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Story-telling is as old as time itself.
For our First Nations people, story-telling has held a central role for tens of thousands of years. Long before written language existed, they used imagery as a living record to communicate with others and pass down vital information on culture and survival.
We may now have significantly more advanced methods of communication, but story-telling remains fundamental in how we all make sense of the world –from our first few years to our last.
It helps us translate complexity into meaning. Facts and figures may inform, but stories engage. A welltold story can provide humanity in an often huge and unwieldy health system – especially when we see ourselves in another’s story. We see our parents. We see our children.
Most importantly, stories help policymakers, many who have never walked the ward floors or worked in
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medical clinics, understand not just what is happening, but why it matters – to doctors and their patients.
As we move closer to the NSW election, we must embrace story-telling in lockstep with the considerable policy and advocacy work we have undertaken to build a better health system and a sustainable workforce.
We must find ways to shed light on the importance of increased hospital funding and investment in the workforce, to encourage decision-makers to support medical-led decision-making in hospitals and see the value in preventive health measures aimed at keeping people out of hospital.
We must find ways to share the unique pressures carried by doctors with lives in their hands each and every day. We must find ways to convey the moral injuries clinicians face when funding deficits impact patient care.
And we must find ways to give voice to those with none.
With 17 months to go, let’s use the art of the story to help save lives.
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.
AMA (NSW) BOARD
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Healthcare is deeply intertwined with economic productivity, social stability and quality of life. A healthy population is a foundation for a thriving state.
Yet, due to systemic funding deficits, our health services are struggling to meet an evergrowing tsunami of patients seeking care.
We are now only 17 months out from the next NSW election and voters deserve to see clear, actionable plans from all parties addressing these issues in our health system.
Our cover story in this edition focuses on western Sydney’s growing pains, but we know this pressure is being felt across the state.
A recent report from the NSW Parliament’s Select Committee on Remote, Rural and Regional Health revealed alarming gaps in access to essential services such as maternity care, mental health support, cancer treatment and palliative care.
The closure of birthing units and escalating workforce shortages are particularly concerning, as they directly impact the safety and wellbeing of families in these regions.
A recent report by the National Rural Health Alliance found an $8.35 billion funding shortfall in rural healthcare compared to urban areas, with rural Australians
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experiencing significantly worse health outcomes, including higher rates of chronic disease and premature death.
Despite some recent budget commitments - such as hospital upgrades and new helicopter bases - the scale of the problem demands more than piecemeal solutions.
Structural reforms are needed, including better incentives for healthcare professionals to work in rural areas, increased training opportunities in regional settings, and a Medicare system that reflects the unique challenges of rural practice.
As our members are aware, AMA (NSW) played a central role in the recent Special Commission of Inquiry into Healthcare Funding –the first substantial examination of the NSW health system since the Garling Report in 2008.
Its outcomes, which included all recommendations made by AMA (NSW), have provided a clear roadmap for reform, highlighting areas where investment and innovation are needed. We must now hold the NSW Government accountable to implement those recommendations and appropriately invest in our hospitals and workforce.
As part of our advocacy planning, AMA (NSW) councillors came together recently to shape our agenda for the year ahead. The day was marked by robust discussions and strategic foresight. Four major themes emerged as top priorities: aged care reform, healthcare workforce shortages and conditions, the role of the GP and the importance of investment in preventative health measures.
The day concluded with a shared commitment: to pursue advocacy that is responsive, evidence-based, and patient-centred.
As the political landscape begins to shift in anticipation of the 2027 election, AMA (NSW) is determined to turn these discussions into action.
We will continue to advocate for these issues to be placed at the heart of the political agendawhere they belong.
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Iwas recently speaking with an IT expert about artificial intelligence.
He said that for the continuum of human history, knowledge and expertise have been held by a relatively small number of people. The ability to access that knowledge or expertise was accordingly valuable – and the transformational power of AI.
His view on AI is that it will make knowledge and expertise widely available, thus decreasing its value, while I hope that there will continue to be a value to knowledge and expertise, even when the AI overlords take over.
While we debate the future of knowledge and expertise, there is no question that we are seeing a public undermining and attacking of expertise.
We have recently seen the unfounded announcements of the link between paracetamol and autism. While these claims have been widely refuted, parents of children with autism reported being overwhelmed with questions about whether they had taken paracetamol during pregnancy.
This torrent of misinformation unleashed unnecessary judgement. For women who are currently pregnant, we can expect that no matter how significant the medical and expert advice is, many women will feel significant concern about taking paracetamol while pregnant.
While the AMA will do everything possible to counter this, the
undermining of the trust in the expert and in knowledge is likely to be a stronger force.
The medical profession needs to counter this torrent of misinformation by standing up for evidence; for facts; and for expertise, both in health and more broadly.
I have found doctors are generally good at accepting advice, although even doctors find themselves prone to falling for the easy answers.
It is remarkable how frequently a significant amount of hard work is claimed to be the result of some often dramatic, but ineffectual action.
In one of my favourite West Wing episode, we are introduced to the concept of “post hoc ergo propter hoc”. According to the internet,
post hoc ergo propter hoc is a logical fallacy that assumes that if one event occurs after another, the first event must have caused the second. This reasoning is flawed because mere sequence does not prove a causal relationship.
So, my call to doctors is that in a time in which expertise is under threat, be the champions of expertise.
Recognise that outcomes require work and skill and stand guard against post hoc ergo propter hoc. If doctors fail to value expertise, we really will have death of expertise.
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Sydney’s west is growing by the day, yet its health services are not keeping pace. Jacob Gormley seeks answers from those in power.
Western Sydney is home to more than 2.5 million people and is one of the fastest growing urban areas in Australia. It is the third largest economy in the nation behind the Sydney CBD and Melbourne.
Its residents come from more than 170 countries and speak more than 100 languages. Many live with socioeconomic disadvantage and have higher levels of unemployment than other areas of Sydney.
Western Sydney – like much of the state – is also experiencing a shortage of general practitioners which means greater pressure on hospital emergency departments –and more people being admitted to hospital for preventable conditions.
Providing healthcare to this burgeoning and diverse population and being able to meet their varying needs is no easy task. It requires investment and vision –both in infrastructure and workforce.
In this edition, we talk to NSW Minister for Health, Ryan Park and opposition spokeswoman on health Kellie Sloane to seek their views on reform.
Delivering more, more quickly, but is it enough?
Minister Park is quick to point to the government’s record investment in western Sydney
At Blacktown and Liverpool hospitals, patient satisfaction remains well below the state average.
health infrastructure, describing a near billion-dollar package which includes an $800 million top-up to meet surging demand.
He highlights improvements in emergency treatment times at Blacktown and Liverpool hospitals and the long-awaited Rouse Hill facility, which he says will “relieve pressure on Blacktown, Westmead and the broader Western Sydney Local Health District.”
Minister Park says the government is “delivering more staff, more investment, more hospitals, more beds in western Sydney, more quickly,” but concedes that “we won’t undo the 12 years of underinvestment in our health system by the Liberals and Nationals overnight.”
Yet, for many clinicians, these measures fall short of what is needed.
The latest Bureau of Health Information Healthcare Quarterly, released in September, shows only 66.1 per cent of non-urgent surgeries were performed on time statewide, a dramatic drop from 82.4 per cent a year earlier. The report also reveals that more than 69,000 people left an emergency department before treatment began or was completed between April and June, representing a staggering 13.3 per cent increase compared to the same quarter a year earlier.
These troubling figures did not go unnoticed. AMA (NSW) made sure the data and the concerns behind it were brought to public attention, challenging any attempt to downplay or obscure the true state of the system.
At Blacktown and Liverpool hospitals, patient satisfaction remains well below the state average a clear reflection of the mounting pressures faced by an overstretched workforce.
No more excuses: Kellie Sloane’s call for accountability
The opposition’s health spokeswoman Kellie Sloane has been unrelenting in her criticism of the government’s response, arguing that a lack of urgency and transparency is letting down the people of western Sydney.
Ms Sloane insists that “the people deserve answers,” and has repeatedly called for a parliamentary inquiry into health outcomes and hospital access in the region.
She believes that “patients in western Sydney know there is a problem because they are living it,” and that only a transparent inquiry
will “help find answers and come up with solutions for the systemic issues western Sydney hospitals are experiencing.”
Ms Sloane is particularly critical of the government’s workforce strategy, noting that consultant positions in public hospitals have not kept pace with demand. She argues that “medical-led healthcare achieves better patient outcomes” and calls for a comprehensive, long-term plan to ensure consultant numbers grow in line with population growth.
Ms Sloane also stresses the need for doctors to be embedded in every stage of planning and redevelopment, warning that “everyone deserves to feel safe when they go to work, but too often that is not the case for our frontline staff in hospitals.”
She has also highlighted the impact of under-resourcing on patient care and the flow on affects that has had to community care.
“No one should be forced to lie on the floor of an emergency department or sleep in their car waiting for treatment. That’s not a health system, that’s a disgrace,” Ms Sloane says, underscoring the human cost of systemic failures.
She further argues that the government’s approach to funding is reactive rather than strategic; that “hospitals are being asked to do more with less,”; and the state must move away from a crisisdriven approach to health funding.
“We need to move towards sustainable funding of our hospitals, and that also means the Commonwealth paying their fair share,” she says.
workforce crisis
For many clinicians, the workforce crisis is the most urgent issue.
AMA (NSW) vice president and general surgeon in western Sydney Dr Fred Betros says that while new facilities like Rouse Hill and Bankstown are welcome, they must be matched by a workforce strategy that keeps pace with population growth.
He argues that “it’s not enough to open new hospitals if we don’t have the staff to run them,” and that western Sydney must become an attractive place for doctors to work, with proper support, career pathways, and a real say in how services are delivered.
Ms Sloane echoes this, warning that consultant positions in public hospitals have not kept pace with demand, and that “medical-led
healthcare achieves better patient outcomes.”
She calls for a comprehensive, long-term workforce strategy, and for doctors to be fully integrated into every stage of planning and redevelopment.
“Doctor and staff concerns need to be heard and respected when they are raised. You are on the frontline every day, and you are the experts. Everyone deserves to feel safe when they go to work, but too often that is not the case for our frontline staff in hospitals,” she says.
But new hospitals and a bigger workforce are not the only answers. As noted in the government’s own recent Special Commission of Inquiry into Healthcare Funding, there must be significant investment in preventive health care – and it must be a whole of government priority.
The report recommends that all new NSW Government initiatives be assessed on how well they support the promotion and maintenance of the population’s health and wellbeing, and they should be informed by advice from a multiagency, multi-disciplinary body under the oversight of the Chief Health Officer.
“Our hospitals will never be able to cope with the tsunami of patients if we don’t urgently address the chronic disease burden and keep people healthier for longer,” Dr Betros said.
“That is why preventive health care is part of our five-point strategy at AMA (NSW) to ensure a sustainable health system.”
We need to make western Sydney an attractive place for doctors to work, with proper support, career pathways and with a real say in how services are delivered. Opposition health spokeswoman Kellie Sloan
AMA (NSW) has initiated arbitration on behalf of visiting medical officers in NSW.
It has been almost two decades since VMO working conditions in NSW were meaningfully reviewed or upgraded. Despite being vital to the delivery of specialist care and making up half the medical workforce in NSW, VMOs have been operating under outdated contracts that no longer accurately reflect the technological changes in their roles.
Arbitration provides a formal mechanism to address these issues, allowing AMA (NSW) to advocate for fairer remuneration.
AMA (NSW) is advocating for reforms to make public hospitals a viable and attractive workplace for VMOs in NSW, with proper support structures, clear career pathways, and a genuine say in how services are planned and delivered.
As western Sydney’s population continues to surge, the region’s hospitals stand at a crossroads. The choices made now about funding, workforce, and clinical leadership will shape the health of its communities for decades to come.
For many on the frontline, the message is clear, urgent, coordinated action is needed, not just more promises.
Dr Betros warns that the system is “at a tipping point,” and that the government’s focus on new buildings and infrastructure is meaningless without the staff to run them.
“We need to make western Sydney an attractive place for doctors to work, with proper support, career pathways, and a real say in how services are delivered.”
Dr Austin is equally clear: “Without more doctors in our hospitals and a greater focus on preventive health care, waiting lists will keep growing and patients will keep suffering.”
As western Sydney’s hospitals continue to absorb recordbreaking demand, the voices of clinicians, patients, and policymakers converge on a single truth: the system is under unsustainable pressure.
While the government tout’s infrastructure and investment, and the opposition calls for inquiry and reform, frontline doctors warn that without urgent action on the workforce, transparency, and clinical leadership, the region risks falling further behind.
As the end of the year approaches, your employees may want to “cash out” their accrued annual leave. Workplace Relations advisor Lisa Bennell provides advice.
Cashing out” accrued annual leave refers to an arrangement where an employee receives payment for a portion of their unused annual leave instead of taking time off work. This can be beneficial if an employee has excessive leave accrued and where an employer is seeking to manage leave balances.
Both awards covering employees working in private practice, the
Health Professionals and Support Services Award 2020 and the Nurses Award 2020 set out obligations on employers when it comes to cashing out annual leave.
Annual leave can only be cashed out if there is a separate written agreement for each occasion when leave is cashed out. The agreement is between the employer and employee. The agreement must state:
• The amount of leave to be cashed out and the payment to be made to the employee for the period; and
• The date on which the payment is to be made.
The agreement must be signed by both the employee and employer, and if the employee is under 18 years if age, by the employee’s parent or guardian.
The employer must keep a copy
Employees must retain a balance of four weeks’ annual leave after cashing out.
of the written agreement for their records. Both the Health Professionals and Support Services Award 2020 and the Nurses Award 2020 include an example of the type of agreement that an employer can use to record the cashing out of annual leave.
How much leave can an employee cash out?
An employee can cash out a maximum of two weeks accrued paid annual leave in a 12-month period.
Employees must retain a balance of at least four weeks of accrued annual leave after cashing out.
The cash out payment that the employee receives must not be less than the amount that would have been payable had the employee taken the leave at the time the payment is made, including annual leave loading. The payment is subject to tax and superannuation, in the same wat as ordinary time earnings.
Can I require my employees to cash out their accrued annual leave if they have an excessive accrual?
No. Cashing out annual leave is entirely voluntary from an
employee’s perspective, and it is unlawful for an employer to exert undue influence or pressure on an employee to make or not make an agreement to cash out annual leave.
If an employee has built up a significant amount of annual leave, (i.e. eight weeks for staff covered by Health Professionals and Support Services Award 2020 and 10 weeks for staff covered by the Nurses Award 2020. Both awards include provisions that allow employers to direct an employee to take some of their leave but not to cash it out.
Can I refuse an employee’s request?
Cashing out of leave is by agreement between the employee and employer, and there is no legislation that requires an employer to approve an employee’s request. However, refusing an employee’s request to cash out annual leave may result in employee disengagement.
Cashing out of annual leave can
be helpful if an employee has accrued a lot of annual leave and would prefer to receive money for some of the unused annual leave hours.
What do I do if an employee requests to cash out?
We recommend that you ask your employee to put the request in writing and then meet with them to discuss the request - for example, how much leave they can cash out, how much accrued leave they need to keep, and when payment will be made. Once arrangements have been agreed, make sure that you have a signed agreement with the employee and keep a copy in the employee’s records. Any future cashing out of annual leave by the same employee will require a new written agreement.
Are there any risks with cashing out annual leave?
Failing to comply with the provisions in the awards can result in legal penalties, back pay
or challenge from employees so following procedures and keeping appropriate documentation, including signed agreements is critical.
Relying on employees seeking to cash out leave rather than promoting and encouraging your employees to take time off can impact your employee’s wellbeing and workplace morale.
Do I need a workplace policy in relation to this?
There is no requirement for an employer to have a policy that addresses cashing out of annual leave. However, employers may wish to implement a leave
policy that clearly outlines leave entitlements and procedures for requesting leave.
On a final note, cashing out annual leave can provide flexibility for employees and help employers manage excessive leave balances.
However, encouraging your employees to take leave and enjoy a break from work can increase productivity, job satisfaction and overall engagement.
If you need assistance with cashing out annual leave or require a leave policy, contact the Workplace Relations team on (02) 9439 8822 or via email workplace@amansw.com.au.
Refusing an employee’s request to cash out annual leave may result in employee disengagement.
The end of the year is coming fast. Workplace Relations senior advisor Anastasia Livanova explains how to ensure you meet your obligations to staff.
Many medical practices are planning for a temporary shutdown over the end of year holiday period.
For some, it’s the only time when everyone can properly pause, reset and recharge. While closing the doors might seem straightforward, managing a shutdown involves careful planning, especially when it comes to employee entitlements and leave.
Under the Health Professionals and Support Services Award 2020 and the Nurses Award 2020, employers can direct staff to take annual leave during a shutdown. However, this must be done in accordance with specific award provisions.
In this article, we unpack what the awards say about temporary shutdowns, what counts as reasonable direction to take annual leave, how to manage staff who do not have enough annual leave accrued and how to manage annual leave requests throughout the year.
What are your award obligations?
If you plan to close part - or all of - your practice over the holiday
period, the awards allow you to direct staff to take annual leave. There are a few key obligations you need to comply with:
• You must give employees at least 28 days’ written notice of the shutdown. A shorter notice period can be used but only if the majority of employees agree to it.
• If someone joins your practice after the shutdown notice has gone out, make sure you let them know about the shutdown as soon as reasonably practicable.
• You can only direct employees to take paid annual leave during the shutdown if they have enough annual leave accrued.
• The direction to take annual leave must be in writing and must be reasonable.
How to determine whether the direction is reasonable?
Whether the direction to take annual leave is reasonable will depend on the circumstances but some factors to consider include:
• The needs and interests of both your practice and the employee.
• Any previous agreements you reached with the employee about the holiday shutdown.
• Whether it is common for medical practices to close over this period
• The length of the shutdown and how it impacts the employee.
What happens when an employee does not have enough annual leave accrued?
Not everyone will have enough annual leave saved up to cover the shutdown period. Maybe an employee is new to your team or maybe they have already taken extended leave earlier in the year. If an employee does not have enough accrued annual leave to cover the full shutdown period, you can discuss other alternative options with the employee, such as taking annual leave in advance, time off in lieu or taking leave without pay.
If the employee agrees to an arrangement where part of the full period of the shutdown is taken as either annual leave in advance, time off in lieu or leave without pay, ensure you document the agreement in writing.
Can employees be directed to take unpaid leave?
You can offer leave without pay as an option if an employee has insufficient annual leave to cover the shutdown period, but you cannot direct them to do so. Any agreement to take leave without pay must be voluntarily agreed to by the employee and documented in writing.
What if an employee does not agree to any alternative options?
Sometimes, despite your best efforts, an employee might not have enough annual leave accrued and they may also decline to take annual leave in advance, time off in lieu or unpaid leave. In this case, you will have options.
If only part of your practice is closing, consider whether the employee can perform alternative duties such as administrative tasks or stocktaking during the shutdown. As long as the work is reasonable and within the scope of their role, this can be a practical solution.
If no alternative duties are available and the entire practice is shutting down, you may need to pay the employee for the period. While this may not be ideal from a cost perspective, it ensures compliance with the awards and avoids the risk of breaching employment obligations.
Alternatively, you may choose to pay employees for the shutdown period as a gesture of goodwill. This can support team morale and may be viewed as an additional employment benefit when recruiting new staff.
One of the best ways to avoid last-minute leave issues during the holiday period is to proactively manage annual leave balances throughout the year. When reviewing leave requests, consider whether approving the request would leave the employee with insufficient leave to cover a planned shutdown.
Under the Fair Work Act 2009 (Cth), employers can refuse an annual leave request if the refusal is reasonable. If an employee would not have enough accrued annual leave to cover the shutdown period, this may be considered a reasonable basis to decline a request for annual leave throughout the year.
That said, whether a refusal is reasonable depends on the circumstances. If an employee is planning something significant, like a wedding or an overseas trip to visit an ill family member, it may not be reasonable to deny their leave request. In these cases, have an open conversation with the employee. Let them know that approving their leave now may mean they won’t have enough accrued annual leave for the shutdown period later in the year.
From there, you can discuss what options they would be comfortable with during the shutdown, such as taking annual leave in advance, time off in lieu or leave without pay. Whatever you agree on, make sure it’s clearly documented.
The key is to strike a balance and support your employees’ personal plans while also ensuring your practice can manage a shutdown smoothly.
Planning for a smooth shutdown
Temporary shutdowns can be a valuable opportunity for your team to rest and reset but they also require thoughtful planning and clear communication. By understanding your obligations under the relevant awards, managing leave balances proactively and engaging openly with your staff, you can avoid last-minute complications and ensure a
smooth transition into the holiday period.
Whether it’s issuing timely notices, discussing alternative leave options or simply being prepared to offer flexibility where needed, a well-managed shutdown can strengthen trust within your team and set the tone for a positive start to the new year.
If you need assistance with managing leave and temporary shutdown, contact the AMA (NSW) Workplace Relations team for tailored advice. You can contact our team on (02) 9439 8822 or via email workplace@amansw.com.au
The key is the strike a balance: support your employees while ensuring your practice can manage a shutdown.
Do you see patients by phone or video? Are you across the service rules? HWL Ebsworth lawyers Scott Chapman, Megan Priestley and Lily Galoustian explain.
What is the 30/20 telephone rule?
On 1 October 2022, Medicare introduced a new “prescribed pattern of service” for telephone attendances, known as the “30/20 telephone rule”.
It states that a medical practitioner who provides 30 or more telephone consultations on 20 or more days in a consecutive 12-month period will be deemed to have engaged in inappropriate practice unless there are exceptional circumstances. The 30/20 rule does not apply to consultations that occur via videoconferencing.
The rule aims to encourage practitioners to engage with their patients, primarily in person. Telehealth should be used only when it is clinically appropriate
to do so and when the patient understands the limits of same.
The 30/20 rule is consistent with guidelines released by the Medical Board of Australia.
What is the 80/20 rule?
The 80/20 rule requires that a practitioner does not claim 80 or more professional attendance items on 20 or more days.
A breach of the 80/20 rule is prima facie deemed to be inappropriate practice pursuant to the Health Insurance Act unless there is evidence of exceptional circumstances.
Following a breach of the 80/20 rule, the practitioner will be referred to the Professional Services Review and sanctions will be imposed.
What are the key considerations practitioners should keep in mind?
1. The 30/20 Telephone Rule applies to professional telephone attendances only (not in person or video consultations).
2. Medical practitioners should closely monitor their numbers of telephone attendances and check what is being claimed under their provider number.
3. Effective since 1 July 2022, the 80/20 rule includes GP telehealth and phone items, in addition to face-to-face consultations, excluding vaccine suitability assessments.
4. Medical practitioners with concerns or queries are encouraged to consult their medical indemnity insurer or contact the HWLE health team for assistance.
Welcome to the Spring edition of Financial Paracetamol for 2025.
As always if you have any questions relating to anything in this edition, please don’t hesitate to get in touch with our award-winning team.
Jarrod Bramble, Managing Partner
The government’s Bulk Billing Practice Incentive Program (BBPIP) is designed to improve affordability in primary care. Clinics that fully bulk bill all Medicare-eligible patients will gain access to financial rewards and support. We’ve broken down the essentials below:
• 12.5% rebate loading
• Quarterly incentive payments (split 50/50 GP/practice)
• Marketing support
• Admin managed by Services Australia
• Fully bulk bill all GP non-referred attendances
• Register with MyMedicare
• Publicly promote participation
• Will the rebate offset lost private billing income?
• Can your practice sustain quality under full bulk billing?
• Is your team operationally ready for the change?
• Rising costs and staffing pressures may still impact sustainability
1800 988 522
cutcher.com.au
While the incentives are attractive, many GPs are questioning whether they offset the real cost of delivering quality care. Rising expenses, staffing pressures, and the frozen Medicare rebate already make practice sustainability a challenge. To find out if this incentive could be right for you book a complimentary consultation with our medical accounting specialists on 1800 988 522 or visit cutcher.com.au.
Buying property is a milestone, but the choice between a first home and an investment property depends on your goals. The below should be considered:
First home >
• Build equity instead of paying rent
• Access grants or stamp duty concessions
• Enjoy stability and lifestyle certainty
• Less ideal if you’re relocating for training or can’t afford your preferred location
Key questions >
Investment property >
• Enter the market sooner in affordable areas
• Rental income can offset repayments
• Potential tax deductions
• Requires managing landlord risks and avoiding over-reliance on capital growth
> Are you settled for 5–10 years?
> Is lifestyle or wealth building your priority?
> How does this fit your long-term plan?
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Prescribing reforms are now in place, but what will that mean for doctors and patients, asks policy manager Marita O’Toole.
NSW has now implemented the first stage of reforms to make ADHD treatment more accessible by streamlining the prescribing process for psychostimulant medications. Until recently, ADHD diagnosis and prescribing has relied on a specialist-dependent model which has come under increasing pressure with a strong uptick in ADHD prevalence in Australia.
Current challenges
ADHD prescribing trends in Australia have grown exponentially over the last two decades according to the Australian Institute of Health and Welfare (see Figure). Prescription rates have risen from two patients per 1,000 people in 2004-5 to 22 patients per 1,000 in 2023-4. As awareness increases, and stigma declines, this trend is set to continue. (fig. 1)
ADHD diagnosis and treatment has placed a heavy burden on paediatricians and psychiatrists, with current guidelines stipulating six-monthly review of medication. This has exacerbated existing long patient wait times, particularly in the public system and in rural, regional and remote areas.
The ADHD Senate Inquiry Final Report and Recommendations, 2023, found waitlists can stretch for months to over a year, with some individuals waiting up to two years for assessment.
Under the new system, eligible general practitioners known as ‘continuation prescribers’, will be able to issue repeat prescriptions for psychostimulant medications such as dexamphetamine, lisdexamfetamine (Vyvanse), and methylphenidate (Ritalin, Concerta) for those with an existing ADHD diagnosis and treatment plan. General practitioners must complete one of three training courses endorsed by NSW Health and then apply to the NSW Ministry of Health for approval. Non-stimulant medications like guanfacine (Intuniv) and atomoxetine may also continue to be prescribed by general practitioners. The diagnosis of ADHD will remain the responsibility of paediatricians and psychiatrists in phase one.
The next phase of the reform will train and support a smaller
number of general practitioners in priority areas (not yet known) to conduct assessments and initiate treatment, with further details expected in late 2025. Co-management arrangements between general practitioners and non-general practitioner specialists will continue unchanged, allowing for collaborative care where needed.
AMA (NSW), along with federal AMA and the Royal Australian College of General Practitioners, has endorsed these reforms with important emphasis on ensuring implementation supports both patients and doctors and maintains a high standard of care. The Royal Australian and New Zealand College of Psychiatrists notes the complexity of ADHD diagnosis and has called for oversight by psychiatrists with ADHD expertise for continuation prescribers.
ADHD reforms have been led at a state level leading to inconsistencies across jurisdictions. While the reforms are a positive shift toward more accessible ADHD care, medical colleges are calling for national consistency as well as adequate funding and training to ensure safe and effective implementation. AMA (NSW) echoes concerns raised by general practitioners that without national consistency and adequate Medicare funding for longer consultations, many patients may still face barriers to care.
Whether these reforms will ease the bottleneck in accessing ADHD prescriptions and diagnoses remains to be determined. Whilst enabling general practitioners to issue repeat prescriptions may help free up specialist appointments, the most significant impact is expected once phase two is implemented, when general practitioners will be able to
diagnose and initiate treatment. Until then, Australians will continue to face long wait times and limited access to psychiatrists for assessment.
Further, the rising prevalence of ADHD is not only placing unsustainable pressure on psychiatrists but contributing to
a national shortage of ADHD medications. Medication such as methylphenidate is expected to be in shortage until December 2026. This challenge highlights the urgent need for coordinated reform beyond this legislation, to truly address ADHD management challenges in NSW.
The use of medical cannabis is on the rise in NSW, but road safety must come first, writes policy assistant Sophia Murphy.
In 2022-23, the Australian Institute of Health and Welfare reported that about 3 per cent of Australians had medical cannabis prescriptions for anxiety, chronic pain, sleep disorders and mental health conditions.
Further, the number of Australians accessing prescribed medical cannabis has increased over 50-fold since 2019, according to The Australian Health Practitioner Regulation Agency.
There are two main compounds used in medical cannabis - cannabidiol and tetrahydrocannabinol - both derived from the cannabis plant. Cannabidiol is non-intoxicating whilst tetrahydrocannabinol is the compound responsible for the “high” effect. Medicinal cannabis exists in a range of forms and its use of has reportedly provided relief for many.
Driving laws and push for reform
Currently, NSW law does not permit driving under the influence of cannabis.
Due to it having no impairment effects, cannabidiol is recommended to those who must drive for their lifestyle, job or other commitments.
On the other hand, mobile drug testing in NSW can detect tetrahydrocannabinol, whether recreational or prescribed, for multiple days after consumption. If detected, this results in an offence of “driving under the influence”, carrying substantial penalties.
Recently, there has been significant discourse and advocacy for a review of these laws. The 2024 NSW Drug Summit recommended NSW legislate a medical defence for people using medically prescribed cannabis who are driving. This is similarly being investigated in Victoria and equivalent laws have already been passed in Tasmania. However, questions remain - is this safe? And how can this be assessed and regulated?
The challenge of measuring impairment
A wide variety of research has gone into assessing whether cannabis impairs driving. Studies show cannabis influences reaction time, tracking, motor impulsivity and response inhibition. However, there are no consistent results about how long these effects last and what dosage leads to impairment.
The Victorian Government began a world first trial in November 2024 to evaluate the effects of prescribed tetrahydrocannabinol on the driving performance of motorists using medicinal cannabis for therapeutic use. This study is the first of its kind and will evaluate the
effects of tetrahydrocannabinolprescribed medical cannabis on driving in real world conditions. The results are yet to be finalised and made public.
Unlike alcohol, there are no clear correlations between dosage and time that can predict impairment from cannabis. There is no equivalent of a “standard” drink or blood alcohol levels that can indicate how one would be affected and for how long.
Cannabis impairment can also be highly influenced by the presence of other medications, alcohol, sleep or even time spent on the medication. This makes it difficult to objectively determine impairment by tetrahydrocannabinol.
In Tasmania, where this legislation has already passed, impairment is measured based on observable behaviour and police discretion. The United States has implemented field sobriety tests to assess impairments, whilst Canada and other European jurisdictions have legal limits in oral fluid screening tests but only after evidence of impaired driving is presented. However, these laws rely on an individual assessing their own impairment before driving which AMA (NSW) believes is challenging to do accurately. Therefore, these tests and regulations do not provide an effective deterrent to driving after cannabis consumption.
In the absence of robust evidence, tests for impairment and against the backdrop of a regulatory framework that is not keeping pace with the commercialisation
of cannabis, AMA (NSW) advocates first and foremost for road safety.
Overall, whilst AMA (NSW) acknowledges the value of medicinal cannabis in healthcare, it questions whether driving under its influence is the solution.
In rural and regional areas, the necessity of driving highlights a broader issue: the lack of accessible public transport. Rather than creating exemptions in road safety legislation, efforts should focus on improving infrastructure and service access.
Ultimately, allowing individuals to drive while having cannabis in their system risks sending a conflicting message to the public – one that
Studies show cannabis influences reaction time, tracking, motor impulsivity and response inhibition.
says driving under the influence of drugs is safe – medicinal or otherwise.
Overall, that is a message that AMA (NSW) cannot stand behind.
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The central western NSW towns of Mudgee and Gulgong may be rich with wineries and goldfields, but doctors were few and far between, writes Jacob Gormley.
When Kate Day moved back to central western NSW five years ago, she was shocked to discover there was only one general practitioner in their nearest town of Gulgong. That doctor then left leaving the town without a GP for 18 months.
“Purely and simply, my husband and I couldn’t get in to see a
doctor,” she recalls. “ And ours wasn’t an isolated story, that’s when I realised something had to change.”
Those collective challenges sparked what would become Doctors 4 Mudgee Region, a grassroots, community-driven initiative designed to bring doctors back to the area.
Supported by corporate partners Ulan, Wilpinjong, and Moolarben Coal Operations, and the MidWestern Regional Council, it highlights how local industry and communities have been forced to address rural health shortages due to government inaction.
Kate Day acts as program coordinator and is supported by
a coalition of health professionals, council representatives, business leaders, and volunteers. The initiative sets an ambitious target to attract 10 new general practitioners within three years. The program offers a suite of incentives for incoming doctors, including a $45,000 cash bonus, complete flexibility to choose their practice model, and what Day calls a “lifestyle concierge” service. From helping spouses find work to connecting families with schools, sporting clubs and even hairdressers, the initiative ensures doctors feel embedded in the community from day one.
“It’s not about asking doctors to sacrifice career for lifestyle,” Day explains. “Mudgee is only three hours from Sydney. It has worldclass wineries, vibrant food and arts, and a close-knit community. What we’re showing is that you can
have both professional fulfilment and personal wellbeing.”
The need could not have been more urgent. Before the program launched, the region had about 20 general practitioners for a population of 26,000, below the World Health Organisation’s recommended ratio of one doctor per 1,000 people.
Wait times for appointments stretched up to six weeks, with residents lining up outside clinics at 8am in hopes of a sameday slot.
For long-time residents, this has been more than an inconvenience; it has shaped how they access care. Many have reported travelling to Lithgow, Newcastle or Sydney to see a GP after Mudgee’s medical centres closed their books to new patients.
Faye Crook has lived in Mudgee and Gulgong for most of her 80 years and says continuity of care has been one of the region’s most significant challenges. “Most doctors seem to only stay a short while. You find a good one and then they’re gone.”
Faye explains that getting a GP appointment often means waiting weeks or joining a queue before the practice opens in the hope of a cancellation. “If you are sick, you can’t wait that long … but you can’t get through on the phone either, because everyone else is doing the same. If you’re not at the front of the line, you have no chance.”
For older patients or those with mobility issues, standing outside is not an option. “Often, people go to Mudgee Hospital emergency department or ring an ambulance instead of trying their luck with a GP, because they know they probably won’t get an appointment,” she says.
Day states the strain was visible in the statistics as well, saying that “in the first quarter of 2025, Mudgee Hospital’s emergency department saw a four per cent increase in presentations, even as statewide figures fell in NSW”.
In July, the first two doctors from the program began practising in the region, heralding the reopening of the Gulgong Medical Centre under a new care model led by GP Dr Mark Adamski and nurse practitioner/practice manager Skye Bradford.
For Dr Sam Graham, another of the doctors who embraced the opportunity, the opportunity has already proved rewarding.
“The people are incredibly friendly, resilient, and down to earth,” she says.
“They have a strong sense of community, are passionate about their health, and take pride in who they are. There is a genuine appreciation for the care they receive, which makes practising here especially rewarding.”
While the program is proving successful, state and federal governments should not be able to foist their responsibilities for delivering public healthcare onto the shoulders of patients, says AMA (NSW) president Dr Kathryn Austin.
“The Doctors 4 Mudgee initiative is a wonderful example of what
communities can achieve when they pull together, but let’s be clear - they shouldn’t have to. Attracting and retaining doctors is the responsibility of government, and relying on local businesses and volunteers to fill the gap is not sustainable.
“We urgently need a comprehensive, long-term strategy from government to ensure rural and regional communities have consistent access to healthcare.”
AMA (NSW) is currently in the Industrial Relation Commission modernising working conditions for visiting medical officers –who make up half the medical workforce in NSW – to make retaining and recruiting doctors easier. This will be the first
meaningful change to VMO working conditions in almost 20 years and is long overdue.
AMA (NSW) also made representations to the Special Commission of Inquiry into Healthcare Funding for recruitment and retention incentives for doctors working in rural and regional areas. “When we start losing doctors in regional and rural areas, we lose whole communities,” Dr Austin said. “Younger people won’t settle in these towns with their children if they cannot access healthcare and once the older generation is gone, the town dies. It is appalling to see governments foisting this onto communities.”
AMA (NSW) is committed to helping advance our members in private practice, whether they are established or just starting. In this edition, Jacob Gormley talks to Cameron Thornton, a practice manager at Frontier Dermatology.
Cameron’s journey to practice management was far from traditional. After a decade as a Health and Physical Education teacher, he stepped away from the classroom to support his wife Alicia’s, career in dermatology. What started as a return to home parenting soon evolved into a complete career change, one that now sees him leading a thriving dermatology practice with a strong focus on patient-centred care.
What inspired you to take on the role of practice manager?
I was ready for change and welcomed the chance to build and lead a practice. I enjoy problemsolving, organisation, and building culture, so when the opportunity came up, I took on the challenge. It was a significant change, but also a rewarding one.
What makes your practice environment unique?
We strive to deliver excellent care from the moment patients arrive. This involves creating a welcoming environment and ensuring our team have the time and space to meet our patient’s needs. We foster a team-based approach administration, nursing, and specialists all working together to deliver personalised
dermatological care. The character of the specialists and their dedication to patient care is one of our key strengths.
How do you make sure patients feel supported?
We aim to engage with patients according to their current needs and circumstances. The first impression is essential. We ensure
that our administrative and nursing team is fully equipped to focus on patient needs while effectively supporting our physicians in delivering highquality care. Little things matter to us, such as a warm, calm waiting area, background music, and personalisation in the way we communicate with our patient cohort. We value every team member, as their individual
contributions are essential to our collective synergy to delivering a supportive, patient-centered experience.
What part of the role do you enjoy most?
Like in many specialties, there is a significant workforce shortage in dermatology in rural and regional areas. I have greatly appreciated the opportunity to make a difference in this area. Contributing to the provision of dermatological care is satisfying and meaningful, as our clinical interventions result in measurable improvements for patients, and so enhance their overall quality of life.
How has AMA (NSW) supported your practice?
The workplace relations team has been excellent. It’s not just that they provide advice, it’s the speed and clarity that really make the difference. When you’re running a busy practice, issues don’t come up at convenient times. The assurance that inquiries or concerns will be addressed promptly and effectively instils
confidence, allowing you to proceed without hesitation.
It’s also the breadth of support – it might be a staffing inquiry, an award interpretation, payroll changes, or a patient matter, and regardless of who responds, the advice is consistent and reliable. Access to expertise in these areas significantly reduces the demands placed on a practice manager.
The webinars and professional updates have also been
The AMA (NSW) Workplace Relations team has been excellent. It’s not just the advice it’s the speed and clarity.
invaluable. Topics like payroll tax changes or award rate adjustments are easy to miss when you’re focused on day-today operations, but AMA (NSW) keeps us up to date and helps us prepare. It’s not just information; it’s guidance on what those changes mean for your practice in real terms.
AMA membership has been invaluable, and has contributed greatly to feeling supported in my role.
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Doctors’ Health NSW is helping medical professionals reconnect with their values and wellbeing. The message: being a doctor is what you do, not who you are, writes Dr Katherine Hutt
f I asked you what your core values are, could you name them? When was the last time you paused to ask yourself that? It matters more than we think.
As doctors, we’re taught to put patients first. To stay late, skip meals and toilet breaks, and keep going when we’re exhausted. Over time, that takes a toll. When work consumes all our energy, it takes away from relationships, creativity, rest. The job can start to feel like the whole story of who we are.
At Doctors’ Health NSW, we help medical students and doctors avoid losing themselves in their roles. Our workshops go beyond preventing illness we focus on what doctors need to thrive. Looking after ourselves isn’t indulgent it’s essential.
One framework we often use is self-determination theory, which highlights three core needs for wellbeing: autonomy, capability, and connection.
Autonomy means making choices that reflect who we are. Medicine can make this hard. Even small choices structuring your day, choosing meetings, supporting juniors can restore control. When those choices reflect your values, they give back energy.
Mayo Clinic physician-researcher
Tait Shanafelt’s work shows that spending at least 20 per cent of your time on work you find personally meaningful is strongly protective against burnout.
Capability is about feeling competent and effective. Many doctors struggle here, held back by unrealistic standards – sometimes from others, but very often from ourselves.
Think of learning to drive or picking up a new instrument. No one expects instant mastery. Progress comes with practice, and a few falls along the way.
We could use the same mindset in medicine: keep learning, accept limits, and keep perfectionism in check. Perfection is not possible in medicine – no matter how hard we try, we will make mistakes. Accepting this is part of professionalism.
Connection steadies us when the job is tough. Relationships with colleagues, friends, and family reduce isolation and remind us we’re not alone.
It takes courage to have honest and sometimes uncomfortable
conversations, but this is where genuine connection happens. We are more than doctors – we are friends, parents, partners, bushwalkers and musicians. Holding onto these other roles makes life richer and takes the weight off the “doctor” label.
Caring for patients will always be central to medicine. This does not mean we have to neglect ourselves in the process.
Each of us can help shift our tired presenteeism culture by being “connectors” in our workplaces –starting conversations, showing our human side, and supporting colleagues.
When our choices reflect our values, work feels more meaningful. When we remember that “doctor” is what we do, not all we are, we protect our wellbeing – and deliver better care to our patients.
Want to take this further?
Doctors’ Health NSW offers practical, evidence-based workshops for doctors and medical students. Our sessions explore peer connection and how to navigate when things go wrong. Call us on (02) 9030 7515 or visit doctorshealth.org.au/educationevents.
Country life can bring career satisfaction, even if you’re from the city, writes Theo Clark.
Global studies have the Australian health system ranked as a world leader.
In 2022, the World Bank had us at 25th of 195 nations studied, in terms of physicians per head of population. But access to healthcare in Australia is far from evenly distributed, with health outcomes between city and rural or remote areas varying markedly as a result.
Maintaining and growing health access in the bush takes long-term thinking and when contemplating the future, it is wise to recall the words of Benjamin Franklin: “by failing to prepare, you are preparing to fail”.
The inaugural Rural Health Pathways Showcase for high school students, held in September, was all about preparation for the future.
Hosted by Rural Doctors’ Network at the International Convention Centre in the heart of metropolitan Sydney, the showcase event drew together universities, health professionals and peak bodies to present to about 800 students, teachers and parents from about 50 – mostly metropolitan - schools.
Through informative talks, an expo hall, and practical workshops, the aim was to inspire a new generation of city students to think about the advantages of going rural.
“Look for opportunities,” urged state Member for Wagga Wagga, and country doctor, Joe McGirr, who delivered the opening address. “There are challenges in rural health, but there are great opportunities. If you want to make a difference, rural health’s the place for you.”
For Lily from Macquarie College, the day was an opportunity to consider new options. “I’ve learned a lot about nursing, a bit of psychology – some paramedicine,” she said. “I think you would have a bigger impact on someone’s life versus just being in the city.”
Careers Advisor Alex Boase from St Luke’s Grammar School in Dee Why was delighted to bring her students. “I have so many students coming through wanting to
Students enjoyed hands-on workshops.
be involved in health, and sometimes when you only look within your little area, the opportunities for that study aren’t quite there,” Ms Boase said.
“I think this really is giving them that understanding that just because you might not get into that pathway within Sydney … you can still follow the dream of wanting to get into a health profession.”
The event is one of a series of initiatives www. ruraldoctors.org/site/students run by Rural Doctors’ Network and its social enterprises, each designed to encourage and support young people into rural practice.
Embracing the philosophy that the best way to predict the future is to create it, the Rural Doctors’ Network Rural Health Pathways Showcase will be back again next year.
Doctors are being urged to prioritise their own wellbeing, as burnout rates climb and new strategies emerge to help protect clinical performance and personal health, Dr Jo Braid writes.
As a burnout recovery expert and rehabilitation medicine physician with 20 years of experience, I’ve seen firsthand how doctors often prioritise everyone else’s well-being before their own. Yet, just like a highperformance vehicle needs regular maintenance, medical professionals need to protect their most valuable asset – themselves.
The reality check
Recent Australian surveys reveal alarming statistics: about 60 per cent of clinicians experience burnout, with higher rates among emergency physicians, psychiatrists, women, and younger doctors. When doctors aren’t functioning at their best, patient care suffers – burnout doubles the risk of medical errors and leads to poor decision-making.
Why protecting yourself matters
Think of yourself as the golden goose in the medical system. Without your well-being patient care quality decreases; medical errors increase; career satisfaction plummets; personal relationships suffer and physical and mental health deteriorate.
Essential maintenance strategies
Just as a car needs regular servicing, here are four key areas to maintain your professional longevity:
1. Sleep hygiene
• Aim for at least seven hours most nights
• Set a bedtime alarm, not just a wake-up alarm
• Maintain regular sleep patterns, even on days off
2 Movement medicine
• Schedule regular physical activity
• Use exercise as natural stress relief
• Build movement into your daily routine, even if briefly
3. Mindset management
• Identify meaningful activities (aim for 20 per cent of your work)
• Practice gratitude to counter negativity bias
• Establish clear boundaries around work commitments
• Treat yourself as you would a good friend with self-compassion
4. Support systems
• IConnect with colleagues who understand
• IConsider professional support (mentor, coach, psychologist or counsellor)
• IBuild positive relationships outside medicine
The return on investment
When you prioritise your well-being, your clinical performance improves; decision-making becomes sharper; patient satisfaction increases; career longevity extends and your personal life flourishes.
Remember: You can’t pour from an empty cup. As a doctor in a stretched healthcare system, you’re particularly vulnerable to burnout due to high workloads and a lack of control. Taking care of yourself isn’t
Dr Jo Braid.
selfish – it’s essential professional maintenance.
Start small. Choose one area from the above and implement a single change this week. Monitor how it affects your energy, mood, and performance.
Your well-being isn’t just about you, it’s about every patient you’ll treat in your career. Make protecting yourself a priority and watch how it transforms both your professional and personal life.
Dr. Jo Braid is a seasoned rehabilitation physician with two decades of expertise in neurorehabilitation and an award-winning coach dedicated to transforming burnout recovery for healthcare professionals. In addition to her clinical and coaching work, she serves as a Councillor on the Medical Benevolent Association of NSWACT and holds a Non-Executive Director position on the Board of the Rehabilitation Medicine Society of Australia and New Zealand.
Nasal spray will be available for next year’s flu season.
Dr Ken McCroary: 7 News September 16th
Flu toll rises as vax rate plunges: 78 dead in NSW in first half of 2025
NSW has recorded 78 flu deaths in six months as doctors warn the state’s dramatically low vaccination rates are putting lives at risk.
Low vaccination is putting lives at risk.
Anti-vax parents using social media to teach others how to get around “no jab, no play” childcare laws.
John Hunter Hospital expansion capacity.
Dr Kathryn Austin: Newcastle Herald July 30th
‘If the expansion was ready now, we could fill it’: crisis at
‘Hiding these results does not make the problem go away’: Doctors lash NSW Health data
The
the
Surgeon’s alarm over patient aggression: ‘They threaten to go to the media if they don’t get what they want’ Frontline staff bear the brunt of the fallout from negative media, says Dr Fred Betros
Dr Fred Betros AusDoc. August 6th
Media reporting is creating an increasingly hostile environment for doctors and nurses
Surgeries plummet at John Hunter over the decade, despite population rising
Hospitals are being “driven by a lack of staff, outdated funding models and poor planning”.
GPs in New South Wales can write continuation scripts for patients with ADHD
Donald Trump makes claims about paracetamol use.
Unassisted births can have tragic consequences
Babies dying or suffering defects as popularity of freebirthing soars
Medical authorities warn social media influencers are ‘brainwashing’ women into dangerous unassisted births, with sometimes tragic consequences.
Elective surgery wait time blowout.
Data breach “a concerning incident” for doctor’s privacy
Doctors outraged after NSW health department ‘recklessly’ leaks their personal and professional data online
Exclusive: Confidential documents, including passports and medical credentials, made available, meaning ‘there is a risk of identity theft or fraud’
GP and AMA (NSW) councillor Dr Kim Loo has made it her mission to make life better for others – and she won’t rest until it’s done.
The turquoise tinge in the Georges River would catch Kim Loo’s eye each morning as her mother drove her to primary school from their home in Chipping Norton.
She didn’t know then that cyanobacteria, or blue-green algae, posed a serious risk to fish, livestock, wildlife and humans –but she knew the scene “couldn’t be right”.
Now a general practitioner in western Sydney with more than 36 years’ experience, that childhood observation – along with strong memories of her parents’ prolific vegetable garden and their belief in living sustainably – laid the groundwork for a life of meaning, of caring for our environment and the people within it.
Earlier this year, Kim was awarded the Australian Medical Association’s 2025 Women in Medical Leadership Award for “unwavering commitment to promoting women in medical leadership, improving quality care, and influencing medical politics”.
At the award ceremony, AMA president Dr Danielle McMullen said Kim’s “tireless advocacy for climate action and social justice reminds us all that medicine isn’t just about treating illness - it’s about healing communities and protecting the future”.
Kim feels honoured to have received the award – in conjunction
with psychiatrist Dr Pramudie Gunaratne – but believes she was chosen simply because she “worries about everything” and “sticks her nose in”.
That dedication sees her spending between 24 to 30 hours a week between two GP practices in Carlingford and Riverstone, and additional time across at least eight organisations, including AMA (NSW); NSW/ACT council RACGP; The Hills Doctors’ Association; WentWest Primary Health Network; Asian Australians for Climate Solutions; Parents for Climate; Hills for Climate Action and Western Sydney Permaculture.
She is also on the board of Doctors for the Environment Australia,
and speaks out regularly on domestic violence, alcohol abuse, gambling, heatwaves and the built environment.
Kim’s deep interest in the world was a gift from her Malaysianborn Buddhist parents who taught her to carefully consider how she interacted with others and value the earth’s precious gifts. She was told to turn off lights when not is use and not waste water. And she practises what she preaches, with a prolific vegetable garden, solar panels, water tanks and chickens. She’s also a heavy user of public transport and pedal power.
Now, her children Alex, 26 and Sydney, 21, are following in her footsteps. Alex works for a superannuation company set up by a climate activist, while Sydney is studying social work at university.
Kim has no plans to slow down and hopes her legacy will be “that I cared enough to advocate”.
“We just need to live a simpler life and really value each other,” she says.
“It’s important we understand the systems and problems that damage our health so we can create healthier spaces for our kids to live in the future.
“The precarity of the lives of some of my patients, and the intergenerational inequity of climate devastation, fuels my advocacy.”
Young adults put less value on having a consistent GP, but there is real value in building a relationship with one doctor, finds Elisha Mistry.
When 22-year-old Sophia Murphy visits a general practitioner, it is juggling act between convenience and affordability.
Her employment and living situation often fluctuate leaving continuity of care low on the priority list.
And she is not alone.
A study funded by NSW health revealed that about 45 per cent of young adults aged 18 to 24 in NSW do not have a regular GP, electing to defer to a clinic that they need is more convenient or affordable in times of need.
The continuity care model promotes care from the same provider or a small, consistent team over time, fostering strong relationships and improving the quality of care.
While young people may prioritise fast, cheap or convenient access to healthcare, this piecemeal approach can have detrimental impacts to long term health.
But continuity of care is what makes general practice really work, says AMA (NSW) board member and general practitioner Dr Michael Bonning.
“Patients can feel heard, safe and understood as a person and not just as a single presentation with some symptoms. And you need
Having a GP shapes young people’ s willingness and ability to use healthcare
to see the doctor less often with a consistent GP because longevity and prevention are the priorities.
“In cases where there is strong continuity of care, patients can feel more comfortable discussing sensitive topics or acute concerns with their practitioner and can received tailored advice and preventative support,” Dr Bonning says.
The transition from adolescence to adulthood is a key point where continuity of care suffers.
There is a 6 per cent dip in those with a consistent GP from ages 12
to17 to ages 18 to 24. During this time, many young people look for more privacy and autonomy, gravitate away from previous family practitioners.
Many do not seek another continuous practitioner, instead prioritising medical care only when acute issues arise. Bulk billing or proximity can take precedence over a consistent practitioner, but this leaves many young people without a trusted professional support network to turn to.
“Having a GP isn’t just a logistical convenience – it shapes young people’s willingness and ability to use healthcare,” says Dr Bonning.
Dr Kathryn Austin AMA (NSW) president Obstetrician and gynaecologist
