The NSW Doctor 2023 March /April

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Can you substitute a doctor with technology? “While technology can assist and support doctors in providing medical care, it is unlikely that it can completely substitute a doctor. Medical care involves complex decision-making and requires a combination of technical skills, critical thinking, and human intuition that technology has not yet achieved.

Doctors use their expertise, knowledge, and experience to assess patients’ symptoms, medical history, and other factors to make accurate diagnoses and determine the best course of treatment. They must also communicate effectively with patients and their families, providing emotional support and explaining complex medical information in an understandable way. These skills require a level of human empathy, communication, and critical thinking that technology has not yet achieved. However, technology can be useful

FROM THE EDITOR

in supporting medical care by providing doctors with tools and resources to help them make more accurate diagnoses, track patients’ medical history, and monitor their health status. For example, electronic medical records can help doctors track patients’ health data, and diagnostic tools such as MRI or CT scans can help identify medical conditions that may not be immediately apparent.

In addition, telemedicine platforms and remote monitoring technologies can help doctors connect with patients remotely, providing medical care in areas with a shortage of medical professionals, or in situations where patients cannot travel to a doctor’s office.

In conclusion, while technology can assist and support doctors in providing medical care, it cannot completely substitute a doctor’s expertise, empathy, and intuition. Medical care is a complex field that requires a combination

of technical skills and human interaction to provide the best possible care to patients.”

Thanks ChatGPT. So there you go, unlike an editor, you cannot completely substitute a doctor. The premise that a doctor is central to the provision of healthcare is at the heart of AMA (NSW)’s Election Priorities document. While we need many more healthcare workers, including nurses and allied health workers, the Government cannot ignore the importance of resourcing its doctor workforce. To adequately address the burgeoning healthcare needs of our population, the Government must look to employ more doctors both immediately, while also planning for the future. The good news is there will likely be more people interested in pursuing a career in medicine, particularly as AI takes over other career paths. Now, can anyone offer me tips on getting into med school?

Andrea Cornish, Editor

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The NSW Doctor is the bi-monthly publication of the Australian Medical Association (NSW) Limited.

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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

Chief Executive Officer Fiona Davies

Director, Services Kerry Evripidou

Director, Workplace Relations

Dominique Egan

Director, Membership Engagement and Commercial Partnerships

Gary White

Editor Andrea Cornish andrea.cornish@amansw.com.au

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WHAT’S THE PLAN FOR HEALTH?

AFTER MONTHS of daily death counts and two solid years of pandemic reports dominating news headlines, there has been a noticeable dearth of health-related news. It appears the pendulum has swung the other way and the public’s appetite for health information has been replaced by stories on inflation and housing concerns.

DR MICHAEL BONNING PRESIDENT, AMA (NSW)

While this is probably a natural response from a population that completely and fully exhausted itself conversationally on COVID, it’s disheartening that our politicians have also gone quiet on the topic of healthcare.

As I write this, the NSW Legislative Assembly has expired, and caretaker period has begun –marking the official start to campaigning. However, in the lead up to now, the discussion on health has taken a backseat.

The Coalition has stood by its Budget commitment to employ 10,000 more healthcare workers over four years and Labor has leaned into university fee subsidies for students who commit to the public system for five years.

But where is the commitment to the current workforce? What is the next government going to do to stop the exodus of healthcare workers to other States?

anyone working in our hospitals or primary healthcare can attest to, they are getting worse.

AMA (NSW) released its Election Priorities document in late February and its focus is workforce. Whilst we acknowledge that the system needs more nurses, midwives and allied health practitioners, we strongly argue that it especially needs more doctors.

Doctors are central to the care team and can’t be substituted out of the health system.

President@amansw.com.au

@michaelbonning www.facebook.com/amansw

Just because there is a resistance to talk about health, does not mean the problems we’re facing in this sector have gone away. In fact, as

AMA (NSW) will look for new ways to engage stakeholders and make our message public. We are seeking to meet our members in health-focused webinars. We have a couple events lined up in the pre- and post-election run and we hope to continue the conversation about health with you, as there’s never been a more important time for doctors to speak up about their experiences in the health system. In this issue, along with reading about our Election Priorities document, NSW Hospitals: Advanced Life Support Needed, we have also included an Open Letter from the NSW Medical Staff Council Executive Committee. The letter details the commitment that doctors have to their hospitals and patients, as well as their exasperation of working in an overstretched hospital system. We have many challenges in our hospitals, but the solutions are there – we just need a Government willing to talk about it. dr.

Weeks out from the State election and the sales pitch from major parties seems to be missing one key component.

Dr Dominic Barnes Member since

FROM THE CEO

STEPPING UP

There are always risks to speaking out. But with so much at stake in health at the moment, isn’t it a bigger risk if doctors say nothing?

My husband, neurosurgeon and past AMA President, Prof Brian Owler, tells the story of starting his internship at RPA. One of the first things he did was walk into the Medical Staff Council meeting and tell some of the most eminent doctors in the country that he was leading the doctors-in-training on strike. He also tells the story of the phone ringing at his family home in Panania. It was Dr Bruce Shepherd on the line – telling Brian that he had heard about the strike and that he was giving Brian his full support. It’s probably not surprising that our Federal AMA colleagues are still able to scare Federal bureaucrats with the threat of taking an issue up to the ‘Owler factor’.

As we have been warning for some time, a profession that has a proud history of fighting for patients, for resources, and for the system, is facing the fight of our lives. Never in my 20-year-career with the AMA have I seen such threats and such a need for advocacy. At a state and federal level, it is as if doctors are the least important part of healthcare – replaceable, unnecessary and a burden. It is part of the trashing of elites, the death of respect for knowledge and expertise.

I find the desire to replace doctors particularly galling given there is one group who take their access to doctors – for their care and their families – very seriously. That group is politicians. And yet for their communities, substitution and any access to care is good enough.

I am often told by doctors that they don’t want to put themselves

out there when it comes to fights. They tell me “it’s different now” or “there will be reprisals”. I am here to assure everyone that it’s not different and there have always been risks for those who put themselves out there. Stepping up happens when, at some point, the harm of continuing on becomes greater than the risks of speaking out.

In the fight we are facing, we will need to use different tools. Our traditional avenues of mainstream media are fading in importance and relevance. Stories come and go. This is why we are moving our campaigning approach to the most important asset we have – our patients – and looking for doctors to step up and tell their stories through their patients.

Dr Aziz Iboyan is one such hero. Dr Iboyan is exactly the sort of family GP everyone would want. He practices in Hornsby and for the past few months, has been telling his patients about the payroll tax grab. He has the AMA materials in his waiting room and has used them to tell patients what payroll tax will mean for his practice. Dr Iboyan also spoke to The Australian newspaper and put a face and a voice to a story the AMA has been running for a number of years. He showed the true value of general practice in a way that 100 media releases could never do.

There will be many such interactions and opportunities for doctors to be advocates and heroes. It’s just a matter of stepping up. dr.

FIONA DAVIES CEO, AMA (NSW)

DOCTORS

Ahead of the 2023

NSW Election, AMA (NSW) had one key ask…

It is a system, however, that has been losing ground over many years. Patients wait – for treatments, for surgeries, for appointments, for care because of under-resourcing and an attitude that our system is “good enough”. Our patients deserve better: better access to doctors across the State, a doctor to do the jobs that patients expect doctors to do, and doctors that have the support and equipment to deliver high quality care that leaves no one behind.

Our health system is falling behind on every measure. If we continue on this trajectory, our hospitals will be overrun, and patients will face dire healthcare consequences. We cannot expand the capacity of the health system without addressing workforce shortages.

AMA (NSW) is calling on the State to harness the same political will it took to effectively safeguard the lives of millions of residents during the pandemic and apply that same energy, funding, time, and strategic decision-making to tackling the healthcare challenges that are fuelling the public hospital crisis.

The pandemic response was demonstrative of the State’s capacity to respond to the crisis at hand. Whilst the COVID threat has waned, the State faces new challenges – hospital logjams, long elective surgery waitlists, and an ever-growing population with increasingly complex, chronic conditions.

AMA (NSW) launched its 2023 Election Priorities document NSW Hospitals: Advanced Life Support Needed which highlights three aims for the next government: support our health system; support rural

healthcare; and support doctors’ health and wellbeing.

Support our health system

Topping the list of priorities is workforce.

In preparing our report, we asked doctors around the State about their experiences and what they saw as the major challenges facing healthcare delivery in NSW.

The responses were unanimous –we need more healthcare workers. We need more allied health, we need more nurses, we need more midwives, but specifically we need more doctors. While all members of the care team are important, doctors are central to that team.

NSW cannot have a world-class health system without doctors. Nor can it substitute its way out of employing more doctors.

AMA (NSW) engaged Deloitte to provide an analysis of the workforce pressures the NSW health system is currently facing. The evidence in Deloitte’s Medical Workforce Pressures in NSW supports a case for change. Specifically, it found that the growth in demand for healthcare services is outstripping

NSW HAS A GOOD health system which is built upon the day-today heroism of doctors and other healthcare workers.

population growth. As a result, health workers in NSW will need to become 40% more productive by 2050 to meet forecast demand.

Doctors are already struggling to meet current demands. Our surveys have identified high levels of burnout with 8 in 10 doctors reporting workplace stress and only third of respondents feeling valued in their roles. The government can no longer rely on the goodwill of doctors to keep the plates spinning.

The system simply cannot meet the current challenges without adequate funding and improvements in workforce. This cannot be done without addressing the current wages policy and updating the Staff Specialist Award and modernising contractual arrangements for VMOs. NSW is losing ground to other jurisdictions that offer better remuneration and support to doctors.

In addition, we recognise the need to use our resources smarter. We need to build the capacity of doctors, who play a central role on the care team, to ensure their hours are maximised to provide the best care possible to patients.

Support rural healthcare AMA (NSW)’s 2023 Election

Priorities also includes specific recommendations to improve rural and regional healthcare. The rural health inquiry shone a spotlight on many areas for improvement and the next Government must be responsible for implementing the report’s recommendations.

There needs to be greater support for the specialist workforce to increase healthcare access in regional areas and improve retention. Similarly, we are calling on government to implement recommendations that provide greater training opportunities for the next generation of regional doctors.

Support doctors’ health and wellbeing

Lastly, we have highlighted the importance of doctors’ health and wellbeing. The Government must care for the carers if our medical workforce is to fulfill the great task of providing world class care to NSW residents.

After two years of the pandemic and sustained pressure on doctors to keep up with patient demand, we know there is a significant level of workplace stress, which leads to poorer mental health.

Time for solutions

The next Government is taking the helm at a pivotal point in history and has an opportunity to shape a health system that is not only responsive to the current needs of the population, but also takes into account the changing needs of future populations. We know the problems that exist and we know the solutions. We’re asking the next NSW Government to trust the same people that got us through COVID, to guide us through the current challenges facing the health system. dr.

...the growth in demand for healthcare services is outstripping population growth. As a result, health workers in NSW will need to become 40% more productive by 2050 to meet forecast demand.

PRIORITIES AND ISSUES

In this election statement, we have outlined three priorities:

1. Support our health system

2. Support rural healthcare

3. Support doctors’ health and wellbeing

Within each priority, we’re asking the next government to address:

Support our health system

➜ Growing demand: We have a growing and ageing population that is increasingly presenting with complex co-morbidities and putting pressure on hospitals.

➜ Public hospital funding: The current funding split between the Commonwealth and States and Territories is compromising NSW’s ability to meet patient demand.

➜ Doctor workforce: There is a significant shortage of doctors, particularly in certain specialties.

➜ Elective surgery: Patients are waiting months, and sometimes years to access elective surgery.

➜ Care in the community: Ambulance ramping and access block are direct consequences of insufficient care in the community.

➜ Health at risk: Expanding the scope of pharmacy undermines general practice and contributes to fragmented care .

➜ Payroll tax: Payroll tax threatens the viability of medical practices and could result in reduced healthcare access for patients should practices be forced to close.

Support rural healthcare

➜ Specialist workforce: Rural and regional residents have reduced access to specialist care despite higher health needs.

➜ General practitioners (GP): Significant shortages of GPs in regional and rural areas result in delayed access to care and poorer health outcomes.

➜ Natural disasters: Rural health services should be recognised as essential services in the wake of natural disaster and provided with immediate grant funding.

Support doctors’ health and wellbeing

➜ Workplace stress: Doctors are facing significant levels of workplace stress leading to higher levels of burnout.

➜ Doctor-in-training fatigue: Almost half of doctors-in-training made a fatigue-induced error in 2022.

➜ Critical incidents: Doctors do not have sufficient support to help them cope with adverse patient outcomes, leading to higher levels of stress.

Dear NSW Government

We are deeply invested in advocating for improved health services and care for patients. We work shoulder to shoulder with other doctors, as well as nurses, allied health, and hospital staff, and we see the day-today impact our health system has on patients’ lives. We have built our professional lives around caring for people and feel a great responsibility for ensuring that the ongoing provision of care is to the standard NSW patients deserve. We love our hospitals and recognise the incredible demands currently facing the system. With this in mind, we feel it is our duty to raise our concerns about the immense challenges facing our hospitals.

Rise in demand

Over the past decade, there has been an increase in public demand for health services. The volume of work has escalated, and doctors are working at unsustainable rates. There is a feeling of desperation and futility as we make greater sacrifices and yet fall further behind. Whilst we have seen major public hospital builds over the past five years, we have not seen the same investment in staffing of our public hospitals.

Public hospital staff were working at an incredible pace prior to the pandemic, and this has continued to escalate without abatement despite moving to COVID-normal.

It is exhausting. And while there is management pressure to take leave and allotted days off, we feel burdened by the realisation that there is not enough fat in the system to absorb the extra work this creates for our colleagues. There is chronic understaffing in all areas.

Our nursing teams are also burnt out. They are leaving as they feel undervalued and burdened by too many patients to do the job they have trained for. Those in critical care are having to turn patients

away from services because of a lack of nurses and the quality of care once admitted is hampered by inadequate allied health care staff and pharmacists. Allied health staff are considered a luxury and remain unsupported to do the work they need to do in public hospitals. Without allied health staff, public hospital doctors cannot provide the care patients need.

Outdated agreements

The wages cap and Award conditions are further demoralising. The outdated Staff Specialist Award and the wages cap in NSW has led to many hours of unpaid work and a skills loss throughout NSW due to the inability of NSW Health to attract and retain highly skilled staff.

The NSW Staff Specialist Award was written prior to the establishment of team based, 21st Century world- class medicine and stands in stark contrast to the updated Victorian and Queensland Awards. This has meant that whilst we all invest our time and NSW money into training world-class doctors –they leave for better packages in other states. The VMO arrangements are also outdated and need immediate attention.

It is frustrating to see NSW hospitals train experts in clinical care and then witness the best of these trainees leave – attracted by better remuneration packages and administrative support by interstate hospitals where their skills and training are highly valued.

NSW must get rid of the current wages policy which creates a false economy for permanent staff versus expensive locums. We need to build a future where staff are proud and happy to work in NSW Health, knowing they can provide the very best of care for patients and their own families simultaneously.

Financial restrictions

This has become steadily worse over the last 30 years and is stifling improvements to patient care. Any proposal to employ a new person or open a clinic is subject to a detailed business case that requires such an enormous amount of detail that it can only be completed with assistance of a business manager. It is nearly impossible to suggest any changes that will not cost something. This puts downward pressure on advancements that support high quality care.

Furthermore, the capital allowance of equipment replacement is inadequate. NSW Treasury expect this to be paid from the No2 accounts or hospital foundations. Most specialties do not have adequate funds to cover these equipment costs and the foundations have many other demands on their funds. The result is that equipment is not replaced in a timely fashion but rather in a chaotic manner in response to failure, and then often only after a prolonged delay.

Yours Sincerely,

New South Wales Medical Staff Executive Council

A/Prof Kathryn Carmo-Browning

Co-Chair – Metropolitan

Dr Kate Sellors

Co-Chair – Rural and Regional

Dr Setthy Ung Deputy Chair

Dr Mark Priestley Secretary

Dr Bruce Cooper Treasurer

Outpatient services

Improvements need to be made to outpatient services in order to improve patient care. Incompatible computer systems have created significant communication problems between hospital care teams and general practitioners. For most specialties, prolonged delays of a year or more are common.

Operating a health system that trades off the goodwill of specialists is not a long-term solution and further disenfranchises hospital doctors.

In conclusion

We need a government that will focus on investing in and rebuilding our NSW health staff. The public of NSW needs to know that investing in the public health system is a priority if we are to build a worldclass health system and workforce into the next decade.

The NSW MSEC is an organisation representing the 40 Medical Staff Councils of the public hospitals of NSW.

Meet the doctors who are looking to improve healthcare through politics.

PROFILES

Dr Michael Holland – Current Member for Bega in the NSW Legislative Assembly, Labor Candidate. Dr Michael Holland is also a specialist Obstetrician & Gynaecologist providing women’s health services in the local area.

improve things politically.

For many years, I have been troubled by the inequity of perinatal mental health services which has a compounding effect on the most vulnerable in our society. This applies across many fields of health.

of primary health care and NSW hospital services.

I want to see the provision of the best of care from before birth to the end of life to everyone regardless of their post code, race, income, gender, ability, or sexual orientation.

DR MICHAEL HOLLAND is the Member for Bega in the NSW Legislative Assembly. He’s worked as a specialist Obstetrician & Gynaecologist in the South Coast for 20 years.

In August 2018, with other concerned individuals in the Eurobodalla area, he cofounded the “ONE - One New Eurobodalla hospital” movement. This resulted in a petition of over 3000 signatories to the Legislative Assembly of the NSW Parliament for a single new level 4 regional hospital and immediate improvement to the clinical services in the Eurobodalla.

Dr Holland was elected as the Member for Bega at the 2022 byelection. It was the first time that the electorate was won by Labor.

Why did you enter politics?

I have seen the generational effects of the social determinants of health on maternal, perinatal, and gynaecological care. The deteriorating situation in rural areas made me make the decision that if I could no longer improve health care clinically, I would have to try to

In many rural areas, previously safe and sustainable cooperative models of care based on appropriately well-trained GPs, nurses, midwives, and other specialists have been allowed to decline to the point of closure or provision of the lowest denominator of service capability.

I realised that I could advocate more strongly in parliament and provide a resource to my parliamentary colleagues in making effective policy.

What are your top health priorities? Good health policy is determined by targeting the greatest needs in health.

The social determinants of health which I referred to earlier include stable housing, safety from domestic violence, access to the best education, opportunity for fulfilling employment, and a protected environment.

Doctors are caring and socially responsible professionals who can contribute to improving these determinants for their patients. They say that all politics is local and at a local level I want to achieve the best sustainable rural health service for my constituents to reverse the high and unnecessary outflow to metropolitan centres for care.

With other doctors in politics, I can contribute to informing government at State and Federal levels how to support the complementary roles

What are the greatest challenges facing the health system?

Ideologically, Medicare should provide universality, equity, and choice in health care. It has been a great example of providing the best of health care to our nation. Our greatest challenge is continuing to live up to these principles.

As a profession, we need to review models of care and the scope of practice of other health professionals to deal with prevention of illness and how to deal with the growth of chronic and complex health demands. We need to examine whether the previous clinical and business models of practice are providing the best care for our patients and whether they are the best for us as individuals.

The current crisis in health care is driving new medical graduates away from primary care and experienced doctors, nurses, midwives, and other health professionals out of the public hospital system due to understaffing, under-resourcing, and the failure to acknowledge their concerns.

Our regional, rural, and remote areas are most at risk.

Governments, our representative bodies, and professional colleges need to work together to train, attract, and retain doctors and other health professionals in rural and regional areas.

PROFILES

Dr Amanda Cohn – Dr Amanda Cohn is a GP based on Wiradjuri Country in AlburyWodonga and a Greens candidate for the NSW Upper House.

victims of bushfires and floods, I developed a passion for addressing the social and environmental determinants of health.

I think there’s a wonderful overlap between the skills of a good GP and the skills of an effective politician – building rapport quickly with a broad range of people, active listening, shared problem solving, and distilling and communicating scientific evidence.

What are your top health priorities?

impact of the public sector wage cap over the past decade.

Finally, to address the single biggest health threat facing humanity according to the World Health Organisation, which is climate change, we cannot allow new coal and gas projects to proceed here in NSW.

What are the greatest challenges facing the health system?

DR AMANDA COHN is a GP and frontline emergency services volunteer based in AlburyWodonga. She is the youngest woman ever elected to Albury City Council and Deputy Mayor from 2016-21. During this time she drove regional coordination to support victim survivors of family violence as Chair of the Border Domestic Violence Network, and also served on the board of Parklands AlburyWodonga.

She is passionate about addressing the social and environmental determinants of health as well as equity of access to health care and was a key voice in the campaign to decriminalise abortion in NSW in 2019.

Why did you enter politics?

Working in community health in a regional area, it became clear to me that my patients needed profound social and political change more than they needed a good GP. From caring for mental health patients languishing for years on waitlists for public housing, to antenatal patients unable to access adequate domestic violence support, and to

Firstly, to emphasise the critical importance of primary care in improving population health outcomes and reducing the need for costly tertiary interventions and hospital admissions. Having a regular GP is an important protective factor for our patients, but it’s getting harder and more expensive to see a GP after decades of underfunding. The Greens have committed to underwriting the pay and conditions gap for GP registrars, exempting GPs from payroll tax, and opening a small number of public primary care services, with GPs employed as staff specialists, to meet the needs of our most vulnerable and disadvantaged communities.

Secondly, to address the staffing crisis facing our public health services. Implementing safe nurse-to-patient staffing ratios, as has been done in Victoria and Queensland, improves patient outcomes across a range of presentations in addition to being cost-saving by reducing length of stay and rate of re-admission. Nurses, paramedics, and midwives are also due a substantial pay rise in the face of both inflation and the

Our health system is in crisis. We are seeing an ageing population and an increasing complexity of presentations and comorbidity, alongside an increasingly fragmented health system, profound burnout among health professionals, and an unacceptable inequity in health outcomes for residents of rural and remote areas, as well as First Nations people. Meanwhile, the cost of providing quality health care has outstripped government funding, leading to increasing out-of-pocket costs for patients, furthering inequity. All of this is compounded by the pressure politicians face to provide visible change within very short electoral cycles rather than prioritising longterm outcomes.

There are huge untapped revenue raising opportunities for the NSW Government that could be used to fund health services, from bringing coal royalties in line with other states to levying the uplift property developers receive from rezoning decisions. But we must also prioritise preventive health measures in addition to primary care and addressing the social and environmental determinants of health.

Dr Joe McGirr – Current Independent member for Wagga Wagga, Dr Joe McGirr specialises in emergency medicine and medical administration.

although I achieved more that 30% of the primary vote and I think that certainly raised the importance of the hospital as an issue. I did not intend to run again, but in 2018 our local member was forced to resign, and I was approached to consider running. I felt that integrity was important and I could provide a real choice for the community.

What are your top health priorities?

MEMBER FOR WAGGA WAGGA, DR JOE MCGIRR, has worked in regional NSW for more than 30 years, firstly in emergency medicine, then in health and hospital management, followed by time in university administration before entering politics.

Dr McGirr was elected the Member for Wagga Wagga in September 2018, following an historic by-election in the seat. He was re-elected into the 57th Parliament of NSW, six months later, in March 2019.

Dr McGirr’s dedication to service and to caring for the needs of the community has extended well beyond the region for almost three decades, and as the Independent voice of the electorate, he vows to maintain this legacy.

Why did you enter politics?

What drove me originally in 2011 was the need to have a new Wagga Wagga Base Hospital. At the time the community and health service had been following the correct processes for a decade and it seemed little progress was being made. I was not elected in 2011,

My top health priority is to bridge the health divide between the remote, rural, and regional NSW and the cities. Regional life expectancy is shorter than that in the city, we have fewer services, more acute health worker shortages and less access to medications.

This is unacceptable.

I will focus on establishing a separate rural health department that will be a voice for rural health needs.

A major focus for the rural health department will be on improving training and education services, with a focus on supporting health staff to develop their careers in rural health areas. The department would be an advocate whose focus would be maintaining and increasing services. It would also focus on relations with the Commonwealth. It would not be a duplication of the machinery of Government but would work more like the department of regional NSW.

What are the greatest challenges facing the health system?

The great challenge facing the health system is the lack of health workforce in remote, rural, and regional areas. This means

that patients cannot access the services they need as close to their communities as possible.

We have done much to bring student training to the bush –the challenge is to convert that to health professionals on the ground in rural areas. An example of potential solutions is the Murrumbidgee training model for GPs that provides a clear supported pathway for doctors to train in a region supported by that region. If that is combined with modern and attractive employment models, we could have a solution. Above all the locus of control for rural medical training has to be in the bush with universities, colleges and health services combining to support and attract a rural workforce.

Currently general practice, which is the bedrock of our system, is under enormous pressure: a remuneration system that has been allowed to slide, a training system that at times seems directionless and above all a lack of prestige that comes from a hospital centric health system are all challenges. dr.

I felt that integrity was important and I could provide a real choice for the community.

GPCRISIS

I HAVE JUST recently been notified of yet another general practice in South West Sydney’s outer metropolitan region that will have to close down due to the nonviability of their business.

Ingleburn GP, despite caring for the community and managing thousands of patients, cannot afford to remain open and has closed its doors on the needy population of this region due to the decades long neglect and erosion of general practice.

I recently spoke Dr John Holt, one of the general practitioners that was working there.

Dr John Holt graduated from the University of Sydney in 2011

with a Bachelor of Medicine and Bachelor of Surgery Honours. He completed his fellowship in general practice in 2016. He has experience in emergency medicine, respiratory medicine, paediatrics, ear nose and throat surgery, neurosurgery, and orthopaedics. Dr Holt previously graduated with a Bachelor of Applied Science (Physiotherapy) in 2003 and worked as a physiotherapist in a variety of settings including private practice, hospital and sports team coverage. His areas of interest are physiotherapy, paediatrics, neurosurgery, and orthopaedics.

Despite serving the community’s healthcare needs for many years, Dr Holt said the ongoing issues in general practice had forced the centre’s closure. With operational costs outstripping the indexation of the Medicare Rebate, the practice tried to make ends meet through Workcover and other forms of income. Introducing private billing, however, was not a viable option, given the population of South West Sydney largely consists of people with lower socioeconomic status who would struggle to pay above bulk billing. The practice tried to implement a small $20 gap for patients on top of the Medicare rebate but only a maximum of two or three patients a day would be considered private patients, as the majority of patients were pensioners and concession card holders.

Dr Holt said the inadequate Medicare rebate affects the quality of care. He is distressed and disappointed about the medical centre vending machine form of medicine.

According to Dr Holt, patients need a minimum 15-to-20-minute consultation to be treated properly and this was no longer viable with poor Medicare funding. Practising

As yet another practice closes its doors due to financial instability, Dr Kenneth McCroary laments the impact of the GP crisis on the South West Sydney community.

quality medicine and paying a mortgage seem to be impossible in the current climate.

In addition to financial instability, the practice struggled to attract GPs to work in the area.

I also spoke with Dr Tom Lieng, practice owner of Ingleburn GP. Dr Lieng graduated from the University of New South Wales in 1991. He completed his fellowship in general practice in 1996. He has an interest in chronic illness, musculoskeletal and sports medicine, work injuries and occupational health. He is an experienced doctor in South West Sydney who is committed to providing comprehensive and holistic care to his patients. He speaks both English and Vietnamese.

Dr Lieng stated that he had to make an incredibly painful decision to close his practice. He can not sell the practice as there is no buyer. He recently met with a broker who advised him that the broker’s fees alone would cost him more than the price that would be raised for selling the business. As a result, the practice which has been operating for 30 years, will fold.

Dr Lieng states the operating conditions are the hardest he has ever experienced. He estimates a 30% revenue loss to the business.

There were two and a half doctors, or equivalent, working at Ingleburn, but he was unable to retain GPs as many were attracted to working at higher paying private practices. He does not begrudge the young GPs moving to bigger centres offering more for service, but he can’t compete. The bulk billing practice lost three doctors during 2022. Dr Lieng said it was difficult to convince GPs to stay when they could move to Double Bay and earn $90 a consult.

Even a recent attempt to increase the management fee from 25%

to 26% was not enough of an enticement. He could no longer continue absorbing the huge losses.

Dr Lieng said the patients that live locally are being penalised because they are poor. He is committed to fairness and believes in universal health care and that is why he decided to practice in this significant area of need in outer metropolitan South West Sydney. To introduce a fee would be like “trying to bleed the people that are already bleeding,” he said.

Dr Lieng laments that the government doesn’t recognise the needs in Western Sydney. There are efforts to assist rural health but less recognition about the significant health deficits and socioeconomic determinants of health in other areas – particularly outer metropolitan Sydney.

An alternative was to rush through 8-10 patients an hour, which Dr Liengs calls “burning Medicare,” but this is not the way that he and his fellow GPs want to practice.

Dr Lieng’s wife is a GP examiner and said that the decrease in the number of GP applicants has meant that everyone gets accepted. Dr Lieng understands why there are fewer applicants – why choose a career where there is more work, the patients are becoming more complex and more complicated ,and there is no recognition by government.

The erosion of general practice continues and this will inevitably

result in poor outcomes for patients in our community. Without a highly functioning and adequately funded GP lead primary care system, the entire health system falls over. Evidence from the UK, the US, Europe, and locally has found general practice is the most cost effective and most efficient form of healthcare in the community. Despite this, our state and federal governments continue to ignore the crisis in general practice.

We need urgent increases in Medicare rebates for quality general practice care. We need the system to be reviewed to provide blended payments for GP lead primary care and our teams to develop and enact systems and protocols to assist our local communities. We need it urgently otherwise our system falls over and Ingleburn GP will not be the last medical practice to close its doors forever. dr.

ABOUT THE AUTHOR:

Dr Kenneth McCroary is the owner of Macarthur General Practice and Chair of the AMA (NSW) Council of General Practice.

To introduce a fee would be like “trying to bleed the people that are already bleeding.”

HEADING HERE

Antimicrobial resistance

Antimicrobial stewardship has never been more important. Without intervention, antimicrobial resistance could be responsible for 10 million excess deaths globally by 2050.

WE ARE ALL too familiar with the phrase ‘too much of a good thing’, an adage which has become increasingly synonymous with antimicrobial drugs in the past number of years. Considered one of the most significant medical achievements of the 20th century, antibiotic overuse and subsequent resistance to these drugs has since been labelled by the World Health Organisation as one of the top 10 global threats to health.

Antimicrobial resistance (AMR) is spreading in ways that are becoming increasingly difficult to detect and manage. Researchers at the University of Western Australia have found a novel mechanism of resistance whereby Group A Streptococcus has demonstrated the ability to take folate directly from its host, rendering antibiotics such as sulfonamides ineffective. This form of resistance was found to be indistinguishable under traditional testing making it more difficult to administer targeted antimicrobial treatment. Such resistance can easily be spread among pathogens via horizontal gene transfer (HGT), enabling resistance in pathogen populations not yet exposed to antimicrobials. Key findings from 2021 data from the Australian Group on Antimicrobial Resistance (AGAR) highlight further worrying developments. These include the emergence of specific types of extended spectrum betalactamases (ESBLs) in E. coli in the community, a longitudinal trend of increasing resistance in gram-negative organisms, and

carbapenamase-producing gramnegative pathogens.

Contrary to popular belief, AMR is arising not just from its use in human health but also from its utility in the animal and environmental health sectors, all three of which are inextricably linked in a model known as One Health. Antimicrobial use in agriculture, and veterinary and human medicine can produce antimicrobial waste which enters the environment. These points of antimicrobial entry into the environment include hospital sewage, crop spraying, livestock feed, and manufacturing effluent. This usage of antimicrobials concurrently leads to the development of antimicrobial resistant pathogens which are also released into the environment through waste, and which can share their genetic resistance factors through HGT mechanisms. These pathogens can then be transferred through a multitude of pathways, including high-altitude winds, movement patterns of wildlife, and routes of surface water, to re-enter human living spaces and environments. As such they are capable of being transferred to humans and animals through food, the environment, or by direct contact with vectors.

With resistance comes increased financial burdens on the economy. The current costs are already large enough to warrant major intervention, with Australian hospitals spending $16.8 million per year treating the five most common resistant hospital-

associated infections. A resistant infection can add as much as $10,000 to the cost of treatment when compared to susceptible infections. The annual impact on the Australian economy is estimated to rise to anywhere between $142 billion to $283 billion by 2050 under a worst-case scenario.

The cost to the patient is likewise severe, with 4.95 million deaths associated with resistant bacterial infections in 2019, including deaths directly attributable to AMR. This figure is projected to rise to 10 million deaths each year by 2050, a figure tantamount to the death toll from cancer in 2020. In terms of the patient quality of life, AMR is associated with poorer outcomes, requiring stronger antimicrobials which carry greater side effects, including nerve damage, hearing loss, and organ failure. Like many diseases, the risks associated with AMR disproportionately affects patients who are vulnerable or disadvantaged.

Dr Kenneth McCroary, a general practitioner and Chair of the AMA (NSW) Council of General Practice, said part of the issue is prescription practices, stating that his LGA has the highest prescription rates of Amoxil in the country. This may be due to the high incidence of solo practitioners in his area who engage with minorities from culturally and linguistically diverse backgrounds who often have different cultural experiences with health systems and health literacy. He considers that deprescribing would require a multifaceted

FEATURE

approach disseminated by the different levels of healthcare including local and higher levels of management. These solutions could include:

• More support in areas with higher incidence of prescribing

• Push letters from Medicare to doctors

• Better engagement of doctors that are more isolated and those that are restricted in their practice

• Developing patient programs

• Implementing collegiate gatherings

Another issue contributing to AMR is the shortage of antibiotics such as cefalexin and amoxicillin in the aftermath of the COVID-19 pandemic. This has led to patients not being treated appropriately or fast enough, and to the use of inappropriate antibiotics in their place, Dr McCroary said. The silverlining is that the pandemic has helped to improve health literacy in the community regarding the difference between bacterial and viral infections and the importance of using antibiotics only when they are indicated, he added. The data from the AURA 2021 report shows a decline of over 30% in the dispensing of antimicrobials under the PBS during COVID-19. Likewise, a 2022 report by the ACSQHC found a significant reduction in antimicrobial use in the community from between 2019 and 2021 (25.3%) compared to 2015 and 2019 (8.9%).

A contributor to the growing issue of AMR is patients demanding antibiotics from their GPs. While this does not happen to him as often, Dr McCroary stated that there have been cases where patients have demanded antibiotics from the registrars working in his practice and who have gone to another general practice when they do not receive them.

In these situations, Dr McCroary said patient education is his go-to solution. The collaborative team environment further ameliorates the situation, with practice nurses helping in and reinforcing patient education and reducing the likelihood of patients asking for antimicrobials.

These sentiments are shared by Professor John Turnidge, an infectious disease specialist and Senior Medical Advisor for the Australian Commission on Safety and Quality in Health Care’s (ACSQHC’s) AURA 2021 reporti He sees the biggest barrier to appropriate prescribing in both general practice and hospitals as ’therapeutic inertia’, the tendency of prescribers to adhere to their prescribing habits due to its past effectiveness, and a historical lack of oversight. In Professor Turnidge’s opinion, education has had limited utility mitigating the issue, with the solution appearing to be peer pressure from responsible prescribers otherwise known as antimicrobial stewardship programs, even for infectious disease specialists.

“Most importantly, I would say that antimicrobial stewardship is here to stay, and every prescriber should check their current prescribing practice against national recommendations such as those found in Therapeutic Guidelines – Antibiotic, the current edition,” Professor John Turnidge said.

With the introduction of state-wide NSW trials enabling pharmacists to prescribe antimicrobials for urinary tract infections (UTIs), the AMA (NSW) is more concerned than ever about the risk to patient safety. Consolidating the prescriber and dispenser roles removes a longheld safeguard and increases

...the [pharmacy] trial by its nature would counteract deprescribing efforts which have aimed to reduce unnecessary prescribing.”

the potential for unnecessary and inappropriate antimicrobial prescriptions. Allowing pharmacists to prescribe also ignores the rigorous, years-long training that general practitioners undertake to inform diagnosis and prescribe accordingly.

The approach is deeply flawed, Professor Turnidge said. Firstly, the natural history of uncomplicated UTI indicates that approximately a third of women will have spontaneous resolution of symptoms without treatment, which means antimicrobials may be prescribed unnecessarily. Secondly, the antimicrobial being trialled, trimethoprim, selects for strains of E. coli with multiple resistance and has a moderate impact on gut microflora. Thirdly, pharmacists cannot order formal urine cultures, and therefore serious diagnoses which could be responsible for the symptoms may be missed and effective treatment may be delayed. Finally, the trial by its nature would counteract deprescribing efforts which have aimed to reduce unnecessary prescribing.

As such, patient demands are not the biggest concern for AMR but rather the oncoming problem of pharmacy prescribing.

“In general practice we are not getting any financial reward for prescribing but now they’re having dispensing prescribers... We are really, really concerned about inappropriate prescribing,” Dr McCroary said.

These sentiments mirror some of the AMA’s questions for the government, namely what is being done to make sure there is no conflict of interest in these trials and why the position of the Pharmacy Board is being ignored in determining pharmacists can autonomously prescribe the medications they sell.

With the rapid decline in antimicrobial effectiveness, Australia is at severe risk of backsliding into the dark ages of an antimicrobial deficient world. In the first half of the 20th Century, Australia, much like the US and UK, experienced outbreaks of influenza, and polio, along with serious bacterial diseases such as septicaemia, scarlet fever,

diphtheria, gonorrhoea, and meningitis, each associated with significant mortality rates. A lack of functioning antimicrobials would mean an inevitable return to a health system where a simple surgery can have devastating outcomes. To stop this encroaching pandemic, there will need to be an international coordinated approach to designing and disseminating AMR solutions to safeguard the future of healthcare. dr.

Australian Commission on Safety and Quality in Health Care. AURA 2021: fourth Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2021.

Australian Commission on Safety and Quality in Health Care. Antimicrobial use and appropriateness in the community: 2020–2021, Sydney: ACSQHC; 2022.

ABOUT THE AUTHOR:

Sara Ghelijkhani is a research assistant with the AMA (NSW) and a current second year student in the Doctor of Medicine program at The University of Sydney.

WORKPLACE RELATIONS

FEE DODGERS

Chasing telehealth payments from patients who’ve cut the phone line after a consultation can be costly to practice owners. AMA (NSW)’s Workplace Relations advisor, Melanie Fayad, investigates what you can do to protect your practice.

TELEHEALTH has found a permanent place in Australia’s healthcare system. Initially adopted by practitioners to provide patients with safe access to healthcare during the pandemic, telehealth has since become a convenient and flexible means of healthcare delivery.

While there are many positives to offering telehealth consultations to your patients, some doctors report it can leave your practice exposed to fee dodgers.

Fee dodgers (or “dine and dash” patients) are patients who have had a privately billed telehealth consultation with the doctor but hang up before being transferred to the receptionist for payment of the private fee.

Former AMA President, Dr Mukesh Haikerwal recently spoke about this issue within his own practice in Melbourne. Dr Haikerwal said that it was a difficult task to get ahold of patients that had not paid, and that follow-up calls to patients were often declined or excuses provided such as being too busy to talk. In extreme cases, Dr Haikerwal has had to use debt collectors.

The impact of non-payment is not small. Dr Haikerwal said that, at one point, the value of outstanding payments for telehealth consultations in his practice reached tens of thousands of dollars. There is also a cost to staff

who are spending valuable time chasing payments from patients which should instead be applied to ensuring the smooth running of health services.

AMA (NSW) President, Dr Michael Bonning, believes this issue arises out of an assumption by many people that the value of a telehealth service is much less than a face-to-face consultation.

Dr Haikerwal agreed with this sentiment, adding that many GPs choose to bulk bill or charge low fees for telehealth consultations to appease a false perception among patients that consults over phone or video have a “low worth”. He called this a ‘slippery slope’, as it only furthered the assumption that telehealth was of low value to the point that when a GP did charge, patients would not pay.

Dr Bonning explained that private fees for telehealth services are reflective of the rising costs of running a business and that, like any other service, the training and experience that GPs bring to these consultations needs to be valued.

“The GP – like any other business owner or small business practitioner – needs to be able to pay to keep the lights on to run the Telehealth service, to pay for receptionists and staff, and all the other members of their team,” Dr Bonning said.

MELANIE FAYAD AMA (NSW) WORKPLACE RELATIONS ADVISOR (LEGAL &POLICY)

WORKPLACE RELATIONS

TIPS TO SECURE PAYMENT FOR TELEHEALTH SERVICES

How can doctors and their staff ensure greater certainty that they will be paid for these services?

Below, we outline some strategies you may like to consider in your practice. The time and costs associated with debt collection mean that taking steps upfront to secure payment at the time the consultation is completed will be more beneficial in the long run.

1. INFORMED FINANCIAL CONSENT

Practitioners and their practice staff should continue to ensure patients are well-informed of the anticipated fees prior to the consultation. Informed financial consent should be obtained from the patient and documented prior to booking a telehealth consultation to avoid later misunderstandings.

If the consultation is booked by the patient online, informed financial consent could be recorded at the time the booking is made online. Where consultations are booked over the phone, consent may be obtained verbally and documented in the patient’s file. Informed financial consent makes securing payment easier.

2. OBTAINING PAYMENT DETAILS PRIOR TO CONSULTATION

This may involve a phone call from practice staff to collect card details prior to commencement of the consultation and then transferring the patient to the practitioner. On completion of the consultation, payment can then be processed using the payment card details obtained.

If this strategy is considered, practice staff must be careful to process and keep payment card data safely and securely in accordance with the Payment Card Industry Data Security Standard (PCI DSS). These are a set of standards mandated by leading card schemes (including Visa and Mastercard) for the acceptance, transmission, and storage of cardholder data. For the latest version of the PCI DSS as well as a directory of Qualified Security Assessors that can assess whether your practice is PCI DSS compliant, please see the PCI Security Standards Council website. Practices may wish to consider using pre-authorisation to ensure the card is valid and has the appropriate amount of funds. Pre-authorisation can be used to hold a booking for a patient and can guarantee the practitioner is paid at the end of the service without the administrative burden. Your payment facilitator should be able to provide further information about this. dr.

Should you require advice and support regarding informed financial consent and risk management strategies for your practice, please contact the AMA(NSW) Workplace Relations Team at workplace@amansw.com.au or on +61 2 9439 8822

The GP – like any other business owner or small business practitioner –needs to be able to pay to keep the lights on to run the Telehealth service, to pay for receptionists and staff, and all the other members of their team.”

SEXUAL HARASSMENT IN THE WORKPLACE

Recent changes to the Fair Work Act increase practice owners’ responsibility when it comes to sexual harassment in the workplace.

THE INTRODUCTION of the Fair Work Legislation Amendment (Secure Jobs, Better Pay) Act 2022 will change the way sexual harassment in the workplace is defined and dealt with under the Fair Work Act 2009. These changes come into effect on 6 March 2023.

The amendments mean that sexual harassment is expressly defined and prohibited under the Fair Work Act and will be separated from other workplace issues such as bullying. The methods that the Fair Work Commission can use to deal with claims of sexual harassment in the workplace will be expanded, and the employer’s level of responsibility in the steps taken to prohibit sexual harassment will increase.

It is important for owners of private medical practices who employ staff to be aware of the changes and the way employers are required to manage the sexual harassment risks within their business.

WHAT IS SEXUAL HARASSMENT?

The definition of sexual harassment will remain the same as it is in the Sex Discrimination Act. Sexual harassment includes making an unwelcome sexual advance or request for sexual favours or engaging in other unwelcome conduct of a sexual nature, and in

circumstances that a reasonable person would anticipate the possibility of “offending, humiliating or intimidating” the other person.

WHAT DO THE CHANGES MEAN?

The intention of the amendments is to expressly prohibit sexual harassment in the workplace. Previously the burden of acting rested with the individual who had been sexually harassed. By incentivising employers to take more accountability in the prohibition against sexual harassment in the workplace, that burden will now be shared. It will also give individuals more options for dealing with workplace sexual harassment.

The new legislation complements the existing prohibition on sexual harassment in the Sex Discrimination Act 1984 and relevant state and territory legislation and does not replace these provisions.

WHO DO THE NEW PROVISIONS APPLY TO?

The new provisions make it unlawful for a person to sexually harass another person who is:

• a worker in a business; or

• seeking to become a worker in a business; or

• a person conducting a business.

FELICITY BUCKLEY

AMA (NSW) SENIOR WORKPLACE RELATIONS ADVISOR

The definition of “worker” has the same meaning as in the Work Health and Safety Act 2011: an individual who performs work in any capacity. This includes employees and contractors, volunteers, trainees, apprentices and students gaining work experience.

Additionally, the prohibition extends to third parties, such as customers or clients.

CHANGES TO REPORTING

Under the changes, not only can the aggrieved person make an application to the Fair Work Commission regarding sexual harassment, but a representative of the aggrieved person, such as their relevant union, may do so.

An applicant can request the Fair Work Commission make a stop sexual harassment order, and / or otherwise deal with the dispute such as through mediation or conciliation, or by making a recommendation or expressing an opinion.

After these avenues have been exhausted the person making the allegations or the union acting on their behalf can then decide to either apply to have the Fair Work Commission arbitrate the dispute, proceed with litigation, or elect not to continue with the dispute any further.

WHAT ARE THE IMPACTS TO EMPLOYERS?

One of the changes that will most impact an employer is the extension of liability in the prohibition of sexual harassment in the workplace. An employer or principal of a business may be held

vicariously liable for any conduct of their employees or agents done in connection with their work. An employer will need to show that they took ‘reasonable steps’ to prevent the sexual harassment to avoid liability.

Private practices should consider these changes and any steps and measures they need to take including:

• Practical measures to be put in place to eliminate workplace sexual harassment (this will be dependent on the particular circumstances) and may include monitoring email and internet use;

• Updating workplace policies,

• Regular training and education for all staff,

• Providing support to staff. dr.

As always, the AMA (NSW) Workplace Relations team are here to help you if you have any further questions about these changes. You can contact our team at workplace@amansw.com.au or on +61 2 9439 8822.

An employer or principal of a business may be held vicariously liable for any conduct of their employees or agents done in connection with their work.”

THE PATIENT DOCTOR

Dr Ben Bravery was only 28 when he was diagnosed with bowel cancer. He survived and is now a qualified doctor telling his story and advocating for a better healthcare system.

THERE WAS no lightbulb moment where Dr Ben Bravery realised he wanted to get into medicine. After being diagnosed with bowel cancer, Dr Bravery said it was the accumulation of his experience as a patient and having much needed time afterwards to reflect on his life post-cancer that made him switch career paths.

“You get discharged, and it’s amazing because you’re alive,

but the hard part is going back to regular life – and my life had changed a great deal. The old work I did just wasn’t pushing my buttons the same way that it used to,” Dr Bravery said.

Prior to undertaking specialty training in psychiatry, Dr Bravery was a Zoologist and Science Communicator who was familiar with putting pen to paper.

“It definitely took some time to work out that I wanted to give back to the public hospital system that had saved my life, and maybe through that process I could potentially tweak a few aspects of healthcare too.”

The Patient Doctor was published in 2022 gaining rave reviews from both doctors and patients. It was written with the intent to bridge the patient-doctor gap that not many are aware of.

“I went to medical school at the age of 32 to learn how to give back but also to learn the language of medicine to better understand how doctors think and approach problems so I could start to influence aspects of healthcare that I thought needed improving from the patient’s perspective.

“But what I realised when I crossed over was that a lot of students and doctors were also hurting, and they were hurting mainly because of system factors – a bit like the patient hurts because of the healthcare system, the people working in it were also hurting because of the healthcare system,” Dr Bravery said.

“With this perspective, my agenda for the book became a bit broader, I realised that addressing only one side of the patient-doctor equation was silly and misguided –you have to balance attention and care on both sides of that.

“The idea for The Patient Doctor was to take my experience as

a patient and now a doctor so that I could bridge the gap that I see growing between patients and doctors to help them better understand what’s going on, on both sides, and from that help them find a common language and common set of values so they can demand change together,” said Dr Bravery.

Dr Bravery states that both sides are asking for the same change – just in slightly different ways. It’s because of the divide in power, knowledge, and status that both patients and doctors are not always at the same table.

Dr Bravery said the system can lack compassion.

“Our health system is world class – I’m not taking away from that and I’m alive because of it. I received all the cancer treatment I needed quickly, confidently, and safely. It was the other experience, the side of the patient being in the system, that was lacking.

“The system can lack humanity and can forget that it’s a human laying in that bed, and not just a problem. It’s things like the way we communicate with each other, the methods of communication, the way ward rounds are structured, the way hospital rooms are designed, the visiting hours, the meals we receive – the list goes on.

“Besides the world-class treatment, it’s that stuff that lingers, and patients remember and talk about for years afterwards. So there’s a real opportunity there to improve some of that stuff, not only so hopefully they can heal faster at the time, but they’re more satisfied

then and into the future,” he said.

Dr Bravery acknowledges that many people have been working on improving the healthcare system for decades – he’s grateful for the opportunity to add to the conversation from a different voice.

“If the unusual nature of my story means a few more people pay attention – both on the doctor side and patient side, and both take an interest in how our doctors are going and how our patients are treated then that’s what I’m happy to achieve the most with this book,” he said.

The writing process for The Patient Doctor took a year as Dr Bravery juggled with being a registrar –having a full-time patient load and keeping up with training requirements, with being a dad to a young child. He says if there’s any doctors out there who have the urge to write a book, to tell a story or their own story – just go for it.

“Medical training positions us well to focus on a big goal, long-term, and just chip away at it. Find the bit you want to contribute to and just start writing. I recognise my voice alone isn’t going to change the system, but it’s a small start,” said Dr Bravery. dr.

The Patient Doctor is available now in bookstores and online. RRP $34.99. Purchase here:

www.benbravery.com/book

The system can lack humanity and can forget that it’s a human laying in that bed, and not just a problem.”

NEW BEGINNINGS FOR LISMORE

One year on from the devastating Lismore floods, healthcare providers celebrated the grand re-opening of Keen Street Clinic. Dr Sue Velovski reports on a community coming together after months of struggle.

ON 28 FEBRUARY 2022 , our Lismore community was devastated by the biggest flood to hit our town in a century. When the power and electricity finally came back on 10 days later our entire world had changed. After days of darkness, I recall the first national radio news bulletin I heard… Lismore trapped in devastating floods... Ukraine at war with Russia… Rod Marsh and Shane Warne, our cricketing favourites, no longer with us…

DR SUE VELOVSKI

And then, just 21 days later, our community was underwater for a second time. With true grit and determination in her voice, Dr Nina Robertson said, “We have not lost life – everything else can be replaced.” These were wise words from a young woman battling to rebuild her general practice, keep her patients alive, her staff healthy and start again.

I cried when she spoke those words – the first of many tears over the following months, as I watched politicians fly in and out – never staying long enough to watch the mould grow back or witness how much our patients suffered as health providers struggled to reopen their practices and provide much needed care to patients.

After months of empty words, it was our medical organisations – AMA (NSW), the Rural Doctors Association NSW, Rural Doctors Association of Australia, NSW Rural Doctors Network, and the Medical Benevolent Society, among others,

that provided support and much needed advocacy to ensure our healthcare providers were provided with grant funding. These organisations spoke “truth to power” in the halls of democracy when we felt all our words had fallen on deaf ears.

The week commencing 17 Feb, we received word from our elected leaders that the Commonwealth and State governments had negotiated a $5m funding package for healthcare businesses in the Northern Rivers area – the first co-contributed fund of its kind for primary service providers affected by natural disaster.

On 3 March, Keen Street Clinic Lismore formally reopened its doors. After months of rebuilding, it is a beautiful, clean, safe environment – filled with dedicated staff of GPs and practice staff. Family friends and community members came to witness this event. Generations of senior clinicians who have looked after our communities joined junior clinicians who fought with grit, so that we as a community, literally, would not sink.

Thank you all for letting us thrive again – letting us start our road to recovery: to health, physical, psychological, financial. It is times such as these when we realise the power of community – both medical and local – rural folk and their determination to see a better place for all. dr.

SPECIALIST GENERAL SURGEON, ST VINCENT’S LISMORE

GARY

PROVIDING MORE ENGAGEMENT AND GREATER BENEFITS FOR MEMBERS

GARY WHITE’S appointment

as Director of Membership

Engagement and Commercial Partnerships brings a new level of excitement and expertise for the Australian Medical Association (NSW).

Mr White has worked in the healthcare industry for 15 years –with the last three years in Australia, following his move from the UK to Sydney in January 2020.

He previously worked as the Director of Strategy and Expansion for My Emergency Doctor; a telehealth company committed to changing the delivery of emergency care.

“I’m really looking forward to starting this new chapter at the AMA (NSW),” Mr White said.

“My time with My Emergency Doctor allowed me to quickly establish a responsive network across the Australian healthcare industry working closely with state and federal government, ambulance services, LHDs, PHNs and hospitals at a time of extreme and unprecedented pressure on the system.”

Prior to moving to Australia, Mr White gained extensive experience across both private and NHS sectors in the UK, with organisations such as Ramsay Health Care, HCA Healthcare, and Guys and St Thomas’s NHS Trust.

Combining commercial acumen with strategic flair, Mr White led clinician and executive engagement to establish strategic priorities and deliver the implementation of innovative service developments and business growth.

“I’ve always had a strong passion for ensuring equitable access to care and believe the unprecedented challenges of the COVID-19 pandemic requires unique innovators and collaboration across the field to deliver healthcare in a new integrated way,” Mr White said.

“A key focus throughout my time in healthcare has been to improve the delivery of care through collaboration and partnership, which will be invaluable in my new role at the AMA (NSW).”

As Director of Membership Engagement and Commercial Partnerships, Mr White will expand the benefits available to members through partnerships and events. Mr White will also focus on ways to facilitate engagement between members, the AMA (NSW) team, and other doctors and industry bodies.

“I’m really looking forward to working with our members to engage and advocate across the industry for their rights and for better health outcomes for our communities,” Mr White said.

He’s already hit the ground running. Within his first month in the role, he has secured a significant commercial partnership to benefit all AMA (NSW) members: Blue Light Card Australia.

“Our partnership with Blue Light

Card Australia is the first of many new commercial partners we are excited to bring on board at AMA (NSW) – giving members access to some big name brands.”

More details on this commercial partnership will be announced soon.

Mr White’s previous experience has given him insight into understanding what doctors need and want in their day-to-day lives.

“I’d like our members to be fully involved in the AMA (NSW) to ensure we advocate on their behalf, and also ensure members gain access to some of the best benefits around.

“There are several ideas to improve how we engage with our members as an organisation to ensure active participation. I am eager to explore this more, but I also would like to hear from members now.”

Members are encouraged to email the AMA (NSW) Membership Engagement Team with ideas on what you would like to see for the year ahead.

“Hopefully this year we’re able to do some big things at AMA (NSW) in order to assist and support members further,” Mr White said.

You can contact Gary White via gary.white@amansw.com.au. dr.

AMA (NSW) Director of Membership Engagement and Commercial Partnership, Gary White, is committed to providing doctors with more value for their membership.

Our partnership with Blue Light Card Australia is the first of many new commercial partners we are excited to bring on board at AMA (NSW).”

2023 INTERNS:

OPPORTUNITY & GROWTH

AMA (NSW) spent the last week of January welcoming our newest cohort of doctors.

Over the last several years the number of medical interns in NSW has been steadily increasing. In 2023, almost 1,100 medical graduates joined the health workforce – up from 1,074 in 2022 and 1,041 the year before that. One-third of these interns (396) were placed in rural and regional NSW hospitals.

“Interns seeking to complete their internship in our regions were able to apply through the Rural Preferential Recruitment pathway and, this year, 176 Rural Preferential intern positions were available – an increase of 13 positions from 2022,” said Minister for Regional Health, Bronnie Taylor.

AMA representatives held events at 20 different locations including hospitals at Westmead, Concord, RPA, RNSH, Lismore, Gosford, St George Hospital, Liverpool, Wollongong, Prince of Wales, Tamworth, Tweed Heads, Wagga Wagga, Newcastle, Blacktown, Orange, St Vincent’s, BankstownLidcombe, Macquarie University Hospital, and Hornsby. In addition,

we held two intern social nights in Wollongong and Sydney to introduce the new interns to the AMA and their new colleagues.

An integral part of these presentations was reassuring our newest doctors that the AMA (NSW) will support our members throughout their medical career in any matters they need assistance with, ranging from bullying and harassment to legal counsel, to unpaid overtime.

Our most recent AMA (NSW) Hospital Health Check survey of 1,766 doctors-in-training revealed 72% of doctors-in-training had reported working more than five hours of unrostered overtime in an average fortnight, up from 60% in 2021 and 49% in 2020. However, 73% of doctors-in-training received all of their unrostered overtime payment.

Meanwhile, 37% of respondents reported experiencing bullying and 27% of experiencing intimidation at work in 2022, this is an appreciable decrease from 50% and 37% in 2021, respectively. While there is clearly still work to do in improving the experience of doctors-in-training in NSW hospitals, our Hospital Health Check surveys show that there is at least movement in the right direction.

AMA (NSW) will be launching its 2023 Hospital Health Check survey in May this year and seeking responses from doctors all stages of training to inform us about the conditions in their hospitals. These responses will help inform our advocacy for rest of the year.

Good luck to all our doctors-intraining in 2023. dr.

After several years of pandemic uncertainty, it was refreshing to meet new interns face to face during Orientation Week. AMA (NSW) will be supporting the profession’s newest cohort as they transition into this important year of professional growth.

CHATGPT SET TO REPLACE DR GOOGLE

Digital health experts call on regulators and healthcare providers to participate in setting quality standards for chatbox responses from AI programs and raise patient awareness about its limitations.

Since the recent launch of ChatGPT, there has been a rapid uptake from users looking for answers to complex clinical questions. Its use is set to expand as Microsoft looks to incorporate AI into its new Bing search engine.

a ‘confident sounding manner’.

“The latter is an important required improvement to ensure the virtual assistant can respond with uncertainty when it is not sure of its answers,” Dr Hopkins said.

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He also found that ChatGPT formulates easy to understand answers that are comparable to Google’s feature snippet.

SHIFT WORKERS have poorer diet

Flinders University researcher Dr Ash Hopkins looked at the ability of ChatGPT to respond to common questions asked by patients with cancer on prevalence, prognosis, and treatment. These responses were compared to Google responses.

The study found ChatGPT responses didn’t provide quality references, only produced answers to some questions, and is not currently kept up to date in real time and produced incorrect answers in

“Notably, the ChatGPT responses often had contextualisations which appeared to minimise the likelihood of alarm, while practical recommendations – such as speaking to your doctor – were also often added,” he said.

The article, AI chatbots will revolutionize how cancer patients access information: ChatGPT represents a paradigm-shift (2023) by Ashley M Hopkins, Jessica M Logan, Ganessan Kichenadasse and Michael J Sorich has been published in JNCI Cancer Spectrum (Oxford University Press) DOI: 10.1093/jncics/ pkad010 dr.

Rotating shift workers consume more kilojoules, and eat more junk food and less nutritious foods than day workers, according to a Monash University-led study. The systemic review of dietary habit and energy intake found rotating shift workers had higher average 24-hour energy intake than day workers. For each recorded day of kilojoule intake, rotating shift workers ate on average 264 more kilojoules than regular day workers. An increase of just 100 kilojoules each day can lead to a .5 kilogram weight gain over a year. dr.

AMA (NSW) EXCLUSIVE MEMBER BENEFITS

For more information and assistance call one of our membership team on 02 9439 8822 or email members@amansw.com.au. You can find a more comprehensive list of benefits and more information visit www.amansw.com.au or www.ama.com.au.

CORPORATE PARTNERS

Accountants/Tax Advisers

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.

PARTNERS

Health Insurance

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

Tyro

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.

Alfa Romeo

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.

AMA Training Services

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.

BMW

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.

Booktopia

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.

Chubb

Doctor-in-training members of AMA (NSW) are covered by our accident journey insurance policy if they are injured travelling to or from work.

Dell Technologies

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.

Jeep

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.

MEMBER BENEFITS

Sydney City Lexus

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.

FOR LEASE

Bondi Junction, NSW 2022

• High security modern building

• Light filled offices in a prime location

Located adjacent to Westfield Shopping Centre and only a short level stroll to Bondi Junction Bus & Rail Interchange. A-Class office suite/s 33sqm to 86sqm with great natural light, suitable for various uses, medical, professional or small business requiring a great corporate identity.

Modern fit-out can be utilized or removed to suit your requirements.

Ample parking available within neighboring properties.

For more information contact Steven Rudman on +61 414 226 691 or steven@capcorprop.com.au

Samsung Partnership Program

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.

CLASSIFIEDS

MIRANDA CENTRAL CONSULTING OPPORTUNITIES (South Sydney)

Solahart

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.

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