November 2015 . vol 97
AMA Queensland Membership Magazine
Restore a child’s hearing this Christmas why we avoid americanisation in healthcare MBS review on wrong trajectory
FREE TO AMA QUEENSLAND MEMBERS
Social photos galore
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CONTENTS
this issue why we avoid americanisation in healthcare
a patient’s bad experience in the american health system shows why we work hard to avoid americanising our healthcare.
12
30
14
16 REGULARS
18
Features
6
From the Editor’s desk
20 revalidation models show serious flaws
8
President’s Report
24 the demise of private health insurance?
10 CEO’s Report 40 Member News
business tools
68 ama queensland foundation news
48 ending the doctor-patient relationship
Current issues 26 2015 advocacy wins
28 MBS review on wrong trajectory
51 owning your practice property 52 Individual Flexibility Agreements 54 top ten insurance mistakes doctors make
32 agony aunt: Surviving the complaints process
56 New research supports email marketing for medical practices
34 resilience on the run update
57 australia, plan for a longer retirement
38 All great stories need a good ending
58 superstream is coming
39 surgeon statistics demand cultural change
60 Spotlight on management Liability Insurance
people & events
Life
12 annual conference wrap up
62 Winemaker profile: Elena Brooks
14 women in medicine wrap up
63 Sparkling Singapore
16 intern workshop
64 Dendy movies
18 new research fellowship for junior doctors
65 Lexus: RAISING THE BAR FOR LUXURY SUVS
20 medico-legal conference wrap up
66 all about you
36 professor michael breakspear
67 ocker doctor
41 member profile: drs eshini perera and ethan salleh
70 In print
42 Calendar 44 local medical association round up 46 book review: death rules
DoctorQ November 2015
5
editor’s desk
from the editor’s desk Board of Directors
Michelle Ford Russ Doctor Q Editor There’s quite a few indicators from Federal Government that doctors are not being held in the highest regard right now: talk of revalidation models; the MBS review and discussion about doctors and wasted resources; and the ongoing problem of the Medicare Indexation freeze. After hearing of a staff member’s experience in the American hospital system (p30) though, at least we aren’t adding some of those problems to the list! It’s a good example of why we fight for many of the standards we’d like to keep in Australia - like not interrupting a clinical appointment to get a patient to swipe their credit card.
obituaries
A lot of you have joined us for some great events recently: the Annual Conference in New York (p12), our popular Women in Medicine Breakfast (p14) and the recent Medico-Legal Conference (p20). We’ve wrapped up those events and included plenty of photos too. Doctor Q will be looking a bit different next time it arrives in your post box, with a little facelift planned for the Christmas period. Speaking of the festive season, I hope you all have a great Christmas and New Year and get some time to lie on the beach somewhere nice. Michelle
The following AMA Queensland members have recently passed away. Our sincere condolences to their families.
Dr Laurence Preston CATLEY Pathologist Late of South Brisbane Member for 7 years
Dr James Stuart DIXON General Practitioner Late of St Lucia Member for 61 years
Dr Julian Paul HIRST Oral and Maxillofacial Surgeon Late of Teneriffe Member for 14 years
Dr Kenneth FREDERICKS Psychiatrist Late of Surfers Paradise Member for 43 years
Dr Chris Zappala President
Dr Kirsten Price Honorary Secretary
Dr Shaun Rudd Chair of Board and Council
Dr Dilip Dhupelia Appointed Director
Dr Bill Boyd Vice-President Dr Bav Manoharan Treasurer
Dr Richard Kidd Appointed Director Dr Sharmila Biswas Appointed Director
Council Dr Tom Arthur Greater Brisbane Area
Dr Sharon Kelly Specialist Craft Group
Dr Sharmila Biswas Far North Area
Dr Richard Kidd General Practitioner Craft Group
Dr Kimberley Bondeson Greater Brisbane Area Douglas Brown Medical Student Observer Dr Lisa Byrom Greater Brisbane Area Dr Sarah Coll Specialist Craft Group Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group Dr Jim Finn Full-time Salaried Medical Practitioner Craft Group Dr Malcolm Forbes Doctors in Training Representative
Professor Steve Kisely Greater Brisbane Area Dr Luke Lawton North Area Honor Magon Medical Student Group Representative Dr Bav Manoharan Gold Coast Area Dr John F. Murray Specialist Craft Group Dr Paul Neeskens General Practitioner Craft Group Dr Kirsten Price Greater Brisbane Area
Dr John Hall Downs and West Representative
Dr Anil Sharma International Medical Graduate Representative
Dr Wayne Herdy North Coast Area
Dr Josie Sundin Greater Brisbane Area
Dr Brad Horsburgh Greater Brisbane Area
Dr Harley Wilson Capricornia Representative
AMA Queensland Secretariat
office closure
The AMA Queensland office will be closed from 3pm, 23 December until 4 January. We hope you enjoy a happy and healthy Christmas and New Year.
Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice. Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.
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November 2015 DoctorQ
Jane Schmitt Chief Executive Officer Filomena Ferlan General Manager Corporate Services
Holly Bretherton General Manager Member Relations and Communications
Editor: Michelle Ford Russ Graphic Designer: Nathan Pitt Journalists: Rachael Finley James Hodge Advertising: Louise Glynn Doctor Q is published by AMA Queensland Contact Phone: (07) 3872 2222 Postal Address: PO Box 123, Red Hill QLD 4059 Print Post Approved PP100007532 Email: amaq@amaq.com.au
76673 Freecall 1800 00 SNORE 76673 Freecall 1800 00 SNORE
PRESIDENT’S REPORT
dr Chris zappala President, AMA Queensland The Federal Government’s review of Medicare item numbers and their recent tactics in ‘engaging’ with the medical profession are of current concern. The Turnbull Government has finally declared in public their true intentions, beginning with a nonsense attack on the credibility of doctors suggesting they practice against the best interests of their patients for personal financial gain. Wow! Even if only done as political manoeuvring, this assertion evinces the true sense of regard our Federal politicians have for doctors. AMA has always indicated support for evolution of the Medicare Benefit Scheme (MBS) to delete unused items, add necessary new items, or adjust existing ones to reflect current practice and technology. The present review does not have this credible objective. The AMA supports sensible reform; this travesty playing out at the moment is unfortunately not that. The Federal Minister for Health Sussan Ley seemed unable to contain her derision citing 30 per cent of healthcare in Australia as unnecessary and harmful. It’s interesting to note that this statistic is drawn from US data that relates to regulatory and administrative, as well as medical systems. It’s clearly not able to be directly extrapolated to the Australian context or interpreted to criticise doctors for waste and inappropriate use of the MBS. Moreover, Minister Ley makes no allowance for the increasing medico-legal obligations doctors sustain and the proportion of activity that relates primarily to managing risk. Recall that the Federal Government has already indicated it will progressively reduce funding to states for healthcare over the next several years. The introduction of a copayment for medical services is, at its heart, aimed similarly i.e. to reduce healthcare expenditure. The MBS indexation freeze is another obvious example. Current Federal Government policy seems to be focussed solely on reducing government expenditure… and increasing everyone else’s! Nonsense issues tend to detract from real ones. Now that the fervour surrounding the failed introduction of the co-payment has settled down, we should perhaps calmly consider the issue. There are a couple of 8
November 2015 DoctorQ
If we ever manage to have a calm, balanced debate about funding of healthcare, a copayment in some form should be actively considered. majority-held views, as far as I can tell, among AMA members. Firstly, doctors should be able to charge whatever they want. In principle I do not disagree, but this somewhat quaint statement neglects competitive pressures and the constraints of socioeconomic status which significantly impinge on what doctors can charge. The government seems to have no concept of (or care about) the costs to patients of travelling to their doctor or the cost of consumables used during consultations by practices. Secondly, the MBS is a contract between Government and patient that shouldn’t affect what a doctor charges. Hmmmm…. See above. If this was a genuine arrangement, then we wouldn’t have financial penalties when bulk-billing does not occur (I’m referring to the reduction in rebate when a gap is charged), the punitive MBS freeze would be swept aside, and the most vulnerable patients would be better protected. This latter point represents the heart of the matter (see below). Thirdly, a price signal (even if quite small) is a good idea for people accessing expensive, publicly-funded services i.e. medical care. Federal politicians all believe it, but paradoxically decry even the faintest suggestion towards it, when it suits them. Their enervating collective and perpetual lack of courage is disappointing, but perhaps not unexpected. Well-informed, balanced debate about healthcare funding and reform seems beyond our politicians at present, when this is exactly what is so desperately and obviously required. AMA should be out in front in this regard and this is thankfully starting to occur. More perhaps needs to be done by our conglomerate organisation however. So, if we ever manage to have a calm, balanced debate about funding of healthcare, a co-payment in some form should be actively considered. It’s important to note that general practice represents efficient and cost-effective healthcare (contrary to what Minister Ley says). However, indiscriminate demand is potentially a problem – so the price signal is likely to be helpful. Importantly, how do we protect those who cannot pay but who need to be protected? This qualification is important – dissipation
and intemperate, ill-considered behaviour that prioritises healthcare lower than is perhaps ideal (or warranted) and renders the individual unable to pay a co-payment represents a circumstance that needs to be distinguished from the genuinely vulnerable and disadvantaged. I can only hope that Centrelink assessment processes become increasingly more adept at making this critical distinction. Doctors have their place in unflinchingly assisting with this when called upon to give a medical certificate or opinion of impairment. It was under the Labor Government of Ben Chifley in 1948 that the Pharmaceutical Benefits Scheme (PBS) was borne. Medicines on the PBS list were free to the consumer until 1960, when a 50c copayment was introduced by the Liberal Menzies Government. Both sides of politics have increased the PBS levy since then. If one reflects on the various increases in the PBS co-payment, the ‘gentle’ increments are combined with appropriate recognition of the genuinely vulnerable and disadvantaged. This has variously included implementation and robust conduct of safety nets, concomitant increments in the pension and obviously in careful consideration of those who are eligible for concession rates. This suggests a similar construct could be used to introduce a modest co-payment for medical services that doesn’t become prohibitively additive with complex episodes of care requiring multiple consultations and/or investigations. The PBS is now well established and generally accepted. If handled properly therefore, a co-payment could be introduced and regarded the same way. Now we just need some politicians courageous enough to start the discussion and introduce it properly! What do we have instead? A MBS freeze and vitriolic rhetoric blaming doctors for increasing healthcare costs, dangerously combined with absent political fortitude on any side of the aisle for credible, balanced debate on healthcare funding and genuine reform. The deterioration in private health insurance rates and credibility only exacerbates these woes (see page 24). We could perhaps do with the advice of Sir Humphrey Appleby to help rescue us from this predicament! Q
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9
ceo’S REPORT
JANE SCHMITT Chief Executive Officer, AMA Queensland
Help restore a child’s hearing this Christmas
Little Bubejah Bell (on the cover) is the face of our 2015 AMA Queensland Foundation Christmas Appeal. This year we are supporting a very worthwhile project that will help improve the health of Indigenous Queenslanders in rural and remote areas. The project aims to improve access to ear, nose, and throat surgical services for Aboriginal and Torres Strait Islander children for the treatment and management of hearing health. You can read more about this project on page 69.
Immunise to 95
AMA Queensland recently partnered with Queensland Health to launch the Immunise to 95 campaign aimed at boosting immunisation rates across the state. Currently, there are around 35,000 children under five who are behind on their immunisation schedule. Through this campaign, AMA Queensland and Queensland Health hope to achieve an immunisation rate of 95 per cent. AMA Queensland is encouraging GP members to support the campaign by volunteering your practice and services for after-hours vaccination clinics. Alternatively, if your practice is already open afterhours, please notify our team for Queensland Health to make referrals.
Resilience on the Run
AMA Queensland recently launched the pilot of our five-week Resilience on the Run program, which was designed to equip junior doctors with the coping and resilience skills needed to thrive in the challenging field of medicine. Resilience on the Run was developed as a direct result of research that showed young doctors have high rates of anxiety and depression. Partnering with psychiatrist facilitators, the program focuses on skills such as practicing mindfulness, exercising resilience, and asking for help. The pilot recently concluded at Rockhampton Hospital and initial feedback shows it was well received. We are currently in the process of reviewing the evaluations and data. We look forward to sharing the results with members and further expanding the program.
MOCA 4 outcome
The Medical Officers’ Certified Agreement 4 (MOCA 4) received a favourable vote from doctors following a count of the ballot last month. Over the next few weeks, Queensland Health will continue to prepare for the implementation of MOCA 4. The next step is to submit the agreement to the Queensland Industrial Relations Commission for certification which will signify the end of high income guarantee contracts. To assist with the implementation of MOCA 4 over the next three years, it is important that you raise with us any concerns regarding your entitlements and how certain provisions have been implemented. Matters that have not been implemented in line with the intent of the agreement will be reported to the MOCA 4 Oversight Committee. 10
November 2015 DoctorQ
AMA Queensland Health Hubs
AMA Queensland recently hosted our first Health Hub at the Eumundi Markets. The Health Hub is part of AMA Queensland’s work towards a healthier state that values the role of general practice. Visitors to the Health Hub received a complimentary BMI and blood pressure check conducted by AMA Queensland GPs. Where necessary, visitors were referred to their regular doctor for a more thorough consultation. In addition, all visitors received an AMA Queensland pedometer to help them in their journey towards better health.
Health Minister’s Breakfast and visit to the ama queensland council of doctors in training
AMA Queensland was pleased to welcome over 50 members to our inaugural Townsville Health Minister’s Breakfast on 9 October. Minister for Health Cameron Dick canvassed key achievements by Queensland Health and answered myriad important questions from members about the issues facing medical practitioners in North Queensland. Minister Dick also visited AMA Queensland’s Council of Doctors in Training to announce a new research fellowships for junior doctors in Queensland. Find out more on page 18.
Happy Holidays from the AMA Queensland team
It’s hard to believe our last 2015 edition of Doctor Q is already upon us. Reflecting on the last year, I am truly proud of what we have been able to achieve in our advocacy work, workplace relations support, public health campaigns, and member offerings. This work is only possible with the support of our dedicated Council, Committees, and Secretariat. We have already started planning some fantastic projects for 2016 which I look forward to updating you all on in the New Year. The AMA Queensland office will be closed over the Christmas period from 3pm on 23 December 2015 and re-opening on Monday 4 January 2016. I wish you all a safe and happy festive season. Q
St Vincent’s Private Hospital Brisbane at Kangaroo Point specialises in medical care for those with chronic, complex and multiple health needs. We offer services for adolescents to the elderly. General medical
Palliative care
• Acute and chronic disease management
• 24-hour Community Specialist Palliative Care Service
• Acute geriatric medicine and evaluation management programs
• 30-bed inpatient unit (24 single rooms)
• Neurosciences for adolescents and adults (epilepsy, post-stroke care, movement disorders, acquired brain injuries, sleep disorders)
• Adolescent palliative care
• New physiotherapy and occupational therapy complex At St Vincent’s Private Hospital Brisbane we have modern, spacious and comfortable patient rooms – most are private rooms with adjoining ensuites. Radiology, pathology, pharmacy, EEG and sleep studies are also available onsite.
Spring Hill
iver ne R Brisba
Bradfield Hyw
Brisbane CBD
New Farm
c cifi Pa
Kangaroo Point
Av e
Shafsto n
Vulture St
Ipswich Rd
ay orw Mot
Highgate Hill
Main St
nk ba uth So
St Vincent’s Private Hospital Brisbane
Vulture St
N
Fortitude Valley
Story Bridge
Riv er T ce
• RECHARGE for life – adult pain management program (over 21 years)
• Multidisciplinary approach
Rd
• LEAP into life – adolescent pain management program (14 to 21 years)
• Full functional assessments and tailored programs for adolescents and adults
ley
• Brisbane Centre for Pain Management – specialist assessment and consultation, medication and prescription advice, surgical procedures
Rehabilitation
Ann er
Pain management
• Patient and Family Support Service
East Brisbane
Stanley St
Woolloongabba
To find out more about our services, please contact us: 411 Main Street, Kangaroo Point Qld 4169 Phone: 07 3240 1111 Email: info@stvincentsbrisbane.org.au
www.svphb.org.au
People & EVENTS
The 15th annual AMA Queensland Annual Conference was staged in the magnificent city of New York during 20 – 26 September. What a wonderful experience it was. The host city was just magnificent in every way. It provided a perfect setting for delegates to learn and enjoy each others’ company. The event kicked off with a pleasant cocktail reception in the hotel hosted by AMA Queensland President Dr Chris Zappala. In the conference room our delegates were educated and entertained by a line-up of speakers of world renown, with the conference theme being A BIG apple a day keeps the doctor away – strategies for a healthy and happy life. Every session was packed with enlightening presentations and generated enthusiastic discussion and debate. The conference was formally opened by Kenny Kramer, the real life version of Cosmo Kramer of Seinfeld fame. It was a fascinating and hilarious welcome to New York. He was quickly followed by keynote speaker Brisbane Radiation Oncologist Dr David Schlect, co-author of the book HOPE - A cancer doctor’s life secrets. Dr Schlect delivered three sessions on Health, hope and human progress; The role of hope in maintaining good health and coping with illness; and The role of diet in maintaining good health and coping with illness. Other Australian speakers to present were Colleen Sullivan, on how Healthy teams make a difference to practice operations; Gary Smith on How to maintain a healthy, high performing medical practice; and Psychologist Carolyn Rogers on the issue of Mindfulness - more than just meditation. Brisbane-based Occupational and Environmental Physician Dr Chris Cunneen, presented on Health challenges for FIFO workers.
EXPLORING NEW YORK AND BEYOND 12
November 2015 DoctorQ
AMA Queensland President Dr Chris Zappala spoke on Sleep – a life essential. Associate Professor Noel Hayman, GP, updated delegates on Indigenous health services and models of care to increase access to primary care. Brisbane Paediatrician Dr Michael McDowell spoke on Co-Management of children with special needs. Our local guest speakers from the USA included Dr Alice Coombs, Past President, Massachusetts Medical Society, who delivered two sessions on Patient empowerment and healthcare literacy and Work-life balance. Dr Jillann Farmer, an Australian doctor and Director, Medical Services Division, UN Headquarters, spoke on the ebola crisis in West Africa and the UN response. Dr Geral Bernstein, Past President, American Diabetes Association, addressed the big issue of global diabetes and and its effect on healthcare economies.
A panel discussion on the final day considered and debated the hot topic of Health reforms in Australia. The final conference session was an Issues open forum chaired by Dr Zappala. Issues significant to the future of medicine were addressed and hotly debated. Conference week concluded with a farewell dinner and what a way to wrap up a great week. The venue was the acclaimed Carmines Italian Restaurant, giving delegates one last chance to enjoy the real New York. The 2015 Annual Conference was a wonderful experience for all concerned and a visit to a country so friendly and enjoyable that it will stay in our minds for a very long time. It certainly exceeded many expectations. Q
Dr Holly Lofton, NYU Langone Medical Centre presented two sessions on Weight management and Caring for yourself. Dr Peter Carmel, Past President, American Medical Association, was the final local speaker and briefed the delegates on The changing American healthcare system. It was an absolute pleasure to have these esteemed local speakers participate in our conference.
A loca l go guest spel choir k s ente rtaine ept d.
The program continued with valuable presentations by Ross Noye, James Hooke, and John O’Connell (all Macquarie Group executives) on securing your financial future. Katharine Philp from TressCox Lawyers spoke on important medico-legal issues and updated delegates on the role of AHPRA and the Health Ombudsman. Her presentation is summarised on page 13.
Outside the conference sessions delegates had opportunities to explore this wonderful city and regions beyond. Some particular highlights within New York were the city tour taking in fabulous sites such as the Statue of Liberty and the 9/11 Memorial. Outside New York a true highlight of the conference was our trip to the Hamptons, a popular seaside resort and preferred holiday destination for NYC’s rich and famous, and also Long Island.
ular
a pop s was b m o r o ice C al speake Dr Al loc
People & EVENTS
OUR SPONSORS Our wonderful sponsors received a special vote of thanks at the dinner. We were most fortunate to have the support and company of Ross and Mandy Noye (Macquarie Bank) and Katharine Philp (TressCox Lawyers). Finally, a big thank you to AMA Travel Queensland, Ros and Andrea, for yet another successful and co-operative operation.
Macqu arie’s pat the Ross Noye go Wall S treet b t to ull. sCox yd, Tres r Bill Bo sland CEO D t n e ueen Presid an and nd Vice , AMA Q ueensla atharine Philp Dr Noel Haym Q , AMA K . n r o Zappala lly Loft s Partne Lawyer itt, speaker Ho sident Dr Chris hm nd Pre Jane Sc ueensla AMA Q
tresscox lawyers Katharine Philp
Health Law Partner Katharine Philp of TressCox Lawyers presented on the coregulatory health complaints system in Queensland since the commencement of the Health Ombudsman Act 2013 from 1 July 2014. Since 1 July 2014 all health service complaints relating to health service providers in Queensland, including mandatory notifications under the National Law, have been referred to the Office of the Health Ombudsman (OHO). If the OHO accepts a complaint he may take any of the following “relevant actions”: Assess the complaint; Facilitate local resolution; Take immediate action; Investigate the complaint; Refer the complaint to Australian Health Practitioner Regulation Agency (APRHA) (or any entity of the State, another State or the Commonwealth); Refer the complaint to the Director of Proceedings for a decision about whether to refer the complaint to Queensland Civil and Administrative Tribunal (QCAT);
The OHO is confined to choosing from the above relevant actions but more than one relevant action can be taken. A health complaint can only be referred to AHPRA if: It concerns a registered health practitioner (i.e. who is subject to one of the 14 National Boards created by the National Law); The matter is not one that indicates that the health practitioner may have behaved in a way that constitutes:
professional misconduct; or other grounds exist for the suspension or cancellation of the practitioner’s registration.
Delegates were taken through examples of various pathways through the complaint process from simple complaints through to complaints involving health (impairments), conduct and performance and how complaints can move from the OHO to AHPRA and back to the OHO again when professional misconduct is identified.
Conciliate the complaint; and/or Carry out an inquiry.
AMA Q Chris ueensland Zappa C la wit EO Jane S h chmit A me Presid ent D rican Med t and Pres id r Pete ic r Carm al Associa ent Dr tion P el (ce ntre). ast
DoctorQ November 2015
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People & EVENTS
Women in Medicine The art and science of happiness More than 300 guests braved the early start and joined us for the annual Women in Medicine Breakfast in early September to discuss the art and science of happiness. Speakers Professor Kerryn Phelps AM, Dr Timothy Sharp, and the Venerable Robina Courtin gave us the lowdown on pursuing a happy life. Professor Phelps had some great insights on the importance of a healthy and enjoyable diet, exercise, and the need to detox from technology. Dr Sharp spoke about the 14
November 2015 DoctorQ
psychology of pursuing a happy life and encouraged guests to recognise what their happy life would look like. The Venerable Robina Courtin spoke about her experiences of working with people making the most of life in difficult situations. Thanks again to our sponsors who make events like Women in Medicine possible: BOQ Specialist, TressCox Lawyers, MDA National, Brisbane BMW, Defence Force Recruiting, and Perfect Potion.
Some great prizes were won on the day, thanks to TressCox Lawyers, Panda Pearls, SnowGoose, MDA National, Medical Indemnity Protections Society, BOQ Specialist, and our speakers Professor Kerryn Phelps AM, Dr Timothy Sharp, and the Venerable Robina Courtin. The team at AMA Queensland looks forward to welcoming you to our Women in Medicine Breakfast next year on 31 August. Check out more photos on our Facebook page. Q
People & EVENTS
Sabiha Deol, Amy Schmidt, Dr Alice Ayres, Dr Laura Meed, and Dr Tanya Trinh
Professor Kerryn Phelps AM, Venerable Robina Courtin, and Dr Timothy Sharp
Venerable Robina Courtin
Dr Lisa Byrom, Professor Kerryn Phelps AM and Dr Katherine Gridley.
Dr Judy Somerville asked a question of the speakers
Dr Timothy Sharp
Dr Katherine Smallcombe, Dr Natalie Bowring, Dr Jan Casey, and Jasna Kim.
Professor Kerryn Phelps AM
Dr Mellissa Naidoo with AMA Queensland CEO Jane Schmitt. Dr Naidoo was one of many lucky prize winners DoctorQ November 2015
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People & EVENTS
More than 300 interns attended.
Get the competitive edge Intern workshop Brisbane More than 300 final-year students turned out for AMA Queensland’s Brisbane Intern Readiness Workshop last month, thirsty for information from current interns and industry professionals. Topics included prescribing and paperwork, ward call, and the RMO application process for 2016 along with valuable lessons from our Doctor in Training representatives on resilience and navigating the early stages of your career. AMA Queensland would like to thank our sponsors MDA National, BOQ Specialist, Experien, William Buck, Avant, the Medical Indemnity Protection Society (MIPS), and Doctors Health Fund for making this informative event free for participants. For those who attended, don’t forget to register for the upcoming free member resume writing workshop on 26 November at AMA Queensland. Details are on page 42. Q
Chris Maguire, AMA Queensland CDT Representative
Mahmoud Hamzi, Goutham Sivasuthan, and Eric Le.
MDA National’s Cathy Kayess, Emma Keen, Andrew Robinson, and Sandra Reed (MDA National).
Brendan Hunter, Shannon O’Beirne, Timothy Croft, and Andrew Taylor. 16
November 2015 DoctorQ
Erin Moffat explained the RMO recruitment process.
Phone 07 3834 4285
www.standrewspainservice.com.au
The St Andrew’s Multidisciplinary Pain Service (StAMPS) is an integrated multidisciplinary service designed to offer patients a “one stop shop” from diagnosis to comprehensive treatment and management of persistent pain. StAMPS brings together a team of experts in the field of pain medicine, dependency, psychology, rehabilitation medicine, occupational therapy and physiotherapy.
Dr. Jason Ray
MBBS (Qld), FANZCA , FFPMANZCA
Dr. Richard Pendleton Dr. Wilbur K.M. Chan MBChB, FANZCA, FFPMANZCA
MBBS, FRACGP, FAFRM, FFPMANZCA
Dr. Jayne Berryman
BSc, MBBS (Qld), FANZCA, FFPMANZCA
Dr. Christian A.C. Rowan
MBBS (Qld), MDiplTrade (Mon), FRACGP, FARGP, FACRRM, FRACMA, FAChAM (RACP)
StAMPS provides:
How to refer to StAMPS
• Individual assessments by leading pain specialists
Medical Practitioners can refer to one of the individual StAMPS specialists or directly to StAMPS.
• Interventional pain treatments by StAMPS specialists
There are four options for referring:
• Individualised physiotherapy, psychology, occupational therapy assessment & treatment
1. Refer online at www.standrewspainservice.com.au
• Persistent Pain Program - an intensive 4 week program, 3 days a week on an outpatient basis
3. Refer by email to enquiries@standrewspainservice.com.au
• Specialised inpatient treatment at the St Andrew’s Pain & Dependency Unit
StAMPS Consulting Suites Level 4, St Andrew’s War Memorial Hospital Spring Hill Q 4001
2. Refer by fax to 07 3834 4291 4. Post referral to StAMPS St Andrew’s War Memorial Hospital 457 Wickham Tce Spring Hill Q 4001
P 07 3834 4285 F 07 3834 4291 E enquiries@standrewspainservice.com.au W www.standrewspainservice.com.au
People & EVENTS
New research fellowships for junior doctors Minister for Health Cameron Dick attended AMA Queensland’s Council of Doctors in Training meeting to announce new research fellowships for junior doctors in Queensland. Mr Dick said up to four fellowships will be on offer from November 2015. “The fellowships will provide successful recipients with $250,000 per year for a twoyear dedicated research period under the mentorship of highly experienced clinical researchers,” Mr Dick said. “These fellowships signal exciting times ahead for junior doctors with a passion for research,” he said. AMA Queensland Council of Doctors in Training Chair Dr Malcolm Forbes said the fellowships are important for Queensland to take its place as a leading centre of medical research. “The research fellowships are the most generous available to junior doctors in Australia and will keep talented junior doctors who want to pursue medical research in Queensland,” Dr Forbes said.
“We eagerly await a further meeting with the government to ascertain further details about the fellowships and discuss how we can ensure equal opportunity among junior doctors in the application process.” The fellowships will be funded through the Queensland Residents and Registrars Research Fund and are the result of AMA Queensland advocacy. Further details about the application process will be released over the coming weeks. The Committee was delighted to host the Minister who also took questions on issues ranging from internship places, bullying in hospitals, and non-physician endoscopy. After the Minister departed, the Committee discussed the 2016 Junior Doctor Conference which will feature keynotes by Laureate Professor Peter Doherty, Winthrop Professor Fiona Wood, and Professor Munjed Al Muderis, and the groundbreaking pilot of the Resilience on the Run program. Q
Council of Doctors in Training member Dr Rhys Thomas addresses the Minister.
The AMA Queensland Council of Doctors in Training also discussed the 2016 Junior Doctor Conference and the Resilience on the Run project.
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November 2015 DoctorQ
AMA Queensland CDT Chair Dr Malcolm Forbes with Health Minister Cameron Dick.
Minister for Health Cameron Dick announced the new research fellowships for junior doctors in Queensland.
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People & EVENTS
third annual medicolegal conference Members joined us on Halloween for insights into the constantly changing and intersecting worlds of medicine and law. President of the Mental Health Court, Supreme Court of Queensland, The Honourable Justice David Boddice discussed mental health reform in Queensland, while Southern Coroner, Magistrate James McDougall’s presentation focused on doctorshopping and over-prescription of oxycodone and fentanyl. Drs Edward Ringrose, Thomas Foote, and Ross Phillipson
The always popular TressCox Partner Katharine Philp demystifyed mandatory disclosure, and MDA National’s Deb Jackson discussed the effect of claims and complaints on medical practitioners. Jennifer Rosengren, a Barrister with the Bar Association of Queensland, explained some recent cases around complaints and disciplinary proceedings. This event was made possible thanks to our generous sponsors at MDA National, Experien, TressCox Lawyers, AMA Queensland Insurance Solutions, and Macquarie. Join us on Facebook to see more photos from the day. Q 20
November 2015 DoctorQ
Francois Makur, Amelia Jenner, and Dr Jessica Page
People & EVENTS
Dr Eleanor Chew
Guests tuned in for a wide variety of topics.
President of the Mental Health Court, Supreme Court of Queensland, The Honourable Justice David Boddice discussed mental health reform in Queensland.
Drs Frank New and Jennifer Gunn
AMA Queensland President Dr Chris Zappala opened the Medico-Legal Conference. Joanne Webb (MDA National) and Chris Mariani (AMA Queensland Insurance Solutions)
DoctorQ November 2015
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CURRENT ISSUES
Revalidation models show serious flaws The medical board of Australia has commissioned a UK research group to review revalidation models to ensure medical practitioners’ skills are up-to-date. The Medical Board of Australia (MBA) has maintained a particular interest in the application of revalidation of medical practitioners in Australia since December 2012. Revalidation, broadly speaking, is the 360 degree assessment of a medical practitioner to ensure their skills are up-to-date. Much of the discussion has been based around the model introduced in 2012 in the United Kingdom, which assesses every medical practitioner every five years. This was implemented in response to low public confidence in the medical profession and had been first mooted in 1998. On 24 March 2015, the MBA announced it had commissioned the Collaboration for the Advancement of Medical Education, Research and Assessment (CAMERA) at Plymouth University Peninsula Schools of Medicine and Dentistry in the UK to conduct an international scan of revalidation models. On 15 September 2015, the MBA published the commissioned research. The research proposes three distinct models of revalidation, namely: Model A A model of revalidation operated entirely online. Running over a period of five years, doctors would be required to produce an annual online portfolio, with documentation, evidencing participation in mandatory but self-directed Continuing Medical Education (CME) and multi-source feedback. Every fifth year would result in a recommendation for revalidation. Model B A model of revalidation comprising of both online and physical elements. Also operating over a five year period, it would require medical practitioners to present an online portfolio detailing their engagement in exclusively directed, mandatory CME-facilitated online learning, bi-annual appraisal for targeted groups, and participation in multi-source feedback from a specified number of patients and peers. A revalidation appraisal would also be taken for all doctors every fifth year.
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November 2015 DoctorQ
Model C Model C comprises both formative and summative components. As with the other models it would operate over a five-year cycle. It would involve doctors providing an online portfolio evidencing engagement in self-directed and direct interactive CME, facilitated online learning, blended learning, annual appraisals, participation in multi-source feedback with accompanying facilitated feedback, and review of patient complaints. Every fifth appraisal would act as a revalidation recommendation and would ideally be conducted face-to-face. The research found there was positive evidence that revalidation was worthwhile and considered Model C the superior model. The MBA has taken the following steps in considering its response to the research: Appoint an expert advisory group to consider the models chaired by Professor Liz Farmer to provide a recommendation with 12 months. Appoint a Consultative Committee to provide feedback on issues related to the introduction of revalidation in Australia. Commission social research into what the profession and the community believe medical practitioners should do to demonstrate ongoing competence and fitness to practice within the next 12 months. AMA Queensland has had significant concerns about the varying models of revalidation proposed by the report. As noted by AMA Past President Dr Steve Hambleton: “We need to make sure we maintain our currency and continue to improve health outcomes, but in terms of value for money, making everybody go through a five-yearly process of 360-degree evaluation is not needed in the Australian health system.� These concerns were highlighted in the research itself that noted the high cost of Model C. Given there are 103,133 medical practitioners across Australia, the MBA would
be required to appraise 283 practitioners each and every day, including Easter and Christmas, to ensure complete coverage. AMA believes patients deserve medical practitioners who are safe and ready for practice. AMA is supportive of a process that further explores revalidation; however, a debate must be had to ensure that any model effectively and efficiently accomplishes these objectives. AMA has been invited to sit on the Consultative Committee and will continue to advocate for a system that effectively balances these objectives in a way that is fair and sustainable. Q
The MBA would be required to appraise 283 practitioners each and every day, including Easter and Christmas, to ensure complete coverage.
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DoctorQ November 2015
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CURRENT ISSUES
The painful, slow demise of private health insurance?
AMA Queensland President Dr Chris Zappala believes the recent attempts by Medibank Private Limited (MPL) to restrict payment under the guise of promoting safety and quality, as reported in the last issue of Doctor Q, are an unseemly attempt to improve profitability at the expense of the patient’s healthcare.
Dr chris Zappala
President, AMA Queensland
By contrast, the patient should be protected against unwittingly purchasing cover that will not meet their needs i.e. they must know that it covers what they want e.g. appropriate reconstructive surgery (not cosmetic), all joint replacements etc. Similarly, there is absolutely never a need for PHI to cover care that does not have an appropriate evidence basis. The health insurance company has no role in dictating the nature or extent of therapy/care received if a patient and doctor have agreed on an evidence-based management plan. The doctor-patient relationship should be held above potential corruption by commercial interests. Managed care, in any form, is unacceptable. Pre-approval processes for certain procedures forced upon surgeons and patients by some funds recently is one such example. Many items on Medibank’s list of ‘preventable adverse events’ have no relationship to promoting safe or good quality care, only controlling payment by funds.
There is no evidence basis for what MPL regards as ‘reasonable’ restriction of payment for ‘avoidable and preventable complications’. Frankly, it appears as a clumsy perversion of the safeguards legislated as part of the Affordable Care Act, which have perhaps been somewhat helpful in constraining healthcare costs in America. So, other than wanting to make more money for their shareholders, why is MPL – with the support of other health insurers – embarking on this combative path? The difficulty of the private health insurance (PHI) industry is that wide-ranging evolution is required to preserve the value and contribution of the sector to healthcare delivery in Australia. The issues to be addressed, and areas most in need of reform, can be divided into three main categories: 1. The nature of health insurance policies 2. Regulation of the industry 3. Health fund-private hospital interactions The nature of health insurance policies PHI, like any other insurance, should reasonably meet our expectation to cover patients’ inpatient hospital care. Beguiling advertising together with ever increasing exclusions (and a bewildering array of extras cover) have led to patients sometimes paying for relatively useless policies. If done consciously to avoid the Medicare surcharge penalty, one must question the healthcare funding wisdom from a system/community point of view. 24
November 2015 DoctorQ
All doctors wish to enhance safety and promote high quality healthcare. This aim is not contrary to the preservation of universal access and equity with a community-rated system. We currently have some stratification based on risk e.g. smoking status, but we must ensure we never penalise patients with complex care requirements, multiple medical problems, or who suffer unavoidable medical complications – just because they may incur greater costs. This is the key difference compared to what Medibank was proposing – grade IV pressure ulcers and operating on the wrong side are preventable and should be penalised. A fall in hospital, despite compliance with rigorous fall prevention practices, should not attract a punitive reaction. Unavoidable re-admission within 28 days of sick patients with multiple medical problems should not attract penalty – these patients will all simply be forced into the public system despite having responsibly purchased PHI. General Practice is the cost-effective corner-stone of primary care – this will never change. There are many pretenders, but no one can emulate the expertise and efficiency of a medically trained individual. Rather than funding treatment that has no evidence to support its use, we should be investigating items to allow easier access to GPs that enhance (community-based) chronic disease management and their efforts in preventative health.
Regulation of the industry Lack of transparency and ease of access to understandable information for patients is problematic. The recent Australian Competition and Consumer Commission (ACCC) report to the Senate regarding PHI and escalation in complaints to the PHI Ombudsmen underline this deficiency and need to act. Patients should be able to access easily understood, non-ambiguous promotional material. The basics of PHI are obvious to all and expensive advertising to over-emphasise the spurious differences between policies is not required and should be limited. It is imprudent to allow funds to spend large sums of premium income on expensive advertising when this money could be spent on patients’ healthcare. Regulation could easily manage this problem. Informative websites such as www.privatehealth.gov.au that simply compare policies and help make clear what is covered and how this compares to other policies, require maintenance and integrity surveillance by regulators. This can then facilitate the process of gaining informed financial consent, together with information produced by the profession to assist patients and doctors in understanding the PHI industry and how healthcare is funded. Doctors themselves need to be well informed and conversant with this information for their own benefit, but also to assist patients. Fundamental to our system is the capacity for doctors to set their own reasonable fees. The MBS item freeze widens gap payments for everyone (including health insurance funds) creating a stress within the system leading to perverse ‘work arounds’. The cost of practice has steadily increased, such that the government is forcing doctors to reduce income or pass the increased gap on to patients. There is no reason why a return to appropriate indexation of MBS items cannot be restored as part of a complete evolution of the PHI industry. Discussion regarding over-servicing, excessive prices, and interventions of marginal benefit, might unsettle us. However, we must be honest about where we, as a profession, can help manage healthcare costs without inappropriate collusion or interfering with the doctor-patient relationship. We are all aware of isolated instances of ‘fringe’ practices and unsightly unrestrained commercialism in healthcare.
CURRENT ISSUES
Within the professional societies and Colleges we need to establish a means to identify clinically marginal practices and positively manage outlier behaviour without discrediting or dishonouring individuals. It would be more fruitful to proactively and positively entice practitioners back to efficient, evidencebased accepted norms. We’d best not be too slow in reconciling ourselves to this need or else it will be forced upon us by government or health funds – potentially in a manner we detest and without our involvement. Now is not a time to naval gaze or highlight our professional differences, but to quickly develop a considered and cohesive strategy that will withstand public scrutiny. Health fund-private hospital interactions It is extremely unsettling that contracts between hospitals and private health insurance funds remain secret – arrangements that transcend the details of our individual policies in dictating what care we can receive (and perhaps how). There is no need for these arrangements to not be transparent – anything that gives doctors and patients greater information to make appropriate decisions about healthcare should be pursued. Moreover, there should be impartial, clinical
Wide-ranging evolution is required to preserve the value and contribution of the sector to healthcare delivery in Australia.
(non-commercial) scrutiny of arrangements to ensure they are reasonable and reflect current evidence. Medibank’s recent attempts to bully concessions with private hospitals, as discussed above, exemplify why these contract details should be published. Rather than using punitive fines to bludgeon efficiency from the system, there is considerable scope to provide incentives for high quality, bench-marked care. There are numerous positive behaviours and indicators that can be used to reward good care: A rigorous hospital quality control program Active morbidity and mortality review with evidence of systems improvements
knowing what a policy covers without the threat of declined payments from the fund, especially after treatment has been provided. After only a moment’s pause, one quickly realises that the entire private health insurance industry requires regulatory evolution and significantly enhanced transparency. Doctors themselves need to always ensure their practice is evidencebased, would withstand impartial scrutiny, and that their fees are commensurate to the service offered. We need to empower government to start the discussion and commit to positive reform without fear of illinformed, destructive criticism. Q
Contribution to industry or patient registries thereby providing a degree of collegiate scrutiny Low infection rates Maintenance of an active clinical research program Agreed incentives must be employed together with penalties (e.g. for operating on the wrong side) after appropriate discussion with the profession. Wherever possible, these measures should reflect current evidence, clearly promote good practice and not be used to disadvantage patients in any way. Patients are not responsible for system failures. As above, there is no argument that truly preventable occurrences should incur penalty. A judicious combination of ‘carrot and stick’ could thus usefully be used in this manner to drive efficiency. Where care arrangements have been implicitly agreed with the purchase of an insurance policy, then the fund should not be allowed to unilaterally refuse to support a patient’s care plan. If there is a genuine safety and/or quality issue, then there are ample avenues already in existence to address these – not least of which is open, frank discussion with the parties involved. Clearly patients and doctors need to have the assurance of DoctorQ November 2015
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Feature story
AMA Queensland 2015 Advocacy in Review
Looking back, 2015 has been a big year for healthcare in Queensland. With your input into the health vision, AMA Queensland has used the vision to guide advocacy efforts to make Queensland a better place to practise medicine. AMA Queensland believes one of its most important roles is to support its members through policy development and advocacy. We do this in a number of ways, such as through internal policy development in consultation with members, and working with other stakeholders to press the case for reforms to the health system directly to key government representatives. We do this because we believe these reforms are not only necessary but because they will empower members to provide even higher quality medical care and, in turn, provide improved health outcomes for their patients. 2015 was an incredibly busy year in regards to AMA Queensland’s advocacy work, and we have had some key wins that have the potential to make Queensland the state to be if you’re a medical professional. It all started back in January 2015, when the then Premier Campbell Newman called an early election. Many political observers had predicted he would call an election in February or March, but
We do this because we believe these reforms are not only necessary but because they will empower members to provide even higher quality medical care and, in turn, provide improved health outcomes for their patients.
Newman visited the Governor in the first week of the New Year to call an election for 31 January. Even though the timing of the election was unexpected, AMA Queensland was not unprepared, having spent much of the latter half of 2014 preparing its election platform just in case an apparently unlikely January election became a reality. Our election platform focused on three key themes: advocacy for our members, advocacy for patients, and advocacy for the community. On the latter, we argued strongly for the Queensland Government to tackle obesity and to reduce the impact of alcohol related violence on the community. Our election platform also advocated for Queensland to improve the uptake of Advance Care Plans and to examine ways in which it could make it easier for doctors to access these plans. Finally, we also asked the Queensland Government to improve Queensland Health’s ICT system, to help our doctors do their job more effectively. Following the election, the Labor Party was elected under new Premier Annastacia Palaszczuk. The new government has made steady progress towards many of the initiatives AMA Queensland advocated for in its election platform. Attorney-General Yvette D’ath has started consultation on new laws to tackle alcohol-fuelled violence, and AMA Queensland has been part of that consultation process. Health Minister Cameron Dick released an end-of-life care strategy in May 2015. The Minister also announced a $1.2 billion ICT improvement strategy for Queensland Health. More work remains to be done on all three of these initiatives, but AMA Queensland is pleased with what has occurred so far. In April, AMA Queensland released the first chapter of its Health Vision, the
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November 2015 DoctorQ
first of five documents which will guide our advocacy efforts over the next five years. The Health Vision was developed in consultation with members and our internal committees such as the Council of General Practice and the Council of Doctors in Training to look for solutions to some of the health system’s most complex and challenging problems. The first chapter of the Health Vision advocated for a whole-ofgovernment public health plan to help tackle issues impacting on the health of Queenslanders, such as obesity, smoking, mental health, and generational disadvantage. With a mantra of ‘health in all policies’, this plan would remove the silo effect that currently exists between many government departments and coordinate the government’s response to public health issues such as obesity. It was envisaged the plan would also bring other organisations into the fold, such as local government and community health stakeholders like AMA Queensland, ensuring the government has access to expert medical policy advice during the development of the plan. The first chapter of the Health Vision also suggested a number of ways in which immunisation rates could be improved in Queensland, including innovative new ways of working with general practitioners to increase vaccination follow up rates. The Queensland Government has responded positively to the Health Vision’s proposals, budgeting $7.5 million over four years for the development of a whole-ofgovernment public health commission. AMA Queensland has been consulted on how this commission could work and we look forward to helping the government implement this important policy initiative. The government also budgeted $1.5 million to help families with children under five who are not up-to-date with their vaccinations to connect with their local GPs and vaccination clinics.
Feature story Part one to four of AMA Queensland’s Health Vision
The Queensland Government encouraged Queenslanders to get their flu shot in April. Premier Annastacia Palaszczuk lined up for her shot from Dr Wendy Burton.
AMA Queensland followed up on the success of Health Vision part one with the release of part two in June. In this chapter we called upon the Queensland Government to devolve workforce development responsibilities away from its regional Hospital and Health Services (HHS) and establish a leading statutory body named the Queensland Medical Education and Training Institute (QMETI). This new body would design, commission, conduct, coordinate, and evaluate education and training for patient care. QMETI would also support reforms to improve workforce capacity and the quality of clinical training, and provide a consistent, high quality training experience for junior doctors across Queensland. The Queensland Government has shown strong interest in this proposal, establishing a junior doctor working group to investigate how we can improve the training experience for junior doctors in Queensland. AMA Queensland is part of the working group and we will work towards ensuring QMETI becomes a reality. AMA Queensland was also asked to provide feedback on a number of pieces of draft legislation before the Queensland Parliament, and to provide submissions to several Government inquiries. For example, when the Queensland Government established the Hunter Review to examine how Queensland Health could be reorganised to make it a more efficient organisation and a better place to work, AMA Queensland provided a detailed submission with several recommendations on how these objectives could be implemented.
We also provided a submission to the Parliament’s Fly In, Fly Out (FIFO) inquiry, highlighting the health risks inherent to the FIFO lifestyle. Our submission got a large amount of media attention, and while the results of the inquiry are yet to be released, we expect the Parliament’s response to the inquiry to make a number of recommendations to government on how to address these challenges. Also of note were our submissions regarding the Mental Health Bill and the Public Health (Childcare Vaccination) and Other Legislation Amendment Bill, both of which AMA Queensland largely supported. However we did use the latter Bill to highlight our significant concerns around the performance of the Office of the Health Ombudsman, an issue on which we will continue to advocate as we head into 2016.
AMA Queensland President Dr Chris Zappala looks forward to working with Health Minister Cameron Dick in 2016.
2015 is not over yet and we still have much to discuss. In the coming months, AMA Queensland hopes to release a position statement on Queensland Health’s plan to introduce Clinical Prioritisation Criteria, and there are still more parts of the Health Vision to be released. AMA Queensland will continue to press its case for reforms and innovation in health policy and ensure the voice of the profession is heard. Copies of the Health Vision and all the submissions mentioned in this article are available on the AMA Queensland website. If you have any questions or policy concerns, please get in touch with our policy team at policy@amaq.com.au. Q
DoctorQ November 2015
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CURRENT ISSUES
surgeon statistics demand cultural change
a disturbing survey into discrimination, bullying, and sexual harassment by the royal australasian college of surgeons shows that a serious commitment to cultural change, education, and a solid complaints system is needed. “You can join us in theatre – not to do anything, just for eye candy.” “I was told I would only be considered for a job if I had my tubes tied.” These are but two of the experiences provided to the Royal Australasian College of Surgeons (RACS) Expert Advisory Group (EAG) on discrimination, bullying, and sexual harassment that delivered its final report on 28 September 2015. The report is available at www.surgeons.org. To say that the research, undertaken by the EAG, revealed some concerning empirical facts about the state of the profession is an understatement. The research found that: 49 per cent of Fellows, Trainees, and International Medical Graduates report being subjected to discrimination, bullying, or sexual harassment. 54 per cent of Trainees and 45 per cent of Fellows less than 10 years post-fellowship report being subjected to bullying. 71 per cent of hospitals reported discrimination, bullying, or sexual harassment by a surgeon in their hospital in the last five years, with bullying the most frequently reported issue. 39 per cent of Fellows, Trainees, and International Medical Graduates report bullying; 18 per cent report discrimination; 19 per cent report workplace harassment; and seven per cent report sexual harassment (with some reporting more than one behaviour). The problems exist across all surgical specialities and regions in Australia and New Zealand. Senior surgeons and surgical consultants are reported as the primary source of these problems. The EAG recommendations, accepted in their entirety by RACS, revolve around three core pillars, namely: 1. Cultural change and leadership With the active support of all Fellows, the College, and specialty societies can lead the way to a future in which there is no place for discrimination, bullying, and sexual harassment in the practice of surgery. This will take courage, resources, and a commitment to change. It will take enforcing the law and imposing sanctions as needed. It will take the College showing how to prevent and address discrimination, bullying, and 28
November 2015 DoctorQ
sexual harassment and how to hold people accountable for their behaviour, working with the medical profession, employers, and the healthcare sector more widely. Effective partnerships will be essential. It will take witnesses ending their silence and speaking out. To achieve the necessary fundamental cultural change, the College must also shine the light of independent scrutiny and greater transparency on its own assumptions and approaches. Critical self-reflection, fearless questioning of old habits and inherited practices, and a looser grip on tradition will be needed to shift the status quo. The risk to patient safety from discrimination, bullying, and sexual harassment must be top of mind. 2. Surgical education Surgical education needs to improve. Bullying, intimidation, and harassment are not acceptable approaches to educating adults. Profound changes to surgical education are therefore needed to address and prevent discrimination, bullying, and sexual harassment in the practice of surgery. All students learn best when they feel safe and supported. Surgical education at all levels needs to be reconfigured on the principles of respect, transparency, and broad professional excellence. In surgical education, the College and Specialty Societies must foster, ensure, and celebrate excellence in teaching and a broad understanding of professionalism, as well as technical skill. Independent oversight, individual and collective accountability for professional behaviour, and external scrutiny at all levels are needed. 3. Complaints management There needs to be a fundamental change in the management of complaints about discrimination, bullying, and sexual harassment in the practice of surgery. Independent scrutiny in complaints processes at all levels is non-negotiable if trust and confidence are to replace fear of retribution and silence. There must be processes that are transparent, robust, and fair. They must enable people to raise concerns without fear of victimisation and deal with both the causes and the effects of discrimination, bullying, and sexual harassment. Lodgement of complaints must be centralised across the College and independent oversight maintained. Consistent policies and agreed standards of behaviour are needed across the practice of surgery. Knowledge must be shared by those responsible for dealing with the issues, with information exchanged between the College,
specialty societies, and employers. The College must hold individuals accountable to its own standards, leading the way and supporting employers to follow suit. AMA Queensland is strongly supportive of the recommendations of the EAG and commends RACS for their adoption. However, there is a difference between the acceptance of a new approach and policy, and its acceptance and adoption by the broader professional group. The RACS approach should be judged not on the high quality report and research that it has produced, but on how these recommendations are implemented at every level of RACS. It has been known for the past 30 years that every healthcare worker has a right to a workplace free of discrimination, bullying, and sexual harassment. At last count, almost every training college and health service, including Queensland Health, has extensive sexual harassment, bullying, and discrimination policies. Yet these have not stopped the development of toxic workplace cultures that allow this conduct to fester and thrive. These have not magically stopped incidences of these behaviours. We welcome RACS’ acceptance of the importance of the culture of healthcare organisations and associations. Genuine, concerted efforts should be made to reform health organisations and address the causes of poor culture and morale. Every element, from training arrangements to staffing, should be on the table. As outlined in Part II of AMA Queensland’s Health Vision, we believe this culture change must begin at the top, with senior clinicians receiving dedicated leadership, education, and training. If a senior clinician is unable to meet this standard, then they should not teach or supervise others. Our junior doctors must have appropriate inspirations on which to model their behaviour. If a junior doctor engages in bullying, sexual harassment, or discrimination, they must be corrected immediately. Such behaviours cannot be allowed to continue unchallenged. AMA Queensland welcomes the acknowledgement from RACS of the enormous challenges facing the reform of healthcare culture. We will work constructively with all stakeholders to help implement reform that improves this culture for the better. AMA Queensland looks forward to responding to RACS’s action plan as the real work starts now. Q
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DoctorQ November 2015 03/07/2015 07:57:05
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Feature story
why we avoid americanisation in healthcare
a staff member’s close relative recently had a horror experience in the American health system. the story reiterates why Australians work so hard to avoid the Americanisation of healthcare. AMA Queensland has long advocated for a system that prioritises clinical outcomes and quality care over profit. In recent months, private health insurers’ attempts to insert themselves into the doctor-patient relationship have yet again raised concerns about the increasing cost of healthcare. Key stakeholders in the healthcare system, including medical professionals, politicians and patient advocacy groups, have long debated the implications of a system where decisions are taken out of the hands of patients and doctors and placed with private health insurers and hospitals. But we needn’t look far to see the impact this type of system can have. In Australia, there is a level of cognitive dissonance associated with the American healthcare system. On one hand, we laud it for its advanced technology, innovation, and leadership in care. Its innovativeness is a primary reason so many Australian medicos choose to spend at least some time in the States. At the same time, healthcare discourse frequently refers to the Americanisation of the healthcare system as a warning. It is our crystal ball very clearly displaying the dangers of a financially-driven system: inaccessibility to care, a focus on profit rather than clinical care, and an extended scope of practice that sees allied health professionals performing duties without adequate training. 30
November 2015 DoctorQ
Case studies are one of the most effective tools available to analyse the impact of policies and societal norms. The story, and the lessons that follow, are entirely based on the experience of an AMA Queensland staff member’s relative. Barbara’s experience Barbara is in her 50s when she learns she has a serious digestive issue requiring a highly invasive procedure. She is lucky to have health insurance through her husband’s employer, so she is able to quickly schedule the procedure at a hospital determined by her insurer. The surgery goes smoothly, though the doctor explains the problem was worse than anticipated. Barbara is discharged on the same day, a Friday, and sent home. As it is the weekend, she’s told the office will follow up the following week. By the middle of the following week, Barbara has not received any follow-up. Later that week, Barbara starts experiencing severe heart palpitations. After phoning the doctor’s office, she is referred to the emergency room, where they take her insurance details before allowing her to be treated. Whilst Barbara is being examined, an administrative staff member interrupts to obtain her $100 gap payment. She is upset at the insensitivity displayed, but provides payment and continues with the examination.
When Barbara recounts her experience, her family is angry with the hospital’s treatment and encourages her to lodge a complaint, but she is hesitant as that particular hospital provider has a monopoly with her insurer. Her bill for hospital fees comes to $15,000, of which she pays around $1,200. Why it matters Barbara received high quality care by welltrained clinicians, yet a number of concerns remain about her treatment and overall experience. While it is tempting to distance ourselves from the American health system, the underlying issues in her care are many of the issues currently being debated by policy makers. Accessibility of care Though various aspects of Barbara’s care raise concern, it is more concerning to consider the alternative: what if she had not had private health insurance? The average emergency department visit in the US comes to USD$1,233 – a cost that is 40 per cent higher than the average American’s monthly rent. While the cost of surgery is much more variable, it can easily cost in the tens of thousands, making healthcare out of reach for many low or middle-income families. Accessibility, regardless of means, is the foundation of the Australian healthcare system. Recent measures such as the government’s MBS rebate freeze, the now
Feature story
Commercialisation of medicine
The American system ... is a crystal ball that very clearly displays the dangers of a financiallydriven system. scrapped co-payment, and a trend towards quality and safety measures in hospitalprivate health insurer negotiations, create uncertainty around how costs will be shifted. Whilst AMA Queensland supports patients making reasonable contributions to their care, we remain adamant that any costs imposed must have proper measures to protect vulnerable populations. Groups such as children, the elderly, and Aboriginal and Torres Straight Islanders must be provided with the safeguards to ensure their care is not limited by their means. The role of primary health care as the health home A successful hospital procedure can be undone without appropriate clinical follow-up. In Australia, Barbara would have been provided with a primary care liaison who would be familiar with her medical history and assist in recovery, pain management, and any emergent concerns. In Australia, general practice is often referred to as ‘cradle to grave’ care. General practitioners play a crucial role in preventative care, diagnosis, and treatment of chronic conditions and acute care. Despite this vital function, we have seen a shift towards a government model that reduces investment in general practice by way of an MBS rebate freeze and attempts to implement poorly designed co-payments.
When a patient enters a hospital, or other clinical setting, their care should be top priority. While gap fees must be paid and insurance information received, interrupting a clinical appointment to gather this payment sends a dangerous message and breaks the trust and privacy that is so crucial to the doctor-patient relationship. As an advocate for doctors and the patients they serve, AMA believes it’s unacceptable to place cost before quality care. Trust and privacy are essential elements of the doctor-patient relationship. Any measure that treats a patient as a number, rather than an individual who needs sound and compassionate care, is flawed and detrimental to good health outcomes. Letting private health insurers call the shots The true intentions of major insurer Medibank Private became clear earlier this year in their contract negotiations with Calvary Healthcare. Medibank’s insistence on an arbitrary quality and safety clause, that included a list of 165 so-called “preventable events,” demonstrates a clear prioritisation of budget over care. Among the events Medibank refused to cover were infections, hospital readmissions, and falls – events that will never be completely eliminated, even with the highest standard of care. While Medibank and Calvary have since reached a confidential agreement, this type of guerrilla negotiation has set a dangerous precedent for future negotiations between healthcare providers and insurers. What about hospitals that refuse to be strongarmed into decisions that might pass the cost along to patients? We risk a shift to a system where patients no longer have a choice in which hospital to attend, taking away one of the key incentives for them to get insurance in the first place. In the US, patients are restricted to preferred healthcare providers – those that their insurance provider has negotiated a contract with. For Barbara, this means that despite living within 50km of 21 hospitals, she can only attend those owned and operated
by one provider. As a result, Barbara was hesitant to lodge a complaint, fearing it may one day negatively impact the quality of care she receives. Accountability and transparency are key to quality care. Barbara’s hesitancy to complain is a symptom of a system where corporations, rather than voters, call the shots. The relevance for Australia In Australia, we often attribute the flaws in the American health system to political and cultural factors that aren’t present in Australia. The simple tenant of accessibility has allowed us to do this convincingly, but we are currently seeing a shift towards a more commercialised system. Whilst some consider it a matter of semantics, a line must be drawn between a healthcare system and a healthcare industry. The former implies a fair, equitable, and accessible healthcare system that instils confidence in patients and doctors. The latter is indicative of a system that prioritises profit over people. The Australian health system is by no means perfect, but when we look on a global scale, it’s clear it remains one of the leaders in accessible quality care. In 2014, Bloomberg named the Australian healthcare system the 6th most efficient globally, beating other lauded systems such as the United Kingdom, Sweden, Germany, and Canada. Our system, which utilises public funds and reasonable contributions by those individuals able to afford private healthcare, does not need the drastic overhaul we so often hear politicians reference. Rather, our goal should be to increase efficiencies through reasonable steps to modernise the system and ensure accessibility remains a cornerstone. There is a saying that one cannot unring a bell, an idiom that certainly applies to healthcare policy. Even more difficult than implementing a policy is reversing an ineffective one. Organisations such as AMA Queensland have a responsibility to contribute to gradual, evidence-based change that will better the system and ensure the basic vision and values Australia was founded on, are upheld in our health policies. Q DoctorQ November 2015
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CURRENT ISSUES
Surviving the complaints process
ama queensland’s ethics and medico-legal committee explain how the process works when a complaint is being dealt with by the office of the health ombudsman. Dear Agony Aunt, I’ve been the subject of a complaint to the Office of the Health Ombudsman (OHO). Given the complaint is vexatious I’m confused as to why the OHO is taking so long to get back to me so I can get on with my life. Thanks, Dr Confused Complainee Dear Dr Confused Complainee,
The no evidence rule
This will be a stressful time for you. The research, as discussed in the last Doctor Q, shows that there are significant negative health effects for medical practitioners who are the subject of a complaint. It’s important that you have a strong support network of friends and family who can help you through this time. Help is only a phone call away, with the Doctors’ Health Advisory Service (Queensland) available on (07) 3833 4352.
The no evidence rule requires that the decision that is made must be based on logical evidence proven on the balance of probabilities.
I appreciate that it can seem that this process can take a very long time. While the introduction of time limits for acceptance, assessment, and investigation (seven days, 30 days, and one year respectively) has created an expectation of timeliness, despite their sometimes lax adherence, they still span a considerable time. However, there are several reasons why an assessment by the OHO is required to take the time it does. The issues must be ventilated fairly for both complainant and complainee. Broadly speaking, the action of the OHO’s powers must be in accordance with the concepts of natural justice and procedural fairness. These principles can be surmised as follows: The hearing rule The hearing rule requires the regulatory body to provide the person whose interests may be adversely affected by the decision, the opportunity to be heard. This can include the provision of appropriately detailed information about the complaint, the factual basis of the allegation, and the ability to respond. This information must be provided to the complainee in sufficient time so as to allow them to respond. The bias rule The bias rule requires that the decision maker should be disinterested and/or unbiased in the matter to be decided. 32
November 2015 DoctorQ
For the OHO to effectively discharge its duties in accordance with the principles of natural justice and procedural fairness, there is a necessary time delay while it collects the information and considers the evidence. While we appreciate that the time delay can feel like an eternity, rest assured that the lawyers and investigators are not sitting around, but instead discharging their responsibilities in accordance with the principles of natural justice and procedural fairness. AMA Queensland has been vocal about the need to reform aspects of OHO so as to effectively accomplish its objectives. We believe the cornerstone of an effective regulator is an appreciation of natural justice and procedural fairness. In answer to your original question, yes the time delay may seem unreasonable or ridiculous, but there is a broader purpose to ensure the decision is fair and reasonable to both parties and the overarching system. Agony Aunt Q
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CURRENT ISSUES
Resilience on the Run wraps up AMA Queensland recently concluded its landmark pilot Resilience on the Run project in Rockhampton. The program was designed, in conjunction with an expert project group, to help junior doctors recognise and respond to emotional fatigue and pressures. Delivered by Dr Ira van der Steenstraten, the course incorporated situations interns would be likely to face, such as adverse outcomes and difficult interpersonal relationships. AMA Queensland has been extremely pleased with the response to the program from the Rockhampton and Queensland medical communities. The program was well
received by the interns and touched on a real and genuine need among this group, with Dr Alistair Quinn noting: “We’re so used to giving advice that sometimes it can be difficult to receive it, and sometimes it can be difficult to put up your hand and say you’re struggling... junior doctors are under a lot of stress and a lot of pressure and I think we need to realise that we’re humans.” Resilience on the Run has also tapped a previously unmet need for these services, says Dr Annette Turley, Rockhampton Director of Clinical Training: “I think it gets harder for senior doctors to put their hand up and say they’re feeling burnout and fatigue and so having something available that would take them through some skills testing and learning would be useful for them as well.” The response from across the country has been staggering. The ABC ran a feature on the program, and we’ve had interest from across Australia into the program design and roll out. AMA Queensland is greatly appreciative of the support of the Rockhampton Base Hospital in agreeing to host the program.
Dr Francis Tomlinson NEUROSURGEON & SPINAL SURGEON
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The project group is currently analysing the findings with a single round of evaluation remaining. Once these findings are established they will form the bedrock of the AMA Queensland Doctors’ Health campaign. We call on the Queensland Government to commit to the expansion of the program to ensure that every intern, at a minimum, has access to this essential program. AMA Queensland would like to sincerely thank the AMA Queensland Foundation for its generous support of the project. The motto of ‘Doctors doing good’ is perfectly encapsulated in this project being able to provide junior doctors, who are making the transition from students to healers, with the skills and capabilities they need to do the best by themselves and their patients. Q 1. http://www.abc.net.au/news/2015-09-23/resilience-on-the-runprogram-helps-junior-doctors-deal-stress/6792432
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CURRENT ISSUES
Professor Michael Breakspear
Doctor Q had the chance to catch up with Queensland Health Research Fellow professor michael breakspear and learn about the advances his team is making in mental health research. in at least one family member. The first degree relatives were at higher than background risk of following suit, particularly in their late teens and twenties. These families are being followed to see who develops the disorder, to identify early clinical and neurobiological indicators and to understand the mechanisms of resilience in those who recover. “We know that the brains of the at risk group process emotional material subtly differently to those in the general community. In our recent work we have identified the brain network disturbances that underlie these differences and as a result, we can work towards novel clinical markers of genetic risk for bipolar disorder. These hold the potential for future work that aims to identify – and modify – the transition from high risk to prodrome and then the early manifestations of the disorder. ”
Professor Michael Breakspear sees mental health as the new frontier in medical research. “It is an area of the unknown where we are making discoveries that will make a difference to the practise of clinical psychiatry,” he said. As a psychiatrist, he wants to contribute to an understanding of major mental illnesses, such as mood disorders, schizophrenia, and dementia. These challenging diseases are social and health issues as they create both a substantial burden of illness in society and distress to those affected. Professor Breakspear is aiming to develop an innovative but pragmatic brain imaging protocol to aid diagnosis and management of patients at risk of bipolar disorder during his Queensland Health Research Fellowship. Combining his clinical training in psychiatry with a PhD in computational neuroscience, he is integrating advanced brain imaging and computational modelling with a longitudinal study of clinical outcomes. “One of the areas where we are achieving great headway is in our knowledge of bipolar disorder. It is well known that bipolar disorder has a strong hereditary component and we are starting to make inroads into the neurobiological underpinnings of this intergenerational transfer of risk.” Professor Breakspear and his research team studied a group of 16-30 year olds from families where bipolar disorder has occurred 36
November 2015 DoctorQ
For Professor Breakspear, improving the community’s mental health is more than a medical issue. It is a social justice cause that is increasingly being addressed in creative approaches. He hopes that in applying the principles of maths and physics to understanding the brain, he, and the mental health research community, may come up with new insights into the principles of healthy brain function as well as the changes that accompany psychiatric disorders. Q
Bipolar disorder is only one of the psychiatric disorders that Professor Breakspear is studying. His team is working on a variety of research projects that range from the early detection of potential developmental delay in very early premature babies to the use of noninvasive technologies like facial recognition to detect major depression. Professor Breakspear is part of an international team, with researchers from Finland and Norway, that has developed a tool to identify long-term cognitive problems in premature babies. They examined electrical recordings of the brains in very premature infants which characteristically show a very erratic pattern of electrical bursts. By using techniques developed in physics, the team discovered patterns in the nature of these erratic bursts which pre-empt short- and long-term neuronal compromise. These include intracerebral haemorrhage as well as delayed mental development. Breakspear’s team has also been looking into new treatments for people with melancholia and depression through an innovative experiment monitoring brain activity while participants watch emotional movies. They found reduced activity in key emotional circuits of the brain in depressed subjects as well as altered patterns of communication between cortical areas. “These findings have clinical potential assisting diagnosis and monitoring response to treatment. Further extensions lend themselves to planning brain stimulation treatment in patients with melancholia.”
Professor Breakspear is aiming to develop an innovative but pragmatic brain imaging protocol to aid diagnosis and management of patients at risk of bipolar disorder.
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CURRENT ISSUES
All great stories need a good ending
the queensland clinical senate has developed a charter to empower patients to make decisions about how to spend their last days. The charter is now endorsed and available for Queensland hospitals and healthcare settings. At 75, there was no stopping Karen. A grandmother of five, the former nurse was always on the go. In between babysitting her youngest grandchild, bowling, and outings with friends, she was busy planning a trip around Australia.
Health Consumers Queensland Chairperson Mark Tucker-Evans said the charter aimed to enable patients, their families, carers and healthcare workers to openly discuss the person’s wishes and improve care at the end of life.
But Karen’s plans came to a grinding halt when she was diagnosed with terminal cancer and given just 12 months to live. Up until this point, Karen hadn’t experienced any major health problems and had generally enjoyed good health. She was now facing the end of her life.
“These conversations should be had now with our loved ones, so our wishes can be carried out at the end of our life,” he said.
Karen was fortunate to be surrounded by three wonderful daughters with whom she was very close. She sat down with them one Saturday afternoon and spoke about what she wanted in her final days. She wrote it down and gave them, along with the hospital staff, a copy. She spoke to numerous staff about it – some of the conversations were easy and some difficult. But Karen knew what she wanted, and wanted those looking after her and making decisions for her to know too. This is not the experience for everyone. Most people aren’t aware of their rights at the end of their life, and don’t have the confidence to ask questions or make decisions. Similarly, many healthcare professionals who care for patients at the end of their life are not equipped to manage end-of-life care discussions appropriately. Knowing this, the Queensland Clinical Senate partnered with Health Consumers Queensland to discuss end-of-life care and what could be done to make the experience more positive for everyone involved. “People nearing the end of their life need to be empowered to make decisions about how they will spend their final days,” said Queensland Clinical Senate Chair Dr David Rosengren. “And health professionals caring for these patients need the tools to have these difficult conversations.” More than 150 senior clinicians and consumers canvassed the topic, and among the outcomes was the development of a charter for care of adult patients at the end of life. The charter is now endorsed and available for Queensland hospitals and healthcare settings. 38
November 2015 DoctorQ
A copy of the charter is available on the Queensland Health website. Other recommendations from the forum included: investment in clinician and student clinician education and training on care at the end of life; a community engagement and public awareness campaign to improve consumer knowledge of end-of-life care, and the development of integrated end-of-life care models that focus on improving the service integration between primary and acute care sectors to provide seamless support to the patient and their carers. “Clinicians from all healthcare settings have a responsibility to provide appropriate end-oflife care to patients,” Dr Rosengren said. “This requires them to work together, across settings and sectors, to provide care that reflects the patient’s wishes.” Q
People nearing the end of their life need to be empowered to make decisions about how they will spend their final days.
CURRENT ISSUES
MBS review on wrong trajectory The MBS Review is an important process which AMA has always, and will continue to, support. But that doesn’t mean we have to agree with every part of it. The Medicare Benefits Schedule (MBS) Review is exactly that: a review. It is an examination of the entire schedule with the purpose of ensuring it supports quality clinical care, and removes anything that doesn’t meet that criteria. The AMA believes the emphasis of the review should be on patient care, and we support that, but it is also important to remember that our healthcare system is already achieving excellent results. The performance of Australia’s health system and the outcomes it produces are ranked highly amongst other Organisation for Economic Co-operation and Development (OECD) countries. Given that the first port of call in the Australian healthcare system is the GP office, it is our nation’s primary care sector that deserves a large share of this credit. The latest Bettering the Evaluation and Care of Health (BEACH) report data shows that in the April 2013–March 2014 year, just over 85 per cent of the Australian population claimed for at least one GP service from Medicare. Medicare paid rebates for about 126.8 million general practice service items (excluding practice nurse items) an average of 5.59 GP visits per head of population, or 6.57 visits per person who visited at least once. A decade earlier, total Medicare claims for GP–patient encounters numbered 96.3 million - an average attendance rate of 4.3 per head of population. This investment is also paying dividends, with a National Health Performance Authority report showing that most Australians have a positive perception of care received from their GP. So although AMA supports the MBS Review, we do have concerns that any attempt to make wholesale change to the system, or to arbitrarily cut costs, could compromise the excellent outcomes our system is currently delivering.
The review must deliver a schedule that reflects modern medical practice by identifying outdated items and replacing them with new items that describe the medical services provided today. The Medical Services Advisory Committee (MSAC) process should be reserved only for new services that have not yet become part of routine practice today. If new items can’t be added, the review will simply be a savings exercise, which the AMA cannot support because of the adverse impact that will have on patient care. Similarly, any review of the MBS that pre-empts the outcome, in terms of individual procedures and generation of savings towards the budget bottom line instead of into services, cannot be supported by the AMA. Commentary by the Australian Minister for Health and academics has set the course of the MBS review on the wrong trajectory. There is no evidence base to characterising 30 per cent of health care in Australia as unnecessary and harmful. There are very big differences between Australian and American healthcare practices (as demonstrated in our feature article) and the estimated 30 per cent of waste in the US relates to regulatory and administrative costs as well as medical costs, and cannot be applied to the Australian health system. The review process must inform the establishment of a mechanism for ongoing review of MBS items to ensure the MBS remains up-to-date. The mechanism must be flexible to facilitate clinical review of services that don’t have, or need, a strong evidence base to support their continued funding under the MBS. We also reject that all Australian doctors are practising against the interests of their patients for financial gain. The AMA believes
the MBS Review is not the mechanism for addressing aberrant behaviour. In closing, the review has the support of AMA, but we do have a number of concerns around the intent of the review. Although AMA is not participating in the review in a formal way, we will continue to discuss these issues with the Minister and others to advocate for better outcomes. To do that for the entire profession, the AMA will engage with the medical groups to understand their concerns about the individual reviews as they progress. Q
Although AMA supports the MBS Review, we do have concerns that any attempt to make wholesale change to the system, or to arbitrarily cut costs, could compromise the excellent outcomes our system is currently delivering. DoctorQ November 2015
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MEMBER NEWS
Congratulations to the following doctors who are now elected members of AMA Queensland. August 2015
September 2015
doctors in training
doctors in training
Dr Fauzia Muhammed Dr Katy Sullivan Dr William Bushby Dr Sarah Yuen Dr Tuan Ha Dr Thomas Moore Dr Benjamin Lim Dr Courtney Tate Dr Nathaniel Milani Dr Kate McDonald Dr Louise Bell Dr Samuel Ibrahim Dr Marlina Ab Rahman Dr Karen Gebusion
Dr Jessica Kwari Dr Keil Auer Dr Shail Tewary Dr Ishwar Bhattarai Dr Anthony De Nardo Dr Kendall Sharpe Dr Rhian Sheppeard Dr Daniel Anderson Dr Shannan Dickinson Dr Rae Madison Dr Narcisa Stancu
General Practitioners Dr George Dohnalek Dr Claire Poolman Dr Harshad Naik Dr Andrew J Weissenberger Dr Kelly Young Dr Deirdre Keary Dr Michael Long Dr Eritabeta Maen Dr Damian Webb Dr Sarah Cunningham Dr Gagandeep Sharma Dr Conor Calder-Potts Dr Fiona Raciti Dr Anna McElrea Dr Sharmila Raju Dr Shawn Perera Dr Kelly Lai Dr Robyn Shirlaw Dr Shamim Siddiqui Dr Anuke Warakaulle Dr Sarat Tata Dr Ali Kolahdooz Dr Anna Alderton
General Practitioners Dr Richard Beatty Dr Leocadio Blanco Izquierdo Dr David Candler Dr Mobolaji Farotimi Dr Erik Lai Dr Rabbani Mihrshahi Dr Sandra Steele Dr Masoud Absalan Dr Roderick Chiu Dr Esther Mowat Dr Myint Soe Dr Hamid Taghipour Fard Ardekani
specialists Dr Patrick Carroll Dr Morgan Pokorny Dr Mark Richardson Dr David J Schlect
part-time Practitioners Dr Rachel M Claydon Dr Karen Shepherd Dr Sara Burton Dr Helene Cooper
specialists
SALARIED
Dr Joseph Churton Dr Andreas Laut Dr Jason Hwang Dr Robert Butler
Dr David Morrissey Dr Alex Olumbe Dr Deborah A Pfeiffer A/Prof K M Atifur Rahman Dr Yee Weng Wong
part-time Practitioners
renew for 2016
To enjoy uninterrupted membership and access to all the services offered by AMA Queensland, your 2016 subscription is due by 31 December 2015. AMA Queensland has been working diligently to advocate for all members across all specialties and career stages. This year, AMA Queensland and ASMOFQ fought hard for fair employment terms and conditions for Salaried Medical Officers and Doctors in Training that restore the employment rights lost under previous contracts. This includes the negotiation of MOCA 4 which will improve vital entitlements, including fatigue provisions, protection of working hours, equity of payment for motor vehicle allowances, and a 2.5 per cent salary increase per annum. Doctors in Training will also benefit from the introduction of indexation for professional development allowances to provide for increases year on year. AMA Queensland recently launched our Resilience on the Run program to help Doctors in Training deal with the stresses and challenges of intern year. We also hosted our second sell-out Junior Doctor Conference supporting their professional development needs. Furthermore, our new alliance with MDA National offers Doctors in Training complimentary medical indemnity insurance (for eligible post-graduate doctors) and premium reductions (for eligible doctors in specialist training). At a federal level, we successfully advocated against the co-payment on General Practitioner services and continue to advocate against the MBS rebate freeze. On behalf of specialists, AMA has led the charge against private health insurers inserting themselves into the doctor-patient relationship - a battle that is far from over. We are also rallying against the recently proposed increase in GST on health services, which will impact the most disadvantaged and vulnerable patients. Q
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40
November 2015 DoctorQ
renew or switch to monthly payments by 31 december 2015 to go in the draw for one of four $500 Coles/Myer vouchers
MEMBER NEWS
member profile: Drs eshini perera and ethan salleh
Drs Eshini Perera and Ethan Salleh are GP registrars at the Gladstone Road Medical Centre, which specialises in caring for Lesbian, Gay, Bisexual, Transgender, Intersex, and Questioning (LGBTIQ) patients. Peter, a 19 year old gentleman attends clinic today to discuss something delicate. We have been attending to his medical needs over the last year since he moved from Toowoomba. Today however, he seemed a little apprehensive. “Doc…” he stammered, “I was wondering if you are able to help me with a sensitive matter….. Is there anything that you can do to help me feel more feminine?” Such a request is not uncommonly encountered working in an LGBTIQ medical centre. Drs Eshini Perera and Ethan Salleh are GP registrars working at the Gladstone Road Medical Centre at Highgate Hill, a suburb in South Brisbane. They are supervised by Dr Gale Beardman, a pioneer in transgender health. The centre has a special interest in caring for individuals from the LGBTIQ community. Their reasons for working with the LGBTIQ community are quite different. For Eshini, her interest in this area was sparked when she met her first transgender patient whilst working in an outer suburban general practice centre. “My patient presented requesting to be more feminine. However, I did not have the knowledge or resources to help her at that time. The social and medical issues faced by the transgender community are complex and require time and a special rapport. I am honoured that a patient would trust me with their deepest secrets. I can’t imagine the turmoil that transgender people face in everyday life living a body that doesn’t match their true identity,” said Dr Perera.
and sexual and physical violence. They face significant mental health issues. In particular, the transgender community experiences higher levels of depression and anxiety due to their confusion surrounding their sense of identity. Suicide rates are significantly higher in this group. There are limited services available for the transgender community. The Brisbane Gender Clinic is the main support facility and has been operating since 1994. The main support group for transgender people is the Australian Transgender Support Association of Queensland (ATSAQ – www. atsaq.com). Other groups include FTM Brisbane (For Trans-men), Many Genders, One Voice (MGOV), and Jelly Beans Trans Youth Group. The clinic assists transgender patients in navigating the medical, emotional, and legal issues surrounding their transformation. These include: provision of hormonal treatment, referral to psychiatric and psychology services, and providing assistance with navigating the legal aspect of changing their gender and identity. Legal aspects include name change, gender marker change in Medicare (to allow for PBS authority for hormone therapy), and assistance with changing their gender identity for other legal documents (including drivers licence and passport). The main challenge faced by medical practitioners is dealing with the significant psychological distress faced by the transgender individuals. This requires time
and patience. However, it is a rewarding experience for practitioners to be able to follow patients through their identity and/or gender transformation journey. Peter has since changed her name to Peta-Rose. She started hormone replacement therapy and has legally changed her name and gender marker in all her legal documents. She is feeling more content and looks forward to her upcoming gender reassignment surgery. Q
The main issues faced by transgender patients include estrangement from family and friends, discrimination in the community, and sexual and physical violence.
For Ethan, stumbling into sexual health and HIV medicine came as an unexpected surprise. His journey into sexual health began when he was encouraged by a colleague to attend a course in sexual health and HIV medicine in 2014. This then led to him attaining his S100 prescriber status in the Highly Specialised Drugs Program for HIV medicines. He joined the Gladstone Road Medical Centre to further his skills in managing patients with HIV. “Although the main focus of my training has been in HIV medicine, I have also been tasked by the practice to look after members of the transgender community. It has been a privilege to have been given the opportunity to work with dedicated GPs who care for members of a community who have specialised needs that most GP practices are not able to offer,” said Dr Salleh. The main issues faced by transgender patients include estrangement from family and friends, discrimination in the community, DoctorQ November 2015
41
events calendar
what’s on 26 November
Resume Writing for junior doctors Hunstanton, AMA Queensland By popular demand, AMA Queensland will host a resume writing workshop to help you attract your ideal role. A stand-out resume and LinkedIn profile is essential in today’s job market, and this seminar will show you what you need to do today to support your career tomorrow and beyond. The workshop will also be available via webinar.
From Boring to Brilliant Stand-out resumés and Linkedin profiles
3 December
10 december
wine evening
gold coast Intern Workshop
Hunstanton, AMA Queensland So often in wine circles we hear references to European wine, but what’s it all about? How good is Australian wine on the world stage? Is champagne all it’s cracked up to be? Is Hermitage as good as an Aussie shiraz? Are the Spanish really the masters of tempranillo? Come along and find out when Phil Manser from Wines Direct hosts a wine evening.
15 december
Townsville Intern Workshop Rydges Townsville Saturday 31 October 2015, law society house, Brisbane CBD
Presented by junior doctors and industry experts, the workshop will ease the transition from student to medical practitioner.
10 March
Hunstanton, AMA Queensland
Victoria Park Golf Complex
In 50 years, many of our loyal members have not only seen, but been a part of, a lot of change in medicine in Queensland. In early December, we’ll celebrate those members who have clocked up a half-century with morning tea and a chance to catch up with colleagues.
November 2015 DoctorQ
Southport Sharks Events Centre
1 december
member milestones
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Third annual
To view the full events calendar
research evening Research is one of the best ways to build your skill set and get the competitive edge. AMA Queensland’s Council of Doctors in Training will present the second annual Research evening to cover topics such as why you should do research, the practicalities of being a clinician researcher, and how to present and get published.
Or to register for an event, visit amaq.com.au or contact the AMA Queensland Membership team on (07) 3872 2222 or email registrations@amaq.com.au
events calendar
2016 events
April and November
13 may
private practice tours
annual general meeting
25 and 26 june
31 august
junior doctor conference
Women in Medicine Breakfast
19 to 23 September
28 and 29 october
annual Conference
Confirm details closer to dates
Medico-Legal and Private Practice Conference
please note: 2016 dates and venues may be subject to change but are provided as a guide. DoctorQ November 2015
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People & EVENTS
join your lma
Local Medical Association round up Stay connected with colleagues and up-to-date with the latest health news and issues affecting your local area. Don’t stand on the sidelines —join your Local Medical Association today and make a difference. Sunshine Coast Contact: Jo Bourke Phone: (07) 5479 3979
Toowoomba and Darling Downs Email: info@tddlma.org.au Web: www.tddlma.org.au
Dr Chris Zappala Visits LMA Meetings
Meeting dates: 26 November Speakers:
Bundaberg Contact: Dr Daud Yunus Phone: (07) 4152 2888 Email: daud.yunus@gmail.com
AMA Queensland President Dr Chris Zappala will attend a number of these meetings to meet members and hear their concerns. He will also discuss:
Dr Bev Powell, Gynaecologist Topic: Sex, Lies and Laserbeams, (or Nonhormonal Treatment of Vaginal Atrophy)
Brisbane Northside Contact: Dr Graham McNally Phone: (07) 3265 3111 Web: www.northsidelma.com
Dr Olivia Bigault and Dr Debra Furness, Radiation Oncologists Topic: TBC
Meeting dates: 8 December
Dr Chris Zappala to attend
Dr Rachael Sharman, University of the Sunshine Coast Topic: Concussion in sport Cairns Contact: Dr Sharmila Biswas Phone: (07) 4036 4333 Meeting dates: 27 November Dr Chris Zappala to attend mackay Contact: Dr Bill Boyd Phone: 0419 676 660
Private health insurance reform Nurse endoscopy / role substitution MBS item freeze The Queensland Medical Education and Training Institute (QMETI) Health complaints process / OHO reform
Redcliffe and District Contact: Margaret McPherson Phone: (07) 3121 4043 Web: www.rdma.org.au Meeting dates: 4 December (Christmas function) Dr Chris Zappala to attend Gold Coast Phone: 0419 780 505 Email: info@gcma.org.au Web: www.gcma.org.au
Next meeting planned for February 2016
fraser Coast Contact: Drs Thomas Dunn and Paul Neeskens Email: tomdunn@bigpond.com.au
Central Queensland Contact: Dr Michael Donohue Phone: 0419 715 658
ipswich and west moreton Contact: Dr Thomas McEniery Phone: (07) 3281 1177
Meeting dates: 25 November
Meeting dates: 18 February 2016 (AGM)
Speakers: Dr Gary Dyke Topic: The future of surgery at Rockhampton Hospital Dr Julia Lisle Topic: Latest research on dementia and best practice
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If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.
can’t find your local area?
Providing exceptional healthcare to this generation and beyond
Mater Private Hospital Springfield Stage one open now Mater’s newest hospital, Mater Private Hospital Springfield is now open and caring for patients. Stage one of Mater Private Hospital Springfield is an 80-bed, $85 million hospital, including a state-of-the-art cancer care centre, partially funded by $21.4 million from the Australian Government. Initially Mater Private Hospital Springfield will focus on referral based short stay elective surgical and medical care, with Stage two expansion plans to include a greater variety of specialities.
Building healthy communities Mater is committed to caring for the Greater Springfield community as it continues to grow. Planning is underway for future expansion, including an emergency department and maternity services, all with the aim of providing exceptional healthcare for this generation and beyond.
Mater Private Hospital Springfield joins Mater’s existing network of hospitals, community health centres, world-class medical research institute and pathology and pharmacy businesses— all with one aim— to provide Exceptional Care.
Designed to provide the highest level of comfort to patients and families • 10 000 m² facility • Four digital theatres • Day surgery unit with 16 beds • 64 inpatient beds, with fold away visitor bed in every room • Integrated room controls for lighting and temperature controls • Outdoor healing garden • Hotel style room service ordering system • Mater Cancer Care Centre – – – –
Linear accelerator 15 medical oncology treatment bays two radiation treatment rooms Radiation Oncology Queensland onsite
Surgical:
Medical:
Ear, Nose and Throat, Gastroenterology, General Surgery, Gynaecology, Ophthalmology, Oral and Maxillofacial, Orthopaedics, Plastics, Urology
Dermatology, General Medicine, Medical Oncology, Radiation Oncology Rehabilitation, Respiratory
Mater Private Hospital Springfield 7002 Health Care Drive, Springfield Central Qld 4300
mater.org.au/mphs
07 3098 3900
People & EVENTS
book review
Death rules: how death shapes life on earth, and what it means for us
With associate professor will cairns locked in for the 2016 Junior doctor conference, we asked ama queensland council of doctors in training chair Dr malcolm forbes to review his book, death rules: how death shapes life on earth, and what it means for us. Associate Professor Will Cairns is Director of the Townsville Palliative Care Service. His book Death Rules is an illuminating and accessible work that explores the concept of death through a naturalistic prism, challenging us to confront our views about life and death. Cairns introduces the book by imploring us to wrangle free from the constraints of our cultural and religious baggage to contemplate death in a scientifically objective and brutally honest manner. What follows is an eloquent description of the biology of death and dying, an analysis of how humans die and how we cope with the death of others and finally, informed speculation on how humans may die in the future.
Associate Professor Will Cairns Vivid Publishing e-book $9.99 US ($14AUS)
Cairns introduces the book by imploring us to wrangle free from our cultural and religious constraints to contemplate death in a scientifically objective and brutally honest manner. 46
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The book begins and ends with a narrative describing Raine Island, a remote and uninhabited island off the coast of North Queensland. Cairns utilises vignettes of the flora and fauna on this island – a microcosm of the dynamic and fragile ecosystem of Earth – to demonstrate that death is a driver of evolution and a necessity for the propagation of life. Cairns explains complex scientific concepts with clarity, informed by a solid comprehension of evolutionary and molecular biology. These explanations are pleasantly interspersed by personal anecdotes from a long and remarkable career in medicine. In the latter third of the book, the relationship between modern society and death is considered. In the past 13 years, the Queensland Health Budget has increased 235 per cent. Health costs will increase as our demographic structure slowly transforms
into inverted triangle with our aging population. While lauding the achievements of modern medical technology, Cairns bemoans the culture of life prolongation at all costs, especially with treatment that offers a low likelihood of benefit and denies patients the opportunity to deal with their impending death with dignity and grace. This chapter resonated strongly with me and invoked memories of a patient I consulted in ICU as a gastroenterology basic trainee. This hapless man was ventilated, had unrecordable platelets, and was bleeding from the bowel. He had terminal blood cancer. Despite the patent futility of further treatment, he remained on chemotherapy and the haematology team had requested we review him to consider a gastroscopy. As doctors, with our knowledge of the limitations of modern medicine, many of us would eschew life-prolonging treatments with significant side effects and limited benefit if we had a terminal illness. However, this is often not the case for our patients. Greater efforts must be made to assist our patients in making truly informed decisions. This book, in addressing how we philosophically approach death as individuals and as a society, is an important tool in these efforts. As Cairns aptly states – death, for all of us, is natural, normal, and inevitable. We only have a finite period of time on this earth. This book, in reminding us of our mortality, offers an opportunity for us to reconsider how we spend our limited years. When we die, we all want to experience a peaceful death. More doctors reading this book will help the profession achieve that aim for our patients. Q
Associate Professor Will Cairns Associate Professor Will Cairns is Director of the Townsville Palliative Care Service. His father is a scientist and Will was raised in a household of open and enthusiastic scientific discussion. He spent much of his early childhood in Australia before his family moved in 1963 to Cold Spring Harbor Laboratory on Long Island in the USA. After graduating from Brown University in 1971, he attended medical school in London before moving with his young family in 1978 to Townsville in tropical Queensland. In 2010 he was awarded an OAM for his leadership in the development of palliative care services in Townsville and the creation of the specialty of Palliative Medicine in Australia. Catch Associate Professor Cairns at the Third Annual Junior Doctor Conference in Brisbane on 25-26 June 2016.
Saturday 25 - Sunday 26 June 2016 BRISBANE CONVENTION AND EXHIBITION CENTRE Featuring Laureate Professor Peter Doherty, Microbiologist, University of Melbourne // Professor Patrick McGorry AO, Psychiatrist and Executive Director, Orygen // Winthrop Professor Fiona Wood AM, Director of the Burns Service of WA and Director of the Burn Injury Research Unit UWA // Professor Ranjana Srivastava, Oncologist, Monash Health and Author of Dying for a Chat // Associate Professor Munjed Al Muderis, Osseointegration Surgeon and Author of Walking Free // Dr Will Cairns, Palliative Care Specialist, Townsville Hospital and Author of Death Rules // Dr Alex Markwell, Staff Specialist, RBWH and AMA Queensland Past President // Dr Nikki Stamp, Cardiothoracic Surgeon, Royal Alexandra Hospital for Children (Children’s Hospital at Westmead) // Dr Ginni Mansberg, General Practitioner and presenter, Sunrise // Dr Leigh Atkinson AO, Neurosurgeon, The Wesley Hospital // Robert Hoge, Author and Communications Professional
Featuring the workshops Maximising your chances of success for College applications // Mock interview skills demonstration // My specialty is the best – a debate on the pros and cons of different specialty pathways // Getting past the primary exams Submit a research abstract or your best moment in medicine for JDC Submit an abstract on a research topic or your best moment in medicine to present at the JDC. Great prizes on offer. Applications open in February via the AMA Queensland website www.amaq.com.au Full program and subsidised Student Member and Doctor in Training Member rates will be released in January 2016 on the AMA Queensland website www.amaq.com.au
professional services
ending the doctorpatient relationship
not all doctor-patient relationships are successful. mda national’s dr sara bird explains what to do if you face a situation where it is appropriate to end a therapeutic relationship with a patient.
Dr Sara Bird MDA National Manager - Medico-legal and Advisory Services 1800 011 255 peaceofmind@mdanational. com.au Dr Bird has worked with medical defence organisations as a claims manager and medico-legal adviser. She has a particular interest in clinical risk management.
For many doctors, acknowledging that they are no longer able, or willing, to look after a patient is not easy and goes against their understanding of their professional obligations as a doctor. Some doctors may be worried about potential liability, based on the American concept of “patient abandonment”. However, it is important to be aware that it is acceptable and, in certain circumstances, advisable to terminate a therapeutic relationship with a patient. The key issues are to recognise when it is appropriate to do so, and know how to do it without breaching your legal and professional obligations as a doctor. Grounds for ending the doctor-patient relationship There are a variety of reasons why doctors decide that a doctor-patient relationship has irrevocably broken down. These include: unacceptable patient behaviour – such as verbal abuse, threatened or actual violence, harassment, and other boundary violations including “lovelorn” patients; a loss of mutual trust and respect and/or a breakdown in communication; continual non-compliance with management recommendations; and criminal acts by a patient, such as forging certificates.
It is acceptable and, in certain circumstances, advisable, to terminate a therapeutic relationship with a patient.
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.
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Not all therapeutic relationships are going to be successful. It is important to remember that one doctor’s difficult or heartsick patient is not necessarily another doctor’s difficult patient. If you are feeling anxious, fearful, angry, or emotionally wound up about a particular patient, then you are not being the best doctor you can be, and the patient is likely to receive better and more effective care from another doctor. Legal obligations In general terms, there is no legal obligation imposed on a doctor to see any particular patient, except in a genuine emergency situation. Therefore, there is no legal duty to continue a doctor-patient relationship once it has commenced. However, it should be noted that some employed doctors may be under a contractual obligation to see certain patients, e.g. in an emergency department setting. It is also important to be aware that health practitioners must not refuse to treat patients based on unlawful discrimination – that is, treating a particular patient (or group of patients) less favourably than they would another patient without a particular characteristic such as disability, race, religion, sex, or gender identity.
for Doctors in Australia when ending a doctorpatient relationship. The Code states: Ending a professional relationship In some circumstances, the relationship between a doctor and patient may become ineffective or compromised, and you may need to end it. Good medical practice involves ensuring that the patient is adequately informed of your decision and facilitating arrangements for the continuing care of the patient, including passing on relevant clinical information.1 Ending the doctor-patient relationship: steps to follow Depending on the circumstances, the doctorpatient relationship can be terminated in a face to face meeting or consultation with the patient, by phone, and/or in writing. Regardless of the method used, it is important to note the following: 1. Inform the patient that the doctor-patient relationship has irrevocably broken down and therefore it is in the patient’s best interests to seek ongoing medical care from another doctor. You may also need to inform the referring practitioner, other specialist colleagues involved in the patient’s care, and/or the local hospital that you are no longer involved in the patient’s care. 2. Advise the patient and, if relevant, the referring practitioner(s) of any outstanding clinical issues that require follow-up and a timeframe for doing this. 3. If the patient will be attending another practice, ask the patient to inform your practice in writing of the name of the patient’s new treating doctor so that a copy of their medical records can be promptly forwarded, to facilitate continuity of the patient’s medical care. 4. Inform your practice staff that the doctorpatient relationship has been terminated, so that no further appointments are made for the patient with you. Also remember to cancel any reminders in the record keeping system. The key issues are to communicate the termination of the therapeutic relationship in clear and unambiguous terms, “drawing the line in the sand”, and confirming that the decision has been made in the best interests of the patient. If you find yourself in the difficult situation of having to end a doctor-patient relationship, we encourage you to contact your medical defence organisation for advice and support.
Professional obligations Doctors need to comply with the Medical Board of Australia’s Good Medical Practice: a Code of Conduct
1. Medical Board of Australia. Good Medical Practice: A Code of Conduct for Doctors in Australia. Available at: medicalboard.gov.au/Codes-GuidelinesPolicies/Code-of-conduct.aspx.
Supporting Queensland’s medical profession together MDA National and AMA Queensland share a strategic alliance to support our collective Members and our local medical profession via: promotion of doctors’ health and wellbeing education, events and collaborative initiatives fundraising for our local medical community through AMA Queensland Foundation and MDA National’s Corporate Social Responsibility Program complimentary medical indemnity for post graduate doctors* 50% premium reduction for eligible doctors in specialist training off the total cost of MDA National’s medical indemnity.*
amaq.com.au
mdanational.com.au
*Premium reductions are applicable for MDA National’s eligible “post graduate” and “doctor in specialist training” categories, where you are a member of both MDA National and AMA Queensland. For more detail visit the Industry Alliance page at mdanational.com.au. These reductions cannot be claimed in conjunction with any other offer. Subject to the terms and conditions of the Professional Indemnity Insurance Policy and underwriting approval. The MDA National Group is made up of MDA National Limited (MDA National) ABN 67 055 801 771 and MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073. Insurance products are underwritten by MDA National Insurance. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your personal circumstances and read the Product Disclosure Statement and Policy Wording and Supplementary PDS and Endorsement to the Policy Wording available at mdanational.com.au. DIP199
WE HAVE IDEAS FOR YOUR LAST MINUTE CHRISTMAS SHOPPING Renew your AMA membership with your AMA American Express® Credit Card for your chance to win one of three $1,000 credits on your card! *Terms & Conditions apply
NSW permit no LTPS/15/07755 and ACT permit no: ACT TP 15/07619
AMA Queensland Business Support Services
Saving you valuable time Our professional team can help you with: Book-keeping
Marketing and communications
Meetings and events
Customised services
Membership needs Who do we help? Private practices, committees, associations, societies and colleges. Find out today how AMA Business Support Services can save you valuable time! P: (07) 3872 2222 W: www.amaq.com.au E: bss@amaq.com.au
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As a new client you will receive a free award subscription update!
SPECIAL OFFER!
owning your practice property
professional services
BOQ Specialist’s Jeff Miller shows how Owning your practice property offers great benefits throughout your career, while Purchasing through your SelfManaged Super Fund (SMSF) may enhance these advantages further. Australia’s well-documented love affair with property means most of us have a solid understanding of the benefits of investing in residential property and the financial processes involved. However, when it comes to buying commercial property for your practice premises, some medical professionals may question the real advantages of ownership, what to look for in a property, and how to set up the financial arrangements. Approaching a commercial property purchase doesn’t have to be daunting and there are significant tax savings and career development advantages that may make it well worthwhile. Owning your practice through your self-managed super fund (SMSF) may be a particularly effective way to access these benefits at various stages of your medical career if commercial property investment is within your SMSF investment strategy. Own a new asset and grow your nest egg Savvy medical professionals are borrowing through their SMSF to purchase their practice premises. Using the current balance of your SMSF as a loan deposit means you effectively pay the rent to your SMSF rather than a landlord. By taking this approach you may be able to acquire an asset which can generate income for your retirement. If done correctly, it can be a real win. As specialists who understand your business, BOQ Specialist is able to lend on a higher loan to value ratio (LVR) than other banks, typically up to 90 per cent of the value of your practice premises.
Due diligence is key to good investment BOQ Economist Peter Munckton advises SMSF trustees to approach investment in commercial real estate, such as a practice premises, in much the same way that they would the decision to buy a family home: with a lot of due diligence. As well as the immediate super and tax advantages the property offers, the details of the surrounding area and the likely period of time that the property will be held must also be taken into account.
Jeff Miller BOQ Specialist (07) 3018 8100 jeff.miller@boqspecialist.com.au
A secure tenancy means you can grow your business with confidence Having a secure tenancy is another very good reason for considering a practice property purchase. The knowledge that you will not have to vacate your surgery unexpectedly, perhaps leaving tens of thousands of dollars’ worth of fit-out investment behind, allows you to build your business with peace of mind. It will also ensure continuity for your patients, who we know take great comfort in your convenient and consistent location. Seek specialists to sort out the structure To take advantage of these many benefits, the ownership of the property and the loan need to be structured in the correct way as some of the details are quite complex. For more information please contact your local BOQ Specialist on (07) 3018 8100 or visit boqspecialist.com.au/medical
There may also be tax benefits of this arrangement. The rent your business pays for the property to your super fund may be a deductible expense for your business.
Top five considerations when purchasing a practice premises through your SMSF: Choose your banker carefully. Refinances are allowed, but are very complex. Take independent financial, legal, and tax advice early in the process. Ensure that the proposed property purchase fits in with the SMSF’s investment strategy. It will be necessary to provide a written copy of the strategy. Carefully consider the loan structure (e.g. fixed rate versus variable rate) on the basis of the cashflows that are expected through the SMSF. Remember SMSF contribution limits could change so you need some flexibility in your approach.
Disclaimer: The credit provider is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence no. 244616 (“BOQ Specialist”). The information contained in this article (Information) is general in nature and has been provided in good faith and has been prepared without taking account of your objectives, financial situation, or needs. Whilst all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, BOQ Specialist makes no representations or warranties. BOQ Specialist recommends you obtain independent financial and tax advice before making any decisions.
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professional services
Individual Flexibility Agreements
rachel drew, Partner at TressCox Lawyers, explains why an individual flexibility agreement can be beneficial to both employer and employee.
Rachel Drew Partner (07) 3004 3527 Rachel_Drew@tresscox.com.au Rachel Drew has expertise in providing advice to employers and human resources professionals in relation to employee management and entitlements at TressCox Lawyers.
All modern industrial agreements must include a clause which allows for an employer and employee to enter into an individual flexibility agreement (IFA). These agreements are of great utility in an employment relationship as they afford the parties the opportunity to mutually alter the terms of the employment provided that those alterations are to the financial benefit of the employee. The rationale behind these agreements is twofold: insofar as employers are concerned, the agreements assist to ensure high performing employees with the necessary skills are both attracted and retained; for employees, the benefit is derived from the ability to change their terms of employment to suit individual changes of circumstances, without acting to their own financial detriment. Typical examples of IFA terms relate to making changes to ‘ordinary’ hours of employment, start and end times, or provisions as to penalty rates and overtime. How to enter into an IFA IFAs can be entered into at the request of either an employer or an employee. Both parties must genuinely agree to the entry into an IFA. Importantly, an employee who refuses the request of an employer to enter into an IFA cannot be treated unfavourably for doing so. The content of an IFA depends on the type of industrial agreement that is being altered. Enterprise agreements
For employees, the benefit is derived from the ability to change their terms of employment to suit individual changes of circumstances.
Enterprise agreements are registered agreements that set out the minimum terms of employment, normally with respect to either one business or a group of businesses. While these will displace any modern award that may cover a particular role, they cannot displace the national employment standards (NES) which are set out in the Fair Work Act 2009 (Cth). Enterprise agreements must include a flexibility term which must identify the terms capable of being varied. IFAs in respect of enterprise agreements can relate to matters such as the employer-employee relationship, how the enterprise agreement is to operate generally, and authorised deductions from wages regarding, for example, salary sacrifice arrangements, union fees, and superannuation payments over the statutory minimum. The notice period for termination of an IFA made in conjunction with an enterprise agreement will vary according to the individual agreement. Importantly, if a new enterprise agreement comes into operation for the specific business, any IFAs made under the former enterprise agreement will automatically terminate.
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Modern Awards Modern awards are the minimum wages and conditions that relate to named industries and occupations Australia-wide. As with enterprise agreements, these awards cannot displace the NES. Further, they will not apply to a worker where the employment is covered by an enterprise agreement. Modern awards must include a flexibility term allowing an employee and his or her employer to agree on an individual flexibility arrangement. For modern awards, the terms capable of being varied by way of an IFA are: arrangements about when work is performed; overtime rates; penalty rates; allowances; and leave loading. Notably, employers are precluded from making entry into IFAs a pre-condition for employment. There is a 90 day notice period where an IFA made under a modern award may be terminated. However, if a new modern award comes into operation, any IFAs made under the former modern award will automatically terminate. Employers and employees must always remain mindful that terms of an IFA must always place the employee in a better financial position than they would have been in under their previous agreement.
, Partner
Simon Harrison, Partner Phone 07 3004 3535 Mobile 0449 533 315 Simon_Harrison@tresscox.com.au
, Partner
THE F O R ONSO LAND P S D PROU A QUEENS ERENCE AM CONF L A U ANN 2015
, Partner
, Partner
, Partner
, Partner
We can help you with: Purchase and sale of medical practices Medical indemnity claims IR & Workplace Safety Registration issues Business structuring and contracts Corporatisation
Employment Contracts General practice and specialist practice issues Dispute resolution and litigation Regulatory investigations and proceedings Medicare Australia investigations Estate Planning and Wills
professional services
Craig Wright 0488 273 399 craig.wright@experien.com.au Craig Wright is a life and income protection insurance specialist for Experien Insurance Services, based in Brisbane. They are the preferred life insurance partner of AMA Queensland. He focuses on the medical industry and understands the unique needs of doctors. This has helped him to negotiate enhanced products for our sector from insurers.
top ten insurance mistakes doctors make
Understanding the fine print of life or income protection insurance policies can be tricky, particularly if you’re buying online or doing it yourself. Too many people choose the wrong policy. In this article, Experien offers an insider’s view of the typical mistakes they have seen doctors make. Understanding the fine print of life or income protection insurance policies can be tricky, particularly if you’re buying online or doing it yourself. Too many people choose the wrong policy. In this article, Experien offers an insider’s view of the typical mistakes they have seen doctors make. 1. Buying products directly rather than via a professional broker You may end up paying more and face unexpected exclusions and gaps in cover if you buy direct. 2. Not considering a level premium option Choosing a policy that has premiums which increase each year as you get older could end up costing you thousands more in premiums in the long term. 3. Choosing the wrong income protection option Not many people know that there is a choice of an agreed value or indemnity type of contract. Each is materially different and it’s essential for you to weigh up the pros and cons of each to ensure you have the cover that is right for you.
Disclaimer: This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and also obtain independent professional advice before acting on the information contained in this publication. Life Insurance services are provided by Experien Insurance Services Pty Ltd (ABN 99 128678 937). Experien Insurance Services Pty Ltd ABN 99 128 678 937 is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367.
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6. Not checking if your policy features automatically get upgraded by the insurer Insurers often enhance their policy terms. But they may not apply them to older policies which you may have. You should see if you are caught by this trap. 7. Getting stuck on pricing with an old policy Did you know that some insurers may offer cheaper prices for new customers than existing customers? If so, you may be able to do something about it! 8. Not updating your insurance when your health or lifestyle has changed Insurers won’t proactively approach you to see if your health or lifestyle has changed to possibly remove a loading or exclusion. You may be entitled to have this reviewed and should discuss it with your adviser. For example, if you were paying the expensive rates of a smoker but stopped smoking altogether for at least 12 months, then you should consider applying to reduce your premiums.
4. Choosing the wrong payment option Some people are unaware of the recent ability to use partial superannuation rollovers to pay premiums in cash strapped situations. Again, you should consider the pros and cons of this with a professional adviser to see if it is suitable for you.
9. Will you have support at the time of any claim and will it be for free? Some organisations will help you to get cover but not support you with any claim. Some will support you but charge a fee. You should always ensure your broker will support you at the time of a claim at no additional cost.
5. Considering all trauma insurance policies the same Will your policy pay a benefit for low grade cancers or a silent heart attack? Will it pay a full amount or partial amount? You should make an informed decision on which trauma policy you should consider.
10. Not using a broker Experien is the preferred insurance partner to AMA Queensland – they act as your personal insurance concierge and manage the entire insurance application process, review your policy each year, and also manage claims that arise on your behalf at no additional cost.
Did you know 83% of Australians say they have insurance for their car?
Yet only 31% have income protection. What’s more important to you - your car or your income? If you DIDN’T have car insurance in place, YOU’D SURVIVE - your income could potentially cover any damage. If you became INJURED or ILL and were unable to work temporarily or permanently with NO INCOME you would STRUGGLE! HOW would you pay your BILLS, RENT/MORTGAGE and LIVING EXPENSES? For the same price of an average annual car insurance premium you can insure your cumulative loss of income to age 70 (in excess of $2,500,000 cumulative income to age 65).*
Income Protection Benefits • • • •
Premium fully TAX DEDUCTIBLE. Premiums are relative to age – the younger you are the cheaper it is. Can be paid via your superannuation fund. Less chance of health loadings or exclusions the younger you are.
Experien is the preferred life insurance provider to AMA Queensland and one of the few national brokers that specialise in the medical sector, having access to all the major 11 insurance companies in Australia.
Contact Craig for a complimentary consultation or review. T: 07 3018 8168 M: 0488 273 399 E: craig.wright@experien.com.au
* Based on an average annual car premium of $900.00. Comparison based exclusively on Male, non smoker, age 28, $5,500 monthly benefit and accurate as of 02/02/2015. Statistical source: lifewise.org.au Life Insurance services are provided by Experien Insurance Services Pty Ltd ABN 99 128 678 937. Experien Insurance Services Pty Ltd is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367. General Insurance services are provided by Experien General Insurance Services Pty Ltd trading as Experien Insurance Services ABN 77 151 269 279 AFS Licence No. 430190. This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and obtain independent professional advice before acting on the information contained in this publication.
professional services
Jason Borody Director (07) 3283 2233 Jason@vividus.com.au
Vividus specialises in healthcare marketing for hospitals, medical centres, GP and specialist practices, and healthcare businesses.
New research supports email marketing for medical practices
Vividus Marketing Director Jason Borody outlines the best way to get the most out of your email marketing. Regular, planned, intentional communications directly influence the relationship you have with patients and referral sources. This in turn impacts trust, reputation, and awareness, which are important factors in referral patterns and treatment acceptance. Email (and electronic newsletters) remain an important communication channel with 91 per cent of people checking their email daily, 66 per cent selecting services and products as a result of email communications, and subscription rate growth of 11 per cent in the last year (according to a study by Yesmail). Many practices however have questions about how they can use email communications more effectively. Recent studies of more than 100 billion emails sent in 2014 and 2015 by more than 650,000 businesses across 40 countries to business and consumer entities, reveals that sending more personalised email campaigns can result in open rates being lifted by nearly 150 per cent. The study also demonstrated that mobile design and sender’s industry significantly impact open rates.
Email marketing is a vital component of your practice’s marketing mix for educating, building relationship and reputation management.
Segmenting email lists to create customised email campaigns is a commonly accepted best practice and this study supports that theory. Campaigns sent to 35 or fewer subscribers (suggesting segmentation), have the highest open rate on average (55 per cent), far exceeding the overall average open rate (22 per cent). Meanwhile, campaigns sent to more than 7,500 subscribers (suggesting low personalisation) averaged about a 14 per cent open rate. This study provides strong proof that personalising email campaigns in order to speak directly to specific interests and wants of a subscriber, strengthens your relationship with subscribers, facilitates meaningful education, creates more authentic connections, and results in better campaign performance. Medical practices generally enjoy higher clickthrough rates than other industries. This same trend is true among average open rates: Religious organisations - 38 per cent Medical services - 32 per cent Non-profit - 29 per cent Professional services - 26 per cent Retail - 18 per cent
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Medical practices generally have a passionate and engaged subscriber base that values regular updates and educational communications. Examples of relevant, meaningful communications that will inevitably result in higher open rates might include promotional emails, content-based newsletters, automated emails, and transactional messages such as: A GP providing seasonal information on flu and allergies, or local health trends such as an increase in chickenpox cases. Obstetricians using an automated weekly email campaign to provide updates on baby’s development and changes mum may be experiencing. Orthopaedic surgeons providing a multimessage automated campaign outlining recovery stages, visitation reminders, and exercise suggestions post-surgery. New patients receiving pre-visit forms and instructions, and then a post-visit electronic practice information kit with their electronic receipt. Mobile devices now make up more than half of all opens. Smartphones account for 39 per cent of all email opens, and tablets account for 12 per cent. Research also suggests that up to 75 per cent of subscribers will delete an email if it cannot be easily read on a mobile device. The combination of these results provides a clear conclusion – medical practices must have a mobile-first mindset when it comes to their email marketing. I would also recommend that this mobile-first mentality must also extend to practice websites. Email marketing is a vital component of your practice’s marketing mix for educating, building relationships, and reputation management. For best results and return on investment, ensure that you provide your segmented audiences with engaging and meaningful content that is optimised for mobile devices. For more email marketing advice download our free guide at www.vividus.com.au
australia, plan for a longer retirement
professional services
The Federal government’s Intergenerational Report highlights the need for Australians to plan for a longer retirement. The good news is we will be living longer. According to the Intergenerational Report released in March 2015, men are expected to live to 80.06 years and women to 84.31 years. The report projects life expectancy of the average Australian will reach 95.1 years and 96.6 years respectively by the middle of the century. The bad news is longevity risk for retirees is increasing with many Australians now having a higher risk of outliving their savings. With Australians likely to spend much longer in retirement than they had previously planned for means they may not have enough investments to meet their ongoing income needs. July 2014 research by Mercer supports the Intergenerational Report confirming: Longevity risk is real One in four white collar workers will live around four years longer than the average Australian. This means they underestimate their life expectancy by up to seven years with potentially very limited income. Australians lack any defence against longevity One in two pre-retirees and one in three retirees are concerned about longevity risk and do not have a formal plan to counter the risk of outliving their savings. Two in three retirees who are concerned about longevity risk must live frugally to make their money last longer. Around 50 per cent of Australians plan to access the Age Pension 46 per cent of pre-retirees and 54 per cent of retirees plan to live on the age pension when their savings run out. Just one in three Australians seek professional advice Just a third of the population seeks professional help to plan against the risk of outliving their savings. You will need more retirement savings than your parents While there is no set rule for how much money is enough to fund retirement, we now know that
Australians are living longer and have higher expectations for their retirement lifestyle. To meet these expectations retirees will need more capital invested to fund their retirement than previous generations.
Ross Noye Macquarie Private Wealth (07) 3233 5805 0438 779 955
Don’t bank on the Age Pension
ross.noye@macquarie.com
Australia’s ageing population will also have an impact on retirement plans of all Australians. The Intergenerational Report suggests that it’s likely there will be fewer working taxpayers to support the age pension. Those in the workforce should look to proactively save and invest for the long term now to grow their retirement savings in order to reduce the chance of having to rely on the Age Pension.
Ross Noye is a stockbroker and financial advisor at Macquarie who specialises in investment and retirement planning.
Be sure to match your risk profile with your investments Countering the financial effects of these demographic trends will require careful planning and proactive financial management. An essential part of this planning should include an understanding of investment risk and risk appetite so plans can be adjusted to match investments with your Risk Profile. This planning should also consider the consequences of taking on too little as well as too much risk. Formalise a plan, review it regularly, and seek advice Having a well documented strategic saving and investment plan is essential to retirement success and will include strategies to mitigate risks. This will include saving and investment inside and outside of the superannuation environment and taking careful consideration of your current financial circumstances and appetite for investment risk. You should also consider debt levels and the need for income protection insurance and life insurance, the level of insurance required, and how it is structured. It helps to talk through the benefits and limitations of retirement income streams with a financial planner before you decide how best to invest and access your savings.
important information: This information has been prepared by Macquarie Equities Limited ABN 41 002 574 923 (“MEL”) participant of Australian Securities Exchange Group, Australian financial services licence No. 237504, No 1, Shelley St, Sydney NSW 2000, and does not take into account your objectives, financial situation or needs. Before acting on this information, you should consider whether it is appropriate to your situation. We recommend that you obtain financial, legal and taxation advice before making any financial investment decision. Members of the Macquarie Group or their associates, officers or employees (“Macquarie”) may have interests in the financial products referred to in this advice by acting in various roles including as investment banker, underwriter or dealer, holder of principal positions, broker, lender or adviser.
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professional services
superstream is coming
superstream is the new electronic superannuation system that all practices will need to comply with by july 2016.
Paul Copeland William Buck (07) 3229 5100 paul.copeland@williambuck.com
Paul Copeland is Business Advisory Director at William Buck Chartered Accountants and Advisors.
SuperStream is a new standard, which requires all super contributions to be made electronically with linked data and payments. The changes will enable all contributions to be treated in the same way – whether an employer is sending them to a default or choice fund, including a self-managed superannuation fund (SMSF). The government introduction of these data standards is aimed at simplifying the super contribution experience for employers, by reducing cost and effort, and eliminating unnecessary variation in how contributions are made. What does it mean for employers? Under the SuperStream standards, it means employers can use their payroll system to generate contributions as a single event and send them through a single electronic channel. This system means that it will no longer be possible for employers to process some superannuation payments on paper and it will need to be done electronically. It will be in the one system, which should speed up the process considerably. The Australian Tax Office (ATO) is also offering a free service for employers with 19 or fewer employees – the Small Business Super Clearing House – which allows the employer to make all contributions at once and at the same time meet the SuperStream requirements. Deadline for changeover
With increasing competition and mounting pressure on profit, practice owners and operators need to seriously focus on the business side of their practice.
DISCLAIMER: This article has been prepared by Paul Copeland of William Buck. The article is intended to be general in nature and should not be relied upon by any person without seeking advice concerning their own circumstances.
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Smaller employers (employers with less than 20 employees) will need to begin preparations to become compliant by 1 July 2016. Larger employers (employers with 20 or more employees) will be required to ensure their current computer software complies with these new SuperStream standards. These SuperStream standards came into effect on 31 October 2015. The ATO will apply penalties after the above dates if employers fail to meet these deadlines. Benefits for employees These new standards will allow employees to have current information about what contributions their employers have made and whether or not these contributions have been received by their superannuation fund. It also allows for data matching, so employees will be able to find their lost super and also consolidate multiple super accounts. What does it mean for self-managed superannuation funds (SMSF)? Contributions sent to an SMSF from a relatedparty employer are exempt from SuperStream and can be made using existing processes.
For all other SMSFs the SuperStream changes mean that all superannuation funds must be able to receive this information about contributions electronically. In order for a SMSF to meet its SuperStream data standard obligations, from 1 July 2016 it will need to provide its members’ employers with the name of the SMSF; the SMSF’s ABN; the bank account details into which the contributions are to be received (BSB and account number), and the electronic service address. An electronic service address can be obtained from a SMSF messaging provider. These messaging providers will supply an electronic service address for that SMSF to each employer. The messages sent from an employer to an SMSF messaging provider will be received via a secure network and translated into a readable format for the SMSF. As an example, we understand Australia Post will provide this service. A SMSF is not required to use a service provider but if they choose not to use one, they will need to register themselves as a service provider so they can receive employer notifications electronically. If you have any questions or require any assistance please contact us at William Buck.
ARE YOU THINKING OF
BUYING OR SELLING A MEDICAL PRACTICE?
WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK CAN HELP YOU BUY OR SELL YOUR PRACTICE AND MAKE THE MOST OF YOUR FINANCIAL FUTURE. We understand that the purchase or sale of your practice is crucial to your financial situation and can help you plan and prepare to achieve the best possible outcome. William Buck is experienced in managing the purchase and sale process for medical practices, and can assist with the following: — Valuing your practice — Negotiations and the purchase process — Due diligence — Prepare your financial data ready for sale — Structuring the sale and maximising tax outcomes — Benchmarking your practice against industry profit trends CONTACT PAUL COPELAND FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION OR FOR A CURRENT LIST OF MEDICAL PRACTICES FOR SALE Phone: + 61 (7) 3229 5100 Email: Paul.Copeland@williambuck.com
professional services
Chris Mariani AMA Queensland Insurance Solutions 1300 883 059 or 0419 017 011 chris.mariani@amaqis.com.au Authorised Representative No. 434578 Chris Mariani is a medical indemnity specialist at AMA Queensland Insurance Solutions.
Spotlight on management Liability Insurance
CHRIS MARIANI FROM AMA QUEENSLAND INSURANCE SOLUTIONS OUTLINES MANAGEMENT LIABILITY INSURANCE: A BUNDLE OF INSURANCES WHICH PROTECTS A PRACTICE ENTITY AND ITS DIRECTORS AND MANAGERS FROM MANY MANAGEMENT RISKS WHICH THEY ARE LIKELY TO BE EXPOSED TO. We regularly receive calls from AMA Queensland members who have had an issue in their practice, where they discover after the fact, they have not had the right insurances in place to protect them. Some of the most common practice risks include employment disputes such as allegations of unfair dismissal, discrimination or bullying, and theft by employees entrusted with banking responsibilities. There are many other management risks the directors and owners of practices are exposed to and a simple way to protect yourself from these risks is to purchase management liability insurance. This is a package of insurances which includes cover for: director’s and officers’ liability; employment practice’s liability; crime (theft by employees); statutory liability (fines and penalties, such as workplace health and safety and privacy fines). Some management liability policies also extend to internet liability (operating a website), kidnap, ransom and extortion, and tax audit covers. Management liability is designed to protect both the company and the directors and officers of the company against liability as a result of a ‘Wrongful Act’, committed while carrying out the duties as directors and officers. Claims can be brought from many sources such as regulators (e.g. ACCC, ASIC, ATO), employees, competitors, customers, suppliers, and shareholders (particularly minority shareholders). An allegation against the company or its directors may be completely without merit, but without management liability cover, you leave yourself exposed to expensive and time consuming litigation to successfully defend an allegation. The cost of management liability depends on the policy limits selected and the turnover/employee numbers of the practice. For example, a practice with $1 million revenue will pay a premium of circa $1,500 for a $1 million main policy limit.
DISCLAIMER: AMA Queensland Insurance Solutions is a trading name of KSLR Pty Ltd, a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, AFSL 240549. Corporate Authorised Representative No: 366807. The information provided in this article is of a general nature and does not take into account your objectives, financial situation, or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.
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Our experience is that many practices are simply unaware of the existence of management liability insurance. One of the reasons for this is that it is generally only available via insurance advisers (due to the complexity of the policy coverage and the need for tailored advice). Other practices assume their medical indemnity insurance will cover them. While this is true to a limited extent for some risks, a management liability policy provides broader protection in many areas. For example, some medical indemnity policies do provide some legal costs cover for employment disputes, but management liability cover goes further by also covering items such as compensation awarded for bullying or discrimination.
ONE LESS THING ON YOUR TO-DO LIST Have all your insurance needs covered through AMA Queensland Insurance Solutions
Free insurance health check
www.amaqis.com.au
We know doctors have a busy schedule, and while it may be easy to renew your insurance each year without proper revision, changes may have occurred for which you may not be fully covered and premiums need competitive comparison.
For peace of mind and an insurance healthy practice, contact AMA Queensland Insurance Solutions on 1300 883 059.
lifestyle
Winemaker profile
Elena Brooks
Wine direct’s Phil Manser reviews the work of elena brooks, winemaker at dandelion vineyards and heirloom. Elena originally hails from Lyaskovets, Bulgaria, a small town famous for its wine. She is a qualified winemaker and has made wine for various Australian wineries as well as being a consultant winemaker to a number of leading wine companies in Spain, Italy, and Bulgaria. Born to a MIG fighter pilot and helicopter mechanic (both of whom happened to be involved in the wine industry in Lyaskovets), Elena’s interest in winemaking stemmed from time spent translating for Australian winemakers Stephen Bennet, David Norman, Dylan Rhymer, Kym Milne MW, and others, who worked at her mother’s winery between 1993 and 1998. With Stephen Bennet’s support and her family’s encouragement, Elena made the move to Australia and started studying winemaking at Adelaide University in 1998, graduating in 2001 with a Bachelor of Science (Oenology). (Elena’s mum was keen on this noting that all winemakers did was meet in the morning in their lab coats, taste some wines, drink some coffee, have a chat, then go out to a luncheon.) Locally, Elena worked vintages at Patritti Wines and Hardy’s Tintara, and was the winemaker at Geoff Merrill Wines, La Curio, Maxwell Wines, and others in McLaren Vale as well as the various wineries of Farnese throughout Italy and Fratelli Urciuolo in Campagna.
judging in 2000. As a self-described ‘trophy wife’, Elena helped make a Jimmy Watson Trophy winner in 2005. She was also the winner of The Great Australian Shiraz Challenge in the same year, and won the trophy at Decanter World Wine Awards for best Rhone style Red in 2007 and made the best red wine for the Gambero Rosso Guide in 2008. Elena also won trophies for Dandelion Vineyards (Elena’s own wine company) in the winery’s first year at the 2009 and 2010 Royal Brisbane Wine Show for best current vintage white. She won Best Small Producer at the 2009 Barossa Wine Show and numerous other awards. Elena sources grapes from South Australia to make all her wine, specifically the Adelaide Hills, Barossa, Fleurieu Peninsula and McLaren Vale. She also makes the wine Carl Lindner’s Sister’s Run Wine Company, her father-in-law’s Heirloom Vineyards, and for her Spanish Wine Company, Cien y Pico in Manchuela. Elena always wants her wines to remember exactly when and where they came from and believes “the truth is in the vineyard and the proof is in the bottle”. Her two most recent triumphs are 2012 Dandelion Barossa Shiraz (two trophies, seven gold medals, and 95/100 Halliday) and 2013 Heirloom Barossa Shiraz (trophy, four gold medals, and 96/100 Halliday). Q
Elena became an Australian citizen in 2006 and married typist Zar Brooks in 2007 after meeting at the Royal Adelaide Wine Show
Phil Manser Wine Direct 1800 649 463 phil.manser@winedirect.com.au
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lifestyle
Sparkling Singapore
ros bulat from ama queensland travel explains why Singapore is so much more than a transit stop on the way to europe. Known mostly as the business and investment hub of the Asia-Pacific region, this incredible city is actually an exciting and colourful destination that offers not only the new and shiny but also the historic, cultural, and fun. It’s well suited to individuals, couples, and families alike. Here are a few ideas on what not to miss when you’re planning time in Singapore: Maria Bay Sands and SkyPark This $5.5 billion mega resort is one of the most iconic modern landmarks in the Singapore Skyline. Marina Bay Sands is more than a resort and casino: it hosts the top floor SkyPark for tourists to come and get a taste of the highlife in Singapore. The SkyPark features a full-view sky deck where you can soak in 360 degree views of Singapore city at 55 floors high. You can also pay to use the famous Infinity Pool that stretches 150 metres across the rooftop. Entrance fee starts at $23 SGD per person. Buddha Tooth Relic Temple The sacred Buddha Tooth Relic is an incredible Relic Stupa composed of over 420kg of donated gold. The temple is a cultural monument living in the heart of Chinatown district. Inside, tourists can see the 27 foot (8m) tall Buddha statue, surrounded by authentic architecture from the Tang dynasty. Singapore Night Safari Singapore has a wild nightlife! Take the night tours of the safari and see over 10,000 animals across 50+ exhibitions! They have exotic and endangered species such as the Himalayan griffon vulture, wildebeests, and gazelles. The Singapore Safari also supports endangered animals and uses profits to care and rescue animals across the world. Opening hours are between 9.30pm and midnight. Marina Bay Gardens Directly opposite the Marina Bay Sands sits
one of the most iconic futuristic gardens in the world. Delight in the stunning surroundings from one of the super tree structure walkways. At night, the 12 super tree structures which host over 200 different plants put on a light and music show at 9.45pm over the park. You can also experience a tree top roofless bar with 360 degree views of the 250 acres that encompass the park. Inside the greenhouses you can experience high mountains of plants and domes filled with flowers. This experience is breathtaking and a beautiful way to discover nature from around the world in one place. Entrance is $28 SGD for adults and the park is open from early until late daily. Geylang In the past the Geylang area was known as the centre of Singapore’s native (Malay) community. Easy to get to with tranport, this hidden pocket is an absolute hive of activity. Here you will find some of the simplest and tastiest food on offer in Singapore. 661 Geylang Road is probably the area’s most famous feasting house, famous for its amazing crab bee hoon (noodles). Check out the chilli crab at the No Signboard Seafood restaurant. Sentosa Island Sentosa Island is ever-evolving into a destination in its own right. Catch the cable car and spend the day visiting the Aquarium or the Adventure Park. The kids will love the chance to swim with the dolphins. Universal Studios Up for some theme park adventure? This firstof-a-kind-for-Asia experience is unforgettable fun – especially if you’re bringing the young ones! The park has more than 20 attractions across multiple zones to explore. Stroll down Hollywood lane, drop into ancient Egypt, and while you’re at it, why not explore The Lost World? You won’t go hungry either with plenty of restaurants to keep you filled up for a big day of rides and adventure. The park opens daily at 9am until 6pm. Access via train by getting off at Waterfront Station. Q
ail Ros ation call or em For more inform land. ns ee Qu l ve AMA Tra
at
262 885 PHONE: 1800 7200 6 555 ) FAX: (07 EMAIL: m.au travel@amaq.co WEB: dtravel.com.au www.amaq.worl
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Book your Private Screening for this year’s biggest films Spectre
The Hunger Games: MockingJay Part 2
From 12 November
From 19 November
Star Wars: The Force Awakens From 17 December
Contact Katelyn Aspery katelyna@dendy.com.au (07) 3137 6002 to book
COMING FILMS 5 Nov Freeheld
He Named Me Malala
Spectre 19 Nov
The Hunger Games: Mockingjay Part 2
26 Nov
Love the Coopers
The Program
3 Dec
In the Heart of the Sea
Truth 17 Dec
Star Wars: The Force Awakens
26 Dec
The Danish Girl
Suffragette Trumbo Joy *films releasing at Dendy Portside are subject to change – check the website for up to date releases
Kenneth Branagh Theatre Live: The Winter’s Tale 30 January 1pm, 31 January 1pm, 1 February 6pm, and 3 February 10am
Shakespeare’s timeless tragicomedy of obsession and redemption is reimagined in a new production codirected by Rob Ashford and Kenneth Branagh, following their triumphant staging of Macbeth in Manchester and Manhattan. Judi Dench will play Paulina and Kenneth Branagh will play Leontes.
WIN MOVIE TICKETS FOR TWO Name:
Member No:
Postal address: Portside Wharf, Remora Road, Hamilton Ph: (07) 3137 6000 www.dendy.com.au 64
November 2015 DoctorQ
Phone:
FAX TO (07) 3856 4727 or email competitions@amaq.com.au by 30 November
lifestyle
The Lexus of Brisbane Group is proud to be in partnership with AMA Queensland. It is with pleasure Lexus of Brisbane Group offers the Lexus Corporate Programme to AMA Queensland members across the entire Lexus range. This includes reduced dealer delivery fees, three years / 60,000km complimentary servicing, invitations to events, and all the benefits the Lexus Encore Programme. The Lexus of Brisbane Group are also pleased to offer an exclusive Airport Valet Service from Brisbane Domestic Airport as well as one Qantas Point# for every dollar spent on a the purchase of a new Lexus. For further information on all the benefits afforded to you as an AMA Queensland member, please contact Derek Klette at derek.klette@ lexusofbrisbane.com.au
RX 350 F Sport (overseas model shown)
RAISING THE BAR FOR LUXURY SUVS
with the release of the All-New RX, Lexus is redefining style, ride comfort and luxury SUVs. The fourth generation RX, which made its debut at the 2015 New York International Auto Show in April and will arrive in Australian showrooms in November, features a redesigned luxurious interior wrapped in a bold and chiselled body with Lexus-first styling cues. It combines the dynamic new look with exceptional on-road performance and new Lexus Safety System, all of which sets the all-new RX apart from other luxury SUVs. Luxury SUV buyers will be offered considerable choice, with the local model line-up featuring RX 200t 2WD, RX 350 AWD, and RX 450h AWD variants in varying grade levels. RX 200t will be powered by Lexus’ new turbocharged four cylinder powerplant, which will develop 175kW and 350Nm and drive the front wheels via a six-speed automatic transmission. SMOOTH, POWERFUL PERFORMANCE The RX features an upgraded and more powerful 3.5 litre V6 and selected variants come with a new 8-speed automatic transmission. The hybrid model’s Atkinsoncycle 3.5-litre V6 is based on the improved V6 powertrain and all RX engines have been tuned to achieve high fuel economy and low carbon emissions.
RX 450h (overseas model shown)
The vehicle’s body structure has been strengthened with added stiffness, helping to improve its handling response while minimising engine and road noise. SAFETY AS A PRIORITY
RX 350 F Sport interior (overseas model shown) * PCS / LDW / AHB is a driver assist device only and should not be used as a substitute for safe driving practices. The area into which the vehicle is driven must be visually monitored by the driver. #Terms and conditions apply for Qantas Points. Please contact Lexus of Brisbane Group for full details. All images depict overseas prototype vehicles with specification, colours, and trims that may not be available in Australia.
The new RX offers enhanced safety features including an upgraded body structure that heightens the overall passive safety of the RX, and makes available the Lexus Safety System which helps avoid or mitigate collisions across a wide range of vehicle speeds. Lexus Safety System, introduced globally, integrates several of Lexus’ existing active safety technologies, including the Pre-Collision Safety System* (PCS), Lane Keep Assist* (LKA), and Automatic High Beam*(AHB).
available triple L-shape LED headlights in the F Sport and Sports Luxury grades, and redesigned fog lights. Sharpened rear styling exudes a sense of stability, emphasised by new L-shaped taillights that wrap around the sides of the vehicle to create a wider presence on the road when illuminated. The new cabin features high levels of comfort and luxury with premium interior finishes. Lexus-first features such as lasercut ornamentation, which was developed by Yamaha, provide an additional feeling of sophistication. Rear-seated occupants are treated to more leg and knee space and the newly-developed seats are available with heating and power reclining features that both enhance convenience and provide a sophisticated, luxurious feel. Available in the Sports Luxury models only, a retractable power panorama roof will be made available, adding to the RX cabin’s spaciousness and providing occupants with an open-air experience. Lexus Australia Chief Executive Sean Hanley said the new RX was built on the success of the previous generations of RX. “The RX has been a significant vehicle for Lexus globally but also here in Australia since we introduced it to the local market in 2003,” Mr Hanley said. “This new, fourth-generation RX takes the midsize luxury SUV to new levels with dynamic and aggressive styling, a range of new technologies, and a new luxury interior.” The new Lexus RX range starts from $73,000 plus on road costs for the RX 200t Luxury. Q
BUILT FOR PURPOSE, STYLED FOR BEAUTY The new RX features a bold new exterior styling package with Lexus-first styling cues and a redesigned luxury cabin. The dramatic new front styling of the RX is highlighted by the spindle grille with a chrome-plated border, DoctorQ November 2015
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lifestyle
All about you
give a goat this christmas Fresh Fruit Christmas Cake with Glazed Nut Topping 150g sultanas 100g fresh apricots, seeded and diced 100g dried figs, diced 1 fresh peach, chopped 1 fresh nectarine, chopped 1 fresh pear, peeled and diced 100g glace fruit of your choice Zest of 1 lemon, about 1 tablespoon Juice of 1 medium lemon 125ml brandy 170g butter 180g caster sugar 4 eggs, room temperature 1 tsp ground cinnamon 2 tsp ground ginger 1 tsp ground cloves 3 cups plain flour 2 tsps baking powder ½ tsp salt ½ tsp vanilla bean paste Glazed Nut Topping 200g mixed glace fruits (chunky) 60g walnuts 60g blanched almonds 2 tbsps honey 2 tbsps verjuice 1 tbsp crystallised sugar
Pre heat the oven to 180c. Combine all the fruits in a large heavy based saucepan over moderate heat. Add in the lemon zest, lemon juice, and the brandy and bring the liquid to a simmer. Cook the fruits until most of the liquid has been absorbed and the fruits have softened. Set aside for 15 minutes to cool. Beat the butter and sugar until pale and fluffy, add in the eggs one at a time beating each time until a smooth batter. Combine all the dry ingredients and sieve once to remove any lumps and combine the flour with the baking powder and spices. Slowly add the flour into the creamed butter and sugar until well combined. Using a large spoon or rubber spatula, stir in the cooked fruits until well combined. Grease and line the tins with baking paper. Spoon in the cake mixture and smooth over the top. For the glazed nut topping, combine the honey and verjuice in a small saucepan over a low heat until combined. Remove from the heat and stir through the nuts and fruits. Pour the fruits and nuts evenly over the cakes and then sprinkle over the sugar. Bake on the middle shelf for one hour and 30 minutes or until a skew inserted into the middle of the cake comes out clean. Allow the cake to cool for 10 minutes in the tin before cutting and eating.
If you’re looking for a gift for someone who has everything, Oxfam might be your first port of call when Christmas shopping this year. Purchase an Oxfam Unwrapped card and they will donate goats, ducks, pigs or chickens to villages in need around the world. Ranging from $10 for a chicken in South Africa to $139 to equip a village in Sri Lanka with the tools and labour needed to build a well, it’s hard to think of a gift that brings a bigger smile this festive season.
A Civilian Surgeon in Vietnam 1967-68 Vicki R H Holman A remarkable account of the trials and tribulations of the Australian Surgical Team, sent from Queensland to Bien Hoa, Vietnam as told through letters and reports from Dr Tom Sale OBE MB ChB FRCS (Edinburgh), AM (Singapore), FRCAS, FRACMA, FACRM and Medical Superintendent of the Rockhampton General Hospital.
APP SNAP - fancy If you’d prefer to do your window shopping online, Fancy is the place to discover, collect and buy from a crowd-curated catalogue of amazing goods, wonderful places and great stores. Fancy your favourite items, create your own wishlists and buy. It’s like Pinterest but with only shoppable items.
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Dominique Rizzo
Dominique Rizzo is a Brisbane-based Sicilian– Australian chef with over 15 years’ experience. Check out her restaurant, catering, and cooking school at Banyo in Brisbane’s north.
lifestyle
Ocker doctor
For Love not Money
as doctors are often unfairly attacked for being motivated by money, it’s worth noting the sacrifices that many doctors make for humanity without reward. Two words: pro bono (apparently nothing to do with the lead singer of U2). It’s a noble concept and the Latin just makes it sound even that little bit nobler. And it’s an integral part of our medical profession and it makes me very proud to call myself a doctor. As the media often portrays our trade in a dim light with every misdiagnosis and bad patient outcome being hauled through the lay press as if it was a war crime, I sometimes find myself tempted to lose my pride in being a member of the medical fraternity. But as my pride is wavering I find myself thinking about the amazing people that occupy the noblest echelons of our people. Those that have an almost saintly fervour for serving humanity. I feel a surge of pride in my heart when I see what incredible things some doctors do with their lives. Doctors like the men and women who join the Red Cross or Médecins Sans Frontières. I reckon they are the most special. Heading into conflict zones really takes some incredible courage and amazing humanity. The third world living conditions, the risk of contracting diseases like Ebola, and of course the threat of violence are ever present. These folk are the selfless idealists and heroes of our profession. They are the embodiment of everything the Hippocratic Oath espouses. The fact they risk their own lives and generally do it for pretty basic wages really inspires me. I am proud to be in the same profession as them. It is a bit like feeling that tug in my chest and sprouting those goose bumps when the Australian flag is hoisted up the flag pole at the Olympics as the immense tones of Advance Australia Fair ring out to celebrate another Aussie gold medal. And it is the same
The media often portrays our trade in a dim light with every misdiagnosis and bad patient outcome being hauled through the lay press as if it was a war crime.
feeling I get when I read about the gallant and valiant deeds of all of our phenomenal Victoria Cross winners. These are the sorts of people that are at the very far right hand end of the evolutionary bell curve, demonstrating all that is good with our species. While not every doctor has the inclination to face Ebola, bombs, and bullets to serve humanity, there are certainly plenty of other doctors that do some magnificent pro bono work. The teams of surgeons and anaesthetists that head overseas to perform life-changing plastic surgery, to liberate kids with birth defects from a lifetime of embarrassment and hardship and doctors that follow in the legendary footsteps of the late, great Dr Fred Hollows are true heroes of our profession and our society. These are the people who make us all look good in the public’s eyes. So many doctors take on roles as teachers and mentors and expect nothing in return. They pass on the proud traits of our profession such as altruism, sincerity, integrity, and of course selfless patient care. Their energies and expertise are generously given in the finest Hippocratic traditions, and the sincere handshakes and smiles from their medical disciples are all the rewards they need. All of my favourite doctors are the men and women who taught me at medical school and in my early hospital days. I am sure they were all
doing their teaching work for the love of it and they are true inspirations and role models for me still. At a grass roots level, so many doctors give of themselves performing talks for community groups and schools. Educating people about the importance of looking after their own health in this capacity probably improves more people’s lives than any 10 minute consultation. Local footy teams are almost universally provided with medical cover by medical volunteers who give up their Saturday afternoons during winter for the good of their local clubs and for the love of their football code. In the medical profession we are all in a really unique position to be able to do some incredible pro bono work. Our skill set is pretty handy and is generally in demand. And while ducking shrapnel working for the Red Cross or MSF is not everyone’s cup of tea, the rewards of some volunteer work are available to everyone. It makes me proud to be a doctor when I think about all of the life-changing work done by our profession, purely for the good of humanity. From the battle fronts of war zones to the battle fronts of suburban footy grounds, we certainly have some amazing people in our medical family. They make me proud to be a doctor. Q
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FOUNDATION
DOCTORS DOING GOOD IN 2015 WHAT YOU HAVE HELPED US ACHIEVE 2015 has been a year of consolidation for the Foundation and the Board has been busy planning the Foundation’s direction for 2016 and beyond. We look forward to keeping you updated on our future programs and activities next year. Thanks to our wonderful donors, the Foundation has been able to impact the lives of many this year.
hard combining many extra-curricular activities with his medical studies. He recently undertook a three-week elective placement in the small town of Young in New South Wales. Here Stuart was able to shadow rural GP Dr Judith Nallbird as well as a series of visiting specialists. When asked about this experience Stuart replied,
Some of our recent achievements include the mental health program Resilience on the Run, launched in August this year at Rockhampton Hospital. The program has been fully funded by the Foundation and aims to improve awareness of workplace stress and pressures for doctors in training. It also aims to provide practical strategies and support to reduce burnout and psychological distress. Results will be measured with validated, widely accepted assessment tools in order to establish if the program has made a significant improvement to the well-being of the participants. A post-program analysis will be conducted with submission of the findings to the Medical Journal of Australia.
“For the first time I felt like I got to experience what it’s actually like to be a rural doctor and not just a transient medical student. As it was my second visit, I was fortunate enough to revisit some of the patients I had seen a year earlier. Seeing some of these characters again was undoubtedly one of my favourite elements of the entire placement and was really gratifying when some of them remembered me. Not only did this allow me to catch up with them and see how their lives have changed, but it also gave me the opportunity to observe their disease progression and see how some of the original treatments implemented last year did or didn’t work.
Another project funded by the Foundation is the Medical Student Scholarship Program at James Cook University. This year the program assisted five medical students, including welcoming second year medical student Jessica Roberts to the program and celebrating Preston Cardelli’s graduation at the end of this year. The scholarship is designed to provide funding to disadvantaged students wishing to undertake medical training but who are unable to do so due to financial hardship.
It reminded me that when you do work as a rural GP, you become part of people’s lives, families, and routines and they have immense trust in you. It really brought it home why I applied for medicine in the first place as well as portraying the major benefits of going rural.”
Fourth year medical student and scholarship recipient Stuart Woods has been working
my rent and other bills, and even organising trips back to Sydney to see my family every now and then have all been made possible because of this bursary! I cannot thank all the people who make it possible, enough.” The Foundation wishes all scholarship recipients the best with their future studies. We would also like to thank our generous donors, our major corporate partners: William Buck, TressCox Lawyers, MDA National, and the Queensland Visiting Medical Officers Committee. It is only through your valuable support that we can continue the work of the Foundation and fulfil our charter of doctors doing good. We wish all our supporters a very Merry Christmas and a Happy New Year. We look forward to your support in this year’s Christmas Appeal which is to raise funds for the treatment and management of hearing health in Aboriginal and Torres Strait Islander children. For more information on the Foundation’s work, please visit www.amaqfoundation.com.au. Q Our Corporate partners and sponsors
Stuart is grateful for the generosity of donors who have helped with the many expenses of medical school. He strongly encourages any medical students to consider doing their placements in rural areas saying, “I have certainly learnt more from my experiences out there than in any lecture theatre.”
Queensland Government Queensland Health
Preferred Medical Indemnity Provider
Louis Jenkins is a third year medical student at James Cook University and has been really enjoying his studies to date. Louis recently spoke about what the scholarship means to him: “Year three is the last of my pre-clinical years and everything that I’ve been taught in the JCU course is all starting to come together! It has only motivated me more to get the most out of the medical course! The scholarship has proven to be invaluable over the past year. Being able to purchase stationery and medical equipment, cover
A LIFETIME OF CARING
A gift in your Will (bequest) can ensure we are there to lend a hand and potentially help us overcome the most challenging medical problems of tomorrow. For more information on making a bequest to the AMA Queensland Foundation please visit www.amaqfoundation.com.au or contact the Foundation Office on (07)3872 2204. 68
November 2015 DoctorQ
FOUNDATION
GIVE A CHILD THE GIFT OF SOUND THIS CHRISTMAS Allunga was a six year old who was struggling at school because he couldn’t hear properly. He felt left out and the other children would tease him saying, “Don’t worry he can’t hear properly, he’s deaf”. Unfortunately, for many children like Allunga here in Australia, this is how they live – held back from school and childhood experiences because they can’t access proper health care when needed. Imagine having a child with hearing difficulties which undoubtedly have a lifelong negative impact unless treated, yet not having the financial means to do so. Sadly, some parents have to choose between putting food on the table or paying for treatment due to long waitlists for this much needed surgery.
Doctors doing good
Do you have a project which needs financial assistance?
Aboriginal and Torres Strait Islander children for the treatment and management of hearing health. Together we can make a difference. This Christmas season - the time for giving, please give generously to the AMA Queensland Foundation’s Christmas Appeal.
Contact Fran Hawkes, Foundation Coordinator: Phone: (07) 3872 2204 Email: f.hawkes@amaq.com.au Website: www.amaqfoundation.com.au
Please keep an eye out for your chance to help when our letter or email arrives. Alternatively, donate online today via the Foundation website or fill in the slip below and return to the Foundation Office. Q
AMA Queensland Foundation is committed to breaking down the barriers to healthcare for children by funding a vital project that will help improve the health of Indigenous Queenslanders in rural and remote areas. Working in conjunction with the North Coast Aboriginal Corporation for Community Health and CheckUP Australia, the AMA Queensland Foundation will fund procedures for 20 children. The project aims to significantly improve access to ENT surgical services for
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In Print
practical skin cancer surgery Practical Skin Cancer Surgery, written by Dr Mileham Hayes, offers primary care physicians a comprehensive practical go-to guide to detail and teach skin cancer surgery operations which can be done in a doctor’s clinic under local anaesthetic. Perfect for primary care physicians and surgical trainees, Practical Skin Cancer Surgery is surgery specific and has clearly structured step-by-step instructions. The book is divided into eight sections, covering all the requirements of the College examinations.
Doctor Q has a copy of Practical Skin Cancer Surgery to give away. Fill out the form below and fax it to (07) 3856 4727 or email competitions@amaq.com.au.
Entries close 1 December
Progressing from equipment and set up, anatomy, basic straight-line excisions to more complex flaps, Practical Skin Cancer Surgery outlines step-by-step, methodical instruction to proficiently excise skin cancer in a clinic, under local anaesthetic. Practical Skin Cancer Surgery is available from Books @ Stones: Shop 1, 360 Logan Rd Stones Corner or www.stonescornerbooks.com.au for $150. Q
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70
November 2015 DoctorQ
Dendy WINNERS Double pass winners 1. Dr Nigel Dore 2. Dr Noel Saines 3. Dr Chris Que Hee 4. Dr Fred Leditschke 5. Dr Tim Briggs 6. Dr Marjorie Busby 7. Dr Karen Yuen 8. Dr Julia McLeod 9. Dr Enno Taemets 10. Dr Alison McColl
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Please contact our practice manager, Robyn Blackmore, for further information on 07 5493 7018, or reception@scgensurg.com.au
P: 07 5437 9788 F: 07 5345 5276 Suite 20, Sunshine Coast University Private Hospital, 3 Doherty St, Birtinya www.sunshinecoastgeneralsurgeons.com.au
VRGPs required for Noosa Hospital, Sunshine Coast
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Further information at www.ramsaydocs.com.au or phone Jude Emmer, CEO on (07) 5455 9203 or email: ea.noh@ramsayhealth.com.au
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PRACTICES WANTED Unprecedented demand for Queensland Three QLD practices sold last month
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