NSW Doctor 2023 May/June

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VMO Survey: ARRANGEMENTS UNDER REVIEW

Suicide prevention ASKING THE RIGHT QUESTIONS

Postvention A TOOLKIT FOR HOSPITALS

HEALTH & WELLBEING

Tackling the unique stressors faced by doctors in NSW

THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION OF NSW

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DURING A RECENT STAFF workshop, AMA (NSW) CEO Fiona Davies relayed the words of her former boss, which were spoken to her when she first joined the organisation. He said to her, “you’ll always be proud to work for the AMA.”

And it’s true. Whenever I’m at a neighbourhood BBQ or chatting on the sidelines of a soccer pitch and the conversation turns to ‘what do you do?’ I’ve always been very happy to tell people that I work for the Australian Medical Association. This in turn usually elicits the reaction, “you must have been busy during COVID.”

Which is also true.

I have enjoyed playing a supporting role for people who have made healing their profession. Whilst the sight of blood makes me faint, I’m glad there are people in

the world that don’t get squeamish at these things. But beyond recognising the importance of their role in society, my job has given me firsthand insight into the incredible self-sacrifices that so many health professionals make to improve the health system for patients and the profession. I’ve been privy to the afterhours councils and committees, the WhatsApp groups, the email chains, the reading of reports, submissions, papers and more. Doctors who are driving home from work at 8pm and participating in conference calls that will last another two hours; doctors who are cradling babies to sleep during emergency COVID meetings held over Zoom; and doctors who drop everything to answer a journalist’s call so that they can share important health advice. I’ve seen the best of health professionals

and it’s given me an incredible appreciation for the work that goes into being a doctor both inside hospitals and consultation rooms and outside the walls that patients see. It’s why the media’s negative reporting of the profession really felt like such gut punch – the so called “greedy doctors” who are rorting the profession are not the majority. I suspect this is the pendulum swing from the public applause of healthcare workers during COVID, and eventually it will land somewhere in the middle again.

I’m leaving the AMA (NSW) for a new role, but I will carry all the lessons I’ve learned with me. Take heart doctors – there are many who still recognise and appreciate what you do. And it probably doesn’t get said enough but thank you. dr.

Andrea Cornish, Editor

THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)

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

Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by

the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor. The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA.

EXECUTIVE OFFICERS 2021-2023

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 and Director, Dr Costa Boyages Director, Dr Kean-Seng Lim Director, Dr Fred Betros Director, Dr Amandeep Hansa Director, Dr Theresa Ly Doctor-In-Training Director, Dr Sanjay Hettige

SECRETARIAT

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

Staff Writers

Sophie Taylor sophie.taylor@amansw.com.au

Isabella Angeli Isabella.angeli@amansw.com.au

Design

Gilly Bibb gilly.bibb@amansw.com.au

Advertising enquiries

Julia Arellano Julia.arellano@amansw.com.au

HEALTH CAN’T WAIT

During the pandemic, politicians repeatedly told residents they were acting on “the advice of health experts.” It’s a strategy that should continue as we move forward.

overburdened hospital system.

I’m hoping this event signals Labor’s willingness to take a page out of the previous Government’s playbook – one that served the people of NSW so well during the pandemic; to rely on the expert health advice of the clinicians and public servants that so effectively guided us through the COVID crisis.

Dr Michael Bonning President, AMA (NSW)

I RECENTLY PARTICIPATED in a press conference with Premier Chris Minns, our new Health Minister Ryan Park, and Chief Health Officer, Dr Kerry Chant to promote the importance of getting vaccinated ahead of this year’s flu season.

Journalists who attended the media event, which was held in front of NSW Health headquarters in St Leonards, remarked that it was reminiscent of the 11am daily press conferences that we all became so familiar with during the pandemic.

Whilst the cast of characters had slightly changed, the underlying message was the same: taking action to prevent avoidable hospitalisations will keep residents healthy and safe and alleviate pressure on our already

The NSW health system faces many challenges, but it’s important to remember that for all its flaws, it is still the best performing system in the country and one of the best in the world.

This is one of the reasons AMA (NSW) has and is continuing to oppose the HSU’s calls for a Royal Commission into Health Spending, which Labor has committed to implementing.

We’re strongly requesting that the new Government not wait for a team of lawyers to decide what’s best for the health system, but to instead take advice from the experts who have successfully guided us through the most devastating health crisis to hit Australia in more than 100 years.

The ALP has committed to a Special Commission of Inquiry into health funding at a proposed cost of $15m. We don’t know what they intend to consider as part of that Inquiry. We assume given the findings of the Philip Review into Medicare that they won’t want to be highlighting the use of Medicare funds in our public health system. We do know that if there is an Inquiry

into health, it will not cost $15m, not if it is to truly consider the scope and complexity of our health system.

NSW has just completed parliamentary inquiries into ambulance ramping and rural health. The new Government should be looking to implement the recommendations out of those inquiries before launching into another examination of the health system. Health can’t wait. We need solutions now.

I’m pleased that the new Government includes some Independents and Greens who have been valuable spokespeople in the past on important health issues. Ahead of the election, AMA (NSW) spoke with politicians who expressed support for a payroll tax exemption and a willingness to do the hard work it takes to improve our health system.

One of the most important fixes that will address many of the challenges we face is to improve workforce numbers across the State. AMA (NSW) made workforce the number one ask in its Election Priorities document and will again focus on this need in its upcoming Budget Submission. Your wellbeing depends on it.

dr.

President@amansw.com.au

@michaelbonning

www.facebook.com/amansw

LET YOUR BABIES GROW UP TO BE DOCTORS

We know how hard doctors’ lives can be – the stressors you face that are compounded by a system that is struggling to cope with increasing pressure. That’s why our job is to support you, individually and collectively. We’re here to make your lives easier.

Membership of the AMA is an important investment. We know it is an investment that comes after the list of the compulsory spends but it’s still a valuable one. The AMA is the only group who are responsible for standing up for the whole profession. Our role is to highlight why doctors should be valued and why they are central to patient care.

Fiona Davies CEO, AMA (NSW)

IN MY MANY YEARS with AMA (NSW), I have heard doctors say that they actively discourage their children from becoming a doctor. It’s a view I have not ever agreed with – frankly, at this stage with my children, I will be happy with any form of endeavour. I recognise that there are challenges in many ways of making a living. However, as threats to the medical profession seem to rise, I increasingly understand the hesitation.

It is for this reason that I am proud that this edition of The NSW Doctor is directly focused on your health and wellbeing. Putting your health and wellbeing in the spotlight is necessary so that you can build a rewarding career, and an element of that is knowing where to find support when things go wrong.

Membership of the AMA also gives you access to incredible expertise. Our Director of Workplace Relations, Dominique Egan brings 20 years as a partner in leading law firms. She has been there for the negotiation of critical decisions; she raised the alarm and ran the campaign on payroll tax which has now been taken up widely by other organisations across the country. She is the person I always call when I have a difficult problem and she, and the team of experts she leads, are available to our members as part of their membership. What makes Dominique and her amazing team different is that not only are they experts, but they also understand, and they listen. Many of the calls they take end with doctors saying, “thanks, I don’t need to do anything now, I am just glad someone cares.” We take calls after hours and Dominque and her team always care. It’s a service that makes me proud.

In addition to expert advice, in this edition, thanks to our impressive Director of Membership Engagement

and Commercial Partnerships, Gary White, we feature amazing deals just for doctors. Gary has been rebuilding our commercial partnerships and there will be so many more to come as we find the best deals and the best businesses. What we ask of our commercial partners is that they understand the value of doctors and that they put offers forward that make doctors’ lives easier.

Finally, this edition marks the end of an era for AMA (NSW) as we farewell the wonderful Andrea Cornish, Manager of Communications and Policy, and Editor of The NSW Doctor. Andrea has been an extraordinary force in AMA (NSW). She has driven campaigns from the heart-wrenching “Share Your Story” domestic violence campaign to recent campaigns around payroll tax and the Lismore floods. She also produces consistently exceptional content in The NSW Doctor.

So, my hope to our members and our non-members is that in this edition, you celebrate the amazing profession you are part of, with all its challenges and imperfections. Take the time to read about the issues that matter, think about the services we offer and the profession you want to be part of. Thank you for all that you do. dr.

WHAT HAPPENS NEXT?

Doctors’ Health NSW is developing a postvention toolkit to ensure workplaces are equipped to provide thoughtful and compassionate responses.

AT ALL TIMES, healthcare organisations and communities are vulnerable to the unexpected loss of a doctor, at any stage of their career. As doctors, we will all experience such a loss at least once in our professional lives. Sometimes this occurs as the result of a sudden illness, unexpected event, or accident. Tragically, and all too frequently in our profession, this can also occur when a fellow doctor or medical student ends their life by suicide. Our immediate response after any unexpected loss is usually profound shock. After a colleague has taken their own life, this shock is often compounded by deep feelings of guilt or remorse. It is a normal response for all of us to develop quite unrealistic thoughts that we might somehow have prevented the tragic outcome. The way we hear the news can

be very distressing, and other difficult thoughts and emotions, such as anger, anxiety and debilitating grief often surface during this time. These feelings can be compounded by the close relationships that often exist within medical teams, and the personal connections that we may have had with the colleague we have lost.

Doctors may also experience other psychological symptoms such as depression, posttraumatic stress disorder, and burnout, which can have significant effects on wellbeing. Depending on a range of factors and vulnerabilities this can also include an increased personal risk of suicide.

It can be very hard to carry on, and the response of the workplace is vitally important to provide support to the entire team during

When we suddenly lose a colleague…

this difficult time.

In the immediate aftermath of an unexpected loss, there is often a lot of confusion about what happens next. Organisational responses can be varied. How can the family be supported? How can the news be communicated without causing further distress? Who should be told and how do we support one another in our grief? We may have our own ways of coping which do not match the expectations of our peers or the needs of the workplace. Pragmatically, there are usually decisions to be made about how the clinical service can continue without one of the key practitioners, in circumstances in which the rest of the team is impacted by shock and grief.

Without access to immediate expert advice and adequate resources, it is difficult for managers to know what to do, and there is risk of further harm being caused in this situation. It is important to recognise that doctors often have many barriers to healthcare access, which may mean they are relatively unsupported during these times.

The AMA (NSW) Doctors-inTraining Committee is very conscious of the need for a thoughtful and compassionate response from workplaces at these times and raised this as a priority issue for our health system to address. In response, AMA (NSW) and Doctors’ Health NSW put together a proposal to ensure that resources are developed, based on the recognised elements of postvention, to assist managers to know what to do at these times.

Thanks to a specific allocation of funding from NSW Health, this essential work is now underway.

This will ensure that best practice, purpose-built resources are developed, in consultation with doctors and medical students.

The development of this NSWwide resource will build upon the existing knowledge about how to provide general support, but in particular will address issues specific to the medical profession in these circumstances.

WHAT IS POSTVENTION?

The term ‘postvention’ refers to the actions taken after a suicide to help support those who have been affected by the loss, including the family and friends of the person who died, as well as their colleagues and other members of the community. Postvention is an essential component of suicide prevention, as it provides a way to address the emotional and psychological impact of suicide and reduce the risk of further death by suicide.

WHY IS THIS IMPORTANT?

Suicide among doctors is a significant problem in Australia. Alarmingly, the suicide rate

among male doctors is 2.3 times higher than in the general population, and the suicide rate among female doctors is 3.4 times higher.1 A 2013 national survey of medical students and doctors conducted by Beyond Blue2 found that more than 25% of respondents had experienced suicidal ideation, and nearly 7% had attempted suicide.

The loss of a colleague can also have a professional impact on other doctors and may leave them struggling to manage an increase in workload under difficult conditions. Communication with patients and their families about the loss can also be challenging and can further complicate the grieving process. It is therefore essential for the medical community to recognise the impact of suicide on doctors and to provide the necessary resources and support to address it via prevention and postvention activities.

HOW WILL A POSTVENTION RESOURCE HELP?

The postvention resource now

Without access to immediate expert advice and adequate resources, it is difficult for managers to know what to do, and there is risk of further harm being caused in this situation.”

being developed by Doctors’ Health NSW will provide managers and other affected individuals with comprehensive information and guidance to help them manage both immediately and into the future, after the unexpected loss of a doctor or medical student. Specifically, it will offer guidance on understanding the levels of impact such a loss can have within a particular health setting as well as addressing the emotional and psychological impact on colleagues, and ensuring adequate support is provided. The resource will also tackle some of the practical and professional needs of doctors and other staff and will provide doctors and managers with guidance to navigate referrals for those who need more in-depth support in the difficult and distressing period that follows the loss of a

colleague. Difficult questions will be addressed, such as the use of appropriate language when discussing a death by suicide, as well as guidance on how to appropriately memorialise a colleague. The availability of this resource will also help to ensure that all doctors and managers have access to the same level of information regardless of the hospital or health setting they work in.

HOW CAN YOU HELP?

Input from doctors and medical students is essential to the development of this resource. If you have experienced the unexpected loss of a colleague, and are willing to share your thoughts, then please contact Doctors’ Health NSW on admin@ dhas.org.au.

Donate to support a colleague

Doctors’ Health NSW provides a safe place for doctors and medical students to talk.

Your donation will help us to keep running our independent, confidential and free 24/7 phone service.

Doctor to doctor –we understand.

If you have been impacted by a loss or other stress, and would like some confidential support, doctor to doctor, please contact Doctors’ Health NSW for confidential 24/7 service on 02 9437 6552 or visit doctorshealth.org. au dr.

References

1. Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, et al. (2019) Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLOS ONE 14(12): e0226361. https://doi.org/10.1371/ journal.pone.0226361

2. Wu, F., Ireland, M., Hafekost, K., & Lawrence, D. (2013). National mental health survey of doctors and medical students. https:// medicine.uq.edu. au/files/42088/ Beyondblue%20 Doctors%20Mental%20 health.pdf

ABOUT THE AUTHORS: Contributed by Doctors’ Health NSW Medical Director, Dr Kathryn Hutt, in coordination with AMA (NSW) CEO Fiona Davies.

Asking the right

QUESTIONS

MANY PEOPLE at risk of suicide are going undetected and unsupported in our community, our research suggests.

Our recently published study found under half of people tell anyone they’re thinking of suicide, making plans or had attempted suicide.

Here are some of the reasons why people don’t often talk about this, and what you can do to help a friend or loved one get the support they need.

We’re getting no better at predicting

In 2021 in Australia, 3,144 people died by ending their life (2,358 males and 786 females).

Worldwide, more than 700,000 people take their life each year. Globally, suicide is the fourth leading cause of death among 15-29 year-olds.

But our ability to predict who might have suicidal thoughts and behaviours or end their life has not really improved over 50 years of research.

Because suicide is relatively infrequent (as a percentage of the population), it is difficult to identify robust risk factors for suicide we can generalise across the population.

We need to know who’s at risk

One of the most crucial steps in understanding and managing the risk of suicide is for individuals to disclose their suicidal thoughts and behaviours to other people. It also gives us a chance to mobilise support.

However, when colleagues and I looked at the evidence, we found less than 50% of people tell anyone else about their suicidal thoughts or behaviours.

Even if they had these thoughts

Most people thinking about suicide don’t tell anyone. Here’s why and what we can do about it.

or behaviours over the past month, only an estimated 38% of people told anyone. Most people don’t ever disclose any suicidal thoughts or behaviours, however long ago these occurred.

Our study was a meta-analysis, which combined information from almost 100 studies to estimate how commonly people disclosed.

Women were slightly more likely to disclose than men and disclosure was more likely when associated with a psychiatric disorder.

Notably, among studies of people who had died by suicide, close to 60% of people had no documented evidence of telling someone they had thoughts or plans of ending their life.

Put simply, the findings suggest a large number of people at risk of suicide are undetected and unsupported.

Why don’t people say anything?

Reasons people don’t disclose thoughts of suicide include: stigma and shame about having the thoughts, fear of rejection or unsupportive reactions from others, concerns about burdening other people, and believing nothing can be done.

Worrying about the consequences of telling other people, such as being hospitalised or receiving unwanted treatment, might be particularly important where people have had negative experiences with disclosure in the past

A lack of confidence in expressing oneself is another significant barrier. Some people avoid thinking or talking about it as their main way of coping.

Having more social support can increase the likelihood of disclosing suicidal thoughts. This is important given most disclosures are made to family or

friends Increased understanding and knowledge about suicide seems to also be linked with a higher likelihood of disclosure.

How do we start conversations?

Public campaigns to increase mental health literacy and normalise discussions about suicide have likely been helpful in facilitating disclosures. Most times, this means talking about it.

Asking someone about suicide risk indirectly can be more comfortable, such as checking in on how they are feeling or how they are doing. But the question might be misunderstood or answered in a “socially desirable” way.

A conversation might go, “How are you doing?”, with a response, “Yeah, not bad.”

But research shows asking more direct questions does not increase their distress and does not cause someone to have more suiciderelated thoughts or behaviours.

So, clear questions – such as “Are you having thoughts of ending your life?” or “Are you thinking about hurting yourself?” – may help draw out an answer.

Asking about how safe they feel now can also be useful: “Do you feel safe at the moment?”

Offering the choice of not responding might lead to opportunities to ask about it later. You can say, “It’s OK if you don’t want to answer that right now.”

Talking about suicide can be difficult. But knowing we don’t need to be perfect at it, and we’re not tasked with trying to solve all of a person’s problems, is important.

You

can really help

For some people, thoughts of suicide reflect a negative or hopeless mental state, but not an intent to harm themselves. Most

people who have thoughts of suicide do not end their life.

But what you can do for someone is significant.

First, the emotional support and acceptance you show by simply asking and listening is immensely important to helping people feel understood and cared for. This can help normalise and de-stigmatise their experience. Depending on your relationship, you may want to know more about what is driving those thoughts, and being curious and non-judgemental can help.

Second, you can give simple practical support by asking someone what they might need. You could try, “Is there anything you need right now? How can I help?”. You could encourage them to tell loved ones, and support them to find professional help. This might be their GP, mental health professional, to call a helpline, or 000 if the person seems very unsafe.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.

Written by Dr David John Hallford, Senior Lecturer and Clinical Psychologist, Deakin University. This article is republished from The Conversation under a Creative Commons license. dr.

ABOUT THE AUTHOR:

Dr David John Hallford is a board member for the Australian Clinical Psychology Association.

Creator: Simon Peter Fox Photographer

UNIQUE STRESSORS ON HOSPITAL DOCTORS

Burnout is rife across the profession, but the everyday stressors differ depending on your role. The NSW Doctor looks at the unique burdens that hospital doctors bear.

ALL DOCTORS shoulder the incredible responsibility of caring for patients. Whether you work as a general practitioner in a rural town or neurosurgeon at a major metropolitan hospital – you are required to make life and death decisions on a regular basis.

While there are significant commonalities, there are also unique differences in the sources of stress that impact doctors. The pressures facing general practice (payroll tax, pharmacy prescribing, the impact of the Medicare freeze) are particular to that specialty. Consequently, we are covering these issues in a separate article.

This feature focuses on hospital doctors, which upon further reflection, is about as specific as looking at doctors with belly buttons. Your specialty, whether you are still training, and your location will have an incredible impact on your day to day – so to this end, we’ve tried to encapsulate the unique stressors hospital doctors face and break those down further based on location, experience, and specialty. We also spoke to a wide variety of doctors to get a sense of what challenges they face.

This is by no means an exhaustive categorisation. There are many lenses from which to examine stressors, including gender, sexuality, race, age and more. Unfortunately, there isn’t space in this edition to adequately examine these characteristics in greater detail, but we invite readers to submit comments and letters (news@amansw.com.au) to drive further discourse on this important topic area.

COMMON STRESSORS

Workforce shortages Findings from Deloitte’s White Paper “Medical

Workforce Pressures in NSW” reveals an increase in demand from a growing and ageing population. Over the past 10 years, growth in service volumes (Hospital Separations 2.2% on average per annum) have significantly exceeded population growth (1.3% on average per annum). Pressure on the system is further documented by the Bureau of Health Information’s Quarterly Reports, which reveal a steady increase in emergency department presentations and a corresponding decrease in the health system’s ability to meet the performance targets set by the State. Comments from an open letter written by the NSW Medical Staff Executive Council encapsulated how this pressure is impacting on doctors: “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.”

According to ENT registrar Dr Jacqueline Ho, doctors-in-training are at the pointy end of the resourcing pinch.

“Doctors-in-training are the forefront of hospital system and see day to day the systemic shortcomings in trying to provide the best care for our patients. They work in an underfunded, under-resourced health system – repeatedly apologising in response to the brunt of patient criticisms about hospital inefficiencies, bed block, long clinic wait times, cancellations and surgical waitlists.”

Radiology registrar Dr Sanjay Hettige said bed-block is more the norm than the exception and junior doctors are under enormous pressure to get patients out of hospitals as soon as possible.

“This means that they are often multitasking, making sure all the tests, investigations, and appointments are sorted for their patients while trying to take adequate notes for a ward round, communicate adequately with patients, answer questions from their consultants, sorting out discharge summaries, answering emergency calls and pages all while trying to find some time to eat and maybe go to the toilet.”

According to Dr Hettige the pandemic laid bare workforce issues that were previously simmering in the background.

“This includes a severe shortage of JMO workforce in our metropolitan hospitals. Unfortunately, as workloads build and working conditions get worse, doctorsin-training are leaving the NSW hospital system in large numbers which adds even more pressure to those left behind, exacerbating the problem.”

Outdated agreements Another source of frustration for hospital doctors are the award conditions and the wages cap. The outdated Staff Specialist Award and the wages cap has resulted in many hours of unpaid work. The NSW Staff Specialist Award was written prior to the establishment of teambased, 21st Century medicine and is well behind updated Victorian and Queensland Awards. The VMO arrangements have also not been meaningfully updated for many years. The VMO Determinations were last the subject of a major

review in 2007. Since that time advances in technology, societal expectations regarding work/life balance, an ageing population and complexity of patient presentations to hospitals, and significant workforce challenges demand a review of current arrangements including what is a reasonable on-call commitment and the need to address the fact that many can and do provide services from locations other than the hospital for which they are not remunerated.

Clinician engagement AMA (NSW) conducted a survey of senior doctors in 2021 that revealed senior clinicians felt unsupported by key decision-makers. The Senior Doctor Pulse Check found 63% of senior doctors did not think their LHD/ network enabled strong medical leadership and cross-organisation participation in decision-making. In addition, almost half (47%) did not think they could openly and honestly discuss workplace problems or issues with their hospital/LHD. Meanwhile two in three senior doctors did not believe senior management at their hospital/LHD could be trusted to tell things the way they are. Twothirds of respondents (69%) did not feel valued by their hospital. Deloitte, in conjunction with AMA (NSW) conducted a similar survey in 2022 which found only 34% of senior doctors reported feeling valued in their roles. Reasons for feeling undervalued included feeling replaceable, lack of support from management (including a sole focus on KPIs and an inability to respond to improvement requests).

Lack of resources According to the 2021 Senior Doctor Pulse Check, eight in 10 doctors reported experiencing workplace stress, with the majority

citing excessive workloads (60%) and lack of resources (69%). In 2022, three quarters of survey respondents in the Deloitte/AMA (NSW) survey found their work settings were under-resourced.

Geriatrician and general physician, Dr Alison Semmonds said there is a strong perception that hospitals have more competition for resources now than previous years.

“One of the issues I’ve found in the public sector is that because so many people are competing for the health dollar, there has been a withdrawal of support that was expected and traditional for doctors.”

She explained that with limited funding, doctors are being bogged down with administrative tasks such as typing clinic letters and arranging clinic appointments.

“They don’t recognise the importance of supporting specialists, so we can look after patients, keep them out of hospital and manage them effectively as outpatients. That would have never happened years ago.”

According to Dr Semmonds, there is greater support in the private sector.

“There are fewer barriers. If you see something that needs to be done it’s more, ‘how can we help you?’.”

Complaints Medical complaints are intensely distressing to all doctors. Even when matters are resolved in favour of the doctor, many describe a medico-legal complaint as one of the most traumatic experiences in their lives.

Dr Semmonds said the prospect of a medical complaint is something that “is with me every day, but not with me with every patient.

“It does influence what I do a lot. You know that even though you can do a wonderful job, there is so much emotion in health that it doesn’t take a lot for there to be a misunderstanding and then there is distress and anger and it can turn into a complaint.”

Doctors who face medical complaints will be forced to question their competence, decisionmaking, and conduct. This can have significant ramifications on a medical professional’s wellbeing. A BMJ study published in 2015 of 8000 doctors in the UK found those who experienced professional complaints had a higher risk of anxiety and

AMA (NSW) Doctors-in-training Committee co-chairs, Dr Jacqueline Ho and Dr Sanjay Hettige.

depression. Doctors were 3.78 times more likely to report suicidal thoughts while going through a complaints process. Unfortunately, given the rise in complaints to AHPRA, it is increasingly likely that more medical professionals will experience at least one complaint in their professional career. AHPRA received 10,803 complaints about 8380 practitioners in 2021/22 – a 6.5% increase over the previous year. The AMA identified the need for AHPRA to address vexatious complaints – those complaints made for vexatious reasons, including using the complaints process as a tool for bullying and harassment, including by other health practitioners.

Following detailed consultation with the AMA in the second half of 2020, AHPRA released its new framework to support the identification and management of vexatious notifications.

Public perception Recent media

reporting on Medicare rorts has had a significant impact on the mental health of medical professionals. Whilst the extent of rorting was greatly exaggerated and an

independent review has revealed that many incidents of incorrect claiming are a result of system confusion, the perception that a significant number of doctors are intentionally frauding the system has left many feeling scarred and their reputations unfairly tarnished.

Dr Semmonds said the negative reporting was heartbreaking.

“When I think about that, it actually makes me want to stop working as a doctor full stop.

“People who end up being doctors generally have worked and worked and studied and studied. When you give so much of your life to this career and you do the right thing, and then you read these reports and think, ‘oh, what does that person think of me?’”

She added that she is grateful she is at the end of her career and that many of her colleagues are now actively discouraging their children from doing medicine.

UNIQUE STRESSORS

Whilst the above provides a few examples of stressors that affect doctors working in public hospitals, we wanted to examine a few of the differences that exist depending on a doctor’s role, locality, and specialty. These are broad brush strokes and do not fully cover the differences that exist within the health system.

BY LOCATION

Regional and rural NSW The rural health inquiry exposed many of the stressors associated with rural and regional healthcare. Despite having a greater need for medical services and practitioners, there is a disparity between the number of specialists in major cities (143.5 FTE per 100,000 in 2020) compared to the remote areas (61.7 FTE per 100,000 ). Without a ‘critical mass’ (multiple doctors with the same speciality in a popular

location) there is greater professional isolation. Regional and rural areas often lack appropriate infrastructure, including availability of long-term certainty of theatres and lists, diagnostic services, access to specialist drugs, specialist nurses and staff, access to private hospitals as well as connection to metropolitan colleagues. Oncology, palliative care, neurology, cardiology and stroke services can be limited in regional and rural areas and have been identified as needing greater investment.

Outer metro hospital Areas such as South Western Sydney and Western Sydney are unique in their demographic and socio-economic status. They cater to diverse populations.

The South Western Sydney LHD is one of the fastest growing areas in the State – from 20162036, population growth is expected to be 45%, which is almost double the average for NSW of 28%. There is a changing age profile that will result

Geriatrician Dr Alison Semmonds

in significant growth in the number of elderly people over the next 20 years. In addition, the proportion of people with profound or severe disability is higher than the NSW average. More than half (51%) of residents speak a language other than English at home. Tthere is high socio-economic disadvantage, unemployment, low levels of English proficiency, and high concentration of social housing. There is also low private health insurance coverage.

For example, Bankstown is a culturally and linguistically diverse suburb, with one in three residents from a Culturally and Linguistically Diverse (CALD) background. This presents challenges for health delivery in terms of health literacy, diagnostic accuracy, engagement with health services, and adherence to treatment protocols. Funding should address the need to improve interpreter services and address these unique challenges.

The parliamentary inquiry report into current and future provision of health services in the South-West Sydney Growth Region, found there has been a history of underfunding in South-West Sydney in proportion to population and need. Funding is provided through Activity Based Funding (ABF) and block funding where ABF is not appropriate. This model does not adequately address the healthcare needs for patients who need to leave the area for treatment.

According to Dr Fred Betros, a general surgeon who works in Western Sydney, the growing population of the region has a significant impact on hospitals.

“Without a doubt, the most challenging part of working in Western Sydney Hospitals is finding a way to cope with the sheer volume of disease burden related to such a large population. Our

patients live in a geographical area that contains some of the most densely populated Local Government Areas in Australia. Compounding this issue, is also the fact these same LGAs have some of the highest incidence of lifestyle comorbidities found anywhere in the country. Our health resources in these facilities are stretched to the limit – sometimes beyond the limit–and this definitely includes our medical staff. The mental energy required to manage our patients safely in this environment cannot be overstated. I believe that for many of our hospital doctors, this type of sustained pressure in the workplace significantly contributes to burnout and mental health issues.”

DOCTORS-IN-TRAINING (DITS)

Working conditions AMA (NSW) conducts an annual Hospital Health Check (HHC) survey of doctorsin-training across NSW to find out about working conditions in their hospitals. DITs report on areas such as rostering, access to leave, overtime, bullying & harassment, and hospital facilities. There have been notable improvements in a number of areas since AMA (NSW)

started surveying DITs in 2017. These include a significant increase in the number of DITs claiming and getting paid for overtime, in part due to AMA (NSW) advocacy to make it easier for DITs to claim their overtime.

There has been a slight dip in the last two years in the number of DITs who reported ‘feeling valued’ by their hospital – from 63% in 2021 down to 46% in 2022.

Most recently, the HHC has uncovered growing concern from DITs about their facilities. Comments from DITs regularly point to a need for safe parking, access to fresh food, and adequate spaces for rest and relaxation. AMA (NSW) has made facilities a focus for its 2023 HHC and will be delving into the areas of greatest need across the State to find out how and where the association can assist.

Dr Ho remarked that the uncertainty of training adds another dimension to the overall stress doctors-in-training are feeling.

“As a doctor-in-training, you are faced with jumping multiple hurdles to get towards fellowship and being a consultant. It is more than just turning up at 7am and leaving at 4pm and doing your job – there’s the unrostered overtime, on call, self-directed learning, studying for exams, putting together research, supervising juniors, audits and departmental presentations. It’s impossible not to take our work home with us. This is often juggled with spending time with family, maintaining wellbeing and trying to avoid burnout.”

SPECIALTY CONCERNS

Each specialty comes with its own unique stressors. Child psychiatrist Dr Sandy Jusuf has had the unique experience of working as an ED trainee before moving across to psychiatry.

General surgeon Dr Fred Betros

“They are almost exact polar opposites,” she explained, adding that different personality types tend to be attracted to the different specialties.

In her experience, ED was more hierarchical than psychiatry, and the doctors tended to be more Alpha dominant. In addition, there was a different expectation when it came to putting up with aggressive patients. She recalls that during her pregnancy, there was expectation to just get on with the job and ignore patient abuse. However, her psychiatry colleagues expressed greater concern for her safety and welfare.

According to Dr Semmonds, in the field of geriatrics, the stressors tend to be related to resourcing.

“There are no KPIs for what are seen as less urgent specialties. For emergency departments there are wait times. There are bed turnovers in the ICU, there are waiting lists for angiograms – there are clearer things that funding can be tied to with those specialties. But in geriatrics there is not. So the stresses have been that a lot of the hospital system and even in the general community, there is this feeling that older people are a problem and a bother and are taking up hospital beds. Therefore, there is always a lot of pressure on resources. It’s difficult for administrators to tie that to KPIs and performance and to understand what all the geriatricians and all the allied health team are trying to do.”

Meanwhile, according to Anaesthetist and Prehospital and Retrieval Medicine Specialist, Dr Simon Martel, anaesthetists face unique stressors in part because of their dependence on, or regular contact with, other doctors.

“Surgeons, to a large extent, control our access to patients and

income,” he said. “Work, on the whole, is on the basis of a surgeon requesting our services. This obviously puts a lot of importance on the surgeon-anaesthetist relationship and creates an unequal power dynamic.

“In the private sector, and to a lesser extent the public, anaesthetists are seen as secondary providers and of less importance. We don’t bring patients, or work, to the hospital, which can put us in a weaker position.

He added, “Whilst it works well most of the time, it does leave open the potential for abuse and stress. Annoy your surgeon at your peril, which can lead to anaesthetists doing things that may not be their first choice.

“The likelihood of this being an issue for an individual anaesthetist would depend on their vulnerability. Many factors could potentially affect this vulnerability. New consultants are more susceptible. People who avoid conflict may be more likely to be bullied. Financial pressures and the dependence on a particular relationship for income may contribute.

“Personally, as a VMO working in

many hospitals, in both the public and private sector, with many different surgeons, I have the luxury of not being dependent on one person or one hospital for my livelihood. I have also prioritised relationships that I value, and discarded those that I don’t, so that I now have a roster that I am happy with,” Dr Martel said.

Conclusion

While the stressors are unique, the solutions tend to be the same. Doctors, whatever their specialty, location, or training level are encouraged to ensure they have their own treating doctor, and focus on eating well, sleeping well and participating in relationships and activities outside of work that give them joy.

For more support, contact Doctors’ Health NSW on 02 9437 6552. This is an independent and confidential service for doctors and medical students. dr.

Anaesthetist Dr Simon Martel

GP BURNOUT

Financial pressure, staffing shortages and public scrutiny is impacting on the mental health and wellbeing of general practitioners. Isabella Angeli asks three different GPs about the unique stressors impacting their specialty.

Having grown her practice into a larger entity, Dr Bernard feels a greater responsibility to her long-term staff, colleagues, and patients. And when the practice was in trouble due to poor indexation of the Medicare rebate, Dr Bernard was forced to dig into her personal funds to keep it afloat.

DR SOPHIE BERNARD

General practitioner Dr Sophie Bernard has been the practice principal of a clinic in Five Dock since 1987.

In addition to being a Fellow of the Royal Australian College of General Practitioners, she has a Masters of Paediatrics. Her areas of interest include child health, chronic disease and mental health.

In the three decades since Dr Bernard became a GP, general practice ownership has changed significantly.

“Running the practice was less stressful,” she said. “I bought into a small two-room practice in partnership whilst caring for two young babies. It was difficult but doable.”

Her practice’s financial hardships mirror the chronic underfunding of the Medicare rebate. According to AMA’s 2022 report, “The general practitioner workforce: why the neglect must end” from 1995 to 2022, Medicare rebates have only seen an average annual indexation rate of 1.1%, well below average changes to the Consumer Price Index and Average Weekly Earnings of 2.4% and 3.5% respectively. There was a slight boost in indexation of 2.5% in 2006, but this was followed by six separate years of no indexation and the other remaining years with an average indexation rate of 1.3%.

Dr Bernard said that in addition to financial instability, the accreditation and audit process has become “a nightmare” placing a lot of unpaid, unrecognised administration burden to jump through the increasing hoops of government bureaucracy. Added to this strain has been the challenge of staffing shortages.

“We lost two doctors to burnout

I teach my registrars, medical students and colleagues that one of our main purposes is to keep people out of hospital. We keep them well enough to not need to go or we manage things well enough that they don’t go when they don’t need to.”

– Dr Sophie Bernard

and one to retirement just before our accreditation. We only just kept our heads above water – it was truly horrific,” she said.

The AMA estimates there will be a shortage of 10,600 GPs by 2031, with the supply of GPs not keeping pace with growing community demand.

Several factors are contributing to this shortfall, including a decline in the number of doctors-intraining choosing general practice as a specialty, as well as an increase in the number of GPs who have indicated they intend to retire in the next five years.

A 2022 AusDoc survey found 28% of respondents said they had already quit the profession or had plans to find a new career or planned to retire within 12 months, citing poor remuneration and burnout as the main reasons.

Now on the verge of retirement herself, Dr Bernard said: “‘I feel for my younger colleagues in terms of the stresses of income and trying to start out in the housing market and raise a family in a very different world.”

DR PRIYANKA ANAND

Dr Priyanka Anand grew up in Hong Kong and Singapore but completed her medical degree when she settled in Sydney.

She is a GP at a clinic in Sydney’s Inner West, although is currently on maternity leave. Dr Anand is also a GP supervisor at the University of Notre Dame and holds a Diploma in Child Health and a Professional Certificate in Dermoscopy. Her areas of interest are women’s health, contraception, paediatrics, mental health and comprehensive skin checks and dermoscopy.

According to Dr Anand, recent reports of Medicare rorting have contributed to a public perception that doctors are greedy.

“The assumption that doctors are rich is breaking us,” she said, adding that the bulk billing under the current rebate is not feasible.

“We can’t make ends meet with this current situation,” Dr Anand said.

According to the Cleanbill’s Health of the Nation report, released in April, only 35.1% of GPs across Australia now bulkbill. The survey of 6,363 GP clinics also

found that average out-of-pocket costs at the 65% of clinics that do not bulk bill are $40.42 for a standard, 15-minute consultation.

Dr Anand also commented that negative perceptions of general practitioners being “the back-up option” has made general practice less attractive as a specialty.

What makes this particularly frustrating for Dr Anand is that the opposite is true.

“If we crumble it will directly affect the emergency department and other specialities … we are the main anchor of our health system.”

Dr Anand suggested international medical graduates should be given greater support to address language and financial barriers, which in turn would assist with workforce shortages. Increasing workforce numbers would also improve the health and wellbeing of GPs, Dr Anand said.

General practice is the anchor of our health system. If this profession crumbles, we are left with a fragmented healthcare system.”

-Dr Priyanka Anand

“There is a lot of burnout and fatigue, especially after COVID, we need to encourage and incentivise GPs to seek treatment from professionals if or when they need it.”

Dr Anand added GPs need to prioritise their own health.

“We need to break down the stigma that holds doctors’ health and well-being differently to those we treat – we all face our own problems,” Dr Anand said, adding that she has her own GP and undergoes regular health checks to avoid self-diagnosing.

According to Dr Luckett, the fear of receiving a ‘nudge letter’ is a big stressor, making underbilling a common practice to avoid being audited.

She echoed concerns about the financial sustainability of general practice and said the Commonwealth must increase the Medicare rebate to ensure practices remained viable and patients didn’t seek “free health care” from hospitals, which are already overburdened.

According to Dr Luckett, exempting general practice from payroll tax is one of the most critical policy-level improvements that needs to be actioned by our State government.

“If they introduce payroll tax it will absolutely directly impact my income and also my practices towards billing patients,” Dr Luckett states. “Furthermore, if I see someone with angina and stop them from having a heart attack, I’ve saved the hospital thousands of dollars. So if you look at the expenses that payroll tax will cause, it’s poor fiscal policy.”

In terms of her own mental health, Dr Luckett emphasised the importance of outsourcing.

DR LUCINDA LUCKETT

Dr Lucinda Luckett has been working as a general practitioner for seven years, currently working at a practice in Balmain.

She is an accredited prescriber of opioid pharmacotherapies and oral medical termination of pregnancy.

Dr Luckett’s areas of interest include women’s health (termination of pregnancy and HRT), drug and alcohol, mental health, sexual health and paediatrics.

“As a mother of two you don’t have to try and do it all, have your priorities and what works for you. I place importance on sitting down with my family and eating together. That’s why I don’t feel ashamed about saying I outsource our dinners during the week and use my trusty robot vacuum. They allow me to gain time with my family and that’s what’s important for my health and wellbeing,” Dr Luckett said. dr.

If they introduce payroll tax it will absolutely directly impact my income and also my practices towards billing patients.”

-Dr Lucinda Luckett

VICARIOUS TRAUMA

help them. The greater the exposure to traumatic material, the greater the risk of vicarious trauma.

Coping mechanisms

I’M AN EMPATH by nature. It’s part of the reason I’m good at my job, and largely why my consults are rarely short. When recording a medical history, conversation naturally covers more ground than just the patient’s physical and mental health – I like to hear their back stories and really learn who they are as a person. While I enjoy my patient interactions, there are times when my investment in them as a person can be overwhelming. Particularly, when dealing with victims of trauma.

We’ve all had those days: when you know there isn’t an easy fix for your patients, and it will take much more than medical advice and medication to make their problems go away. You feel helpless at your inability to help. As many of my colleagues know through their own experiences, these feelings are associated with vicarious trauma: the common, cumulative, and detrimental effect of working with and being repeatedly exposed to traumatic information. It is an occupational hazard for those working on the frontline or in essential service roles such as healthcare, with constant exposure to survivors of traumatic incidents.

Vicarious trauma is the negative transformation in the helper that results from empathic engagement with trauma survivors and material, combined with a commitment to

Vicarious trauma varies in intensity and symptoms and can be challenging to recognise. Those working within the health system should be aware of the signs of vicarious trauma in order to better understand how to recognise the risks early and manage them.

Signs of vicarious trauma include:

• Invasive thoughts of the trauma of someone you have cared for

• Feeling hypervigilant/numb/loss of empathy

• Frustration/fear/anxiety/irritability

• Disturbed sleep/nightmares/ racing thoughts

• Problems managing personal boundaries

• Taking on too much responsibility or feeling you need to overstep the boundaries of your role

• Difficulty leaving work

• Loss of connection with self and others

• Loss of own identity

• Increased isolation/withdrawal

• Need for control in your life

• Loss of pleasure in daily activities

Contributing factors

Doctors are particularly prone to vicarious trauma, not only because of the nature of their work and interactions with victims of trauma, but also as a result of several other contributing factors. These include overwork, professional isolation, impact of shift work and irregular sleep, inability to access leave, and the need to maintain patient confidentiality which impinges on your ability to discuss situations with others, to name a few.

Increased self-observation is important. Check in with yourself regularly and cross check the list of symptoms of vicarious trauma with your own responses. For me, the red flags include not being able to laugh at things that I’d normally enjoy. When I feel I’m going down an emotional slippery dip, I open the ‘Photos’ app on my phone and check out the ‘For you’ section. I’m forever thankful for these algorithmgenerated little photo montages from my past. Seeing faces and places from my life remind me of the beauty in the world and how much I’ve been able to experience over my time.

Other tips include:

• Maintain a healthy work/life balance

• Be realistic about what you can accomplish

• Don’t take on responsibility for your patient’s well-being but supply them with tools to look after themselves

• Balance your caseload

• Seek social support from colleagues, family

• Practice proper sleep hygiene

• Connect with nature

• Seek professional help dr.

ABOUT THE AUTHOR

Dr Danielle McMullen, Board Member of Drs4Drs. For more information visit www. drs4drs.com.au or contact Doctors Health NSW on 02 9437 6552.

It’s important to act if the intensity of your response to patient trauma is affecting you outside the consult room.

BORN AND RAISED in a family that cherishes food, Dr Jessie Goldberg’s life has been a journey of discovering different meals and flavours, and the joy they can bring. Growing up, family and food were indistinguishable – one was never without the other. Her mother, Lisa Goldberg, who is a cookbook author, would welcome Jessie home each day after school with treats to try and critique. She describes coming home to what would be my personal paradise – a line-up of chocolate cakes waiting for her feedback. Jessie even has a recipe featured in one of her mother’s books, Now for Something Sweet (I cannot recommend the book highly enough, it’s my go-to cookbook for delicious baked goods).

For Jessie, food represents care, comfort, and culture – from Shabbat dinners to Jewish cultural festivals throughout the year. To her, food has always been more than just sustenance. It’s an expression of her identity and a way to share her culture with those around her, and to learn from them in return. Food offers another dimension to understand the people around us, and the flavours that have shaped

YOUR SOUL FOOD FOR

Dr Jessie Goldberg, an emergency medicine registrar working at Prince of Wales Hospital in Sydney, shares her thoughts with Dr Ashna Basu about the role food plays in her wellbeing.

them. She shares a phrase by Jewish comedian and satirist, Alan King, “A summary of every Jewish holiday: They tried to kill us, we won, let’s eat!” In the face of adversity, food can serve as a unifying and nurturing element that brings people together.

This connection to food proved invaluable during the COVID-19 pandemic. Working in a busy emergency department during wave after wave of the pandemic and various lockdowns, Jessie was separated from her family. She found solace in regular Zoom cook-a-longs with her mother and co-hosted a Zoom cook-a-long for a Prince of Wales Hospital charity fundraiser. At a time where there was little else to do, Jessie and her housemates found excitement in planning elaborate Saturday night meals, transforming a mundane day into a momentous (and delicious) occasion. At times, Jessie has taken her love of food to social media, documenting her experience making every recipe from Bill Granger’s Australian Food, and reviewing different restaurants with her friends. At one stage of the pandemic, the only way to see

her family and close friends was during walks. They devised a routine of walking to various bakeries and eateries, sampling local creations. This inspired her mother’s new Youtube show, Walking up an Appetite (www.youtube.com/@ walkingupanappetite). Jessie recently walked across Sydney with her mother and the film crew, enjoying Sicilian gelato in a brioche burger bun!

After a long day in ED, cooking is a helpful way to delineate her work and home life. To Jessie, the act of cooking is a form of mindfulness – nothing keeps you in the present moment like three pots on the stove and a dish in the oven! I can personally attest to the fact that Jessie’s love for food is a gift to those around her; she enjoys bringing treats into work, and cheekily admits that she loves the compliments from people enjoying her food. To Jessie, food is not just a way to nourish the body; it is a means to nourish the soul. dr.

ABOUT THE AUTHOR:

Dr Ashna Basu is a psychiatry registrar and President, Medical Women’s Society of NSW.

WORKPLACE RELATIONS

VMO ARRANGEMENTS: UNDER REVIEW

Your responses to our VMO survey are informing AMA (NSW)’s ongoing negotiations with the Ministry, and if required, provide critical evidence in arbitrations to amend the Determinations.

THE CHANGE in the State Government brings with it a foreshadowed lifting of the wages cap in New South Wales and presents the opportunity for a review of many industrial arrangements that have not been meaningfully updated for many years.

AMA (NSW) did not wait for the 2023 election to commence its review of VMO arrangements. This process commenced in 2022, and AMA (NSW) and the Ministry commenced discussions regarding the VMO Fee-for-Service (FFS)

Determination in late 2022.

By way of relevant background, AMA (NSW) and the Ministry reached agreement in 2018 for the indexing of payments under the FFS Determination, and that agreement expired in 2022. The Ministry approached AMA (NSW) in 2022 to discuss remuneration arrangements. AMA (NSW) has agreed, in principle, to a review of the remuneration arrangements to address the current position whereby some VMOs are remunerated by reference to the current MBS (as may be indexed from time to time), others are remunerated by reference to the 2018 MBS.

The agreement to amendments to the remuneration arrangements is conditional on agreement being reached on other changes to the

FFS Determination.

In 2022, AMA (NSW) accepted a pay increase for sessional VMOs which precludes the seeking of amendments to the Sessional Determination until July 2023. AMA (NSW) will be seeking a review of sessional arrangements following the review of FFS arrangements.

The AMA (NSW) 2023 VMO Survey

We have recently conducted a survey of VMO members. It is pleasing that so many members have taken the time to complete the survey. To date, 594 have completed the survey and a significant number of those have kindly offered to speak further with AMA (NSW). More than 200 regional VMOs completed the survey.

The VMO Determinations were last the subject of a major review in 2007. Since that time advances in technology, societal expectations regarding work/life balance, an ageing population and complexity of patient presentations to hospitals, and significant workforce challenges demand a review of current arrangements including what is a reasonable on-call commitment and the need to address the fact that many can and do provide services from locations other than the hospital for which they are not remunerated.

VMOs fill the majority of places

on on-call rosters for the NSW Public Hospital System. While the extent to which a VMO will be called back into a hospital when on-call will be dependent on specialty and location, 44% of survey respondents said they either always or usually were called to go back into the hospital when on-call. Another 35% were sometimes called back in.

Almost three-quarters (72%) of respondents indicated that they provide services that directly involve patient management from a location other than the hospital (when on-call or otherwise). These are services for which VMOs currently receive no remuneration. A key ask of the Ministry is that they agree to amend the Determinations to permit VMOs to be remunerated for these services as they are in the ACT.

While approximately onethird of respondents indicated that advances in technology had reduced the need to attend the hospital when called, it was somewhat surprising that 41.5% of respondents are unable to access the eMR when not physically present at the hospital.

Several members have recently raised concerns with us, particularly in regional locations, that while a list may not be cancelled by the hospital where they work, the

major case or cases on a list are cancelled. The VMO Determinations do not provide for remuneration for cancelled cases, only cancelled lists. Approximately 25% of the 323 respondents who had major cases cancelled told AMA (NSW) that this happens at least once a week, and a further 20% said this occurred at least a couple of times a month, and another 18% at least once a month. Forty percent of respondents received less than 24 hours’ notice, and another 18% received between 24 to 48 hours’ notice. Only 8% received more than 72 hours’ notice. There can be several reasons for cancellation, however, it is concerning that in almost 40% of cases efforts were not made or rarely made to schedule other cases.

Of those regional VMOs who completed the survey, 64% said they never claimed the Professional Support Payment. A recent email to members indicated to us that many VMOs remain unaware of the entitlement, and we will be undertaking an education campaign to ensure members are aware of the entitlements they are able to claim.

The survey responses and additional information that has been provided by members will be critical in AMA (NSW)’s ongoing negotiations with the Ministry, and if required, critical evidence in arbitrations to amend the Determinations.

As discussions progress, we may return to you with a further survey to focus our evidence.

RELATIONS WORKPLACE

If you would like further information or would like to speak with us, please email the AMA (NSW) Workplace Relations Team at workplace@amansw.com.au or on +61 2 9439 8822.

Not a member?

To join call one of our Membership Team on +61 2 9439 8822 or go to www.amansw.com.au/join-theama/

Contributed by AMA (NSW)’s Director of Workplace Relations Dominique Egan.

FAIR WORK ACT CHANGES

Is your practice up to date with the latest changes to the Fair Work Act?

AMA (NSW)’s Felicity Buckley and Lisa Bennell detail what employers need to know to ensure they don’t fall afoul the new rules.

THE FAIR WORK Legislation Amendment (Secure Jobs Better Pay) Act 2022 made changes to the Fair Work Act 2009 (the Act) last year. This article examines the changes and what they mean for medical practices.

SEXUAL HARASSMENT IN THE WORKPLACE

The Act now expressly defines and prohibits workplace sexual harassment, separating it from other workplace issues such as bullying.

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

• a worker in a business (including contractors, volunteers, trainees and work experience students); or

• seeking to become a worker in a business; or

• a person conducting a business.

These changes came into effect on 6 March 2023.

The means by which the Fair Work Commission (FWC) may address and deal with claims of sexual harassment in the workplace have increased.

Workers will now have the choice to pursue disputes through the FWC, the Australian Human Rights Commission or via state and territory anti-discrimination processes. The new FWC dispute resolution process permits FWC

to deal with disputes through conciliation or mediation. Where a dispute cannot be resolved in this way, and parties agree, the FWC can determine the dispute and make orders including orders for compensation.

What does this mean for employers?

The changes extend the liability of an employer or principal of a business, as they may be held to be vicariously liable for their employees or agents conduct that may amount to sexual harassment. The employer must be able to demonstrate that they took reasonable steps to prevent the conduct to avoid liability.

These changes have been implemented to ensure workplaces adopt a preventative approach to sexual harassment. Employers should ensure:

• they introduce or update workplace sexual harassment policies,

• provide training and education to everyone in the medical practice, and

• provide a supportive environment for all workers.

PROHIBITION ON PAY SECRECY CLAUSES

The amendments to the Act prohibit pay secrecy clauses in employment contracts, improve transparency, and give employees a positive right

to disclose, or not disclose, their remuneration to others.

Pay secrecy clauses included in new employment contracts from 7 December 2022 will have no effect, and from 7 June 2023 will attract penalties.

Pay secrecy clauses in employment contracts in place prior to 7 December 2022 will continue to have effect, until those contracts are varied, in which case such clauses should no longer be included and will be of no effect.

What does this mean for employers?

Employees are free to choose whether to discuss and disclose their remuneration arrangements to others and they are protected from adverse action if they exercise their right to disclose or not disclose their remuneration.

Employers are not required or expected to hand over or disclose details of employee remuneration.

Employment contracts issued after 7 December 2022 should not include pay secrecy clauses, and we recommend you review your current employment contracts.

Current agreements and contracts of employment which do not have pay secrecy terms are not affected.

It is important that employees are not treated differently because they have disclosed (or have not disclosed) their remuneration details to others.

WORKPLACE RELATIONS

FAMILY AND DOMESTIC VIOLENCE LEAVE

In 2018, five days unpaid family and domestic violence leave was introduced into the National Employment Standards.

The amendments to the Act provide eligible employees access to 10 days paid family and domestic violence leave per year. From 1 February 2023, paid leave is available for those working in a business with 15 or more employees, and for small businesses with 15 or less employees, from 1 August 2023.

Employees may continue to access up to five days unpaid family and domestic violence leave until the new paid entitlement becomes available to them.

It may be taken by employees experiencing family and domestic violence to deal with the impact of family and domestic violence, where it is not practical for them to do so outside their work hours.

Paid leave is available to full time, part time and casual employees. The 10 days become available upon commencement of employment and the days do not accumulate from year to year. The paid leave entitlements renew on the employee’s work anniversary.

What does this mean for employers?

Leave can be taken as single or multiple days. An employer and employee can also agree for an employee to take less than one day at a time.

Employees are required to notify their employer as soon as possible if they need to take the leave. An employer can ask for evidence, but the information can only be used to satisfy themselves that the family and domestic violence leave needs

to be taken. The evidence provided must be stored in such a manner to ensure it remains confidential.

Payment is to be at the employee’s full pay rate for the hours they would have worked but for the fact they were on leave. A payslip should not record that the leave taken was family and domestic violence leave.

RIGHT TO REQUEST FLEXIBLE WORKING ARRANGEMENTS

Changes have been made to the Act to strengthen the right to request flexible working arrangements to assist eligible employees to negotiate flexible arrangements that suit both the employee and employer. Changes come into effect on 6 June 2023.

The amendments to the Act:

• expands the circumstances in which an employee may request flexible work arrangements to include employees who are pregnant as well as situations where an employee, or a member of their immediate family or household, experiences family and domestic violence,

• provides a fair and transparent process for responding to flexible working arrangement requests, and

• allows the FWC to deal with a dispute about a request, including attempting to resolve the dispute by conciliation, mediation or if necessary mandatory arbitration, in circumstances where employers and employees cannot agree on a solution at the workplace level.

What does this mean for employers?

Employers have an obligation to discuss an employee’s request for a flexible working arrangement when

RELATIONS WORKPLACE

the eligible employee makes the request.

In circumstances where the employer refuses the request, the employer needs to provide written reasons for the refusal.

The employer also needs to consider and inform the employee in writing, if there are other changes they are willing to make to accommodate an employee’s circumstances.

The threshold of “reasonable business grounds” on which an employer can refuse have not changed.

Employees will have increased access to dispute resolution through the FWC if they cannot resolve disputes about flexible working arrangements at the workplace level. 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.

Not a member?

To join call one of our Membership Team on +61 2 9439 8822 or go to www.amansw.com. au/join-the-ama/

Contributed by AMA (NSW)’s Senior Workplace Relations Advisor, Felicity Buckley and Workplace Relations Advisor, Lisa Bennell

PAYROLL TAX: AN UPDATE FOR PRACTICES

The NSW Court of Appeal dismissed the application by Thomas and Naaz to appeal the tribunal decision. What are the implications for medical practices?

RECENT PAYROLL TAX developments have made it clear that a practitioner who has a contract with a medical practice may be deemed to have a ‘relevant contract’ with the medical practice, and money remitted from the practice to the practitioner may qualify as ‘wages’ for payroll tax purposes. A medical practice will be liable for payroll tax if its payroll exceeds a threshold of $1.2 million in a financial year. Revenue NSW may consider a contract to be a ‘relevant contract’ for the purposes of the Payroll Tax Act (2007), and their wages will be included in a practice’s overall payroll liability.

Legal background

Payroll tax is governed by the Payroll Tax Act (2007) (‘Act’). Under s32 of the Act, payroll tax may be payable if there is a ‘relevant contract’ in place for services in a financial year, and if those services/related wages are obtained and paid ‘for or in relation to the performance of work.’ This test is very broad, but there are key exemptions to payroll tax set out in section 32(2) of the Act. If an exemption applies to a practitioner, then the contract is not a ‘relevant contract’ for the purposes of the Act and payroll tax does not apply.

Key exemptions that may be relevant in a medical practice are:

(a) Where a practitioner has

worked in the practice for less than 90 days in a financial year;1 or

(b) The services are performed by a practitioner who ‘ordinarily performs services of that kind to the public generally in that financial year’.2 For example, a medical practitioner that provides services to the general public by consulting patients at different locations or working in a hospital may apply for this exception.

Case law

Historically, if a medical practice had medical practitioners providing services to their own patients from the practice’s premises and paying the practice a service fee for services provided by the practice to the practitioners, no payroll tax was payable on amounts remitted by the practice to the practitioners. This was turned on its head in Commissioner of State Revenue v Optical Superstore Pty Ltd [2019] VSCA 197 and Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2021] NSWCATAD 259.

Focusing on Thomas and Naaz, the subject of the latest Court of Appeal decision, the facts are as follows:

• Thomas and Naaz (the applicants) were directors operating multiple medical centres.

• Practitioners entered into written agreements to use rooms, access shared services, and see patients.

• Patients did not pay the practitioners directly, but assigned their medical benefits to the practitioners, and the applicant submitted the benefits to Medicare. The applicant then retained 30% as a service fee, and the remaining 70% was remitted to the practitioners.

• Revenue NSW considered these practitioners were employees and issued notices of assessment for 5 years including the 70% remitted to the practitioners, amounting to over $795,000. Further penalties of 30% and interest were applied.

The medical practice objected on two grounds, namely that the contracts were not relevant contracts under the Act, and that exemptions applied to practitioners, mainly that they were free to provide services elsewhere. In support of this, the medical practice provided evidence that the practitioners had been working elsewhere as well as at the practice.

The Commissioner rejected the medical practice’s objections, and Thomas and Naaz subsequently applied to the NSW Civil and Administrative Tribunal (NCAT) to review the objection decision. NCAT upheld the NSW Revenue assessments, including the

RELATIONS WORKPLACE

application of penalties and interest. The contracts were relevant contracts under the meaning of s32 of the Act, and no exemptions applied, noting that the evidence provided was not sufficient to negate findings that the practitioner’s earnings were relevant for payroll tax.

Appeal

Thomas and Naaz again appealed the decision, contending that NCAT incorrectly applied section 32 and 35 of the Act. However, the NCAT Appeal Panel reaffirmed the decision (Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2022] NSWCATAP 220).

The decision of the NCAT Appeal Panel was then appealed to the Court of Appeal. The Court of Appeal handed down their decision in the matter on 14 March 2023, Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2023] NSWCA 40: the Court of Appeal upheld NCAT’s decision. Importantly, the Court held it was correct that the practitioners were providing services to the practice as well as the patients, noting that the medical services provided were an integral part of the practice running its business, and that the contracts were clearly ‘for or in relation to the performance of work’, noting that there was a clear relationship where the practitioners had a contract and were paid to treat patients.

The Court observed that the practitioners who processed their own claims for Medicare benefits and did not receive the 70% paid to them by the applicant, but instead received the funds directly into their own accounts and paid 30% to the applicant as a service fee, were not included in the calculation for

assessable wages. The Court noted that the Act extended the scope of concept of employer, employee, and wages. One element in which the deemed provisions operate is the making of a payment by the deemed employer to the deemed employee, and the approach taken by these practitioners to process their own claims meant that there was no payment from employer to employee and the deeming provisions were not engaged.

What does this mean?

The NSW Court of Appeal decision is applicable and enforceable law. If a medical practice cannot establish that the contracts of the practitioners working at their practice are not ‘relevant contracts’, the money paid or remitted to them may be considered deemed wages for payroll tax purposes and will contribute to the practice’s overall liability. In the 2022/2023 financial year if a practice exceeds the threshold of $1.2 million in payroll for a financial year, they will be liable to pay 5.45% in payroll tax for all monies exceeding that threshold.

It remains important to be aware of the provisions in service agreements and whether those provisions indicate a practitioner may be an employee for the purposes of the Act. If attempting

to rely on legislated exemptions to payroll tax, particularly the 90-day exemption or providing services to the public exemptions, clear records should be kept that indicate the number of days a practitioner has worked in a financial year, and written evidence should be kept showing they also work elsewhere.

All agreements with contracting practitioners (and other allied health) should be reviewed and advice sought from accountants and / or lawyers. While it is unclear at this stage what the Government may do in response to the decision, the Court of Appeal decision indicates that measures including banking fees into separate accounts will be relevant when assessing the nature of the agreements or arrangements in place in your medical practice, and whether amounts remitted will be included for the purposes of payroll tax calculations. dr.

1 Payroll Tax Act s 32(2)(b)(iii).

2 Payroll Tax Act, s 32(2)(b)(iv).

Contributed by Romy Sirtes, Associate, and Scott Chapman, Partner HWL Ebsworth Lawyers

It remains important to be aware of the provisions in service agreements and whether those provisions indicate a practitioner may be an employee for the purposes of the Act.”

CAPTIVATING CHATGPT

TIME IS A LUXURY that eludes most physicians, as we juggle patient care, documentation, and the elusive work-life balance. Enter the world of Natural Language Processing (NLP) tools, where ChatGPT looks to be a promising aide in the medical field.

DEMYSTIFYING CHATGPT

ChatGPT, a brilliant innovation in AI, is engineered to interpret and generate human-like text. Birthed from the GPT (Generative Pre-trained Transformer) family,

it is specifically designed for conversational responses. The two-phase creation process—pretraining and fine-tuning—shapes this digital virtuoso. It learns language structure, grammar, facts, and even reasoning through massive text datasets during pretraining, while human-generated conversations refine its aptitude for crafting relevant, coherent responses during fine-tuning.

ChatGPT employs ‘sampling’ and ‘beam search’ techniques to produce diverse and deterministic responses, respectively. In a human-moderated training phase, it is carefully groomed to avoid malicious intents, ensuring responsible behaviour.

UNLOCKING THE POTENTIAL:

PRACTICAL APPLICATIONS

Transforming notes to letters

Imagine converting point-form

A doctor’s guide to harnessing the power of AI in medicine, written by Dr Ron Granot (with a little help from ChatGPT).

notes into articulate, wellstructured letters. ChatGPT’s prowess in crafting coherent narratives of patient encounters alleviates documentation burdens, empowering physicians to prioritize patient care.

Crafting email and document templates

Streamline your communication process with ChatGPT-generated email and document templates for various tasks, such as sharing test results or scheduling followups. These customizable templates minimize errors and fit seamlessly into your medical practice.

Summarizing medical research and answering queries

Struggling to keep up with medical research? ChatGPT offers a swift solution by summarizing articles and addressing queries, enabling informed clinical decisions and improved patient outcomes. While ChatGPT has limitations, models like those found at MediChat.au excel in this area.

Customizable GPT Model for Patient Queries

Enhance patient experience and alleviate administrative burdens with a trainable GPT model tailored to provide factual information about your medical practice.

Medical Education

From elucidating complex medical concepts to generating casebased scenarios, ChatGPT serves as an invaluable study aid and clinical reasoning tool for medical students and trainees. It has passed the USMLEs and MKSAPs (scoring 75%), so it has content in it that is appropriate.

THE FLIP SIDE: LIMITATIONS AND CAUTIONS Hallucinations

Despite its many virtues, ChatGPT may occasionally produce plausible sounding but inaccurate or nonsensical information. These hallucinations are a byproduct of its training process, which emphasises coherence and engagement over strict factual accuracy. These include false journal references, which appear plausible but are non-existent.

Fact-Checking and Untrained Models

To mitigate the risks of hallucinations, verify ChatGPTgenerated information with reliable sources and use trained, customized models in medical practice. As with any tool, vigilance and corroboration with established medical knowledge are crucial.

Updating and Data Privacy

Keep in mind that ChatGPT’s knowledge extends only until September 2021, necessitating regular updates and customization. Additionally, ensuring compliance with legal and ethical standards for data privacy and security is paramount.

EMBRACING THE FUTURE: CHATGPT AS A MEDICAL ALLY

While not a replacement for human expertise, ChatGPT and other NLP models offer a plethora of benefits for medical professionals. Embrace these tools but remember to wield them wisely. Join the conversation and share your ChatGPT experiences, good and bad, at PromptsDoctor.com. Let’s harness the power of AI together and revolutionize medical practice. dr.

References https://www. sciencefocus.com/ future-technology/ gpt-3/ https:// towardsdatascience. com/how-chatgptworks-the-modelsbehind-the-bot1ce5fca96286

ChatGPT, an AI Expert, and a Lawyer Walk Into a Bar...: The Evolution of Creativity and Communication; Rogers B, Hart T; HartRogers Media; 2023.

Citation: Kung

TH, Cheatham M, Medenilla A, Sillos C, De Leon L, Elepaño C, et al. (2023)

Performance of ChatGPT on USMLE: Potential for AIassisted medical education using large language models. PLOS Digit Health 2(2): e0000198. doi:10.1371/ journal.pdig.0000198

https://openai.com/ research/gpt-4

ABOUT THE AUTHOR:

Dr Ron Granot is a neurologist with East Neurology, an AMA (NSW) Councillor, and a designer of MediChat.au.

CELEBRATING

our 50 Year Members

AMA (NSW) is pleased to honour members who dedicated their lives to medicine and remained committed and supportive of the Australian Medical Association throughout their careers.

AMA (NSW) honoured our 50 Year Members at a special luncheon in early April. Whilst the event is typically an annual occasion, it has been on hold for several years due to COVID. Consequently, this long overdue celebration was particularly significant. In addition to honouring members who reached 50-year membership with the AMA (NSW) in 2022, AMA (NSW) honoured members who also reached the milestone in 2019, 2020 and 2021. AMA (NSW) President, Dr Michael Bonning welcomed the special guests and congratulated them for their commitment to the profession.

Our 50-year members made lasting contributions to medicine through practice, teaching, and mentoring. Many of these members have also been active in medico-politics and served on various boards and committees for Colleges, Societies and Associations.

Through all these roles, they have improved the lives of patients, colleagues, and the generations of doctors who followed in their footsteps.

Whilst many of our 50-year

members are now retired, they remain an integral part of the fabric of Australia’s health system.

In the five decades that they have been part of the Australian Medical Association, there have been exciting innovations in medicine as well as many challenges.

It is only with their continued support that AMA (NSW) has been able to evolve and respond to the issues that have risen over the years.

We value the continued support of our long-standing members and thank them for their commitment.

dr.

VALE: Prof Stephen Lee AM

within the medical profession, serving the field of dermatology for over 45 years in Sydney, China and Hong Kong.

Prof Lee was a Clinical Professor in Dermatology within the Central and Concord Clinical Schools of the University of Sydney, teaching for over 30 years. He was Head of the Department of Dermatology at Concord Repatriation General Hospital since 1997, and a Visiting Dermatologist at Royal Prince Alfred Hospital since 1981.

craft group representative for his speciality at the AMA. Since 2002, Prof Lee was a Federal Councillor and Director of the AMA and had been the Dermatology Representative on the AMA Federal Council. During his time at the AMA, he served on several committees, including Ethics and Medico-Legal, Constitution and Policy Review and Public Health.

THE AUSTRALIAN MEDICAL ASSOCIATION (NSW) is mourning the loss of Professor Stephen Lee AM. Prof Lee will be remembered as an educator and mentor to many

In 2006, Prof Lee was appointed a Clinical Associate Professor at the University of Sydney, additionally, he played a prominent role in the Australasian College of Dermatologists. He was a founding

Professor Lee will be deeply missed by his family and friends, along with colleagues, the community and the AMA. The field of Dermatology through literature, research and consultation will forever be grateful for the efforts of Professor Stephen Lee. dr.

LETTER TO THE EDITOR: Patients urge protection for use of title ‘Surgeon’

We had a very close call in 2018 after our young daughter was referred to a podiatric surgeon by a podiatrist, after suffering ongoing foot pain. We initially thought the podiatrist said "paediatric surgeon", so attended the appointment. After multiple X-rays it was discovered, our daughter had a tarsal coalition in her left foot. The podiatric surgeon assured us he would be able to perform the surgery, despite also saying he had never done it before, and usually performed surgeries on in-grown toe nails.

My husband asked about follow-up pain medication, and the Podiatric surgeon said Panadol would suffice. We later realised he was not a registered doctor, so couldn't prescribe any pain medication.

This appointment raised concerns for my husband, who did further research into the training of Podiatric Surgeons and then we realised he

was only a podiatrist with some further training. I was almost sucked in by the professional image and confidence of this untrained professional who could have seriously damaged our daughter's foot. I am so relieved my husband followed up on his concerns and intervened.

We located a Paediatric Orthopaedic Surgeon, who specialised in feet and he performed the surgery. He told us it's a delicate operation because there are many nerves that needed to be protected. He prescribed oxycodone for pain relief, so clearly Panadol wouldn't have sufficed. He told us we had dodged a bullet and cowboy, and explained the very limited training podiatric surgeons receive.

The term Podiatric Surgeon should be banned, and the title "Surgeon" protected and its use restricted.

– Author’s name withheld at their request

Practice Managers’ Masterclass on tour

AMA (NSW)’s Workplace Relations Team has been presenting its highly successful Practice Managers’ Masterclass to members and their practice managers around the State.

The presentation includes information and resources on topics that are integral to running a thriving and efficient medical practice, such as tips and tricks for recruiting staff, managing performance, terminations and unfair dismissal claims, difficult conversations with staff and patients, billing, and medico-legal risk management.

The team has presented in the Northern Rivers, Nowra, Sydney, and Coffs Harbour. Next stops on the tour include Norwest on 26 May and Newcastle on 28 July. If you’re interested in attending one of these sessions, please visit our events page on our website: amansw. com.au to register.

IMPROVING ENGAGEMENT WITH OUR MEMBERS

As a key strategic priority to improve our member engagement, AMA (NSW) is exploring the concept of launching both AMA (NSW) Special Interest Groups (SIGs) and AMA (NSW) Networks.

Every member of AMA (NSW) has a role to play in shaping the direction of healthcare and ensuring we advocate for improvements in the delivery of healthcare, the wellbeing of staff and outcomes for patients. Members of the AMA (NSW) are recognised nationally and globally as leaders, and emerging leaders, in all fields of health and our collective voice holds great influence.

SIGs will serve as links between

members, our council, our board, and the leadership team to ensure we are representing the collective voice on areas of interest that align with our priorities. SIGs are multidisciplinary at their core, representing the diverse clinical and professional range of expertise within the AMA (NSW) membership. Special Interest Groups (SIG) will provide an opportunity for our members to connect with other health professionals in their area of interest and build on clinical skills and knowledge to improve professional performance and to help shape our priorities.

AMA Networks will allow us to embrace what make each of

us unique and get to know our membership on a more personal level to provide content, events, and a like-minded network to connect with. AMA (NSW) networks could include AMA Rural and Regional, AMA Pride, AMA First Nations Australians, AMA Mothers in Medicine – the list is endless but will provide the opportunity for people with lived experience or shared interests to come together as a community to influence change for a more inclusive workplace.

Please contact us on gary.white@ amansw.com.au and share your ideas on topics of interest for SIGs or if there is a specific Network you would like to see. dr.

Dr Michael Bonning President, AMA (NSW)

MEDICAL CONFERENCE

MUST-KNOWS

Is your calendar full of conference dates this month? Here are a few tips to help you get the most out of your next medical conference experience.

MANY OF US attend medical conferences with the best of intentions, but sometimes fail to make the most of these opportunities. Worse yet, we forget about the people we met and the information we learned as soon as the conference pass expires. Medical conferences can be an exciting and productive part of your professional growth if approached right. Here are some tips on how to reap the benefits of attending medical conferences.

PRE-CONFERENCE

Choose Wisely:

Before you commit your time and finances, select a conference that accommodates your needs. Consider what you want to get out of a particular event. Whether it’s for educational or networking purposes, having a clear goal of what you want to obtain from the conference before booking ensures your needs will be addressed. Analyse conference programs that correlate to your needs, gain insight into panellists and available sessions, and review previous feedback.

Be Prepared:

To get the most out of your chosen medical conference, ensure you are prepared by familiarising yourself with the topics and reviewing the schedule beforehand. Your research should prompt a few questions that

you can ask during the sessions. Conferences have fixed session times and schedules, so schedule your time carefully to ensure you can attend the sessions that meet your needs. Also be sure to pack any essentials you may need for notetaking and networking.

During the Conference:

Despite this being an exciting experience, don’t overextend yourself by trying to attend too many sessions as this can be counterproductive. Adhering to the above preparation techniques beforehand will allow you to attend sessions that matter to you most. Ensure that you make the most of the opportunity and participate, along with taking thoughtful notes to reflect on later.

Medical conferences are a great networking platform, you will have the opportunity to connect with others in your chosen field or potentially the wider profession. You can get ahead on this by looking up the conference’s social media details, and exploring who else is engaging. Use the conference hashtag! Becoming an active participant and networking during conferences allows you to meet significant figures from the medical community, gain professional visibility, and have meaningful interactions.

Post-Conference:

Returning home from a conference, you may be eager to go straight into work. But before you jump back into the routine, give yourself some time to review the notes you made and reflect on what you’ve learnt. Things to consider:

• What sessions were most informative and what were the key takeaways?

• What lessons can put into practice within your medical career?

• What insights would your colleagues find helpful?

Write the answers to these questions alongside the notes you took from the conference so that you can access it easily if you need to refer to information from this event.

Follow up:

Don’t forget about all the new connections you’ve made. It is important to follow up with the new community of medical professionals that you met at the conference. Connecting with your contacts on LinkedIn is a great way to keep the conversation flowing. These professional relationships could be useful in the future, whether they be a source of good information in your specialty or have insight on other upcoming conferences that may be of interest to you. dr.

AMA (NSW) EXCLUSIVE MEMBER BENEFITS

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.

Blue Light Card

Blue Light Card Australia is a discount service exclusively for frontline workers and emergency volunteers, to give you a FREE 2-year membership if you sign up through their website or app. Blue Light Card helps members save money on everything from fuel and food to holidays, technology and fashion across Australia.

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.

Emirates

Emirates offers AMA members great discounts on airfares around the world: Economy Class: Saver $50, Flex $70,Flex Plus $90 off. Business Class: Saver $90 Flex and Flex Plus $200 off. The partnership agreement between Emirates and Qantas allows codeshare.

MEMBER BENEFITS

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.

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.

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.

The AMA also provides individual benefits, such as workplace relations, professional and networking events, and more. To join AMA (NSW) call one of our membership team on +61 2 9439 8822 or members@amansw.com.au

To join online at www.amansw.com.au/join-the-ama/

CLASSIFIEDS

PRIVATE MEDICAL PRACTICE FOR SALE

- CENTRAL COAST NSW

The practice operates in an ultra-modern facility and generates an exceptional income from in-patients, outpatients, rounds and home visits.

• Brilliant Hospital Support’

• Fantastic Income. Multiple Referral streams

• Full admin and nursing support are already in place

• Opportunity to continue to use current ‘brand’ name Would suit 1 or 2 Geriatricians or General Physicians/ Specialists with an interest in the elderly and produce an excellent income for one or both.

Asking Price: $745,000

Please contact Nick Wolski

M: 0402 460 078 | E: nick@xcllusive.com.au

OPPORTUNITY FOR OBSTETRICIANS CAIRNS PRIVATE HOSPITAL, FAR NORTH QLD

Seeking interest from Specialist Obstetricians looking relocate and establish private practice in Cairns. We are able to provide the following support package:

• Financial underwriting for first 12 months

• Assistance with consulting suites & start up support

• Marketing to establishing referral network

Minimum Requirements:

FRANZCOG, specialist AHPRA registration, eligible for unrestricted Medicare provider number.

Please contact Ben Tooth, CEO

E: toothb@ramsayhealth.com.au | T: 07 4052 5213

DOCTORS-IN-TRAINING

#MOVE2IMPROVE

Five hospitals will compete for the ultimate common room makeover. Find out who is leading the pack by following AMA (NSW) on social media.

AMA (NSW) HAS partnered with Blue Light Card Australia and other key partners to bring doctors-intraining (DITs) the opportunity to win a makeover for their hospital’s common room.

Five NSW hospitals will be chosen from the nominations to compete in a holistic fitness and wellbeing challenge. An exercise bike will be placed in each of the five hospitals during the first week of June, in the run up to Thank a First Responder Day on 8 June. Staff are invited to access the bike and its range of fitness classes, such as cycling, yoga and meditation, during their breaks or log their own physical or mental health activity to push their hospital to the front of the pack. The hospital to move the most within the week will be the winner and will get to keep the exercise bike, as well as a range of sponsored prizes to makeover their common room including brand new kitchen appliances, furnishings, and fresh pantry staples.

At the time of writing, the five hospitals have not yet been selected by our panel. But winners will be announced by mid-May. Check out AMA (NSW) social media accounts to find out what five hospitals will be competing in #Move2Improve – it could be yours!

Although, the five hospitals will be competing against each other for the ultimate common room makeover, there is also the opportunity to be the most moved

overall. This person will receive a special prize.

Everyone at the participating hospitals who joins in the challenge to help contribute to their hospital’s movement total will also go into the draw to win one of the many raffle prizes ranging from holidays and experiences, to shopping vouchers.

AMA (NSW)’s new partnership with Blue Light Card Australia has opened up a range of new opportunities for our members, and thanks to them, the list of #Move2Improve prizes will be continuing to grow right up until the week of the race.

The #Move2Improve campaign aims to boost hospital morale and spread a positive message about doctors’ health and wellbeing. We understand that workforce shortages, COVID-19, and increased pressure from growing patient loads – has led to higher rates of burn out amongst doctors-intraining.

We want to bring colleagues together to bond, blow off some steam, exercise, and most importantly – have some fun!

We’ve listened to doctors-intraining through our annual Hospital Health Check (HHC) survey, and this year we’ll be taking more action.

A common theme that emerged from the ‘facilities’ section of the HHC was a lack of healthy food options. AMA (NSW) will be assisting hospitals with the provision of healthier food options in their

hospitals, particularly for afterhours.

#Move2Improve is a way for AMA (NSW) show our support for doctors to say thank you for all you do. Much like the hospitals competing, AMA (NSW) is willing to go the distance to support doctors.

This campaign kickstarts our advocacy to improve hospital facilities. Despite there being only five NSW hospitals in this competition, AMA (NSW) wants to provide more hospitals with similar opportunities.

Keep your eyes peeled for official partners and prizes to be announced and stay tuned for the beginning of June to find out what hospital will be crowned the #Move2Improve Champion. You can stay updated by following the AMA (NSW) social media channels. dr.

www.facebook.com/amansw @AMA_NSW /company/ama-nsw

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