hot Water. We continue to build here locally in Sydney 68 years on. AMA members receive 10% off retail price of any of our Solar Power or Solar Hot Water Systems. Please mention your AMA membership. Not in conjunction with any other discount offer.
• Comprehensive radiology practice in building, pathology nearby.
• Spacious, light, modern & well-equipped.
• Adjacent to Calvary John James & Canberra Private Hospitals.
• Terms negotiable.
Contact: Practice Manager
Email: info@canberrahandcentre.com.au Phone: 02 6185 2705
Fully Equipped ENT/Plastic Surgery/Cosmetic Clinic Space and Procedural Rooms 200sq m. Total or individual consulting rooms available for rent on a sessional basis. Busy and established practice over 20 years, recently refurbished and fully fitted, with microscopes/endoscopes/ENT and Plastic instrumentation for minor surgery. Accredited day surgery and hospitals nearby. We can provide sessional or full time facilities for a single or multiple consulting rooms on a part-time or full-time basis. Experienced staff and IT if required. Large referral base of supporting GPs and Specialists.
Please contact Amanda Koroi on (02) 9526 8000 or amanda@dralanevans.com.au. A/H 0417 179 150
