The NSW Doctor - Spring 2024

Junjie Ling Consultant psychiatrist

KATEBENSON

DOCTORSMATTER-JUSTASKTHEIRPATIENTS

EuniceLeelosttwoofherthreesonstothebleeding disorderhaemophiliaB–thefirstafteraroutine circumcisionbeforeshewasawarehewasaffected,and thesecondfromabrainbleedattheageof17 Herthird son,Mark,spenthischildhoodbeingrockedtosleepto soothehisnever-endingpainfrombleedsbroughtonby life’smostsimpleacts Heenduredinfusionsthreetimes aweekandstruggledwithbeingexcludedfromsport Sevenyearsago,thatallchangedwhenRoyalPrince AlfredHospitalhaematologistJohnRaskoanda researchteamfromChildren’sHospitalinPhiladelphia celebratedaworldfirstbreakthroughwithagene therapycure20yearsinthemaking.

Afteroneinjection,38-year-oldMark’sbleeding stopped Eunicecouldbreatheagain Andhergranddaughters-bothcarriers–wouldneverendurewhat shehad

So,itwasapowerfulmomentwhenshewalkedinto RPAtomeetProfessorRaskoforthefirsttime,flingingher armsaroundhimandsobbingquietlyintohisneck “Hecreatedamiracleforus Whenyoumeetsomeone whoputshisheartandsoulintosomethinglikethis,itis incredible”

Thismovingstory–justlikethecountlessothersIhave encounteredduringmythreedecadesinmediawith

TheAustralianMedical Association(NSW)Limited ACN000001614

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TheNSWDoctoristhequarterlypublication oftheAustralianMedicalAssociation(NSW) Limited

TheSydneyMorningHerald,theNSWMinisterforHealth andMinisterforMedicalResearch,SydneyLocalHealth DistrictandNSWAmbulance–areattheveryheartof whyourdoctorsdowhattheydo

Iamlookingforwardtotellingthesestories–your stories–duringmytimeatAMA(NSW),and showcasingtheincrediblebeingdonebyAMA(NSW) andthedoctorsandmedicalstudentswerepresent Inthisedition,wetalktoregionalspecialistsandtheir patientswithaheartwarmingfeaturebyStephanie Osfieldshowcasingtheverybestourstateoffersto thoseinregionalandruralareasbattlingthetyrannyof distance.Butbeaware,youmayneedthetissues.

WealsofeaturetheextensiveworkourWorkplace RelationsteamhasdoneforVMOsandobstetrician PhillipCockstakesusdownmemorylaneforastoryon 40membersnotchingup50yearswithAMA(NSW) IdohopeyouenjoythiseditionofTheNSWDoctor. AndIhopewecancontinuetoshinealightonthe issuesmostimportanttoyouandyourpatients Ifyou haveastorytip,I’dlovetohearit,sendmeanemail wwwfacebookcom/amansw

ViewsexpressedbycontributorstoTheNSW DoctorandadvertisementsappearinginThe NSWDoctorarenotnecessarilyendorsedby theAustralianMedicalAssociation(NSW) Limited Noresponsibilityisacceptedbythe AustralianMedicalAssociation(NSW) Limited,theeditorsortheprintersforthe accuracyoftheinformationcontainedinthe textandadvertisementsinTheNSWDoctor TheacceptanceofadvertisinginAMA(NSW) publications,digital,orsocialchannelsor sponsorshipofAMA(NSW)eventsdoesnot inanywayindicateorimplyendorsement bytheAMA

AMA(NSW)BOARD

DrKathrynAustin,President

DrFredBetros,VicePresident

DrMichaelBonning

DrCostaBoyages

DrBrianFernandes

DrAmandeepHansra

DrJacquelineHo

DrTheresaLy

DrDavidMalouf

SECRETARIAT

ChiefExecutiveOfficer,FionaDavies Director,WorkplaceRelationsDominiqueEgan Director,MembershipEngagement andCommercialPartnershipsGaryWhite

Editor KateBenson katebenson@amanswcomau

StaffWriters

AllyChandler

Allychandler@amanswcomau

IsabellaAngeli Isabellaangeli@amanswcomau

Design DesignBees

Advertisingenquiries

AllyChandler allychandler@amanswcomau

Coverimage AmyAllenPhotography

PRESIDENT’S WORD

DRKATHRYNAUSTIN

WHYWECANNOTALLOWTHEDEATHOFEXPERTISE

Wetakeseriouslytheimportanceofhighlightingthatthefirstpriorityofthedoctoristhewelfare andwellbeingofourpatientsandthatourexpertiseisdirectedtosupportingtheirhealthcare

Asdoctors,wegettobewithour patientsatthebestandworst momentsoftheirlives. Someoftheworstmomentsare whendeliveringthemost challengingnews,acancer diagnosis,acatastrophicbrain injury,thedeathofachildora pregnancyloss Thelistgoeson At thosetimes,werelyonour expertise,ourskillsfromyearsof trainingandpractice Werelyon thelatestresearchgainedfrom conferencesandourseemingly unendingyearsofstudyand learning Webalancethis knowledgewithempathy, humanityandcompassion However,wealsodeeplyrelyon trust,thatthepatienttrustsour expertiseandskill

Thattrustisanessentialpartof goodclinicalcareandaclinical partnershipwithourpatients.Sadly, weareseeingagrowingpressure toerodethattrust,embodiedmost recentlybysectionsofthemedia andcelebrityhealthopinion.We haveseenthismostrecentlywith thearticleregardingElle Macpherson’scancer management.

MsMacphersonclaimedthat shehaddisregardedmainstream medicaladviceinthetreatmentof hercancerdespitehavinginitially undertakenevidencedbasedcare thatlikelyresultedinherpositive treatmentoutcome Somemedia outletsallowedherclaimstobe publishedwithnomedical responses,resultingin understandablefearsofsignificant harmstopatientsrelyingon completelyharmfulandnonexpertadvice.

Asanobstetrician,Iamsadlyall toofamiliarwiththequestioningof themotivesandexpertiseofdoctors

Intheexcellentarticlebytalented journalistandcancersurvivor,Julia Baird“Idon’twanttopileonElle,butif I’dignoredthedoctorsI’dbedead” SMHSep62024,MsBairdidentified thatwomenseemedparticularlyat riskofbeinginfluencedinhealth, oftenwiththesuggestionofbeing partoftheempowermentagenda

Bairdwrites“Patientsneedtolearn toadvocateforthemselves,hardas thatcanbe,andwomenarerightto carefullyscrutiniseinvasive, patriarchalmedicalsystems Butin recentyears,researchershavenoted howoftenanti-sciencesentimentis cloakedinthelanguageoffemale empowerment,sothatrejecting expertadviceisnotpresentedas harkeningbacktothedarkagesof superstitionandhighdeathtollsbut somethingwomenneedtodotobe strongandindependent–girlbosses don’thaveoncologists,theyhave holisticdentists!Throwincelebrities, profitmotives,andwellness influencers,andthepropensityfor evidencetoslideoffthemapiseven greater.”

HereinNSW,andlikelyacross Australia,sincetheBirthTrauma Inquiry,thisdistrustandrelianceon non-medicalsourceshasgrown.I remindallofmypatientsthatthereis nothingIwouldlikemoreforthem thananuncomplicateddeliverybut whetheryoumanifestormeditate, whateverthemodelofcare,statistics like20%offirsttimemothersneeding aninstrumentaldeliverydon’t change

It’sabsolutelyimportanttolook atpractisingthebestevidence

basedholisticcareinanyareaof medicineasthiswilllikelycontribute tothebestpossiblehealthoutcome forpatients Trueholisticcaredoes notmeanignoringmodernevidence basedmedicalpractice.Itisalltoo apparentthatthemedicalcontrol groupsforlackofaccesstomedical carecontinuetodemonstratethe realitiesoflackofmedicaltreatment.

Weknowthatalmost95%ofall maternaldeathsoccurinlowand lowermiddle-incomecountries,and mostcouldhavebeenpreventedwith accesstomedicalcare.

OneofthekeyrolesoftheAMAisto providethevoiceofexpertiseinthe mediaandinpoliticaldiscussions We takeseriouslytheimportanceof highlightingthatthefirstpriorityofthe doctoristhewelfareandwellbeingof ourpatientsandthatourexpertiseis directedtosupportingtheir healthcare.Whetheritisvaccination, cancercareorpregnancy,weneedto ensurethatthevoiceoftheexpertis respectedandlistenedto

Expertiseisnotonlyimportantin medicine,itisimportantinadvocacy Ifwewanttoberespectedforour medicalexpertiseandleadershipin thehealthsystem,wealsoneedtobe respectedandtrustedadvocates Thisiswhyexpertisematters Thisis whyweneedtobeproudofour expertiseandtalkaboutthereal informationthatchangeslivesforthe better

President@amansw.com.au wwwlinkedincom/in/ kathryn-austin-a2920073/ wwwfacebookcom/amansw

CEO’S WORD

FIONADAVIES

EXPERTISEMATTERS,DOCTORSMATTER

Themostrewardingpartofmyjobhasalwaysbeen thetimeIgettospendoutwithourdoctors. Overmymanyyears,Ihavevisiteddoctorsintheir homes,theirpracticesandtheirhospitalsinevery cornerofthestate ArecentvisittoOrangewasthe inspirationforouropeningstory,ClosetoHome Sadly, toooftendiscussionsaboutruralandregionalhealth focusonthechallenges Whiletherearemany challenges,Ihavefounddoctorsworkinginruraland regionalareasareoftenincrediblyengagedandare focusedonextendingtheservicesfortheirpatients.For patientsinruralandregionalareas,accessto specialistservicesisnotjustnicetohave,itcanbe aboutlifeanddeath Thisisperfectlydemonstratedby thepatientsfeaturedinourstory,allofwhomtalk aboutthebarrierstheywouldhavefacedifitwasnot forthedoctorswhoprovidedthemwithcare WewillbesharingmoreofthesestoriesthroughThe NSWDoctor Theseareimportantstoriesfordoctorsto readbuttheyarealsoimportantwaystoshowcasethe valueofdoctorstokeydecisionmakers AMA(NSW) sendsTheNSWDoctorwidely,includingtothemedia andtopoliticians.Inthistime,inwhicheverygroup seemstowanttoclaimtobeabletoundertakethe workofdoctors,AMA(NSW)willbeusingevery opportunitytohighlightthe incrediblevaluedoctors provide ThiswillbepartofourExpertiseMatters, DoctorsMattercampaignwhichwewillbeusingmore widely

IndustrialRelationsClimate

AtAMA(NSW),wedon’tjustbenefitfromdoctors’ expertise,wealsobenefitfromtheextraordinary expertiseandskillsofourstaff.Wearefortunateto

havethebenefitofDominiqueEgan,Director WorkplaceRelationswhoisprovidinganupdateonthe VMODeterminationprocess Dominiquehasbeen workingwithdoctorsonthereviewoftheVMO Determinationformanyyears Thishasallowedusto bewelladvancedinfilingforarbitrationwhichwehope tobeabletodoinNovemberthisyear Ourclaimis basedonthosecriticalissuesdirectlyrelatedto recognisingVMOsfortheworktheydoundermodern arrangements WhileAMA(NSW)isnotresponsiblefor theawardentitlementsfordoctorsintrainingorstaff specialists,wedohopethattheworkwearedoingfor VMOswillhaveflowonbenefitsforourothergroups.

AMA(NSW)hasaclearindustrialstrategywhichwe areworkingtowards:

WewantthebestdoctorstoworkintheNSWpublic hospitalsystem

Thereshouldbeappropriate,modern arrangementsinplacefordoctorstoworkunder wheredoctorsareappropriatelycompensatedfor theworktheydo

Doctorsshouldbeabletodeterminethe arrangementtheywishtoworkunder.Thisdecision maychangeatdifferenttimesoftheircareerorin differenthospitals.

Inadditiontocreatingmoreappropriateindustrial arrangements,itiscriticalthattherearesufficient rolesforconsultantscomingoutoftrainingtomeet healthsystemneedsnowandintothefuture

fiona.davies@amansw.com.au wwwfacebookcom/amansw

DrAshnaBasu Registrar,AMA(NSW)Member

AMA(NSW)hasaseatatthe tablewiththegovernment; advoca

Liley Wykes, Dubbo NSW

Amy Allen Photography

CLOSETOHOME

PatientsinregionalNSWareenjoyingbetteraccesstolocal,specialised healthcareprovidedbydedicatedspecialists.Wespoketothreepatientsand theirdoctorsaboutthebenefitsofthiscare.

ByStephanieOsfield

LileyWykes,84grewupinOrange andin1967,marriedhusband Trevor,afarmer,inDorigo. Afterafewyearsonadairyfarm, thecouplespent17yearsemployed andlivingontheYatesVegetable WestResearchStation,in Narromine,wheretheypropagated, tendedandpollinatedplantsto collectseeds Theyalsoraisedtheir twochildren,latermovingtoa25acrepropertynearby,wherethey continuedtogrowcropsforYates. FastforwardmanyyearsandLiley nowagrandmotheroftwo,lives withherhusbandinaretirement villagenearDubboZoo,having movedtotownforeasieraccessto amenities SowhenLileydiscovered alumpbehindherrightearin2022, shewasverygratefultobeableto receivetreatmentandcarecloser tohome

Abiopsyofthelumpshowed atypicalcells “TheENTdoctorin DubbosaidIneededtoseea SydneyENTdoctorspecialisingin thatkindofsurgery,”Lileyrecalls “Theprospectofdealingwiththe travel,traffic,crowds,stressand

costofaccommodationwasvery off-putting We’retoooldtodrive thatdistancesowewouldhavehad tocommuteovereighthoursvia busandtraintogetthere.Thewait fortheSydneyappointmentwasat leastfivemonthsandwouldhave coincidedwithbigeventslikeTaylor Swift’sconcertandMardiGras,so hotelswereallbookedout”Liley wasthenreferredtoanENT specialistinNewcastle,butthewait wassixmonths.“Then,luckily,my DubboENTdoctorsuddenlysaid, ‘howwouldyouliketoseeanewENT specialistinOrange?”Lileyexplains “Thenewspecialisthadjustcome backtothecountrytosetup practice Iwasoverthemoon”

Twodayslater,Lileyhadan appointmentwithhim “Hewasso lovely,dedicatedandinclusiveof myfamilyandgoodatexplaining everything”

Afewmonthslater,heremoved thelumpinhospital.“Gettingcare closertohomemadeitsomuch easiertogoforthepreandpost-op visitsatthehospital Thenursing staffweresolovelyandwithmy

specialistIwasinthebestofhands Thehospital,whichhasbeenredone inrecentyears,haslovelygardens andviewsofthegolfcourse,soitfelt verycalming,”saysLiley,whofelt morerelaxedknowingthatwhen shewasdischargedthenextday,it wouldonlytaketwohourstoget homebycar.

“It’salovelycommutepast canolacrops,wattlesandeucalypt trees,”shesays.“Tendaysafterthe surgery,Iwasveryhappytolearn thatthelumpwasbenign Iwasso luckytoseeanamazingspecialist nearby ItmeantIcouldreceivetop qualityhealthcarewithfarless stressandtravel”

DrSamRoberts,Liley’sENT specialist,whohasexpertiseinhead andneckoncology,seesmany patientswhofindtheideaof commutingtoSydneyfortheir healthcareintimidating,“especially iftheyhaveneverbeentoacity biggerthanOrangeorDubbo”. DrRobertshimselfgrewupnear Walgett,thenlivedonafarm

Dr Sam Roberts, ENT Specialist

Liley Wykes, Dubbo NSW. Amy Allen Photography

betweenArmidaleandTamworth“In additiontoappointments,rural patientstreatedinthecitymight havetogobackandforthfortests andthenstaynearbyaftersurgeryin caseofcomplications,”hesays “But sinceCOVID,ithasbecomeeasierfor specialiststoliveandpractisein ruralareas,increasingpatient options IoperateattheChrisO’Brien LifehouseinSydneyonceamonth Recently,Idida14-houroperation thereandafterwards,Ididallthe follow-upcareforthatpatientin Orange Telehealthisofgreatbenefit asitmeansIcanpractiseinOrange butdialintoonlinemeetings,talk aboutapatient’stumourandget pathologyandscanslookedatby expertradiologistsandpathologists whospecialiseinneckandhead healthinthecity.”

Threeyearsago,ClairThompson, now77,aregisterednursefor30 years,lostsomehearinginherright ear.TheninJanuarythisyear,she heardaloudsquealingsoundand herleftearsuddenlylostallhearing Testsconfirmedshewasnow ‘profoundlydeaf’.“Myqualityoflife quicklydeteriorated,”Clairrecalls.“I wentfrombeingabright,happy, personwhowasactivesocially, goingoutforcoffeeandplaying cardsregularly,tobeingmostly housebound Ididn’tfeel comfortableorconfidentgoingfor walksordrivingveryfarfromhome I couldnolongertalkonthephone–eventomakeanappointment Thoughmywonderfulgroupof friendswereverysupportive,the spontaneityofnormalconversation wasgone.”

Dauntedbytheprospectof drivingfivehoursforanMRIscanin Newcastle,Clairdidn’thavethetest “ThenaCochlearearimplantwas recommendedandIneededtobe assessedattheclosestclinic,three hoursawayinSydney’swest Ididn’t wanttobotheranyone,soIpaida driver$400totakemetoSydney andbackinoneday”Clinicstaff explainedthatafterthesurgery

FEATURE

Clairwouldhavetotrav twicemonthly,thenmon mademefeeloverwhelm thinktwiceabouthaving surgery,”sheconfesses wasfortunatetofindsur coulddotheoperationi

“Itmadetheworldof asInolongerhadthish commuteandwasable supportivefriendsaroun pickedupthingsforme, appointments,didmyw droppedincleanclothe thepre-opandpost-op closebywasahugeplu psychologicalwellbeing

Earlierthisyear,aftertheimplant wasswitchedoninNewcastle,Clair wasrelievedthatshecouldhaveit furthertunedinOrange. “Iwassogratefulforthetechnology anddedicatedsupportofthestaff butveryrelievedtherestofmy carecouldbefollowedupnear home.Icannowhearbirdssinging, mycatpurringandwaterfallingon theleaveswhenIwatermygarden Mydaughterrecentlysaidshehad heardmelaughmoreinaweek thanIhadallyearandwaspleased to‘havehermotherback’ It’sstill earlydays,butIhavehadmyfirst conversationonthephonewhich wasveryexciting.Ihavenewfound energyandoptimismandcansee thelightattheendofthetunnel I cannotpraisemyspecialisthighly enough.Iamsogratefulforhis incrediblesupportand encouragement Thequalityofcare providedbyhim,myanaesthetist andallthenursingstaffwas exemplary.”

ForDrAydinMohammadi,an Otorhinolaryngologistheadand necksurgeon,“beingableto restoreClair’shearinghasbeenan absoluteprivilegeoneofthemost professionallyandpersonally rewardingexperiencesofmy careersofar”

DrMohammadiworksincentral westNSWinseveralregional hospitalsincludingBathurst, Forbes,andOrange,wherehis practiceisbased.“Itrainedin NewcastleandSydneybutmy exposuretothekindnessofpeople ofParkesNSW,whereIgrewup, alongwithmypassiontofillgaps inruralandremotehealthcare, drewmebacktothecountry,”he says “Ihopethataccessing specialistcareclosertohome helpedClairfeelmoreempowered andlessstressed

“BeingabletorestoreClair’shearing hasbeenanabsoluteprivilegeandone ofthemostrewardingexperiencesofmy careersofar.”

DrMohammadi

Dr Aydin Mohammadi, ENT Head and Neck Surgeon

Workinginaruralregion,Ifeela deepconnectiontomyverygrateful patientcommunityandImore directlyseeresultsoftheirhealthcare. Ialsoliveonlyfiveminutesawayfrom work,soIenjoybetterwork-life balance”

JoyCochrane,72,grewupin Barradine,marriedin1968and movedtoWalgettwheresheworked asanurseatthehospital “Backthen andwhenIwasachild,ifsomeone hadaconditionlikecancerthey usuallywenttothecityfortreatment, buthealthcarehascomealongway sincethen,”sheobserves

In2020,whenJoysawhersurgeon afterahysterectomy,shewas shockedtolearnshehadatotally unrelatedformofcancercalled folliclelymphoma.Initially,she travelledtoTamworthandNewcastle forspecialistappointmentsandtests, whichshefoundexhausting

“So,itwasareliefwhenIsoughta secondopinionwithahaematologist inDubbo,andthecommutetook threehours,notuptosixhours,”Joy says “Ican’tspeakhighlyenoughof him.Heisawonderful,caringdoctor, verywarmandcompassionateand soclearinhowheexplainsthings I wasalsoluckytobeabletohavemy threecyclesofchemotherapyin DubbowherethereisanewPET machine,soIcangetscanscloserto home,too”

Joyiscurrentlyundergoingchemo inDubboeverythreeweeks.Three timesshehashadadversereactions andhadtobeairliftedfromBaradine toDubbowhichtakes50minutes “Atthosetimes,itisverygoodtosee myspecialist’sfamiliarface,”she says “Havingchemoclosertohome issolesstaxingformeandmyfamily Myhusbandandtwinsistercometo everytreatment,sittingbymyside, chattingandkeepingmecompany fortheeight-hourinfusion Whenwe leave,it’sareliefthatthesoothing drivehomeisonlyacoupleofhours alonglovelyquieterroadsseeingthe treesandbirds I’mabighomebody

FEATURE

g hugedifferencetoJoy’squalityof life

“Joyhasbeenabletohaveallher consultationsandchemotherapyin westernNSWwithouteverhavingto traveltoSydneyforcancercare

“Herconsultationsareamixofher comingtoseemeinDubbo,me flyinguptoseeherinmyoutreach clinicinWalgettandalittlebitof telehealth,too

“ShehasreceivedallherchemoimmunotherapyhereattheWestern CancerCentreDubbowhereIam

Coonabarabran,Walgett,Bourke andCobar

“Theseclinicsallowpatientsin ruralandremoteareastoreceive specialistbloodcancercarecloser tohome,andinmanycases‘on country’,inaculturallysafemanner bypartneringwithlocalIndigenous EldersandAboriginalHealth Workers,”saysDrGleesonwhois workingtoincreaseequityof accesstospecialistcancercare andoutcomesforpeopleinrural andremoteareas.

“Joyhasbeenabletohaveallherconsultations andchemotherapyinwesternNSWwithoutever havingtotraveltoSydneyforcancercare.”

DrTomGleeson

Dr Tom Gleeson with patient Joy Cochrane

WORKPLACE RELATIONS

VMODETERMINATIONSIN PUBLICHOSPITALS: THECASEFORREFORM

AMA(NSW)ispreparingforarbitrationtoupdateandmodernisetheNSWPublicHospital VisitingMedicalOfficerDeterminations

ThelasttimetheVMO Determinationswerethesubjectof asubstantivereviewwas2007,and thelasttimeaworkvaluecase wasrunforVisitingMedical Officerswastheearly1990s Recent NSWGovernmentWagesPolicy hasrestrictedtheabilityofAMA (NSW)andunionstoseekreform oftheindustrialinstrumentsthat applyintheNSWPublicHospital System.

WhatisAMA(NSW)roleinthe NSWIndustrialRelationssystem forVisitingMedicalOfficers?

AMA(NSW)istheregistered industrialbodyforVisitingMedical Officers(VMOs)inNSWunderthe IndustrialRelationsAct1996(NSW).

UndertheHealthServicesAct,AMA (NSW)hastherighttoseekthe appointmentofanarbitratorto determinethetermsand conditions(including remuneration)forVMOs ASMOFis theregisteredindustrialbodyfor employeddoctorsintheNSW PublicHospitalSystemunderthe IndustrialRelationsAct1996

WhathasAMA(NSW)beendoing toprepareforarbitration?

PriortotheCOVID-19pandemic, AMA(NSW)hadcommenceda reviewofVMOarrangements,and inparticulartheworkbeingdone fromoutsidetheHospitalforwhich VMOsarenotpaid.

TheformerNSWGovernment’s WagesPolicy,inplacefrom2011

untilthechangeofGovernmentin 2023,cappedremunerationincreases butperhapsmoreimportantly, placedsignificantrestrictionsonthe capacityforindustrialorganisations toseekchangesintermsand conditions

SessionalVMOs(whoare remuneratedatanhourlyrate) receivedincreasesinmostyears undertheWagesPolicy Fee-forService(FFS)VMOswhoare remuneratedbyreferencetoservices providedandremuneratedbasedon theCMBS,didnotreceivethesame increases.

BecauseofthethenFederal Government’sMedicarerebatefreeze, AMA(NSW)andtheMinistryreached agreementforincreasesforFFSVMOs over5years.Undertheagreement, VMOswereentitledtoindexationof 25%eachyearforfiveyears,provided theMedicareItemNumbersclaimed werenotchangedbecauseofthe MedicareReview Assuch,forVMOs whoseitemnumberswerenot changedbytheMedicarerevieware nowpaidabaseremunerationrateof 113.1408%oftheCMBS.Forthoseitem numbersthatwerechanged,theydo notreceivethebenefitofthe indexationandarepaidabaserate of100%oftheCMBS.

TheFFSagreementexpiredon30 June2022 AMA(NSW)andthe Ministryengagedindiscussions regardingchangestotheFFS Determination,includingthatall VMO’spaidbyreferencetothe currentCMBS(asindexedfromtime

totime)(desiredbytheMinistry) andotherchangestothe Determination.Ultimately, agreementcouldnotbereached, withtheMinistryadvisingthat Treasurywouldnotprovidefunding formanyofthechangessoughtby AMA(NSW).

In2023AMA(NSW)accepteda remunerationincreaseforSessional VMOsthatmeantarbitration proceedingscouldnotbepursued forSessionalVMOsuntilJuly2024 Intheinterestsofefficiency(both timeandcost)adecisionwas madetoseekarbitrationforboth SessionalandFee-for-ServiceVMOs atthesametime

In2024AMA(NSW)hasbeen meetingwithVMOsatMedicalStaff Councilmeetings,andmeetings specificallyfocusedonreformofthe Determinations,todiscussthe changesAMA(NSW)hasidentified andtoheartheirviewsonwhat needstochange

Shortly,wewillbesurveyingVMOs andtheresultswillformpartofthe evidenceinsupportofthecasefor change.

WhatchangeswillAMA(NSW)be seeking?

AMA(NSW)seekstosecure changestotheDeterminationsso thattheybetterreflectmodern workingpracticesandformpartof asuiteofmodernindustrial instrumentsthatofferconsultants genuinechoiceonhowtheyare engagedtoprovide

WORKPLACE RELATIONS

servicesintheNSWpublichospital system

Thearbitrationwillalsoreview currentratesofremunerationand whethertheyreflectthecurrent valueoftheworkperformedby VMOsworkinginthepublichospital system.

AMA(NSW)strategytopursue arbitrationisinformedbythe feedbackprovidedbyVisiting MedicalOfficers.Whileremuneration isrelevant,theissuesthatthey wouldliketoseeaddressedinclude: VMOsarenotpaidforservices providedfromlocationsother thanthehospital, Recognitionthatincreasingly non-emergencyworkis undertakenafter6pmandon weekendsyetthereisno recognitionofthevaluebutalso inconvenienceofsametoVMOs doingthatwork,andneedfor remunerationarrangementsto change;

Thelackofanon-callallowance forFee-for-ServiceVMOs; Alackofflexibilityintermsof remunerationforservices providedwhenon-call(in particular,shouldFFSVMOshave theoptiontoremuneratedat sessionalrates); Paymentforcancelledcasesas opposedtolistsindefined circumstances; Thefailuretoindexthe ProfessionalSupportPaymentfor regionalVMOsandtheneedto reconsiderthequalifyingcriteria foraccesstothepayment; Privatepatientsinpublic hospitalsandthechallenges associatedwithalackof communicationbyhospitalsto VMOsregardingpatient classification

Whenwillarbitrationcommence?

AMA(NSW)hasaskedtheNSW governmenttochangethe legislationregardingwhocanbe appointedasarbitrator

AMA(NSW)ispressingforthese changestobemadeassoonas possibleandwillthenfileits application

AMA(NSW)wantsthelegislation changedtoprovidethatajudgeof theIndustrialCourtmaybe appointedasarbitrator.Duetothe previousgovernment’swagespolicy thereareveryfewpeopleinNew SouthWaleswhohavethenecessary knowledgeandexperienceinthe applicationofrelevantindustrial principles Twoofthemost experiencedindustrialpractitioners wereappointedtotheIndustrial Courtearlierthisyear

In2016,thethenNSWIndustrial Courtwasabolishedbythethen StateGovernment Untilthistime,the HealthServicesActprovidedforan arbitratortobeappointedfromthe NSWIndustrialCourt Followingthe abolitionoftheCourt,thelegislation wasamendedtoprovidethe arbitratorwouldbeaformerJudge oftheNSWSupremeCourtoralegal practitionerofatleast7years experience.

TheIndustrialCourthasbeen re-establishedandwhilequestions

ofinterpretationregardingthe Determinationshavebeenreturned totheIndustrialCourt,theprovisions regardingthequalificationsofthe arbitratorhavenotchanged

WillthecaseforVMOsbenefitthe system?

AMA(NSW)anticipatesthatthe caseitrunswillbenefittheNSW PublicHospitalSystem.Modernising industrialinstrumentswillassist NSWtoretainitsexistingworkforce andattractadditionalworkforce

Themattersforwhichweseek changearenotuniquetoVMOs, andifwearesuccessful,we anticipateitwillstrengthenthecase forthemodernisationofother industrialinstrumentsintheNSW PublicHospitalSystem

DominiqueEgan.

ContacttheAMA(NSW)Workplace Relationsteamifyouhaveany furtherquestionsaboutthese changes.Youcancontactour teamon(02)94398822orvia workplace@amansw.com.au

WORKPLACE RELATIONS

WHATYOUNEEDTOKNOWABOUTAIIN

MEDICALNOTE-TAKING

TheintegrationofArtificialIntelligence(AI)intonote-takingprocessesinmedicalpracticesis rapidlygainingmomentum.AInote-takingprogramsareemergingaspowerfultoolsfor medicalpractitioners,offeringenhancedefficiency,accuracy,andoverallqualityofmedical documentation.ThisarticleexploresAIinmedicalnote-taking,howthesetoolsworkand factorsyouneedtoconsiderbeforeimplementingsuchtoolsinyourpractice

AIinmedicalnote-taking

Manymedicalpractitionersare oftenoverwhelmedwith administrativepressuresincluding creatingcomprehensiveand preciseclinicalnotes Traditional methodsofmedicalnote-taking involvemanualdataentryandthe transcriptionofpatientinteractions, whichcanbetime-consuming AInote-takingtoolsoffer assistanceformedicalpractitioners balancingthedemandsofabusy practice Theyseektostreamline documentationprocessesand allowmedicalpractitionerstofocus moreontheprovisionofpatient care Thisshiftcouldimproveboth efficiencyandtheoverallqualityof medicaldocumentation

HowAInote-takingtoolswork

AInote-takingtoolsoperateby recordingthedialoguebetweenthe medicalpractitionerandthe patientduringaconsultation.Using advancedtechnologies,thesetools extractrelevantinformationand generatecoherentclinicalnotes Overtime,AIsystemslearntomirror theuser’stoneandstyle,ensuring thattheAI-generatednotes resemblethosecreatedmanually bythemedicalpractitioner.Medical practitionerscanreviewand andamendAI-generatednotes

beforefinalisingthem Thisallowsfor theinclusionofpersonal observations,additionalnotes,and testresults,ensuringthenotesare accurateandcomplete

Keyconsiderations

WhileAInote-takingtoolsoffer promisingbenefits,practicesand medicalpractitionersthatwishto utiliseAInote-takingtoolsneedto considerseveralimportantfactors:

Privacyandsecurity

Practicesshouldreviewprocedures formanagingpotentialbreachesof patientprivacyanddatasecurityto ensuretheycoverandaddressthe useofAIinthePractice

Giventhesensitivityofmedical information,stringentdataprotection measuresareessentialWhen selectinganAInote-takingprogram, practicesshouldreviewthefollowing: DataEncryptionandStorage: Understandhowpatientdatais encrypted,storedanddestroyed DataProcessingLocation: Determinewhetherdatais processedorstoredinAustraliaor overseas.

SecondaryUseofData:Clarifyif thedatawillbeusedfor secondarypurposesbytheAI providerorthirdparties

Compliance:EnsuretheAI provideradherestothe AustralianPrivacyPrinciplesand thePrivacyAct1988(Cth)

Consent

Patientconsentisessentialwhen usinganAInote-takingprogram duringconsultations Somepatients maynotbecomfortablewithAI,soit isessentialtoobtainconsenteach timeanAInote-takingprogramis used Thisconsentshouldbe documentedinthepatient’s medicalrecord.Relyingsolelyona referencetotheuseoftheAInotetakingprograminthePractice PrivacyPolicyisinsufficientand practicesshouldestablishaclear processforseekingandrecording patientconsentoneachoccasionAI isused

Accuracyofnotes

Medicalpractitionersmustreview AI-generatednotestoensurethey accuratelyreflectwhatwassaid andobservedduringthe consultationandcorrectanyerrors beforeenteringthemintothe patient’smedicalrecord

AlthoughAIisadvancing, inaccuraciescanoccurinAIgeneratednotesduetofactorssuch asaccents,useofslang,orfailureto filterirrelevantinformation

WORKPLACE RELATIONS

AInote-takingtoolswillalsonot capturenon-verbalcuesand medicalpractitionerswillneedto ensuretheseareincorporatedinto theAI-generatednotes.

Transferofrecords

AI-generatednotesmaynotalways includeessentialpatientidentifiers, leadingtopotentialissuesduringthe transferofrecordstothepractice’s systems Tomitigatetheriskofdata lossorincorrectstorage,practices shouldimplementrobustprocesses andprovidetrainingtostaffinvolved inhandlingAI-generated documentation

AHPRAguidanceforpractitioners

TheAustralianHealthPractitioner RegulationAgencyhasreleased guidanceforpractitionerswhich explainshowexistingresponsibilities inNationalBoards’codesofconduct applywhenpractitionersuseAIin theirpractice Youcanreadthe guidanceontheAHPRAwebsite ThereisnoobligationtouseAIin medicalnote-taking.However, Practicesandmedicalpractitioners whousingAIfornote-takingorare thinkingofpurchasingand implementinganAInote-takingtool intheirpracticeshouldensurethe selectedtool: meetsclinicalneeds, enhancesthedeliveryofquality patientcare;and complieswithlegaland professionalobligations

Itisrecommendedthatpracticesandmedical practitionersconsultwithanITexpert,their cybersecurityproviderandtheirMedical DefenceOrganisationwhenimplementingan AInote-takingtoolintheirPractice.

ItisrecommendedthatPractices andmedicalpractitionersconsult withanITexpert,theircybersecurity providerandtheirMedicalDefence Organisationwhenimplementingan AInote-takingtoolintheirPractice. Carefulattentiontopatient consent,dataprivacy,andthe accuracyofrecordsisessential

AsAItechnologycontinuesto evolve,itholdsthepotentialto furthertransformmedical documentation,makingthe integrationofthesetoolsa promisingsteptowardsmore efficientandpatient-centred healthcare

AnastasiaLivanovaand DominiqueEgan.

ContacttheAMA(NSW)Workplace Relationsteamforspecificadvice relatingtoyourpractice.Youcan contactourteamon(02)94398822 orviaworkplace@amansw.com.au

WORKPLACE RELATIONS

PAYROLLTAXEXEMPTIONFOR GENERALPRACTICE

AMA(NSW)longrunningadvocacycampaignforanexemptionforgeneralpracticefor potentialpastpayrolltaxliabilitiesforgeneralpractitionercontractswassuccessful,resulting inanexemptionforgeneralpracticesinrelationtounpaidpayrolltaxthatmayhavebeen payable.Theexemptionisforunpaidliabilitiespriorto4September2024.

HWLEbsworthprovidethefollowingupdateontheexemption forgeneralpracticeandthebulk-billingrebateuponwhich somegeneralpracticesmaywishtorely.Itisimportantto rememberthatthebulk-billingrebateisanadditional measure,andthatonlygeneralpracticeswhomeetthe relevantthresholdarerequiredtoregisterwithRevenueNSW.

Background

On18June2024,whendeliveringthe 2024-2025StateBudget,theNSW StateGovernmentannounceda seriesoflegislativeamendmentsto thePayrollTaxAct2007(NSW)(Act) whichwereaimedatprovidingrelief frompayrolltaxformedicalcentres engagingGeneralPractitioners(GPs) asindependentcontractors.

TheCommissionerofState RevenuelaterreleasedaPractice Noteexplainingtheamendments whichwereintroducedunderthe RevenueLegislationAmendmentAct 2024No83(NSW) Theseincluded: Anexemptionforanyunpaid payrolltaxthatwaspayableon ‘wages’paidorpayabletoGP contractorsunderarelevant contractpriorto4September2024 (UnpaidPRTLiabilitiesExemption) [1]

Arebateforpayrolltaxonwages paidorpayabletoGPcontractors onorafter4September2024when certainconditionsaremet(Bulk BillingRebate)[1];and Theadditionalreliefsupplements theexistingexemptionsunderthe Act,includingthe90Day ExemptionandthePublicService Exemption[1]

UnpaidPRTLiabilitiesExemption

Anyunpaidpayrolltaxthatwas payableonwagespaidorpayable toGPcontractorsunderaRelevant Contractpriorto4September2024 arenowexemptfrompayrolltax liabilities Thismeansthatwhere payrolltaxmayhavebeenpayable inrelationtopaymentsmadeto GPsunderarelevantcontract,the medicalcentreisnotrequiredto declarethosepastpaymentsprior to4September2024aswagesfor thepurposesofpayrolltax

Arefundisnotavailablefora medicalcentrewhichhaspaid payrolltaxinrelationtopayments madetoaGPunderarelevant contractpriorto4September2024.

RelevantContractsandExemptions Ifageneralpracticehasgeneral practitionersprovidingservicesto patientsatthegeneralpractice,the firstmattertobeansweredis whetherthecontractisaRelevant ContractforthepurposesoftheAct, andifso,arethereanyexemptions whichmayapply Whilethereare severalexemptionsundertheAct, thosemostrelevanttogeneral practicesarethe90DayExemption andthePublicServiceExemption UndertheActacontractwillnot beconsideredaRelevantContract forthepurposesofpayrolltaxifthe contracteddoctorconductstheir businessatthemedicalcentrefor lessthan90daysinafinancialyear [1]Forthepurposeofcalculatingthe numberofdaysthecontracted doctorworksatthemedicalcentre, partofadaywillcountasafullday [2]Inordertosatisfythe90Day Exemption,amedicalcentrewould needtodemonstratethatthe contracteddoctorhasconsultedwith patientsforlessthan90daysatthe medicalcentreinafinancialyear.

WORKPLACE RELATIONS

relevantcontract Inordertoclaimthe BulkBillingRebate,medicalcentres locatedinmetropolitanSydneymust bulkbillatleast80%oftheirGP services Whereasformedicalcentres locatedinotherareas,only70%of theirGPservicesmustbebulkbilledto attracttheBulkBillingRebate.

ThePublicServiceExemption statesthatacontractwillnotbe considereda'relevantcontract'for payrolltaxifthecontracteddoctor alsoprovides'servicestothepublic generally'[1]Toqualifyforthis exemption,thecontracteddoctor mustprovideservicesofthesame kindtopatientsofanother business,possiblybyvisitingthe localHospitalorconsulting patientsatotherpractices References:

BulkBillingRebate

From4September2024,medical centresmeetingprescribedbulk billingthresholdsmaybeentitledto claimarebateonwagespaidor payabletoGPcontractorsundera

ForthepurposesoftheBulkBilling Rebate,RevenueNSWhasdetermined whichsuburbsaredeemedtobepart ofMetropolitanSydneyandalistcan befoundontheirwebsite.Anysuburb whichisnotincludedinthelistis outsideofMetropolitanSydneyand attractthelesserthreshold

TheBulkBillingRebateisonly availableformedicalcentreswhich engageGPsandhaveregisteredfor

payrolltax Onceamedicalcentre haspaidpayrolltaxinrelationto thepaymentsmadetoGPsunder therelevantcontract,theywillthen receivearebateiftheprescribed bulkbillingthresholdismet

ScottChapman,Partner; LukeDepares,SeniorAssociate; MadeleineMurray,Solicitor.

FEATURE

AREVOLUTIONINGENERAL

PRACTICE

WesternSydneydoctorstryingtoimprovegeneralpracticefordoctorsandpatients

“Imagineasituationwhereachildmightpresentwithaspecifichealthcondition.Managingthe healthconditionmightbestraightforwardexceptthatbothparentsareunemployed,oneusing recreationaldrugs,theotherinjailThegrandparentsaretheprimarycarersTheylivewithdiabetes andheartdisease.It’sanexamplewherethere’sacombinationofmedicalandsocialcomplexity thatGPsstrugglewitheverydayThisiswhereHealthicarecomesin”

DrKean-SengLim,LocalGPandChairofHealthicare

BasedintheBlacktownExercise SportsandTechnologyHubin RootyHill,Healthicareopenedin January.Tenyearsinplanning, fiveyearsinthemaking,thehealth hubhastakenontheambitious taskofrevolutionisingprimary care

It'stheseeminglyintractable problemwhichisonlygrowing GP numbersaredwindlingaspatient needandcomplexitiesincrease.The issueisfeltmoreacutelyinareaslike westernSydneywhereGPsshutup shoponanalmostweeklybasis So, whatifyoucameupwithasolution thatwouldbothhelpthepatientsin greatestneed,andtakethepressure offGPs?Asolutionwhichmakesan areamoreattractiveforGPstowork while keepingpatientsout

ofthehospitalsystem?Western Sydneydoctorsareatthehelmofa groundbreakinglocallyled neighbourhoodhealthhubthat couldhelpaddressAustralia’sGP crisis.

HEALTHHUB

Healthicareisanewneighbourhood healthhubinSydney’swest,codesignedbylocaldoctorsandthe PHN,whichitscreatorssayisunlike anyotherinNSW Theresultofyears ofplanning,study[1]andresearch tripstocentresoverseas,ithasa growingteamofGPs,GPregistrars, nurses,apharmacist,dietician, exercisephysiologist,psychiatrist andsocialworker.Keytothemodel, ithasdedicatedpatientadvocates tosupportsurroundingpracticesto extendtheirserviceoffering,whilst

simultaneouslyhelpingpatients tonavigateeverystageoftheir healthjourney

“Healthicareaimstosolvethe problemoflackofaccessto generalpractice,particularlyin underservedareasinwestern Sydney Weknowthat40%of peopleinwesternSydneydon’t havearegularGP.Weknowalot ofpatientsaredischargedfrom EDswithouthavingaregularGP andthosepatientswillveryoften endupbackinhospital Wereach outtothosepatientsandbring themintooursystem,”Clinic DirectorDrJaspreetSainisaid It'snotjusttheprimaryhealth servicesofferedonsite,it’sthe hubandspokemodelthatis designedtosupportGPpractice throughoutthearea

participatingpracticesandisusing thattoidentifywhichpatientsare goingtobeatthehighestriskof hospitalisationinthenext12months. Thehubwon’tknowthenameofthe patientsbutoncethedataisanalysed Healthicarecangobacktothe practicesandsay“Thesearethe patientsmostatriskofcomplications fromheartfailure,diabetes,kidney disease”orwhatever Thepracticecan thencontactthatpatientandrefer themtoHealthicareorreceive assistancetoimprovetheirhealthand reducetheirrisk

“Healthicarewillbethefirsttimewe lookatpopulationdataandmobilise teamstoprovideproactiveoutreach caretopatientssothattheystaywell andhealthyandthoseoutofhospital” DrSainisaid,“Usingpredictive analyticsbasedontheCSIRO hospitalisationriskalgorithmwecan predictthepercentageprobabilityof unplannedhospitalisationforevery individualinthecohort.Fromthis

FEATURE

Co-designedandestablishedby WentWestinpartnershipwiththe MtDruittMedicalPractitioners Association,Healthicareisan independentnotforprofit organisation It’swhereoverrun localGPscanrefertheincreasing numberofpatientswhose complexmedicalissuestake hours,not15–20minuteslots

Healthicaretakeschargeof referredpatients,identifiesand separatesthedifferentelements ofcarerequired,thenseeksto addresseachindividually.

OUTREACH

Referralisnottheonlyway patientsarriveatHealthicare The centrereachesoutintothe communitytofindthepatients whoaregoingtoneedcare, beforetheyneedit

Throughacollaborationwith localhealthbodiesandthe consentoflocalpractices, Healthicarehasaggregatedthe deidentifiedclinicalinformationfor

Healthicare Health Hub, Blacktown Sports and Technology Centre NSW

Local GP and Chair of Healthicare Dr Kean-Seng Lim and Clinic Director Dr Jaspreet Saini

dataweknowthat11%ofthe populationhasagreaterthan20% probabilityofunplanned hospitalisationinthenext12months Wecanseewhothehighestrisk groupsandindividualsare Wecan seewhoislikelytohavehadan exacerbationofCOPDinthepast12 monthsandwhethertheir medicationscouldbeoptimised.We couldseewhichpatientswith diabetesanddecliningrenalfunction couldpotentiallybenefitfromnewly availablemedications.Wecan identifygapsandopportunitiesto influencetheircaredirectly, improvingtheirhealthandreducing theirriskofgoingtohospital.”DrLim explained.

SUPPORTFORGPs

“AsaGP,youmightspendalotof timeonphoneswhichisofcoursenot remuneratedunderMedicareandit canbeavery,verytrickythingtojoin allthedifferentaspectsofcare together.ThisisoverwhelmingforGPs andit’sonlygoingtogetworse”Dr Limsaid

“Werecognisethatattracting clinicians,whetheritsnursesorGPs intoareaslikewesternSydneyis quitedifficultbecausethecasesare morecomplexandnotnecessarily remuneratedinthesamewayasin moreaffluentareas.”DrSainiadded.

FEATURE

“Ourpopulationovertheageof65 issettotripleoverthenextdecade, thecurrentwayweprovidehealth careisnotgoingtobesustainableor reallyservetheneedsofour demographic”DrSainisaid

DrLimsaid“TheHealthicarehub becomesthecoordinatingcentrefor thiscarebutalwayswiththe intentionofreturningthecareofthe patienttotheirusualgeneral practice Thisisbasedonverygood evidencethatregularqualityGPcare doesreducehospitalisation,does reducetotalcostofcare,does improvelifespananddoesimprove patientwell-being.So,partofthisis tryingtoestablishanongoing connectionbetweenpatientsand theirGP Thehopeisthatby

augmentingorsupportingtheusual generalpracticetoprovidebetter qualitycare,sayinfiveyearsthis makeswesternSydneyabetter placetobeaGPandisexactlythe sortofplaceyouwanttobeaGP becauseyoucanprovidethatcare thatyouwanttoprovideandyou’re wellsupportedtodothat”

“MostGPsaresobusy,so overworked,sostuckintheir day-to-daygrindthattosee somethingdifferentishard Thisis partofourgoalhere,toshowthat youdon'thavetodothings inthesamewayandthatyou canhaveadifferentlifeasaGP”

NEWFUNDINGMODEL

Healthicareensuresitsdoctorsare appropriatelyremunerated Some areonsalaryandsomeon independentservicesgrants

“ThismeansGPsdon’thavethe concernsofneedingtoseelarge numbersofpatientsinorderto makeendsmeet Thatpressureis

takenoffthem WhiletheFederal Governmenthasmadesignificant investmentinMedicareitstillfalls wellshortofwhatgeneralpractice needstoprovideadequate servicestopatients”DrLimsaid Healthicareisfillingthefunding shortfallininnovativeways,while theMBScoversaround70%, alternativesourcesoffunding comefromgrants,research fundingandothernon-MBS sources.Itisalsocontinuingtolook atpartnershipsandnewwaysto ensureongoingsustainable funding

“Asapercentageoftotalhealth expenditure,theamountspenton GeneralPracticehascontinuedto fallfromover7%tenyearsagoto nowlessthan5.7%[2].AMApolicy andinternationally,wethinkthis needstobeatleast10% At Healthicarewearewantingtodo GeneralPracticeasitshouldbe doneanditlooksliketherewill needtobeatleast30%topup fundingtomakethishappen”

Patient Barbara Blissett with Medical Practice Assistant Camelia Najjar

“We’renotafraidofdoingthings differentlyandbeing collaborativeandholistic The practicehasaWednesday walkinggroupwhichpatientsare invitedtoattend Peoplewho haven’texercisedforalongtime arenowparticipating Asaresult, manyhavestartedtoincrease thelevelofactivitytheydoon theirown”

SCANTHEQR CODEFOR REFERENCES

FEATURE

INNOVATIVECARE

AtHealthicareDrSainiisjustas likelytoprovideyouwitha prescriptionforexerciseasheis formedication

“Soonwe’llberunningmore specificprograms We’vegota COPDprogramandanobesity cliniclinedup.Theobesityclinicis apartnershipwiththelocalhealth districtwhereserviceswithin hospitalsettingshavebeen unabletohandlethelargevolume ofpatientsthatarereferred Similartowhatwedowithwestern SydneyDiabetes,we’llhave specialistendocrinologistscome intoHealthicareonasix-weekly basis,providemoreintensive

supportandtrainuptheGPs internalpracticeteamtoprovide supporttoourstations.Weare workingoninnovativehealth coachingapproachesaimingto improvepatientactivationwiththe WesternSydneyDiabetesteam.The otherthingwe’relookingatthe momentisanInflammatorybowel diseaseclinic”

AROLEMODEL

“WehopethatHealthicarewillbe thefirstofmany.It’sourhopeto inspirepeoplearoundthecountry tosetupsimilarservicesinsimilar clinics”DrSainisaid“Thisiswhat generalpracticeofthefuturecould looklike,”addedDrLim

AsanAMA(NSW)member,foreverynewmemberyourefer,we’llrewardyouwithagift card Themorepeopleyourefer,themoregiftcardsyou’llreceive!Findoutmoreatthe QRcode

=

Innovative practice rooms include Tv for kids to watch and music to make patients feel comfortable. Here is patient Erin Clark with Dr Hani Bittar

Patient Simone Fisher with baby Brooklyn

MY PRACTICE

MemberFeature MyPractice

We’recommittedtohelpingadvanceourmembersintheirprivatepractices, whethertheyareestablishedorjuststartingout.Weaimtocelebratethe achievementsofmembersbyhighlightingtheirworkinTheNSWDoctor.

Eacheditionfeaturesselect membersinprivatepractice, offeringaplatformtoshowcase theiruniqueapproaches,learnings andsuccessstories.

Bysharingtheirstories, challenges,andtriumphsweaimto encourageknowledge-sharing whilealsoprovidingmemberswith well-deservedrecognitionfortheir contributionstotheprofession InthiseditionwehighlightDr AkalyaMahendran, Gastroenterologistand Hepatologist,andvaluedAMA (NSW)Councillorandmember.

DrMahendranFoundedthe SydneyGastroenterologyCollective

inSydney’sInnerWestinJune 2023 TheCollectiveisacollegial modernspecialityservicewhich pridesitselfonhighquality evidencebasedcare,accessibility andkindness DrMahendranis passionateaboutholisticpatient focusedcare

Whatwasyourvisionforstarting aprivatepractice?

Iwantedtostartapracticebased aroundmypersonalityandhowI deliverhealthcare Ithrivemoston theunderstandingthatevery patientisanindividual,whetherit’s thefirsttimeorthe300thtime you’veaddressedasimilar complaint Ialsowantedtocreate aflexiblepracticemodel;I’ma youngmumsoIwantedtobe mobileandaccessible,andI wantedtoexpandmypracticeto encourageotherpeoplewithyoung familiestojoin Therearefewer women,particularlyyoungwomen inmedicinewhoarestartingtheir ownbusinesssothatheavily influencedmyideas.

Whatwasthebiggestchallenge?

Marketinghasbeenthesinglemost challengingarea,becauseyou havetogooutthere,introduce yourself,sellyourselfandtell colleagueswhatyou’reabout You’vegottoconvincecolleagues thatyou’vebeentrainedwell,you knowwhatyou’redoing,andthey shouldtrusttheirpatientstoyour care.Youhavetoapproachother doctors,particularlyGPs,whoare alreadyreferringtoother gastroenterologists.So,the questionbecomeswhyyouand whynow Thatwasasteeplearning curveandIthinkmyconfidencein thatareahasincreasedoverthe last12months

Whathasbeenrewardingabout theprocess?

Ithinkpatientfeedbackisthe numberonepositivethatkeeps yougoing,itisalwaysasurprise whenitcomesbutitmakesitall worthit Youaretryingtoaddress thepatientsandtheirconcerns-if yousucceed,thenthat’sthe ultimategoal.

Dr Akalya Mahendran, Founder of Sydney Gastroenterology Collective

Strathfield Private Hospital, Sydney, SCG Rooms Photo credit: Brendan Reid

“Iwantedtostartapractice basedaroundmy personalityandhowI deliverhealthcare Ithrive mostontheunderstanding thateverypatientisan individual.”

Whatwouldyousaytoadoctor decidingwhethertostarttheirown practice?

Oneofthemostchallengingand rewardingpartsofitislearningthe businessofmedicine,whichweare nottaughtwell,orifatall,inthe publicsector.ThebestadviceI received,andwhatIwouldgive othersis,it’sworthwhileworkingat manypracticestounderstandthe differentmodelsthatpeopleworkin Getasmuchexposureasyoucan andknowthatsucceedingdoesn’t comequicklyorimmediately Ithas beenquitechallenging,especially beingearlyinmycareer,butitis

MY PRACTICE

definitelydoable I’mapaperless practicewhichIthinkisquite appropriatefor2024,andI’vefound thebusinessofmedicinevery fascinatingandaskillsetthatI’ve reallyenjoyedlearningabout

Hasprivatepracticemadelife easierforyouasaworkingparent?

Ithinkthereisaflexibilityinprivate practiceingeneral,youcandecide tohaveliststhatfinishlate,oryou havetheabilitytocontactpatients andsendemailsafterhourswhen thebabyisasleep That’snotunique toprivatepracticebutwhatI’ve foundis,becauseIhaveacloud basedmedicalsoftware,Icando myworkatanytimedayornight, whilealsoprovidingadequate patientcare 9-5isgreatand predictablehoweverlifeisnot predictablesothat’swhereIfound thathavingmyownpracticeis goodformylifeandsuitsthe differentchallengeswithhavinga child.

Whatisonesimplethingthatyou havelearntsinceowningyour practice?

It’sthatyouwillmakemistakesand don’tbeafraidofthat Don’tbe afraidofsayingsorry Startingup yourpracticeandgettingtothat fiveyeargoalisaslowprocess You’renotalwaystaking2steps forward;youarecontinuously makingmistakesandlearning.That canbequitedauntingbecauseyou aredoingthatonyourown,however itisdefinitelyworthpushingthrough becauseit’sjustpartofthelearning process.

Itisabalanceofensuringyou’re maintainingaprofessional specialistpracticeandensuring patientsarecomfortableand secureinyourcare Iamalsoopen withmypatientsaboutthefactthat Iamayoungmumandthatgives metheabilitytorelatetothemina positiveway.

AMA(NSW)islaunchingtheEmergingSpecialistNetwork.

TheEmergingSpecialistNetworkwill allowspecialiststomeetnew colleaguesandshareinformation andideasabouthowtosetupa privatepractice

Buildyourreferralnetworkand connectwithestablishedmembers whowillsharetheirinsightsinto buildingapractice

Hearandbenefitfromourinhouseexpertsandexclusive commercialpartnerswhowillhelp equipmemberswiththeknowledge

andtoolstoestablishthemselvesin privatepractice-fromthebasicsof business,medicareandbilling solutionstoindemnity,cyberand liabilityinsurance

TheEmergingSpecialistNetwork willbeyouronestopshopasyou transitionintothisexcitingnew phaseofyourcareer

Toexpressyourinterestin thenetwork,pleaseemail events@amansw.com.au

ASSOCIATION UPDATE

CELEBRATINGTHELEGACYOFTHE

AMA(NSW)CHARITABLEFOUNDATION

ByStephanieOsfield

ThoughtheAMA(NSW)Charitable Foundationisnowcomingtoa close,it’sphilanthropicworkwill haveimpactsforyearstocome.

Fromraisingfundsforlife-saving equipmentdonatedtochildren’s hospitalsandruralregions,to supportingpeopleimpactedby naturaldisasters,disabilityand domesticviolence,theAMA(NSW) CharitableFoundation,whichis windingdownoperation,leavesan impressivelegacy

When15-year-oldAnnaWood diedin1995,thelossofheryounglife saddenedthenation Intheweeks thatfollowed,agroupofGPs pledgedtodosomethingaboutthe tragedy.Withinmonths,their altruismledtotheformationofthe AMA(NSW)CharitableFoundation whichlaunchedtheAnnaWood DrugandAlcoholEducationProject. Donationsfloodedintosupportdrug andalcoholeducationprogramsfor NSWstudents Intotal,thefinaltally raisedwasover$100,000,includinga $50,000donationfromtheNSW government

Volunteers,Collaborationand

Partnership

Thesameyear,theFoundationheld agolfdaytoraisefundsfortheFred HollowsFoundationtopurchasea diodelaserunittobehelpimprove theeyehealthofAboriginaland TorresStraitIslanderpeopleinFar NorthQueensland “Atthat wonderfulgolfeventIwashandeda chequefor$30,000’’,recallsGabi Hollow,FoundingDirectorofthe FredHollowFoundation

TheFoundation’samazing philanthropicworkspanned29 yearsandraisedover$125million

“Throughoutitsimpressiverun,we partneredwithcharities,businesses andcommunitygroupstowork togetherandfundprojectstomeet therealandimmediateneedof peopleincrisisorthose experiencingdistress,disadvantage andchallengesimpactingtheir mentalandphysicalhealth,”Dr DanielleMcMullen,formerAMA (NSW)President,Chairofthe FoundationandincomingAMA President

Thisimportantworkwasmade possiblebyasmall,incredibly dedicatedAdvisoryBoardcomprised of10membersincludingtheChair andCEOofAMA(NSW).“Ourboard includeddoctors,lawyers,members ofthepublicandpeoplefromother professions,”saysA/ProfJohn Gullotta,previousAMA(NSW) PresidentandChairofthe Foundationfortenyears “This diversemixofpeoplehelpedour breadthofvision’’

SophieScott,thenABCreporter, wasaCharitableFoundationboard member “Ifelthonouredtobe involved,becausewhetherraising fundsforbraillebooksforchildren impactedbyvisionimpairmentor life-savingequipmenttogoon rescuehelicopters,wedeliberately chosesmallercharitiesthatoften struggledtocompeteforfunds,”she recalls

Supportingpeoplewithdisability andhealthchallenges

Overthreedecades,animpressive rollcallofcharitiesbenefitedfromthe Foundation Theseincludedthe MuscularDystrophyAssociation (electricwheelchairs),Vision Australia(Brailletypewriters,reading materialsandkits),theHousewith NoSteps(sensoryroomandexercise equipment)andtheMultiple SclerosisSocietyofNSW(specialised showercommodes,mobile showeringtrolleysandreconditioned wheelchairs).

Othercharityrecipientssupporting peoplewithdisabilitiesincludedthe BobbyGoldsmithFoundation(three mobilityscooters),WheelchairSports NSW(fivewheelchairsfortheirsports rehabprogram)andtheExodus Foundation(whoreceivedamuch needed22-seaterbustotransport disadvantagedstudents).“Our missionwastochannelthegoodwill

A/Prof John Gullotta (left) handing over cheque to Can Assist, AMA (NSW) Charitable Foundation Gala Dinner 2012

ASSOCIATION UPDATE

andcharitablespiritofthemedical professiontosupportadiverserange ofcharities,”saysA/ProfGullotta

“WhenmynieceBernadettewas three,shedevelopedmeningococcal diseaseandtragically,lostbothher legs,”herecalls “AnECMOmachine helpedkeepheralive,butWestmead Children’sHospitalonlyhadone ECMO,soIassuredthemwewould raisefundsforanother Wehelped donated5ECMOmachinestoenable childrentofullyrecoverfromtheir meningococcaldisease.’’

Helpingchildren,familiesand communities

Charitiesrelatedtochildren’s wellbeingwerealwaysaFoundation priorityandincludedBearCottage (fundsforanewhospiceandfacility upgrade),andCAN-Assist(which receivedaminibustotransportrural cancerpatients) Raisingawareness of‘forgotten’diseaseswasalways topofmind,leadingtothe2013 donationof$66,000toAlzheimer’s AustraliaNSW,withthenNational PresidentItaButtrose,AO,OBE appearingasguestspeakerat annualGalaDinnerthatyear. Contributingtomentalhealth organisationswasalsohighon agendaandledtofundsbeing raisedforimportantneedssuc suicide/interventionprograms Lifelineandvideoconferencing equipmentforHeadspace

TheAMA(NSW)Charitable Foundationwasalsoreadyto supportthoseimpactedbyadv andcrisis In2004,aspecial campaignraisedfundsforthe

RedCrosstohelppeopleimpacted bytheBandaAcehtsunami.In2016, $25,000wasdonatedtoSoldierOn,a charityforthosewoundedwhile servingintheArmy,NavyandAirforce andtheirfamilies.

Atthe2014FoundationGalaDinner, RosieBatty,Australianoftheyear, wasguestspeakertoraisemoneyfor theLukeBattyFoundation,whichshe startedtohelpothersafterthetragic deathofhersonduetodomestic violence “Australiansoftheyear oftenpartneredwiththeFoundation andspokewithgreatpassionatour GalaDinnertoraisefundsfortheir charityofchoice,”A/ProfGullotta explains “In2008,LeeKernaghan passedhiscowboyhataroundthe room,raising$6,000withinminutesto supportpeopleindrought-stricken bushcommunities”

Othercharitiesalsobenefitedfrom fundsraisedtoassistruraland remotecommunities Theseincluded AussieHelpers,(donationofatruck usedtosupportpeoplestrugglingin bushcommunities)andtheRoyal FlyingDoctorService,(whoreceived intravenouspumpsetsanda ventilator)

“Withthesupportofvalueddonors liketheAMA(NSW)Charitable Foundation,wekeepouraircraftand vehiclesequippedandoperating,to proudlydeliverfreeaccesstoour servicesforthoseliving,workingand travellinginoutbackNSW,”saysRFDS SouthEasternSectionCEO,GregSam

Carryingthetorchforward “Thoughitissadtosaygoodbyeto theAMA(NSW)Charitable Foundation,wealsoneedtoadapt andmovewiththetimes,”says FionaDavies,AMA(NSW)CEO.“The Foundationbeganwhenpeople usedtoputcashonthetableand writechequesandnow,theyare verycomfortabledonatingonline So,theFoundationiswindingdown andwehavepassedtheremaining fundstotheMedicalBenevolent Associationtoprovidecounselling andfinancialassistanceduring timesofneedsfordoctorsandtheir families TheAMAisalwaysmindful ofhowwecanengagein philanthropicworkandwillcontinue tobringtheFoundation’sspiritof communityandgenerositytoallof ourAMA(NSW)eventsand activities.”

DrAndrewWines,Presidentofthe NSWMedicalBenevolent Associationsaid“TheMBAis honouredtoreceivetheremaining fundsfromtheCharitable Foundation TheMBAhasaproud supportingdoctorsattheirmost difficulttimes,wewelcomethe chancetobothreceivethefunds andtoalsoraisetheprofileofthe MBAandtheworkwedo’’ AMA(NSW)wouldliketo particularlyacknowledgeRon HeinrichandScottChapmanof HWLESolicitorswhoservedasboth FoundationAdvisoryBoard membersandadvisors HWLE SolicitorssupportedtheFoundation withpro-bonolegaladviceduring theoperationoftheFoundation AMA(NSW)wouldliketo acknowledgeallofthemembersof theCharitableFoundationBoard throughouttheyears:

A/ProfJohnGullotta

DrBrianMorton

DrMichaelSteiner

DrKathrynAustin

DrDanielleMcMullen

DrElizabethFeeney

MsSophieScott

MrScottChapman

MrRonHeinrich

MrLauriePincott

MsFionaDavies

2009 AMA (NSW) Charitable Foundation Gala Dinner; Grant to Wheelchair Sports NSW

2022 Gala Dinner; Charitable Foundation raised funds for; The Torie Finnane Foundation for Women, Bravehearts and the MBA of NSW

IPTAAS

DOYOUKNOWABOUTIPTAAS?

TheIsolatedPatientsTravelandAccommodationAssistanceScheme

“DoyouknowaboutIPTAAS?”

Byaskingthissimplequestion, medicalspecialists,GPs,practice nursesandreceptionstaffcanlet patientsknowfinancialassistanceis availabletohelpthemaccess specialistcarenotavailablelocally.

TheIsolatedPatientsTraveland AccommodationAssistanceScheme, knownasIPTAAS,helpsNSWresidents whoneedtotravelmorethan100km eachwaytoaccessspecialisthealth care,or200kmweeklytothesame medicalprovider

IntheMurrayregionofNSW, RadiationOncologistDrJohnathon Waketreatspatientswithawide rangeofcancers;includingheadand neck,brainandlung Patientsand carersoftentravelfromsurrounding areastoattendconsultationsand accesslife-savingoncology treatment

Financialsupportprovidedby IPTAASisanessentialpartofthe cancertreatmentpathwayforDr Wake’spatients

“IdiscussIPTAASwitheverynew patientwhoiseligible.We introduceourselvesandthenIask thequestion,‘Doyouknowabout IPTAAS?’

“Fortunately,manycancerpatients havebeenadvisedaboutIPTAAS(by theirGPorotherspecialist)and manyhavereceivedfinancial assistancebeforetheradiation oncologystage.

”Ifpatientsarrivewithout knowledgeofthefinancialsupport available,theAlburyWodonga RegionalCancerCentrehelpsthem applyforIPTAAS.

“Wehavepatientsupportofficers, nursepractitionersandasocial workerthatarewellversedinfilling inthepaperwork,”DrWakesaid. IPTAASplaysanimportantrolein supportingpatientsduringlong periodsofcancertreatment

“Cancertreatmentisalongroad Afterdiagnosisandoftensurgery, radiationtherapiesareonaverage 25to40treatmentsoverfourto eightweeks Manypatientswholive morethanonehourdriveawaywill stayinaccommodationinAlbury duringtheweekandgohomeforthe weekend,whichwerecommendfor theirwellbeing.TheyclaimIPTAAS subsidiesforaccommodationand fuelforeachtrip

“It’sahugeundertakingasit meanstimeawayfromtheirwork andfamilieswhilestayinginAlbury. Itiscriticalforthesepatientsto receiveIPTAAS,”DrWakesaid

Attheotherendofthestate, NorthernNSWresidentLilliForrest’s worldwasturnedupsidedownwhen shereceivedhercancerdiagnosisaveryraremelanomaontheirisof herlefteyethatneededimmediate treatment.

ItwastheheightoftheCOVID-19

pandemicandLillihadjust discoveredshewaspregnantwith hersecondchild.

Waitinguntilafterherbabywas bornwasnotanoptionand,dueto thenatureofthecancer,neither wasbeingtreatedlocally Lilli,wholivesnearLismore,received hercareinBrisbaneapproximately 200kilometresawayandsobegan monthsofnavigatingborder closures,medicalprocedures,travel andaccommodationand eventuallyherrecovery

ArayoflightinLilli’sjourneywas thesafearrivalofbabyLucinda whoherparentssayisalittleballof energyandjoy

AnotherturningpointforLilliand herfamilywasbeingabletoaccess IPTAAS.

“HavingtheIPTAASprogram meansthatyouhavelessfinancial burdenandyou’reabletogetthat treatmentassoonasyoucan,”Lilli said.

Forsomepatients,accessing financialsupportmeansthe differencebetweenseeking healthcare,orgoingwithout.Ifit wasn’tforIPTAAS,Iwouldn’tbe here”

Dr Johnathon Wake, Radiation Oncologist at Albury Wodonga Regional Cancer Centre

Cancer patient and IPTAAS client Lilli Forrest from Northern NSW

AsfarasNoelineNichollsis concerned,it’sassimpleasthatwithoutthefinancialassistanceshe receivedthroughIPTAASshewould nothavesoughtspecialistmedical treatment.

IPTAAS

“Wherewelive,wetraveltoget food,petrolandmedical IfIdidn’t haveIPTAAS,Iwouldn’thavebeen abletodoallthemedicalthingsI neededtodo,”Noelinesaid NoelinelivesatPilligainremote NSW-athree-hourdrivefrom Tamworth Sheregularlyvisits AboriginalHealthWorkerJacob ShanleyatTamworthHospital’s HealthyDeadlyFootClinicto receiveessentialmedicalcare

Jacobandhiscolleagues regularlyhelppatientsaccess IPTAAStoensuretheyreceive essentialcareattheHealthyDeadly FootClinic.

“Oneofthebiggestbarrierswe findwithpeopleistransportand money.Alotofpeopleare comingtoseeusfromasfar awayasPilliga,MoreeandWee Waa,uptothreehoursaway. Ourhigh-riskfootclinicisthe closestservice,”Jacobsaid

JacobencouragesAboriginal patientstouseIPTAASfinancial assistancetoattendmedical appointments

“Thereisalotofpride,especially inourcommunity,aboutnotwanting totakehandouts,butifitisgoingto bethedifferencebetweengettingto anappointmentornot,Isayfillout theformandgettoyour appointment”

ArmidaleGPDrSalmaAliregularly refersherpatientstoIPTAASand she’sseenfirst-handthepositive impactsofthescheme.

“Ithelpsthemmakethedecision toseethespecialist Ittakesaway someofthefinancialburden”

DrAlispecialisesincarefor refugeesandculturallyand linguisticallydiverse(CALD) communities ShesaysIPTAAS addressesthehealthinequities facedbyregionalandCALDpatients.

“IPTAAShelpsthesevery vulnerablecommunities Ithelpsour regionalcommunityaccess healthcareinaneasierandquicker way”

DrAlisaidawarenessofIPTAAS isspreadingamongthecommunity “Bythetimethenextgenerationof refugeescomein,Iwon’tneedto

educatethem–theyarealready awareofIPTAAS!”

DrAlicreditstheincreased awarenessanduptakeofIPTAASto allofherteamsupportingtheir CALDpatients Receptionand nursingstaffassistpatientsin completingtheapplicationforms, lesseningtheloadonthisverybus regionalGP

IPTAASprovidesfinancial assistancetopeoplefromregional NSWtoaccessspecialistcare, approvedalliedhealthcareservices andnon-commercialclinicaltrials

Eligiblepatientsreceivea subsidyfortraveland accommodationcostsincluding privatevehicletravel(40centsper km),accommodation(ranging from$75-$120pernight),public transport(trains,buses,and ferries),taxis(includesridesharing likeUber)andairtravel(inspecial circumstancesandwithprior approval)

TolearnmoreabouthowIPTAAS canhelpyourpatientsvisitthe IPTAASwebsiteorcallyourlocal teamon1800478227.

Dr Salma Ali, General Practitioner at Armidale Medical Centre

IPTAAS client Noeline Nicholls and Aboriginal Health Worker Jacob Shanley

RURAL DOCTORS NETWORK

RURALMEDICALCADETPROGRAMCELEBRATES 35YEARSINSPIRINGCOUNTRYDOCTORS

ByTheoClark,RuralDoctorsNetwork

fromBrisbane “Medicineisthebest wayIcanadvocateforpeopleat theirmostvulnerabletimeandthe Cadetshipaddedanotherdimension tomedschoolintermsofsupport,” hesaid

DrRachaelFikkerswasacadetin 2010/11 ShegrewupintheIllawarra andisnowSeniorMedicalOfficerat theRiverinaMedicalandDental AboriginalCorporation.“Iwaslucky enoughtoobtainanRDNrural Cadetshipwhichgavemesome financialsupportwhilststudyingfulltimeandbroughtmetoWagga Waggaformyinternshipand residencyyears,”shesays

“TheCadetshiphasprovidedmewithanincredible networkoffriendsallaroundNSW,wealwayssaythat weknowwe’vefoundourtribebecauseweareallsolikemindedandsupportiveofoneanother.”TaylorGlover

Thisyearmarks35yearsofthe NSWRuralResidentMedicalOfficer CadetshipProgram,whichis fundedbytheNSWMinistryof Healthandhasbeenadministered byRuralDoctorsNetwork(RDN) since1993.

TheProgramhasbeenhighly successfulindrawingmedical studentstowardcareersserving remote,ruralandregionalareas andanIndigenousCadetship programwasaddedin2012

Cadetsreceive$15,000peryear forthelasttwoyearsoftheir medicalstudiesiftheycommitto spendingtwoyearsinarural locationaftertheygraduate Indigenouscadetsreceive$30,000 spreadthroughoutthecourseof

theirstudy “Afterbeingthefirstin thefamilytogotouniversity,Ihad nocontactsorideaaroundmedical programsliketheRDNcadetship,soI wasveryexcitedwhenIsawan advertisementontheirFacebook page,”saidTaylorGlover,acurrent Indigenouscadet,whowasraisedin theIllawarraandisnowinherfinal yearofmedicineatANU

Theprogramhasachieved enviablelong-termretentionresults Thesecretofitssuccessliesnotonly inthefinancialsupportitoffersbut alsointhisemphasisonbuilding connectedness “Itsbiggestoffering isasupportivenetwork–fromthe Cadetweekendsandconferences”, saysfourthyearWollongongmed student,MorganSeewhohails

“Iwasstrugglingfinanciallyand theCadetshipofferedanopportunity torelievesomeofthatburden...What Ididnotanticipatewaslovingthe treechangesomuchanddeciding tostaylongterm”

Significantly,inresponsetothe NSWRuralHealthInquiryandthe excellentoutcomesfromthe cadetshipprogram,theNSWMinistry ofHealthannouncedanincreasein fundingin2022,enablingRDNto support48cadetsperintakefrom 2023,asubstantiveincreaseonthe12 peryearpreviouslyfunded

InNovemberthisyear,thecadets willbeamongthosegatheringforthe MedicalStudentRuralInspiration ConferenceaspartofRuralHealth MonthatManly,inSydney.To completetheinspirationalcircleof connectedness,acadetalumni eventwillbeheldandstudentswill joinpractisingruralGPsattheRural GPsConferenceDinnerandRural MedicalServiceAwards,recognising GPswho’vededicated35yearsto workingrurally

Rural Doctors Network cadets guided around Tamworth Hospital by junior medical officers, March 2024

FEDERAL AMA

HowanewAMAWorkingGroup isstandingupforInternational MedicalGraduates

ByDrMahaSelvanathan,Chair,AMAIMGWorkingGroup

Manyyearsago,aftercompleting mymedicalstudiesinRussiaand myinternshipinmyhomecountry ofMalaysia,Itookthepathof manyotheroverseas-trained doctorsbymovingtoAustralia. AsIhadalreadycompletedmy training,Ithoughtthehardpartwas over WhatIthoughtwouldbea reasonablystraightforwardprocess ofgainingemploymentasadoctor inAustraliaturnedouttobe anythingbutthat Iwasfacedwithbureaucratic hurdlesandredtape,Ihadtomake severaltripsbackhometo completevariouspaperwork,andI enduredmanysetbacksbefore finallymakingmywayouttheother sideofthemazetoemployment.

Iknowjusthowharditisfor internationalmedicalgraduates (IMGs)whoaretryingtonavigate thatseeminglynever-endingmaze.

Inthedecade-plussinceIfirst startedworkingasadoctorin AustraliaIamafraidtosayIhave seenveryfew,ifanyatall, improvementstothevisaand employmentprocessesfor

internationalmedicalgraduates Andthatisjusttheprocessof becomingadoctor Oncethatmaze iscompleted,overseas-trained doctorsfacemanychallengesinthe workforce,includingexploitation, discriminationanddifficulties establishingthemselvesinthe communitywithoutasupport network

Inresponsetothesechallenges, theAMAhascreatedanIMG WorkingGroup,andIamproudto havebeenelectedaschairafterthe group’sinauguralmeetinginJune 2024

ThisissomethingIamextremely passionateabout,andIhopethis workinggroupcanbeareal catalystforchange.

Australiaisaveryattractive destinationforIMGs,andIwouldnot hesitatetorecommendthiscountry forotheroverseas-traineddoctors lookingtoadvancetheircareer

Australiaissufferinga considerableworkforceshortage, especiallyinruralareas,suchas ArmidalewhereIhaveworkedasa GPforadecade Inmanycases,

IMGsarehighlysoughtaftertohelp addressdoctorshortagesinthese areas

Ruralhealthcareisextremely rewarding,andassomeonewhohas workedinArmidaleformanyyears now,Iamastrongadvocateforit It ischallenging,ofcourse,but extremelysatisfyingandrewarding

Generallyspeaking,beinga doctorinAustraliaprovidesgreatjob satisfaction,betterpayand conditionscomparedwithother countries,andtherearemany opportunitiestocontinuelearning andimproving

Buttherearecertainlymajor issuesthatmustbeaddressed,and theAMA’sIMGWorkingGroupis dedicatedtounearthingand pursuingsolutionstothese problems

Australiaisdependenton overseas-traineddoctorstofill workforcegaps,butthere’sno supportsystemorsafetynetthey canfallonto IMGsareoftenplaced intoajobinacommunitywithno orientationorguidance,anditcan leadtoburnout

FEDERAL AMA

ByestablishinganIMGWorking Group,theAMAistellingall overseas-traineddoctorsin Australiathattheyareextremely valuedhere,andthatsomeoneis lookingoutforthem

TheAMAhaslongadvocatedfor IMGs,butthisworkinggroupwill ensurethissupportisfurther solidifiedandthatnewpoliciesand reformswillbepursued

Reformingthepathwaysto employmentforoverseas-trained doctorsisanobviousplacetostart AlltoooftenIhearaboutthered tapepreventingIMGsfromstarting acareerinAustralia,andI’ve experienceditmyself Ihavea friendwhoistrainedasa neurosurgeonbutiscurrently workingatasupermarket.These kindsofstoriesarealltoocommon Visaprocessesandemployment practicesmustbereviewedand effortsmustbemadetoensure IMGshaveequalopportunitiesthat leadtolong-termemployment, particularlyinruralandregional areas

Exploitationisonebigissuewe areurgentlyworkingtoaddress WhenseekingworkinAustralia, manyoverseas-traineddoctors willlookpastlowwagesandpoor

conditions,eitherbecausetheyhave alreadystruggledimmenselytoget theirfootinthedoorinAustralia’s healthsystem,orbecausetheyare simplyunawarewhatthebenchmarks are

Resourcesmustbemadeavailable forIMGstoassistthemwhenseeking workinAustralia Primaryhealth networks(PHNs),generalpractices, medicalcolleges,localgovernments andothermedicalstakeholdersall haveimportantrolestoplayin ensuringIMGsarewelcomein Australia Someoftheseproblems werediscussedattheAMA’sRural MedicalTrainingSummitheldin Canberralastyear PHNscanplaya greaterroleinsupportingIMGsand establishingsupportgroupsto connectoverseas-traineddoctorsif theyarefeelingbullied,exploitedor otherwisestrugglingwiththeir wellbeing

Wewanttoensurethatonce overseas-traineddoctorsarrivein Australia,theystayhereandenjoy theirtimehere InArmidale,wehadsix toeightdoctorsleavetowntwoyears ago,andthislargegaphasnotyet beenfilled

Australiacanbeafantastic destinationforoverseas-trained doctors,butitisdishearteningmore

isnotbeingdonetoensureIMGs haveopportunitiestothriveand enjoylifehere

AstheIMGWorkingGroupchair,I lookforwardtobeingatthefrontof theAMA’seffortstoimprove outcomesforalloverseas-trained doctorsandIhopeIcanencourage moreIMGstoengagewiththeAMA atstate,territoryandfederallevelsto ensurewecancreateabetter systemforall

DrMahaSelvanathan,Chairofthe AMA’sIMGWorkingGroup

DrSelvanathanhasworkedin Armidalesince2015andbegan practisingwiththepracticein February2021.Shehaspursueda numberofpost-graduate certifications,includingtheFPAA NationalCertificatefromFamily PlanningNSW,aProfessionalDiploma inDermatology,andanAdvanced CertificateinWomen’sHealth She hasastrongbackgroundinsexual healthandfamilyplanning,providing contraceptionandsafesexadviceto schoolsandcommunities.Sheisalso qualifiedtoprovideImplanonor Mirenacontraceptivesandisa providerwithFamilyPlanningNSW’s CondomCreditCardProgramanda providerofPrEP

The inaugural AMA IMG Working Group Meeting held online via Zoom on 12 June 2024

Dr Maha Selvanathan, Chair, AMA IMG Working Group

MEMBER FEATURE

SPOTLIGHT

SpotlightonAMA(NSW)MemberDrDianaSemmondsAM

IntheKing’sBirthdayHonoursthis yearDrDianaSemmondswasone ofseveralAMA(NSW)members appointedaMemberoftheOrder ofAustralia(AM).DrSemmonds wasappointedintheGeneral Divisionforsignificantserviceto ophthalmology,toregulatory bodies,andtoprofessional organisations.

DrDianaSemmondsgrewupin Turramurra,theeldestoffour children DrDianaSemmondsis nottheonlydoctorinthefamily HeryoungersisterDrAlison Semmondsisageriatricianand AMA(NSW)Councillor.Whilethe sistersdon’tcomefromamedical backgroundit’stheirbelieftheir father,achemicalengineer, harbouredaspirationstopractise medicine

Whatmadeyouwanttobecomea doctor?

WhenIwasatschool,Ienjoyed behaviouralbiologyand studyingFreudandJung I thereforedecidedtodomedicine inordertobeapsychiatrist This wasmyinspiration.Ialsowanted tohaveajobwhereIthoughtI couldbeincontrolofmyworklife

Doyourememberyourfirstdayof university?

Iwouldhavebeenveryexcited.I certainlyrememberthoseearly weekswhenImetsomany differentlike-mindedpeople This beganawonderfulsixyearsof medicalstudies

Whatspecialtieswereonyourlist whenyoustartedyourstudies? Iinitiallywantedtobea psychiatristbutafterdoingvarious terms,IrealisedthatIenjoyed manydifferentareasofmedicine Inmyfirstyearasanintern,Ifound theloveofsurgery.Ifapatient cameintocasualtyneeding suturingorneedingorthopaedic care,Iwasalwaysthefirsttoput myhandup. Howdidyousettleon ophthalmology?

Idecidedonophthalmologyasitis asurgicalspecialty.Ialsoknew thatIwishedtohaveafamilyand wantedasurgicalspecialtywhich wouldallowmetohavechildren whileIworked Thisthereforeruled outthosesurgicalspecialtieswhich requiredalotofnightwork Imay otherwisehavedoneorthopaedics Whatisthemostsatisfyingthing aboutophthalmology?

Beingadoctorisincredibly rewarding Beingan ophthalmologistandthereforeable toreturnormaintainpeople’s visionisincrediblysatisfying. Peopleputalotofimportancein theirvision Evenaftermanyyears inpracticeandhavingperformed thousandsofcataractsurgeries,I stillgetjoyoutofremovingthe patchandseeingthepleasurethat patientsfeelwiththeimprovement intheirvisionfollowingtheir cataractsurgery. Whathasbeenthemost rewardingpartofyourcareerso far?

Justcaringforpeopleandhelping themtomakethemostoftheirvision. AlsoplayingaroleinRANZCOand beingabletohaveinputandtoeffect changeforthefutureof ophthalmologyandpatients. Whatdrewyoutoadvocacywork?

WhenIwasatuniversityIwaselected totheSydneyUniversityunionboard ItwasthenthatIrealisedhow importantgoodgovernancewasand howitwaspossibleforindividualsto effectchange Soonafterfinishingmy specialisttraining,IjoinedsomeAMA committeeswhichIenjoyed,andit continuedfromthere

Whatwouldyousaytootherswho wereconsideringbecomingmore activeinassociations/colleges?

Whileclinicalmedicineisrewarding andinteresting,itisnicetothink outsidethesquare Becomingactive inassociationsorcollegeactivities canwidenonesunderstandingand appreciationofwhatgoesonwithin themedicalworkforce

Doyouhaveanyrolemodelsin medicineorout?

Therewereveryfewfemale specialistswhenIwastrainingsomy rolemodelswerethemanydecent maledoctorswhotaughtusover manyyears.

Youandyoursisterarebothdoctors, doyouprovidesupporttoeach other?

Yes,wecertainlydoprovidesupport toeachother,bothmedicallyandas sisters Itiswonderfulhavingasister withwhomyoucandiscussallsorts ofthings

Whatwasyourreactionwhenyou discoveredyou’dbeenrecognisedin theKing’sBirthdayHonours?

Iwas,firstly,amazedthenvery pleasedandthenquitehumbled.It doesmakeonefeelquiteproudof whatonehasachieved The expressionsofcongratulationsfrom mycolleaguesandpeersaswellas theotherorganisationsthatIam involvedwith,hasbeenreally wonderful

What’sthebestpieceofadvice you’vebeengiveninyourcareer? Frommyfather Nilbastardum carborundum

MEMBER FEATURE

InterviewwithDrDianaSemmonds’sister

Semmondsisthirteenyears youngerthanDrDiana Semmondsbuthasmany fondmemoriesfromher childhoodofherbigsister “Di” AlisonsaysDiwasher inspirationtobecomea doctor.

Whatareyourearliestmemoriesof yoursister?

y p y sister?

Howmuchshegivestoherpatients andprofessionandadoresher family,andhowshestillworksonher fitness.

DireceivedaMemberoftheOrderof Australia(AM)forsignificant servicetoophthalmology,to regulatorybodiesandto professionalorganisations Were yousurprised?

Iwasoneofthemainpeoplewho nominatedher;Ifeltstronglythatshe deserveditafterwatchingwhatshe p

IclearlyrememberDitakingmeto anopendayatSydneyUniand beingfascinatedbythespecimens inalab Tellmeaboutyourchildhood. Mumworkedhardraisingfour childrenandDadworkedhiswhole lifeatTaubman’spaintsfirstasa chemicalengineerandlatermoving intomanagement Youhavechosenverydifferent specialties,wereyoueverinspired togointoophthalmology? Iwasmarriedtoafarmerandmy daughterwas18monthsoldwhenI starteduniandtheplanwasalways

Sovery,veryproud Bothwouldhave beamedandtherewouldhavebeen tearsandMumwouldhavehadmore storiestotellthenextladyshemetat thediningtable Andthenextone Andthehairdressertooofcourse

ScantheQRcodeto readaboutthe achievementsforwhich DrDianaSemmonds wasnominated didoverherwholecareer;somevery sageguidancefromhercolleagues helpedmakehernominationspecial Bothyouandyoursisterareinvolved inadvocacy Whatdoyouthinkitis thathasdrivenyoubothtoservice? Idon’tthinkmedicineisaneasygig I knowhowhardeveryonehasworked, notonlyeveryafternoonafterschool butallthewaytogettingtheirfirst providernumber Therearesomany doctorswhoarenotokbutputona professionalface.Supportingthe AMAtosupportdoctorswasthewayI wantedtogivebacktomy colleagueswhohavesupportedme Whatdoyouthinkyourparents wouldhavethoughtofyoursister’s honour?

CROSSWORDANSWERS

Diana and Alison Semmonds as children

Diana (left) and Alison (right)

Celebrating20Yearsofthe StudentsAsLifeStyle ActivistsProgram

ProfessorSmitaShahOAM,CatrionaLockett,KymRizzoLiu,DrKean-SengLimandChristineCawseyAM

2024marksthe20thanniversaryof theaward-winningStudentsas LifeStyleActivists(SALSA)program, apioneeringinitiativeinWestern Sydney.

Theprogram'ssuccessunderscores itseffectiveapproachtofostering healthiercommunitiesthrough collaborationswithschools, healthcareprovidersand universities.

TheSALSAprogramwaslaunched in2004bytheMtDruittMedical PractitionersAssociation(MDMPA)in responsetoescalatingchildhood obesityratesinwesternSydney Recognisingthechallengeof reachingadolescentswhoseldom visitedGPpractices,theMDMPA, alongwithRootyHillHighSchooland thePreventionEducationand ResearchUnit(PERU),developeda school-basedpreventative intervention.Thisprogram,basedon SocialCognitiveTheoryand EmpowermentEducation,involves Year10studentsteachingYear8

studentsabouthealthylifestyles, therebypositioningthemasrole modelsandmotivators

“Challengedbytheconfronting statisticsaboutadultobesityand poordietinAustralia,initiativesthat worktochangetheattitudes,eating behaviours,andexercisehabitsof secondarystudentsarerare

SALSAisonesuchinitiative,”saidDr Kean-SengLim,Presidentof MDMPA

In2014,SALSAwashonouredwith multipleawards,includingthe CommunityChoiceAwardandthe PartnershipAwardfromthe WesternSydneyLocalHealth District Tomaintainitsrelevance andeffectiveness,theprogramhas evolved,incorporatinguniversity studentsasSALSAeducatorswho trainYear10peerleaders The introductionofSALSAYouthVoices (SYV)in2017furtherextendedthe program’simpact SYVempowers Year10leaderstocreateand implement‘SchoolActionPlans,’ leadingtoinitiativessuchas redesignedsportsuniformsand waterrefillstations(2) SALSA’s effectivenesshasbeenvalidated throughextensiveevaluations supportedbytheFederalHealth Department

Partnership between local GPs, AMA (NSW) and SALSA, Rooty Hill High School 2016

Erskine Park High School SALSA Peer Leaders, Westmead Hospital 2019

Theprogramhaspositively influenceddietaryandphysical activitybehavioursinYear10and Year8studentsacross23high schools Itisalsorecognizedforits cost-effectiveness,withanexpense oflessthan$10perstudent(3,4).

Sinceitsinception,SALSAhas trainedover550universitystudents andengagedmorethan26,000high schoolstudentsfromover40 schools Theprogram’ssuccesshas ledtointernationaltrialsintheMiddle East,China,andVietnam,andithas beenrecognizedbyUNICEFasa modelforadolescentandyouth programsintheMiddleEastand Africa(5,6,7)

TheSALSAprogramfocusesonthe richestresourceofourcommunitystudentsthemselves Ithasprovento beasustainableandimpactful initiativeinpromotingimprovingdiet andincreasingphysicalactivityin highschoolstudents Wewouldlike tothankthestudentsandstafffrom theSALSAschoolsfortheir participationandsupport Wealso acknowledgethefinancialsupport wereceivefromWentWest,Western SydneyPrimaryHealthNetworkand fromDanielMcAlary

SALSA

“Challengedbytheconfrontingstatisticsaboutadultobesityandpoor dietinAustralia,initiativesthatworktochangetheattitudes,eating behaviours,andexercisehabitsofsecondarystudentsarerare.SALSA isonesuchinitiative,”

DrKean-SengLim,PresidentofMDMPA

ScantheQR codetoread thereferences.

Oxley and Gunnedah SALSA Peer Leaders and University Educators; 2023

Prevention Education and Research Unit (PERU) receiving the Quality Award in 2014

MEMBER UPDATE

MEMBERMESSAGING

AMA(NSW)hasrecentlylaunched anewmembernewsletter:Vital Signs.Thecurrent-affairsfocused newslettergivesmembersinsight onthebehindthescenesatAMA (NSW)regardingadvocacy,policy andnews.TheAugusteditionof VitalSignscoveredtopicsincluding theNationalRegistrationand AccreditationScheme,Budget EstimatesandtherecentSessional VMOOfferandthecorresponding AMA(NSW)surveyresults This editionalsocoveredtheunfolding IVfluidcrisisfeaturinganaesthetist DrKatherineJeffrey,and congratulatedAMA(NSW)Vice PresidentDrFredBetrosonhis inductiontotheAMARollofFellows, andbothDrDanielleMcMullenand A/ProfJulianRaitfortheirpositions ofAMAPresidentandVice President

TheSeptembereditionofVital Signsrequestedfeedbackfrom membersregardingtheMedical Board’sconsiderationtointroduce healthchecksfordoctorsover70 andgavemembersinsightonthe recentconversationswithThe MedicalRepublicandAMA(NSW)

CouncillorandwesternSydney generalpractitionerDrKen McCroaryregardingexpandingthe scopeofpharmacy AMA(NSW) CEOFionaDaviesalsospokewith TheMedicalRepublicregardingthe payrolltaxreliefinrelationtobulkbillingGPs.Thenewsletteralso detailedsomebehindthescenes detailsaboutwhatAMA(NSW)has beenuptoinordertoensurethe bestoutcomesfordoctorswithin

NSW

SCOI

AMA(NSW)DirectorofWorkplace RelationsDominiqueEgan continuestoupdatememberson theSpecialCommissionofInquiry intoHealthcareFunding(SCOI) In June,MsEgandetailedthehearings thatwereheldwherebyevidence wasgatheredaboutissuesrelating toStVincent’sHospital,Hawkesbury HospitalandtheSydneyChildren’s HospitalNetwork.Memberswere informedthatAMA(NSW)metwith chairsofMedicalStaffCouncilson 27June2024todiscussthe effectivenessoftheMedicalStaff Councilasameansfor managementtoconsultand engagewithmedicalpractitioners

inthepublichospitalsystem In August,MsEganupdatedmembers onthehearingsthathadtakenplace throughoutJuly2024 Atthese hearings,evidencewasgivenbykey stakeholdersincludingAMA(NSW), theMinistryofHealth,colleges, ASMOFandothers Memberslearned thatthehearingscanvassedseveral issuesrelevanttothemedical workforce.

Memberswerealsoinformedthat throughoutAugust,theCommission wouldvisittheSouthCoastofNSW andpublichearingswouldbeheldin BatemansBay,focusingonthe deliveryofhealthcareservicesat SNSWLHD

MsEganensuredmembersthat furtherupdatesonthesehearings wouldbeprovidedwhenthe informationbecomesavailable

If you have matters you would like to raise with the commission, please email workplace@amansw com au We want to make sure our valued members are receiving all information they need, so send us an email at news@amansw.com.au to let us know what you want to hear more about

ValeDrMonicaMaryBullen

AMA(NSW)wouldliketoacknowledgethepassingofDrMonicaMaryBullen DrBullenpursuedacareerinmedicine,graduatingfromtheUniversityofSydney MedicalSchoolandspecialisinginpathology Herexpertiseanddedicationshone throughinherroleasadistinguishedmicrobiologistatRoyalPrinceAlfredHospital

DrBullenpassedawayon26August2024,attheageof102yearsand9months At thetimeofherpassing,DrBullenwasoneofouroldestmembersandwasfeatured intheAutumn2024editionoftheNSWDoctorMagazine AMA(NSW)extendsits heartfeltappreciationtoDrBullenforherinvaluablecontributionstothemedical fieldandoffersourdeepestcondolencestoherfamilyandlovedones

Dr Bullen on her 100th birthday

MEMBER UPDATE

Bymaintainingastrongandongoingpresenceinmainstreammedia,AMA(NSW)ensuresthatthe associationremainsfirmlyatfrontofmindasthestate’speakbodyfordoctors

“Themostvaluableassetindeliveringgoodhealthcare arethehealthcareworkerstaff–thosewhoarekindand havetimetospendtimewithpeople”DrBonningsaid

July16,DailyTelegraph:DrKathryn Austinsaidtherewereissuesin attractingandretainingdoctors toworkinruralNSW “AMA (NSW)isconcernedthat fewerdoctors-in-training appeartobeattractedto workinregionaland rurallocalhealth districts,”DrAustin said.

August1,SydneyMorningHerald:DrKatherineJeffrey saidIVfluidswerethesimplestwaytodeliverpowerto thefastingbodyandpreventcomplicationssuchas heartorkidneyinjury “IamworriedbecauseIcannotdo mynormalpractice IfIdon’tgetenoughfluidsinthe rightpatient,they’renotgoingtowakeupwell”

August12,DailyTelegraph: DrAustinsaidtheassociation supportedurgentcareserviceswhen theydon’tcompetewithgeneral practices.“AMA(NSW)isconcernedby theCommonwealth’surgentcare centremodelwhichcanattimes competeforgeneralpractice workforceandmayimpactonthe viabilityofgeneralpractice.”

September4,TheMedicalRepublic: AMA(NSW)CEOFionaDaviessaid“AMA (NSW)hasalwaysstatedthatpayrolltaxwas notdirectlyrelevanttobulkbillingandthata doctor’sdecisiontobulkbillornotisrelated tootherfactorssuchasthecostsofpractice andthelevelofrebatesprovidedbythe CommonwealthGovernment”.

September6,TheMedicalRepublic: DrKenMcCroaryspoketoThe MedicalRepublicontheannouncementfromtheNSWGovernmentto expandthescopeofpharmacy DrMcCroarysaidtheannouncementwas “short-sighted”,“narrow-minded”and“wrong”

July 2, Sydney Morning Herald: Dr Michael Bonning spoke about the body-worn cameras within NSW public hospitals

EVENTS

50YEARMEMBERLUNCHEON

Theannualluncheoncontinues tobeoneofAMA(NSW)most lovedevents,bothbystaffand valuedguests.

AMA(NSW)50YearMemberLuncheonwasheld andrecognisedfortymembersfortheirvalued teachinghospita achieverstorura thatworkedfors veryunfair beca achieverswerem receiveadequate training

Theeventoffersachancefor gueststoconnectwitholdfriends andcolleaguestorecall memories,ofwhichstillstandas importantmomentsintheir careers.

Wewerehonouredtobejoined byfortyguests,andformerAMA (NSW)PresidentProfBrianOwler, whodeliveredthekeynotespeech DrPhillipCocks,oneofthe40 membersrecognisedfor50years ofmembership,deliveredan inspiringspeechreflectingonhis careerandtimewithAMA(NSW) DrCockshighlightedthekey milestoneshehadadvocatedfor duringhistimeasadoctorand memberoftheassociation.

Herearesomehighlightsfrom hisspeech

IjoinedtheAMAasamedical studentin1971andsooncameto appreciatehowimportantthe supportofourassociationcould

WesoughtAM theIncomingRes andweputalot governmentand tochangetheint systemsothatev appointedtoate andspentthreet twotermsaway systemstartedw in1973andisstillinplacetoday. Threeyearsaftergraduation afterI’dwrittentotheHeraldand causedabitofakerfuffle,theAMA andPublicServiceAssociation helpedjuniorcolleagues,Stewart Fleming,TerryMahoneyandothers throughTownHallmeetingsanda courtbattletosuccessfullysecure penaltyratesforResidentMedical Officers Beforethatitwasafixed salaryforayearanditdidn’tmatter howmanyhoursahospitalrostered youfor.Igottiredofwalkingtothe

wouldbecheapertogetsomebody elsetodothosejobs Thiswasdespite oppositionnotonlyfromthe Governmentbutalsofromsomeof ourmoreseniorcolleagueswhofelt thatwewerewimpsforobjectingto theprolongedshiftsthattheyhad endured.Thiswasaverysignificant stepinprogresstowardssafer workinghours

AtanAMA(NSW)BranchCouncil meetingin1976,Igingerlysuggested thatwestartadoctorshealthfund alongthelinesoftheteachersand thedefencehealthfunds

Theideawasadoptedand advancedbyLauriePincottandPeter Arnold TheAMAHealthFundstarted in1977,nowhas32,000membersand wasboughtoutbyAvantin2012for 28milliondollars.

Inthenineties,theindemnity disputewascausinghavoc, especiallyinmyspecialty–obstetrics andgynaecology–whereannual premiumsreached$150,000,which meantyouwereworkinguntilMarch orApriltokeepyourheadabove waterforthatfinancialyear.Atan AMAmeetingwith600colleaguesat RandwickRaces,AndrewPesce

AMA (NSW) Member Dr Phillip Cocks

Former AMA (NSW) President Prof Brian Owler

andIurgedthegovernmenttocover publicpatientindemnity.

TheTreasuryManagedFundwas commencedsoonafterandhasbeen verysuccessful Onalighternote, duringtheMedicaredispute,Iwas operatingatBaulkhamHillsPrivate Hospitalwhenimmediateevacuation ofthehospitaltookplace,duetoa bombthreat.Perhapsco-incidentally BruceShepherdoperatedthereon thesameday Ittookabout15 minutestocompletethe hysterectomyandthenthe anaesthetistandIcarriedthepatient downthefirestairsandonatrolley outside Whensheawokeinthe parkingarea,Icarefullyexplained whatthetreesandblueskywere doinginherlineofvisionasIwas concernedthatshemightthinkthat shewasinheaven

Lookingback,Ihavehadlotsoffun withgreatcolleagues,andIam gratefulforthepositiveexperience thatIhaveenjoyedwiththeAMAand inparticularwiththeNSWBranch Thankyouandpleasekeepupthe goodwork

PhilCocksOAM–whichthe grandchildrenhavedecidedstands forOldAgedMan!

EVENTS

Dr Peter Cohen accepting his 50 Year Membership Certificate

Dr John Wong accepting his 50 Year Membership Certificate

Members enjoying the luncheon at The Royal Exchange, Sydney

Better value hospital cover

CROSSWORD

THE STITCH UP

ByDrAshnaBasu

ACROSS

DrAshnaBasu isaPsychiatry Registrar workingin Sydney She Servesas theChair oftheYoungbranchofthe MedicalWomen’sInternational Association,thePresidentofthe MedicalWomen’sSocietyof NSW,theNSWrepontheRANZCP BinationalCommitteeofTrainees, andasamemberrepresentative ofAMA(NSW)DITC

Highlycontagioustransmissibleskin disease,onedescribedbyAristotle as‘liceoftheflesh’(7)

Photoreceptorcellsintheretinathat helpwithvisionduringlow-light conditions(4)

ClassofmedicationsusedinHIV treatment,actingonreverse transcriptase(4)

MeasureoffrequencyinEEG(5) See4-down

Testwhichmeasuresthechangesin theelectricalfieldintheeye,usedto evaluatevertigo(abbreviation;3)

Masticated,colloquial(6)

Partofthebasalgangliaimplicated inmodulatingmotormovement(10, 5)

Reductionintheoxygen-carrying capacityofbloodduetodecreases inhemoglobinconcentration(7)

Autoimmuneconditionthatcauses lossofskincolourinpatches(8)

Hormoneproducedbythepituitary glandwhichtriggersreleaseof cortisolfromadrenalglands (abbreviation;4)

Surgicaltoolthatuseselectrical energyinacontrolledmanner, causingtargetedthermaldamage totissues(9)

Soundassociatedwithturbulent bloodflow(5)

GeneimplicatedinCysticFibrosis (abbreviation;4)

Medicationclassthatenhancesthe effectoftheneurotransmitter gamma-aminobutyricacid(15)

Signofliverdiseaserelatedto prominentbloodvessels;also12across(6,5)

Thestudyofthestructureand functionoftheskeletonandbony structures(9)

Anticonvulsantandmood-stabiliser associatedwithneuraltubedefects (6,9)

Typeofulcerseeninoralmucosa (8)

MemberoftheViridans

Streptococcusgroup;foundinthe humanmouth(9)

Net-likepatternofreddish-blueskin discoloration,------reticularis(6)

Colloquialmovementfacilitatedby thetrapeziusmuscles(5)

Releasedbythelacrimalgland(4)

Surgeryinwhichasectionofa bloodvesselisgraftedfromthe aortatothecoronaryartery (abbreviation;4)

Sexchromosomekaryotypeseenin

JacobsSyndrome(3)

Findtheanswersonpage31

Whilst

Youcanfindacomprehensivelistofbenefitsandmoreinformation atwww.amansw.com.auoremailmembers@amansw.com.au