SPRING 2016 VOL. 100

NEW AMA PRESIDENT DR MICHAEL GANNON DR CHRIS ZAPPALA ASKS HIM THE BIG QUESTIONS

WHEN EMPLOYEE CONSULTATION IS REQUIRED

A HOW-TO GUIDE ON CORRECTLY CONSULTING WITH EMPLOYEES

HEALTH VISION BECOMING A REALITY ITS IMPACT ON THE FUTURE OF HEALTH IN QUEENSLAND

Doctor Q is free to AMA Queensland Members

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1. Complimentary scheduled servicing expires at 3 years or 60,000km from the date of first registration, whichever occurs first. Conditions apply. See your Lexus dealer for further details. 2.. Eligible employees must provide such about-us/benefits for full terms and conditions. *Offer applicable to Private and ABN buyers, who are current members of AMA Queensland, on all new vehicles purchased between 1st January - 31st December 2016 and delivered Complimentary membership will be offered to customers who are not already members. Membership and Qantas Points are subject to the terms and conditions of the Qantas Frequent Flyer Program available at Qantas.com/ between the 1st January -31st December 2016. Points paid on total net contract price of vehicles after discount but before trade-in.

2 | Doctor Q Spring

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Doctor Q Spring | 3

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4 | Doctor Q Spring

PRESIDENT TO PRESIDENT INTERVIEW AMA Queensland Dr Chris Zappala puts the big questions to AMA President Dr Michael Gannon.

CONTENTS 6

FROM THE EDITOR’S DESK

PRESIDENT’S REPORT

CEO’S REPORT

CDT UPDATE: BULLYING AND HARASSMENT NOT JUST IN SURGERY

MEMBER NEWS: FREE MEMBER RESOURCES

DO YOU HAVE A PATIENT THAT NEEDS FINANCIAL SUPPORT FOR THEIR MEDICAL CONDITION?

CURRENT ISSUES

AMA QUEENSLAND’S NEW BOARD AND COUNCIL Take a look at the people who are here to represent and advocate on behalf of all members.

BARRETT CENTRE REPORT RELEASED

HUNTING FOR JUNIOR DOCTORS IN THE TROPICS

INCREASE TO MINIMUM WAGES

COMPLAINTS OR NOTIFICATIONS

WHEN EMPLOYEE CONSULTATION IS REQUIRED

HEALTH VISION BECOMING A REALITY

QUEENSLAND DOCTORS’ HEALTH PROGRAMME PROVIDING LEADERSHIP IN DOCTORS’ HEALTH

EMERGENCY ACCESS ON TARGET IN QUEENSLAND

PEOPLE & EVENTS 12

DINNER FOR THE PROFESSION WRAP UP

JUNIOR DOCTOR CONFERENCE WRAP UP

PROFESSOR JOHN FRASER

RESILIENCE CONTRIBUTES TO BETTER CHILDHOOD HEALTH

44 CALENDAR 45

LOCAL MEDICAL ASSOCIATION ROUND UP

PRIVATE PRACTICE AND MEDICO-LEGAL CONFERENCE SPEAKERS SHOWCASE

AMA QUEENSLAND’S NEW BOARD AND COUNCIL

FEATURES 18

INTERVIEW WITH AMA PRESIDENT DR MICHAEL GANNON

JUNIOR DOCTOR CONFERENCE WRAP UP

BUSINESS TOOLS

Doctors flocked to the Brisbane Exhibition and Convention Centre for Australia’s biggest junior doctor conference.

MORE SUPER CHANGES TO COME?

MEDICARE FREEZE CHANGING THE FACE OF GP PRACTICES

RISK MANAGE YOUR REVENUE

WHAT TO LOOK FOR WHEN BUYING OR FINANCING A PROPERTY

THE IMPORTANCE OF MEDICAL INDEMNITY FOR JUNIOR MEDICAL STAFF

TREATING FAMILY MEMBERS

LIFESTYLE 64

DENDY MOVIES

ALL ABOUT YOU

MCLAREN VALE, SOUTH AUSTRALIA

OCKER DOCTOR: YOU’VE GOT TO HAVE MATES

IN PRINT

67 CUBA

DR STEVEN WALKER Understand more about open disclosure in practice with Dr Walker at the Private Practice and Medico-Legal Conference.

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EDITORâ€™S DESK At AMA Queensland, we want to hear from you. We invite members to get involved, as with your direct input and participation, we can shape valuable, innovative member services that engage, inspire and support doctors and their patients across Queensland. Here are a few ways to get involved... Do you have a burning issue in your local HHS or community that you would like to take forward? Contact the Policy Team to help you get traction on the issue with the support and advice you need. Want to join a committee to have a hands-on role shaping our approach to member advocacy? We have a number of committees including the Council of Doctors in Training, Council of General Practice, Ethics and Medico-Legal Committee who undertake crucial representation on behalf of members lobbying government and key stakeholders.

Got a great idea for a story or know of someone we should do a story on? Contact us about a story for Doctor Q. Got a great event idea? Let us know. Members of our Council of Doctors in Training proposed the idea for the Junior Doctor Conference, which is now an annual, low-cost professional development fixture to support our Doctors in Training. Members have also directly developed the content for our Private Practice and Medico-Legal Conference. Would you like to start a special interest group for interested member colleagues? We can provide the facilities, catering and support on site here at AMA Queensland, and we will also consider requests for support of regional member networking activities. Enjoy the spring edition, Michelle

OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Kevin Francis BRENNAN

Dr Kenneth Robert HAYES

General Practitioner Late of Eastern Heights Member 64 Years

Internal medicine physician Late of Keperra Member for 64 years

Dr Eric Kyriakos SCLAVOS

Dr Kenyon Geoffrey FRY

Radiologist Late of Auchenflower Member of 9 Years

Obstetrician/Gynaecologist Late of Chermside West Member for 47 years

Dr Mark Shawn SKINNER General Practitioner Late of Mooloolaba Member for 6 Years Disclaimer â€“ 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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Board of Directors 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 Jim Finn Appointed Director

Council Dr Tom Arthur Gold Coast Area

Dr Geoffrey Hawson Retired Doctors

Dr Sharmila Biswas Far North Area

Dr Scott Horsburgh General Practitioner Craft Group

Dr Kimberley Bondeson Greater Brisbane Area Douglas Brown Medical Student Observer Dr Lisa Byrom Greater Brisbane Area Dr Thomas Campbell Greater Brisbane Area Dr Matthew Cheng Doctors in Training Dr Sarah Coll Specialist Craft Group

Dr Richard Kidd General Practitioner Craft Group Professor Steve Kisely Greater Brisbane Area Honor Magon Medical Student Group Representative Dr Bav Manoharan Greater Brisbane Area Dr John F. Murray Specialist Craft Group

Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group

Dr Paul Neeskens General Practitioner Craft Group

Dr Jim Finn Full-time Salaried Medical Practitioner Craft Group

Dr Alex Ritchie Specialist Craft Group

Dr Katherine Gridley Greater Brisbane Area

Dr Anil Sharma International Medical Graduate Representative

Dr John Hall Downs and West Representative

Dr Harley Wilson Capricornia Representative

AMA Queensland Secretariat 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 Journalist: Rachael Barr Advertising: Louise Glynn Doctor Q is published by AMA Queensland Phone:

(07) 3872 2222

Address: PO Box 123, Red Hill QLD 4059 Email:

amaq@amaq.com.au

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PRESIDENTâ€™S REPORT

I am always amazed when people ask me what the AMA actually does. I accept that this is not readily apparent all the time and you have to actually read Doctor Q, Online News, etc to remain abreast (hint, hint…), but it’s actually the less tangible functions of the association that I often think are more important, that should perhaps paradoxically be more obvious.

to accusations of elitism or arrogance (which have been ridiculously overstated) that we rarely properly stand up for ourselves or allow ourselves to unashamedly promote the interests of the medical profession. This is manifest throughout the entire health system at all levels. As a result, the medical view often gets diluted or is missing entirely.

We have very active and focused chief nursing and allied health officers within Queensland Health. From their departments have sprung such travesties as nurse endoscopy, radiographer reporting of X-rays and prescription of S8 narcotics by physiotherapists in emergency departments. Under the guise of ‘expanded scope of practice’, there are plans for pharmacists on geriatric wards to prescribe osteoporosis medications; initiation of anti-retroviral therapy in HIV patients and a growing list of at least dubious and perhaps dangerous ideas. At the heart of all of these ‘innovative’ models of care is an unashamed grab for medical role substitution without the responsibility or appropriate training. Where is the medical balance to these avaricious parochial interests (and how on earth do such notions get started in the first place)?

I regard one of the AMA’s main roles as fearlessly providing the medical argument/position so our profession’s voice is heard. Equally, it is to provide (political) cover and fortitude for those bold few among us who are arguing on our collective behalf and who are being subject to aggressive rebuttal that borders on manipulative

“WE HAVE BECOME SO SENSITIVE TO ACCUSATIONS OF ELITISM OR ARROGANCE THAT WE RARELY PROPERLY STAND UP FOR OURSELVES OR ALLOW OURSELVES TO UNASHAMEDLY PROMOTE THE INTERESTS OF THE MEDICAL PROFESSION” The Chief Medical Officer role is currently melded with the Chief Health Officer role and therefore, its presence within the department is diluted. The other crippling problem we have as a profession is that we have become so sensitive

“I AM HAPPY TO ENDURE THE POLEMICAL ARGUMENTS OF OTHER TRIBAL HEALTH CARE GROUPS AND REFUSE TO SUBMIT INTO THE ‘HIGH MORAL GROUND’ OR BE PARALYSED BY FEAR OF RETRIBUTION FOR NOT BEING SEEN AS A TEAM PLAYER.” from other tribal interests. It really worries me when I hear colleagues taking refuge in the ‘high moral ground’ when in a political or administrative stoush. I’m yet to witness this frankly craven stance to ever work. It’s tempting to justify our occasional lack of resolve or submissiveness by believing we are being ‘team players’ – but this blinkered relinquishing of self-worth merely lastingly concedes responsibility and scope of medical practice to others. It, therefore, worries me that our colleagues sometimes cannot clearly see the critical role of the AMA in strenuously representing our collective interests. This brings me to the issue of the Rockhampton Base Hospital review into maternity services and the enduring, well-known

problems with midwifery-led care. This review clearly calls for greater involvement and leadership of obstetricians in patient care. This rather sounds like a blinding glimpse of the obvious… but, as we all know, we often need special reports to point out the obvious. AMA Queensland has emphasised for many years now what has been clearly detailed in the literature. Midwifery-led care outcomes are inferior to those experienced in an obstetrician-led model of care, such as in the private hospital system. Queensland Health’s reports show neonate mortality is higher in the public hospital system versus the private hospital system. The rates of third degree and fourth degree perineal tears are woefully more frequent with midwifery-led care as another example. How did we miss this? Or did we know and felt powerless to do anything about it? See above… I was recently quoted in The Courier Mail as saying the obstetrician was the only health care professional adequately trained and experienced to deal decisively with all complications of pregnancy and their involvement is clearly associated with improved outcomes for mother and neonate. Soon after, it was seriously put to me that I had said something offensive and inappropriate and could be subject to reprisal. In the most heinous example of role substitution that has clearly negatively impacted on our patients, we should have an association and profession that is ready to strongly defend/promote the interests of doctors and, in doing so, protect patients.

Finally, I wish to point out the importance of this strong stance and issue for all doctors. As with all things that are slowly whittled down over time, what is left becomes accepted practice. Role substitution is rarely appropriate and, besides devaluing what we do as doctors, it tacitly allows core responsibilities of other usurping health care groups to be abandoned. I absolutely understand the benefits of multi-disciplinary care, but this does not have to equate to devolution of medical role or responsibility to others. ‘Expanded scope of practice’ should not be thinly veiled substitution and existing models, such as nurse endoscopy and midwifery-led care, which are clearly associated with increased cost or inferior outcomes (or both), need to be strenuously and fearlessly rolled back. National medical student numbers continue to steadily increase and post-graduate vocational training has expanded nearly 2.5-fold in the last decade. We should have no part in models of care – labelled deceptive as innovative or otherwise – which trade away the future of our younger generation of doctors. In the near future, AMA Queensland will release our thoughts on how to improve public hospital maternity services in Queensland. You can be sure we will aggressively promote the critical role of the obstetrician. We have also submitted our thoughts on the ‘expanded scope of practice’ policy generating potentially dangerous ideas, such as nonmedical prescription of opiates. Thanks goodness for the AMA! Q

I’m pleased to say the association is fearlessly entering this fray once more. I am happy to endure the polemical arguments of other tribal health care groups and refuse to retreat into the ‘high moral ground’ or be paralysed by fear of retribution for not being seen as a team player. This is exactly what the AMA is for. The published outcomes speak for themselves and to do any less would be inappropriate and not in our patients’ best interest. Doctor Q Spring | 9

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CEO’S REPORT Revalidation The Medical Board of Australia recently released the interim report from the Expert Advisory Group on Revalidation and launched consultation on the report. Revalidation has been a contentious area of discussion over the last several years. Whilst medical practitioners, patient advocacy groups and regulatory bodies agree on the importance of having highlytrained, qualified and capable clinicians, any revalidation model needs to be fair and feasible.

“FOLLOWING OUR SUBMISSION, WHICH CALLED FOR IMPROVEMENTS TO THE HEALTH COMPLAINTS SYSTEM, AN INQUIRY INTO THE PERFORMANCE OF THE OHO WAS ANNOUNCED.” The proposed model will focus on strengthened continuing professional development (CPD) and systems to identify and assess at risk or poorly performing medical practitioners. Whilst these are reasonable goals, and we welcome the Medical Board’s modest approach, it is critical any model of revalidation does not create additional work without tangibly benefitting patients and the health system. 10 | Doctor Q Spring

Australia is a leader in strong health standards, guided by highly-trained and capable clinicians. Whilst improvements can always be made, AMA and AMA Queensland are wary of any system that seeks to overhaul our effective and safe health care system. A system of revalidation should take reasonable and gradual steps to improve on the building blocks already in place. At the federal and state level, we will continue to contribute to the discussion on revalidation and will be providing a submission during the consultation process. We all share a responsibility for creating the safest health system possible and member feedback is always welcome. You can make your voice heard by contacting us at amaq@ amaq.com.au or by contacting your local area or craft group representative. New AMA Queensland Constitution There is no doubt that the health environment is complex, requiring us to adapt, be more proactive and innovative, and be constantly thinking about the

“IT IS CRITICAL ANY MODEL OF REVALIDATION DOES NOT CREATE ADDITIONAL WORK WITHOUT TANGIBLY BENEFITTING PATIENTS AND THE HEALTH SYSTEM”

future. The AMA Queensland Council recently approved a new company Constitution, which will be put to members at an extraordinary general meeting in November. The new Constitution will allow for increased flexibility, broader skills and depth of governance experience.

Members will be invited to vote on the changes at an extraordinary general meeting in November. I encourage all members to have their say, so please keep an eye out for upcoming member communication.

Some of the key additions under the proposed new Constitution are:

AMA Queensland, along with our union partner, the Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ), continues to support members on the key issues faced in their workplaces, whilst advocating for good workplace conditions.

Allowing for up to two directors (non-medical practitioners) to be appointed to the Board, enabling specialist governance skills (e.g. law, finance, digital marketing, membership and the like) to be brought onto the Board; Add a further membership category of associate member for persons who are not a medical practitioner but have provided honourable and substantial service to the profession. This category will not have voting rights at general meetings; Enshrine the role of Council in the Constitution, however, through new terms of reference, allow the Council the flexibility to co-opt individuals to assist on specific policy matters as required. These changes all provide not only a contemporary company constitution but enable the association to better respond to the needs of members and emergent issues in our health system.

Advocating for fair workplace conditions

Out team has negotiated the Mater Visiting Medical Officers (VMO) Agreement 2015. The agreement received 100 per cent support in the vote, which speaks to the level of consultation and negotiation which occurred to ensure an amenable agreement was reached. AMA Queensland also continues to advocate for increased fairness and transparencyWin the Office of the Health Ombudsman (OHO). Following our submission, which called for improvements to the health complaints system, an inquiry into the performance of the OHO was announced. Expediency and fairness are critical in dealing with health complaints – both for the patient and the practitioner. We welcome the review and will continue to advocate for improved systems and processes. Please take the time to read our submission, available under the advocacy section of www.amaq.com.au. Q

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Doctor Q Spring | 11

PEOPLE & EVENTS

DINNER FOR THE PROFESSION On a cool night in June, members and guests came together for the annual Dinner for the Profession at Victoria Park Golf Club. The night is a chance for the profession to join together in an elegant setting, hear from the AMA Queensland President and to award student prizes and awards of distinction. Guests enjoyed a dance after dinner with the band Savvy. This year’s entertainment also included a silent auction with all proceeds being donated to the AMA Queensland Foundation. Items up for grabs included exquisite rings, pendants and earrings from award-winning local jeweller Stephen Dibb; an autographed Australian Wallabies rugby union jersey; a case of wine; concert tickets; luxury beauty vouchers; hampers; and a VIP game day experience with the Brisbane Lions. We extend our sincere thanks and gratitude to our generous sponsors for donating the auction items, as well as the bidders for taking part. $6,200 was raised from the auction which will help support the important work of the Foundation. Thank you to our generous sponsors, who make events like these possible: Macquarie Private Wealth, BOQ Specialist, William Buck, MDA National and Lexus of Brisbane. Q

AWARD WINNERS AMA Memorial Prize Mitchell Walmsley William Nathaniel Robertson Prize Rahul Snelling Harold Plant Memorial Prize Ricky Nelles John Bostock Prize in Psychiatry James Doherty Lilian Cooper Prize Natasha van Zyl AMA Medal of Achievement - James Cook University Alice Hurley AMA Queensland Child Health Prize – Bond University Sophie Sturrock AMA Queensland Children’s Health Prize – Griffith University Ross Bourne Citation of the Branch Dr Beverley Rowbotham Citation of the Branch Dr Martin Nothling

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1. Shadow Minister for Health and Ambulance Services John-Paul Langbroek with Dr Sharon Kelly and Peter Hackett 2. AMA Queensland CEO Jane Schmitt, Queensland Health Deputy Director-General Dr John Wakefield, Minister for Health Cameron Dick, AMA Queensland President Dr Chris Zappala, Claire Rudd, Dr Shaun Rudd, Professor Graeme Nimmo and Queensland Chief Health Officer Dr Jeannette Young 3. Drs Rob and Zelle Hodge with Dr Gino Pecoraro 4. Dr Sarah Coll, James Coll and Dr Sharmila Biswas 5. Drs Emily Farrell, Thomas Campbell, Emma Ruckley and Lisa Byrom 6. Drs Edwin Kruys,

6 8

7 Gino Pecoraro, Beverley Rowbotham and Eleanor Chew 7. Drs Peter Stickler, Matthew Cheng and Hannah Bellwood, Honor Magon and Drs Emily Shao and Johnson da Huang 8. Drs Chris Ho and Su Mien Yeoh 9. Hannah Wilkey and Dr Ian Wilkey RFD

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PEOPLE & EVENTS

JUNIOR DOCTOR CONFERENCE 2016 Doctors and students flocked to the Brisbane Exhibition and Convention Centre in June for the largest junior doctor conference in Australia. The conference opened with no less than Laureate Professor Peter Doherty AC, recipient of the 1996 Nobel Prize in Medicine, and was soon followed by burns treatment pioneer, Winthrop Professor Fiona Wood AM. Associate Professor Munjed Al Muderis shared his incredible story of coming to Australia as a refugee and becoming an osseointegration pioneer. Professor Leigh Atkinson AO and Robert Hoge shared their inspiring doctor-patient story, before guests took a night out for the cocktail party with special guest, General Practitioner and magician Dr Vyom Sharma. The Honorary Dr Anthony Lynham MP spoke on Sunday morning about Queensland Health developments for junior doctors and then joined a live issues forum. Throughout the weekend, junior doctors presented research, described their best moments in medicine and presented health posters. Q Best moments in medicine (John Dorian Cup) Winner: Dr Lulu Zhang Runner up: Dr Kellie Hillsley Research presentation Winner: Dr Sonia Chanchlani Runner up: Dr Arjun Shivananda Poster presentation Joint winners: Nicole Jones de Rooy and Dr Gillian Gallagher Runner up: Dr Amy Leung

14 | Doctor Q Spring

THE 2017 JUNIOR DOCTOR CONFERENCE WILL BE HELD ON 1 - 2 JULY – DON’T MISS OUT! 1. Honor Magon, Sulagna Gupta, Nikita Allan, Vandit Bhasin and Aveechal Prasad 2. Robert Hoge and Professor Leigh Atkinson 3. Dr Mikaela Seymour 4. Winthrop Professor Fiona Wood AM 5. Drs Sally Harrison and Rhys Thomas 6. Drs Thomas Boosey and Sanjay Hettige 7. Drs Rachel O’Neil, Shannan Searle, Sara Sharma and Breanna Abraham Alex 8. Best moments in Medicine winner Dr Lulu Zhang 9. Laureate Professor Peter Doherty AC 10. Research presentation winner Dr Sonia Chanchlani with Dr Matthew Cheng 11. Cherie Hsiung and Stephanie Zhu

Doctor Q Spring | 15

CURRENT ISSUES

BARRETT CENTRE REPORT RELEASED The review into the former Newman Government’s decision to close the Barrett Adolescent Centre (BAC) has been completed, with Commissioner Margaret Wilson QC presenting her report to the Premier on 24 June 2016. The report was released publicly on 18 July 2016 to allow the government time to brief the families of the centre’s former residents first. The decision to close the mental health facility was announced by previous Health Minister Lawrence Springborg in August 2013. This decision was heavily criticised at the time by a number of organisations, including AMA Queensland. Within eight months of the centre closing, three former patients of the BAC had died. Justice Wilson, a former Mental Health Court judge, said it was “extraordinary” that “no one person or entity assumed responsibility and accountability for the processes of the decision-making”. The commission also made criticisms regarding systemic issues associated with the redirection of funding from the Redlands project, which was originally planned as a replacement facility for Barrett. It found the decision by former Minister for Health Lawrence Springborg to redirect funding from the Redlands project to rural hospitals, was within his discretion to make, but that he had not been adequately advised. Other criticisms relate to over-reliance on views of some key individuals and inadequate briefing notes, record keeping and communication with patients, families and staff. The commission did not find evidence of any contravention of laws or directives relating to patient safety or 16 | Doctor Q Spring

confidentiality. However, the report makes adverse commentary against a number of government employees. The report’s recommendations, broadly summarised, are: review legislation that establishes the devolved Hospital and Health Service model in Queensland Health; improve service agreements Queensland Health uses to contract services provided by non-government organisations; improve the availability and use of evaluations to inform clinical interventions in mental health; improve transitions for adolescents moving into adult mental health services; and improve coordination between services designed to support young people who have both an intellectual disability and mental illness. The report also recommended the government consider building a new centre in south-east Queensland offering a range of mental health services for young people, including bed-based services, a proposal the government has accepted. Health Minister Cameron Dick said the cost, size, location and model of care provided in the proposed new treatment facility would be guided by contemporary practice, current research and consultation with health consumers, including families from the former Barrett Centre and a detailed implementation plan will be prepared by the end of September. If your patients need help or support, they can contact Lifeline on 13 11 14, beyondblue on 1300 224 636, Kids Helpline on 1800 551 800 or Headspace on 1800 650 890. Q

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Doctor Q Spring | 17

FEATURES

PRESIDENT TO PRESIDENT INTERVIEW AMA QUEENSLAND President Dr Chris Zappala asks AMA president Dr Michael Gannon the big questions. What are the three most important initiatives/changes we need to convince the Federal Government to implement? The AMA released a policy document – Key Health Issues for the 2016 Federal Election – earlier this year. While it canvassed a range of issues, the three most pressing policy changes the AMA has been advocating are the lifting of the Medicare patient rebate freeze, reversing the cuts to bulk billing incentives for pathology and diagnostic imaging services, and increasing funding to the states and territories for public hospitals. These priorities were endorsed by the AMA Council and the state AMAs, many of whom were involved in weekly teleconferences throughout the federal election campaign. I have raised these matters in person with the Prime Minister and the Health Minister, both during the campaign and in recent weeks following the election. These issues were also at the core of my nationally-televised speech to the National Press Club (ama.com.au/media/ dr-gannon-national-press-club-address), which received widespread media coverage around the country. The policy document, numerous media releases and interview transcripts, and the National Press Club Speech are available on the AMA website. How can AMA be a more effective lobby group? For example, do we need to be more mindful of the Pharmacy Guild and others? The AMA was voted the most effective lobby group in national politics by Federal MPs and Senators in 2006, the last year this poll was conducted. The AMA was also voted the best lobby group in the health sector in 2014 and 2015 - the two and, to date, only times this poll has been conducted in a national poll of health groups, including the Pharmacy Guild. 18 | Doctor Q Spring

The AMA is a member organisation that lobbies on a broad range of issues on behalf of all doctors and patients in Australia. The Pharmacy Guild is an organisation that represents pharmacy owners, not grassroots pharmacists, and is heavily funded by its corporate membership. Its major lobbying efforts occur every five years in negotiating the Pharmacy Agreement with government. The AMA is vigilant on efforts by other health professions attempting to encroach on roles traditionally conducted by doctors. This involves collaboration between the federal and state AMAs, as much of the legislation is state-based. It is a fact that most Canberra-based lobby groups and member associations are envious of the AMA’s profile and regularly approach us for advice. Recent examples include the Law Council of Australia, Engineers Australia and Palliative Care Australia. We also spend a lot of time working with, not against, organisations like the Pharmacy Guild in pursuit of shared objectives. The audience at the Press Club was full of representatives of many groups from across the health sector and the lobbying community. In recent media coverage – and in the introduction to my Press Club speech – the AMA was described as “the nation’s most powerful union” and “a well-oiled machine”.

“BEFORE WE CONSIDER REDUCING MEDICAL GRADUATE NUMBERS, WE MUST MAKE SURE THAT WE HAVE REDUCED OUR RELIANCE ON INTERNATIONAL MEDICAL GRADUATES, AS LOCALLY TRAINED GRADUATES COME THROUGH THE TRAINING PIPELINE. ”

We are credited with forcing the government to drop its co-payment plans, reform Medicare Locals and increase GP infrastructure grants, among other advocacy wins. The AMA is highly regarded by federal politicians, and envied by other lobbyists. We are travelling well. Is the failure to significantly improve GP membership a consequence of the times or a failing of the association? How do we combat it? GP membership has been an issue for the AMA for a very long time. Our GP member numbers are not falling, but the growth in the GP workforce is not reflected in an increase in the number of members. There are many factors at work including corporatisation of general practice, an increase in the proportion of part-time GPs, large numbers of international medical graduates, the proliferation of single-issue alliances (refugees, climate, rural, marriage equality), ideology, cost of membership and efforts by the colleges and other groups to be more like the AMA – a strong advocate with a high public and media profile. There is also the age-old problem of doctors who benefit from AMA advocacy without being a member. They see no reason to join. This is a big concern for associations and unions around the world. The federal and state AMAs are constantly working on membership strategies to increase membership across all sectors of the profession, including general practice. The AMA is concerned at the threats to the viability of the private health insurance market. What specific interventions does government need to implement to preserve the value of private health insurance? What specific changes does the profession need to contemplate? The AMA supports a system where the public and private systems work side-byside to provide universal access for patients to health care. The public system relies on a complementary, strong and innovative private system. While the private health insurance market appears to be viable at the moment, we are

seeing worrying signs of the value of the product depleting.

rebates are two key reasons patients can face out-of-pocket costs.

It is commonplace for doctors to see patients who think they are covered for a treatment, but find out that they are not. Patients are finding out, in their time of need, that the insurance they paid a considerable sum of money for does not cover them.

Even before the freeze was put in place, the MBS fees and the fee schedule of most private health insurers has not reflected the true cost of providing quality medical care.

The AMA is glad to hear that the government intends to reform the provision of private health insurance policies whilst maintaining the community rating system. Developing gold, silver and bronze health policy categories, standardising terms and mandating minimum levels of cover should make choosing the right health insurance product easier for consumers.

“THE THREE MOST PRESSING POLICY CHANGES THE AMA HAS BEEN ADVOCATING ARE THE LIFTING THE MEDICARE PATIENT REBATE FREEZE, REVERSING THE CUTS TO BULK BILLING INCENTIVES FOR PATHOLOGY AND DIAGNOSTIC IMAGING SERVICES, AND INCREASING FUNDING TO THE STATES AND TERRITORIES FOR PUBLIC HOSPITALS.” The government has also announced it will be removing 'junk' policies from the market. The AMA has consistently advocated for the removal of those policies which have as their primary purpose avoiding the Medicare Levy Surcharge, as they are detrimental to the health system. The AMA has long-established positions on informed financial consent, on setting medical fees and billing practices, and on providing quality care. The high-quality care our patients expect should continue. Does every college need an ‘excessive fees’ committee similar to RACS? At 86 per cent, the overwhelming majority of privately insured medical services are provided at no gap to the patient. A further seven per cent are provided with a known gap, meaning there is only a very small proportion of patients who face surprise out-of-pocket costs for their privately insured care. Differential rates paid by private health insurers for the same treatment and an ongoing freeze on patients' Medicare

I am anecdotally aware of some practitioners charging excessive fees. The AMA has consistently said that this minority of outliers should be called out. Many of our members are frustrated with the recent treatment of retired doctors and the removal of meaningful registration, despite willingness to maintain training and education levels. Is there future scope for the AMA to support an expanded role for our senior, retired doctors that would allow limited prescribing and referral? The Medical Board’s view is that medical practitioners who choose to maintain any form of practice, including writing prescriptions and referrals for relatives and friends, must maintain a category of practising registration and must meet the Board’s registration standards. The AMA supports this view and we encourage all medical practitioners to maintain registration and continuing professional development (CPD). We think that medical practitioners have a duty, if they continue to provide patient care, to undertake continuing medical education. The general registration category is the best option to allow any doctor who decides to scale back their practice, for any reason, with or without remuneration, to determine their own scope of practice. If you were to identify the single greatest public health challenge of the next decade, what would it be? How should we deal with it? Obesity is probably the single biggest public health challenge we face. The management of the obesity crisis we are facing should be a national health and economic priority. The only way we can tackle obesity and overweight is with a whole-of-society approach that is commensurate with the breadth of the prevalence of obesity; knowing that the rate of Australians who are obese and overweight, and who do not partake insufficient physical activity, is increasing. The AMA wants to see employers, schools, community organisations, government, the media, non-government organisations, the health and food industries all working together. There is no single approach. What is needed is a suite of approaches - regulatory and financial - that modify behaviours and social practices that promote and sustain obesity. We also see an important role for those

making decisions on town planning and urban design, transport, school curricula and activities. We want to see investments that increase the community’s health literacy so that individual people make better choices. Do we have enough doctors in Australia? If we do, given medical student numbers are increasing, how do we encourage universities to train fewer medical students? We have got to a point where we have reached the peak in terms of medical graduate numbers, with data from the former Health Workforce Australia (HWA) suggesting that overall doctor numbers are about right - both now and into the future. Our advocacy is focused on ensuring that there are enough postgraduate training places and governments have well-crafted policies in place to improve the geographical distribution of the medical workforce, as well as encourage more graduates to look at careers in under-supplied specialty areas. We obviously need to make sure that the medical workforce continues to match community need. Before we consider reducing medical graduate numbers, we must make sure that we have reduced our reliance on international medical graduates, as locally trained graduates come through the training pipeline. You come from a state that faces regional and rural health care challenges like Queensland. What initiatives are required to more decisively manage the paucity of doctors outside metropolitan areas? Why have governments been relatively ineffective at dealing with this problem for many years now? Doctor numbers in rural and regional areas have been increasing, but a big factor in this has been international medical graduate recruitment. Governments have still not found the right formula to attract more local graduates to work in these areas but we know what the evidence suggests works. Coming from a rural background and/ or training in a rural area are positive recruitment factors, and the AMA has developed some good policy proposals in these areas. These include selecting more medical students with a rural background, introducing a community residency program, the establishment of regional training networks, and the funding of extra specialist training place in rural areas under the Commonwealth's Specialist Training Program. The AMA is also committed to working with the government on the design and implementation of a national rural generalist training program - building on the success of similar initiatives in states like Queensland. Q Doctor Q Spring | 19

CURRENT ISSUES

INCREASE TO MINIMUM WAGES

The Fair Work Commission has published their decision for the 2015-2016 Annual Wage Review, announcing that the national minimum wage and modern award wages will increase by 2.4 per cent. When do I need to apply the 2.4 per cent increase to my staff wages? The increase applied from the first full pay period starting on or after 1 July 2016. Who will the 2.4 per cent increase apply to? The increase will apply to employees whose pay rates are derived from either the national minimum wage, a modern award or, in some circumstances, a registered agreement. Employers who pay staff under a modern award, and pay an aboveaward pay rate which adequately absorbs the upcoming minimum wage increase, will not need to take any action, unless the employment contract provides otherwise. 20 | Doctor Q Spring

Additionally, employees not covered by an award or agreement will not require a pay increase if their current wages will be higher than the new national minimum wage ($672.70 per week or $17.70 per hour). Other increases The high income threshold for unfair dismissal applications under the Fair Work Act will also increase from 1 July 2016, from $136,700 to $138,900. The meal allowance in the Health Professionals and Support Services Award 2010 and the Nurses Award 2010 has increased. The tool allowance in the Health Professionals and Support Services Award 2010 has also increased; however, for many employers this allowance will not be relevant as it only applies to chefs and cooks. If you require information on the allowance increases (or any other matters regarding the increased wages), contact the Workplace Relations Team on (07) 3872 2211 or s.tilby@amaq.com.au. Q

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Doctor Q Spring | 21

CURRENT ISSUES

WHEN EMPLOYEE CONSULTATION IS REQUIRED From time to time, your practice will have more or less work on, and you’ll need to adjust your employees’ hours, change their roster or possibly consider a redundancy. Under the modern awards, you will need to meet particular requirements when consulting with employees. All modern awards, such as the Health Professionals and Support Services Award 2010 and the Nurses Award 2010 require you to follow a specific process if: a ‘major workplace change’ as defined by the award is potentially going to occur; or if you are proposing to change an employee’s regular rosters or hours of work. Following the consultation requirements properly in the modern award is important, as a breach of the consultation clause can create a risk of: claims against an employer for breaching the modern award provisions; unfair dismissal claims without proper consultation if staff are made redundant; discrimination claims if an employer fails to properly consult with staff who have a protected attribute such as family or caring responsibilities. Consultation requirements for major workplace change Clause 8.1 in the Health Professionals and Support Services Award 2010 and the Nurses Award 2010 states ‘where an employer has made a definite decision to introduce major changes in production, program, organisation, structure or technology that are likely to have significant effects on employees, the employer must notify the employees who may be affected by the proposed changes and their 22 | Doctor Q Spring

representatives, if any.’ The clause provides a definition of ‘significant effects’ for the purposes of the employer’s consultation requirements. It includes: terminating employment; major changes in the composition, operation or size of the employer’s workforce or in the skills required; the elimination or diminution of job opportunities, promotion opportunities or job tenure; altering work hours; the need to retrain or transfer employees to other work or locations; and the restructuring of jobs. In addition to notifying the employee/s about the major workplace change, the employer is required to discuss with the employee(s) (and, if relevant, any employee representatives) the following matters: the introduction of the changes; the effects the changes are likely to have on employees; and measures to avert or mitigate the adverse effects of such changes on employees (if it was possible in the circumstances for the employer to take any measures). For the purposes of the discussion, the employer is required to provide in writing information which is relevant to the changes, but it is not a requirement to disclose information which is contrary to the employer’s interests.

Any matters raised by the employee(s) during the discussion should be promptly considered by the employer before a final decision is made. Consultation requirements for proposed changes to regular rosters or hours of work Where an employer is proposing to change regular rosters or hours of work for an employee or group of employees, a similar process of consultation is required. The employer would need to: provide information about the proposed change to the employee (and their representative if applicable), specifically in regards to exactly how their regular roster or hours might change; invite the employee (and their representative, if applicable) to give their views about the impact of the proposed change, such as any affect on family or caring responsibilities; and genuinely consider any views raised by the employees. There is no specific requirement to provide written information to employee when consulting about proposed changes to regular rosters or hours of work. However, it is still recommended to, at a minimum, document the details of any consultation discussions with employees, so the employer has documentation demonstrating that they have followed the required process. This requirement to consult for proposed changes to regular rosters

or hours of work does not apply where an employee has ‘irregular, sporadic or unpredictable working hours’. Casual employees are not always excluded from this requirement, as there can be situations where a casual employee is working regular and systematic hours. What is proper consultation? Whether you’re consulting with staff due to major workplace change or possible changes to regular rosters or hours of work, it is important to give prompt consideration to matters raised by the employees and/or their representatives in relation to the changes. The focus should be on genuinely considering any matters raised by employees, rather than having already decided a pre-determined outcome. The Fair Work Commission, in a decision discussing the meaning of consultation, has noted that consultation ‘is not to be treated perfunctorily or as a mere formality’1.They also referenced a previous decision of the Federal Court of Australia, agreeing with the observations of the judge in that case, who said: There is a difference between saying to someone who may be affected by a proposed decision or course of action, even, perhaps, with detailed elaboration, “this is what is going to be done” and saying to that person “I’m thinking of doing this; what have you got to say about that?” Only in the latter case is there ‘consultation’.2

Where, during consultation, an employee raises any matters which relate to an attribute protected under discrimination laws, such as family or caring responsibilities, the employer should consider these matters before making any final decision with extra care, in order to minimise the risk of a discrimination claim. Have you followed a consultation process and want to change an employee’s roster? Don’t forget the rostering requirements in the modern award. If you’ve followed the appropriate process after keeping in mind the above information, don’t forget that, before going on to make any changes to the roster, you should follow the requirements in the relevant rostering clause of the modern award which covers the employee. For both the Health Professionals and Support Services Award 2010 and the Nurses Award 2010, the rostering requirements are found in Clause 25. Want more information? AMA Queensland members who have any questions in relation to their consultation obligations under the relevant modern award, or need advice on any other workplace issue, can contact the Workplace Relations Team on (07) 3872 2211. Q 1. Decision - Consultation clause in modern awards [2013] FWCFB 10165 2. See Communications, Electrical, Electronic, Energy, Information, Postal, Plumbing and Allied Services Union of Australia v QR Limited (QR) [2010] FCA 591 at [44] to [45]

Doctor Q Spring | 23

CURRENT ISSUES

HEALTH VISION BECOMING REALITY With the recent release of Health Vision Part Four, it’s worth looking at what impact the Health Vision has had on the delivery and future of health in Queensland.

From there, we spent almost two years researching and developing an evidence base which would help inform our solutions. We consulted with other health stakeholders and our own internal policy committees, such as the Council of General Practice and the Ethics and Medico-Legal committee.

What is the Health Vision?

Finally, in April 2015, we released the first part of the Health Vision and began the process of advocating our ideas.

The AMA Queensland Health Vision is a five-year plan which will guide our advocacy plans between 2015 and 2020. The first three parts were released in 2015 and part four was released in June 2016. It is a clear, evidence-based plan for how to improve the delivery of health services in Queensland. You can download copies of the Health Vision via the AMA Queensland website. How was the Health Vision developed? AMA Queensland consulted with members on what they felt were the biggest issues facing Queensland’s health system. This was done both online and in person, with member forums in Brisbane and Townsville.

Health Vision Part One: Public health and generational disadvantage In the first part of the Health Vision we advocated for a whole-of-government public health plan to help Queensland improve on some of the major problems facing public health, such as obesity and chronic disease. Research and consultation with members indicated that our public health crisis had come about, in large part, due to a distinct lack of a coordinated, overarching, whole-of-government policy that tackles the best way to manage public health in a state

as large and decentralised as ours. Each government department is seemingly left to its own devices to formulate policy in a silo-like approach, often without tying their work into the efforts of other departments. A whole-of-government public health plan would introduce a new way of thinking into government policy making, known as health in all policies. Policy makers in other departments not typically associated with health would be asked to consider how their policy could include or impact upon public health. The Queensland Government seemed to acknowledge there was some merit in this idea, announcing $7.5 million (over four years) in their 2014-15 budget for the development of a Queensland Health Promotion Commission which would have a whole-of-government responsibility for public health. AMA Queensland believes that a whole-of-government public health plan would help bring coordination to government policy development. The proposed Queensland Health Promotion Commission would be the ideal body to facilitate the development of the plan and bring coherence and coordination to Queensland’s response to public health issues. We continue to work with the State Government to develop this proposal and to see it come to fruition. Health Vision Part Two: Workforce and training Queenslanders want access to the health care they need, close to their homes, from highly skilled health practitioners. For this to happen, it is vital for Queensland to have a dynamic, efficient and sustainable health workforce. We want Queensland

24 | Doctor Q Spring

to be a leader in planning its workforce needs and utilising new ways of training doctors, building support networks and engaging clinician leadership. To achieve this vision, AMA Queensland wants to see action at every level of the training pathway, from internship through to retirement, to ensure that Queensland trains, recruits and retains the best doctors in Australia. Part Two of the Health Vision advocated for a culture in Queensland which encourages robust debate, expert engagement, best-practice innovation and a culture of compassion towards fellow health professionals and patients. It contained a number of initiatives which could help make this happen, but chief among them was our proposal for the establishment of a Queensland Medical Education Training Institute (QMETI), responsible for the development and execution of innovative workforce strategies. The Queensland Government established a Junior Doctor Working Group designed to investigate the merits of this proposal and AMA Queensland was invited to participate in this group. After a few meetings in late 2015, the work of this group has been put on hold while the Government works on the Medical Workforce Review (MWR), but this work has fed into the larger review. and AMA Queensland’s Council of Doctors in Training provided a submission to the MWR advocating for QMETI. Health Vision Part Three: Reprioritising care in response to need We all know that our State is facing an epidemic of lifestyle related chronic disease. We know these diseases are largely affecting our most disadvantaged citizens, including

to trial similar schemes and we believed it was important Queensland follow suit. Since we released Part Three of the Health Vision, the medical home concept has become a popular idea amongst our political leaders, with Prime Minister Malcolm Turnbull and Health Minister Sussan Ley announcing the Healthier Medicare package in March 2016, which would trial Health Care Homes to co-ordinate, manage and support a patient’s care. While we do not attempt to claim that the Health Vision in and of itself convinced the Federal Government of the merits of the PCMH concept, we nonetheless feel it was important to advocate for the concept given its clear benefits to the health system. Health Vision Part Four: Unifying the health system

the unemployed, Aboriginal and Torres Strait Islanders and refugees. Areas where generational disadvantage has become entrenched suffer high rates of type 2 diabetes, heart disease, stroke and chronic lung disease. Evidence also shows that our most disadvantaged citizens are experiencing higher rates of mental illness. Our doctors and clinicians are doing amazing work in regard to managing this deficiency, but clearly more needs to be done. AMA Queensland believes that we must reprioritise our health care funding so our health system is refocused on patients’ need and at the same time strives for greater equity and sustainability. To achieve this goal, we advocated for the establishment of a trial of Health Hubs which are based on the patientcentred medical home (PCMH) model. This model is designed to better coordinate the care of patients in the community, improve the quality of health

care in Queensland and reduce future potential costs by reducing demand on hospital services. The medical home has been used extensively overseas, dating back to 1967, and trials of a PCMH are now underway in Western Australia and Victoria. This provides us with a growing body of evidence demonstrating the effectiveness and efficiency of the model. To achieve this goal, we felt the Queensland Government should invest in a trial of a Health Hub, which would demonstrate the clear advantages of reprioritising our health system into a patient-centred, coordinated care model. We made this recommendation at a time when the Federal Government did not seem willing to implement the recommendations of the Mason Review, which also called for the establishment of medical homes. Other states, such as Victoria and Western Australia, had already begun

The theme for Health Vision Part Four is about finding ways to unify the health system, which is currently riveted by divisions that have led to duplication, cost shifting and blame shifting. Unifying the health system would help to alleviate this problem, but this is easier said than done. There is a complex division of responsibility for health care services in Australia, with many types of providers and a range of funding and regulatory mechanisms. While a single funder health system would be an obvious way to solve this problem, the reality of our health system is that such a solution would be decades away at best.

develop collaborative working relationships with the Hospital and Health Services (HHSs) (or similar) within their geographic area. We also call for the development of a standardised online pathway for GPs and patients. Many hospitals use real-time patient tracking data, so it shouldn’t be too difficult to provide the public with this kind of information. The development of a state-wide, standardised online pathway for GPs and patients would allow them to track their position on the waiting list and the length of time they will wait, as well as help patients make informed choices about the type of care they access. As Part Four of the Health Vision has only been released in the past few months, there has been little time to see the results flow through into firm action. But we will continue to advocate for these ideas at every opportunity. What’s next? Health Vision Part Five is expected to be released before the end of the year. This section will deal with the challenges facing the delivery of palliative care in Queensland and the low uptake of advance care plans. Although the Health Vision is now nearly complete, we still welcome feedback from our members. If you would like to provide your input, please contact our Policy Team via policy@amaq.com.au Q

Until a single funder is a reality, we believe the Queensland Government should look at ways it can improve connections between primary and secondary care. Doing this doesn’t require monumental change. For example, under the Hospital and Health Boards Act 2011 there is already a legislative requirement for every HHS to ‘use its best endeavours to agree on a protocol with local primary healthcare organisations to promote cooperation between the service and the organisations in the planning and delivery of health services’. Similarly, Primary Health Networks (PHNs) are also expected to Doctor Q Spring | 25

CURRENT ISSUES

BULLYING AND HARASSMENT NOT JUST IN SURGERY The percentage of bullying and harassment experienced by doctors in training (DITs) is alarmingly high, and the percentage of DITs who feel empowered to act on it is worryingly low. This is the most concerning result coming from the first AMA Queensland Council of Doctors in Training (CDT) Resident Hospital Health Check, which was recently released. DR MATTHEW CHENG

AMA Queensland Council of Doctors in Training Chair

This health check was a survey completed on a voluntary basis by DITs (interns, junior house officers and senior house officers) across all Queensland hospitals. The purpose was to get a snapshot of the working environment in Queensland hospitals for DITs. This was primarily to help medical students, current interns and residents with their decisionmaking process when deciding on which hospital to apply for. The most concerning findings came from the culture domain. Just over one in three (34 per cent) DIT respondents experienced bullying and harassment, and 40 per cent had witnessed another colleague being bullied. Even more alarmingly, only 18 per cent of respondents felt they could do anything about it.

26 | Doctor Q Spring

The issue of bullying and harassment in the workplace is not new, but certainly has come to the forefront since the media coverage on bullying and harassment reported inthe surgery specialities. This survey demonstrates that bullying and harassment is not just isolated to surgery, but is also present in our junior doctors across all fields and hospitals. It is also an indicator that this issue permeates throughout our profession and is something we should not ignore. An important consideration is that bullying and harassment is judged by the recipient’s experience, rather than the actual interaction. For instance, if a person is left feeling degraded after an interaction with a colleague, this is still bullying, regardless of whether the interaction was viewed as innocuous to an outsider. At the root of this issue of bullying and harassment is a spiral seen when a senior bullies a trainee. When that trainee becomes a senior, they do the same thing to their junior, and this is accepted as the norm. We need to break this cycle. In medical school, there is little training on non-clinical skills such as conflict resolution, interpersonal communication, leadership and teaching. Yet these non-clinical skills make up a significant portion of our working life. Formal training in these areas is critical. The second issue is the apparent lack of empowerment to report bullying. The stigma associated

with being the whistle-blower and the perceived threat to one’s personal career is likely the core barrier to report bullying. The Royal Australasian College of Surgeons (RACS), in conjunction with its Trainees’ Association (RACSTA), have been leading the way in addressing this. Of particular note, a well-established and funded anonymous reporting hotline is active and offers a good solution to report bullying, whilst protecting the reporter. Unfortunately, there are limited similar services available in Queensland hospitals and in other specialities. The AMA Queensland CDT is actively trying to address this issue of bullying and harassment on multiple fronts. We are advocating for the development of more anonymous bullying reporting systems in Queensland hospitals. We are supporting the development of widespread formal teaching on essential non-clinical skills such as conflict resolution, interpersonal communication, leadership and teaching. The CDT has also rolled out a Resilience on the Run program empowering junior doctors to deal with workplace stressors. Finally, the CDT plans to continue the Resident Hospital Health Check annually to track progress and better inform our profession. Q

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ama.com.au/careers Doctor Q Spring | 27

CURRENT ISSUES

HUNTING FOR JUNIOR MEDICS IN THE COLONIES See the world! It’s a recruitment tool famously used in WWI. Intern Dr Chris Maguire says that Australian interns should consider the urge to cross the pond just as carefully. I received an email recently spruiking the benefits of working in the United Kingdom as a junior doctor. Reasonable pay, reasonable hours, impressive supervision – these were the by-lines that subtly built the impression that a greener, though perhaps soggier, pasture existed across the horizon. The advertisements were sponsored by the English Government and I could almost see the unctuous smile of Jeremy Hunt hovering in front of me with a glass of beer, laden with the king’s shilling, as I perused the message. Perhaps he imagined that the news of his mighty disdain for junior medical staff was yet to reach the mangrove-laden shores of Moreton Bay – perhaps he didn’t care. In either case, a small population, who by necessity or ignorance grasp the opportunity to ‘see the 28 | Doctor Q Spring

world,’ always appear to stand ready to answer the call. The tactic is an old one – employed across centuries by those attempting to avoid union-led industrial action – hire your way out of vulnerability. We should be wary of it for good reason: it often works. I wouldn’t expect Secretary Hunt to be aware of our industrial disputes, but our own experience with the SMO contract crisis in Queensland will no doubt affect the response he receives to his advertisements. I’m sure you remember it all. The proposition to radically change the way in which senior medical staff were managed and compensated. The resounding cry that rose up from doctors of all seniorities across the state. Fortunately, we were aided by able representation and a community fury that reached historic proportions. I wonder if we should be so lucky in the future under different circumstances. Particularly, if junior staff were the target. As I write this article, the situation in England continues to decline in the wake of the Brexit vote. The Cameron Government has fallen – though not before declaring its willingness to impose their draconian conditions upon

junior staff – and the intentions of Prime Minister May remain uncertain. Dark days await the National Health Service (NHS). The outcome of this fight is important to us in many ways – some positive, others exceedingly negative. To start with, Queensland benefits from the despondency of highly trained junior English medics in our own recruitment. You don’t have to walk very far before hearing a British accent in Queensland Health these days. A sad story awaits any who ask about the fate of their aspirations back home. I questioned a few of them about what they thought of the email I mentioned earlier: “It’s a trap!” was my inexpertly polled, and favourite, average response. The more serious consequence

relates to the slippery slope of expedient government encroachment on necessary and fair compensation in the workplace. Let us not kid ourselves into thinking that the lessons from David Cameron’s experience with the NHS will not reverberate throughout other Westminster democracies. We are a smaller pond, but a similar one in many ways. I can see a time in the near future when the moral wedge of weekend admission morbidity will be deployed against the well meaning here and it is worth considering now, while we have time, what our response would be. What would we be willing to do to protect the working rights of our junior staff? Q

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jobs.doctorportal.com.au Doctor Q Spring | 29

CURRENT ISSUES

COMPLAINTS OR NOTIFICATIONS The Queensland Board of the Medical Board of Australia (QBMBA) are contributing a series of columns that aim to demystify, explain and expand upon the functions of the Board. In the second column from QBMBA, Board Member Associate Professor David Morgan OAM explains the process when a complaint, or notification, is made.

LET’S TALK ABOUT NOTIFICATIONS Make no bones about it, a notification is a complaint! If the Office of the Health Ombudsman (OHO) receives a notification, you can rest assured that somebody is complaining about you as a practitioner and something that you have allegedly done. The OHO receives about 3,400 complaints every year about Queensland registered medical practitioners. Just under a third of those are referred on to the QBMBA and Australian Health Practitioner Regulation Agency (AHPRA). Of the remaining twothirds, some are deemed to be unworthy of further action or further assessment whilst a small subset is deemed to be so serious that the OHO retains the contents for further action.

SO WHAT DO THE QBMBA AND AHPRA DO UPON RECEIPT OF A NOTIFICATION? There are three steps: 1. The assessment phase Importantly, we determine that the subject of the complaint is actually a registered medical practitioner, and that the complaint relates to their professional performance. The notification is carefully reviewed and a Notification Committee analyses the material. About 48 per cent of these notifications can be closed at this stage. Of that 48 per cent, 66 per cent require no further action, 17 per cent result in a caution being issued to the practitioner, whilst a further 11 per cent of practitioners are subject to the imposition of conditions. We also accept undertakings. If it is proposed to caution or apply conditions to a practitioner, a show cause process is initiated.

30 | Doctor Q Spring

Of the remaining 52 per cent that cannot be closed at this stage, almost all of them go on to investigation. 2. The investigation phase Of the notifications that require further investigation, all are again submitted to the Notifications Committee or the Board when the investigation is complete. About 55 per cent require no further action, 22 per cent result in a caution and 12 per cent result in the imposition of conditions. Panel referrals occur in six per cent of cases. 3. The referral process Even at the end of this prolonged process, not all notifications can be resolved. About six per cent require referral to Performance and Professional Standards Panels, health panels, other authorities such as the Queensland Police Service or the Queensland Civil and Administrative Tribunal.

WAIT – THERE IS ANOTHER ROUTE This refers to the need for immediate action. It occurs when there is a genuine concern for immediate public safety. The Immediate Action Committee meets weekly or as required and outcomes can include suspension, the imposition of conditions or referral to another agency. This is an interim step to protect the public whilst the matter is investigated. A show cause process is initiated. This signals the Board’s intent and allows the practitioner an opportunity to respond before the action is taken. In the 2015/16, year there were about 50 immediate actions taken. Some 70 per cent resulted in the imposition of conditions and a further 15 per cent resulted in the acceptance of undertakings from the practitioner and his or her advisors. A further 15 per cent suffered registration suspension.

HOW LONG DOES ALL OF THIS TAKE? Unfortunately, for the subject of a notification, it takes far too long. Of those notifications that can be finalised at the end of step 1, less than 50 per cent are finalised within three months. The majority do take longer. For those requiring investigation, about half are resolved within 12 months with a further 50 per cent or more dragging on for as many as 18 months. If referral to a panel or tribunal is required, it can take years. The QBMBA is acutely cognisant of the stress, strain, emotional load and turmoil that these lengthy delays can cause. You can trust that we are working as efficiently and economically as possible to limit this imposition.

WHY ARE COMPLAINTS MADE? It appears that issues with clinical care are of primary importance. About 60 per cent fall within this subgroup. Pharmaceutical or medication errors account for a further 11 per cent, whilst health impairments (alcohol or drug abuse) account for another seven per cent. Communication problems and documentary deficiencies also feature far too regularly. Whilst almost 60 per cent of all notifications do ultimately end in no further action, the remaining 40 per cent sometimes reflect badly upon us as a profession.

THE SOLUTION? Well – good medicine, good notes and good manners will go a long way towards avoiding the scrutiny applied to a notification by the Medical Board. Reading our Code for Good Medical Practice now, and annually, will prove to be invaluable. Q

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FEATURES

2016-2017 BOARD AND COUNCIL COUNCILLOR

COUNCILLOR

BOARD MEMBER

DR CHRIS ZAPPALA

DR BILL BOYD

President Specialty: Thoracic and sleep medicine

Vice President Specialty: Obstetrics and gynaecology

“I’m interested in emphasising the central importance of members and I want AMA Queensland to be a proactive and positive participant in health care reform. The fundamental purpose of AMA Queensland is to restore faith whenever it is required, and, through broad representation, be able to respond to industry and professional threats and opportunities in an intelligent and evolving manner to best meet our collective objectives. Key to this is a critical requirement to always find unity and strength from our diversity.”

“It is my intention as Vice President to assist our President, Dr Chris Zappala, in the performance of his duties. I will support and uphold AMA Queensland, its standards and activities and will work on behalf of the members towards achieving the goals of the association.”

MBBS(Hons) MHM AMusA GCAE GAICD MD FRACP

DR SHAUN RUDD

MBChB (Dundee) FRACOG FRANZCOG GAICD

COUNCILLOR

MBBCH BAO (Belfast) FAMA Chair Specialty: General practice “My goal is to represent and serve the members of our association and continue building a strong membership and financial base that provides us with a powerful lobbying platform.”

COUNCILLOR

DR TOM ARTHUR

DR SHARMILA BISWAS

DR KIMBERLEY BONDESON

Gold Coast Area Representative Specialty: Surgery

Far North Area Representative Specialty: General practice

“I’m a firm believer in the importance of the AMA to the medical profession and the health system as a whole. It is an organisation that can, and does, initiate change for the better. My role within the Council is to promote the interests of practitioners in my region, so that they can have a voice in the decisions that affect our profession and our patients. As a trainee, I have a particular interest in the education and training of doctors, and will advocate strongly to ensure doctors in training have adequate educational and employment opportunities.”

“My intention as a councillor is to support and maintain the integrity of the profession, maintain standards and advocate for the delivery of services to patients using best practice in all areas. My primary interest is to raise the profile of the regions.”

Greater Brisbane Area Representative Specialty: General practice, aviation medicine

BSc MBBS GradDipAppAnat

32 | Doctor Q Spring

MBChB DCH

BSc (Hons) MBBS FRACGP DAME

“My intention is to represent the views and voices of the doctors in the Greater Brisbane area. This includes both public and private doctors, specialists, general practitioners, and doctors in training. I will ensure that concerns of our patients and the public are listened carefully to, and advocate for those who do not have a voice. We are proud to have set up ongoing dialogue between politicians, AMA Queensland and our local doctors.”

Responsible for determining questions and matters of policy for the association, making by-laws about ethical considerations (including handling complaints related to the profession), and making recommendations to the Board of Directors about representing the association on all matters of policy with government or other stakeholders, the 2016-17 AMA Queensland Councillors are here to represent and advocate on behalf of all members.

COUNCILLOR

DR LISA BYROM

DR THOMAS CAMPBELL

DR MATTHEW CHENG

Greater Brisbane Area Representative Specialty: Dermatology

Greater Brisbane Area Representative Specialty: Ophthalmology

“I understand the importance of advocacy for both patients and our profession. As an AMA Queensland Councillor for the Greater Brisbane Area, I will continue to advocate for doctors working conditions and rights, provide support for their professional development and career progression, and I will continue to share my passion and enthusiasm for medicine.”

“I am a member and Councillor of AMA Queensland because I strongly believe in our responsibility to advocate on behalf of both patients and doctors, and because I value the AMA Queensland’s tireless efforts to ensure that we all benefit from an excellent health care system.”

Doctors in Training Representative Specialty: Plastic and reconstructive surgery

Bphty MBBS

MBBS DPhil

COUNCILLOR

DR SARAH COLL

MBBS FRACS FAOA Specialist Craft Group Representative Specialty: Orthopaedic surgery “I am keen to represent regional doctors, and those who work too hard to represent themselves. I would like to see doctors advocate for their own quality of life and set an example of healthy living. I am interested in the role doctors have to play in advocating for change in nutrition and activity practices across their communities.”

Amus A BSc MBBS (Hons)

“As a doctor in training and the Chair of the AMA Queensland Council of Doctors in Training, I endeavour to be a strong voice for all doctors in training around the state. The most significant issues facing the doctors in training include workforce planning and fair access to training programs, bullying and harassment, industrial relations and professional development. A particularly vulnerable group are non-accredited registrars. I will continue to be a strong advocate and ensure matters facing doctors in training are highlighted and addressed.”

COUNCILLOR

BOARD MEMBER

DR DILIP DHUPELIA

DR JIM FINN

Part-Time Medical Practitioner Craft Group Representative Specialty: General practice

Full-Time Salaried Medical Practitioner Craft Group Representative Specialty: Addiction medicine

“Having had extensive medical experience in both the public and private sectors, as well as federal and state government sectors, I feel I have a good grasp of health policy drivers, improvement strategies in areas such as integration of primary and secondary services in rural areas and ensuring holistic care within a seamless patient journey. As an AMA Queensland Councillor and Board Director, I look forward to working within a wide-ranging team and hopefully add value to the fine work already being performed in representation, leadership and advocacy.”

“I support continued government funding of the public and private medical sectors with no reduction of services in either sector. In these times of fiscal austerity an AMA Queensland Council which continues its support for government funding of medical services at historical levels of service growth is vital. AMA Queensland’s continued excellent advocacy in the field of preventative health is even more essential in these financially restricted times. I am excited to be part of such a forward looking innovative evidence based organisation and look forward to further initiatives, which support the cohesion of the profession.”

LRCPS (Ire) Dip Obst ACOG FRACGP FARGP AFRACMA FAICD

DipT BEd MBBS FRACGP FACRRM

Doctor Q Spring | 33

FEATURES

COUNCILLOR

DR JOHN HALL

COUNCILLOR

DR SCOTT HORSBURGH

ASSOCIATE PROFESSOR GEOFFREY HAWSON

MBBS BSc (Hons) FRACGP FACRRM DRANZCOG (Adv) GradDipRural ACSCM Downs and West Area Representative Specialty: Rural procedural medicine and general practice “As a representative of rural and regional Queensland, I hope to help advise the Council on issues affecting the health of rural Queenslanders and their health care teams. I intend to highlight important issues including the strengthening of the rural health care workforce; access to essential health care for the bush, including quality primary care, emergency services, inpatient care and maternity services; and strengthening access to outreach specialty services.”

COUNCILLOR

B Nurs MBBS FRACGP

FRACP FAChPM Dip ClinHyp CFTe [ATAA]FRCPA Retired Doctors Representative Specialty: Clinical haematology, medical oncology, palliative care “Having reached the period of incipient permanent retirement, I am passionate about ensuring we medical professionals can continue to contribute to medicine and a lifetime of training does not go to waste. I hope to be able to lobby on behalf of our senior members. If a retired judge can run a royal commission, why are we considered past our prime just because we hang up our shingle? Consideration needs to be made for genuine impairment but, if not impaired, why waste a resource?”

General Practitioner Craft Group Representative Specialty: General practice “As an AMA Queensland Councillor, I hope to focus on improving the MBS rebate for medical practitioners to help make general practice viable. I feel it is important that we keep advocating for improved clinical training pathways for medical students and junior doctors with access to general practice exposure during that time. I have worked across many aspects of the health care spectrum including critical care, general practice and defence. I look forward to working with the hard-working team that makes up the AMA Queensland Council and I hope to continue advocating for all doctors.”

COUNCILLOR

BOARD MEMBER

COUNCILLOR

DR KATHERINE GRIDLEY

DR RICHARD KIDD

Greater Brisbane Area Representative Specialty: Emergency medicine

General Practitioner Craft Group Specialty: General practice

“As a trainee, I believe I bring a different perspective to the AMA Queensland council. My work with the Council of Doctors in Training means I am aware of the contemporary issues facing our large trainee cohort and I endeavour to ensure their voices are heard. What I lack in years of medical experience I believe I make up for in my constant engagement with my local trainee, medical student and AMA community, and I continue to strive to be an approachable colleague whom they can trust to advocate on their behalf.”

“I intend to work for doctors to be free and safe to practice and teach medicine to the highest standards and thereby promote patient and community good health.”

BSc MBBS PGCertAeromed

34 | Doctor Q Spring

BHB MBChB Dip Obs

COUNCILLOR

PROFESSOR STEVE KISELY

MD PhD FRANZCP FRCPsych FFPH FAFPHM FAChAM Greater Brisbane Area Representative Specialty: Psychiatry, public health and addiction medicine “I was elected last year on a platform of AMA reform with a refocus on advocacy and equity for all members irrespective of gender, age, career stage, practice location and country of graduation. Importantly, office-bearers must remain independent of party politics and pursue the interests of physicians and patients irrespective of the government in power. My goal is to improve the Council’s transparency for AMA Queensland members.”

COUNCILLOR

BOARD MEMBER

COUNCILLOR

BOARD MEMBER

DR BAV MANOHARAN

DR JOHN F. MURRAY

DR KIRSTEN PRICE

Greater Brisbane Area Representative Specialty: Surgery

Specialist Craft Group Representative Specialty: Salaried anaesthetist

“As a training doctor and a Brisbane and Gold Coast region representative, I will focus on representing my colleagues at both the Council of Doctors in Training (CDT) and Council level. We need to work to improve the quality of and fair access to training and education in both the prevocational and vocational arenas, including ensuring training is affordable to trainee doctors and working conditions and awards are protected and enforced. As an organisation, we need to prioritise our engagement with our membership and deliver value to them. I look forward to assisting all Directors, Councillors and members of the profession who ask for my counsel.”

“My intention is to present the concerns of specialist AMA Queensland members to Branch Council.”

Honorary Secretary Specialty: Breast physician, general practice

MBBS BSc

MBBS MBA FRACGP GAICD

MBBS FFARACS

COUNCILLOR

“The AMA has a powerful voice, and we must ensure that we work constructively toward outcomes are real and useful. I am pleased to do my part to achieve the best possible healthcare for Queenslanders, including assuring sustainable high quality training for our junior colleagues.”

COUNCILLOR

DR ALEX RITCHIE

DR ANIL SHARMA

DR HARLEY WILSON

Specialist Craft Group Representative Specialty: Thoracic and sleep medicine

International Medical Graduate Representative Specialty: Ophthalmology

Capricornia Area Representative Specialty: General practice

BA BSc MBBS (Hons), FRACP

“As a new consultant in specialist medicine, with a broad practice that encompasses the public and private sector, I feel I can contribute meaningfully to the AMA Queensland Council and explore some of the challenges faced by junior Specialist doctors. I look forward to working with my fellow AMA Queensland councillors as we strive to continually improve the delivery of best medical care for all in Queensland.”

MD MS (Ophthal) FRANZCO

“l aim to undertake more educational activities and address health issues of the public in the Capricorn Region, thus promoting the AMA in Rockhampton and the Capricornia.”

MBBS FRACGP MPHTM FACRRM

“I’m hoping to reinvigorate appeal and interest into AMA Queensland’s advocacy work, particularly in the area of task substitution. Without active debate from doctors, an obvious enthusiasm for task substitution has grown from pharmacists, nurses and various allied health and university groups in the areas of immunisation, generic medication and nurse practitioner activities and I’d like to weigh into the discussion to ensure the most effective, evidence-based solution. I have concerns about the inequality in provision of medical and health services between the rest of Queensland and the south east corner and the lack of impetus of government or the medical profession to remedy this. When issues such as co-payment arise, my aim is to represent my region to ensure the views of my colleagues are heard.”

Doctor Q Spring | 35

CURRENT ISSUES

QDHP – PROVIDING LEADERSHIP IN DOCTORS’ HEALTH QDHP OBJECTIVES

Enable doctors and medical students in Queensland to access reliable, quality health care; educate doctors and medical students to maximise their physical and mental health; and enhance the skills of doctors providing care to doctors and medical students.

1982

DHAS(Q) incorporated, with inaugural president – Professor Joan Lawrence AM

1999

DHAS(Q) hosted the first Australasian Doctors’ Health Conference

2009

DHAS(Q) is a founding member of the Australasian Doctors’ Health Network

2012

Medical Board of Australia consultation on funding of external doctors health programs

2013

beyondblue study released

2015

Medical Board of Australia announces support of doctors’ health programs

2016

QDHP established with Dr Margaret Kay as Medical Director

36 | Doctor Q Spring

For nearly 30 years, the Doctors’ Health Advisory Service Queensland DHAS(Q) has been providing leadership in doctors’ health, supporting and assisting medical colleagues. DHAS(Q) would like to introduce their new company – the Queensland Doctors’ Health Programme (QDHP) which commenced in June this year. Following the release of the 2013 beyondblue report, National Mental Health Survey of Doctors, that reported alarming rates of anxiety and burnout, doctors’ health and wellbeing was highlighted as a priority for the profession. Recognising this, the Medical Board of Australia, engaged in an external consultation process and announced it would provide financial support to high quality doctors’ health programs across Australia. For almost thirty years, the Doctors’ Health Advisory Service (Queensland) has acknowledged that being a medical practitioner can be an immensely rewarding vocation, but this work can also take its toll. By providing a telephone support line, staffed by volunteer senior general practitioners, DHAS(Q) has provided support and advice to doctors and medical students who needed help or guidance with challenging circumstances. The DHAS(Q) has also been active in championing further clinician-led research into the area. It was a founding member of the Australasian Doctors’ Health Network (ADHN), a collaborative organisation with extensive expertise in doctors’ health. This network has convened biennial doctors’ health conferences since 1999 and regularly engages with international experts in the field. In recognition of this expertise, the Doctors’ Health Advisory Service (Queensland) was selected by the national Doctors’ Health Services Pty Ltd (a subsidiary of AMA), to establish the Queensland Doctors’ Health Programme (QDHP). QDHP will be supported by a portion of the national funds made available

to support doctors and medical students to maintain their health and wellbeing. As a wholly owned subsidiary company of DHAS(Q), QDHP will operate as an independent service and will be guided by DHAS(Q) in its development, with Dr Frank New as the current President. As well as continuing the confidential helpline, QDHP will focus on establishing initiatives to better meet the needs of the medical community. To facilitate this, Dr Margaret Kay has been appointed as the inaugural QDHP Medical Director. At present, the QDHP is undergoing a period of intense consultation and engagement with a broad range of stakeholders, including medical specialists, health services, and educational organisations, to better understand what support the medical community needs. In time, as the service matures, the QDHP intends to supply more complex intensive support, such as helping doctors to return to the workforce. QDHP look forward to expanding and developing our services to better assist the Queensland doctors and medical students in urban, regional and rural settings. To find out more, visit www.qdhp.org.au. The website will be soon be updated to provide educational information and links to appropriate resources for doctors and medical students who are seeking more information or assistance. Q

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Doctor Q Spring | 37

PEOPLE & EVENTS

PROFESSOR JOHN FRASER Queensland Health’s Health and Medical Research Unit present Research Fellow, Professor John Fraser, a colourful character who leads a research team working on the evolution of man-made hearts and lungs.

He is Pre-Eminent Staff Specialist in Intensive Care and Director of the Critical Care Research Group at The Prince Charles Hospital (TPCH), Director of the Intensive Care Unit (ICU) at St Andrew’s War Memorial Hospital and an internationally respected research entrepreneur. He is a family man, acted alongside Daniel Craig and Gerard Butler, a Guinness World Record holder, a one-time lead singer in a band and a Glasgow Celtic Football Club tragic. But most of all he is a visionary. He wants to make the world a healthier place and he sees the most effective way to do that is through research. “I can mend four people in the ICU but with research we can mend 4 million people,” the doctor from Glasgow says in his contagious Scottish brogue. Whilst Professor Fraser’s skill as a clinician is undeniable, it is his enthusiastic charisma that has attracted a large cohort of philanthropic donors and research funding enabling the seemingly impossible vision of Professor Fraser and his fellow researchers to create an international program developing bionic hearts and lungs.

38 | Doctor Q Spring

“In the past I saw an opportunity to create a Centre of Excellence for cardio respiratory research. I applied for grants and, although not initially successful, TPCH seed funded us brilliantly and from there I was able to convince the best and brightest groups in Australia and around the world that mechanical heart and lung research was a worthwhile, ground breaking investment. It’s from this kernel of an idea, the BIONIC project was born. And from that small beginning, the research hub, based in a Brisbane laboratory, is now the most advanced centre of cardio respiratory research in the world. “We have a hub and spoke model with an extensive team of the best in the world covering all areas including clinical, engineering, and physiological, working on the evolution of man-made hearts and lungs.” “Most people in the group are smarter than me - and whilst I love the research process, my best contribution is to come up with ideas, bring the brightest minds together, where we can collect all the pieces to put the jigsaw puzzle together. Thus creating the perfect makeup of a research team,” says Professor Fraser.

“Like most clinician scientists, patients are my inspiration to continue to reduce the unnecessary disease burden of refractory cardio respiratory disease and radically change the longevity of these patients. My memories of a young mother who died of heart failure leaving a five-year-old son haunt me; but it is patients like her that give me and my team the motivation to find the answers for others,” says Professor Fraser with a depth of conviction that shows his heartfelt determination. “We can replace engines in cars, why can’t we replace the pump in our body? I know that too many people are dying from cardio respiratory failure and that there are not enough transplants available, so the creation of mechanical devices that can be taken off a shelf when needed is the Holy Grail. Equally, we are, with the help of Dr Nathan Palpant at the University of Queensland, now integrating heart and lung stem cells with mechanical devices in these patients. So the mechanical devices can do the work of the failing heart, whilst we integrate stem cells to regrow part of the native heart. It’s a big task, but there are some brilliant minds in our team... and one rubbish footballer as well!”

“My collaborators on this project are the brains trust in ensuring the device can work and that it is a viable solution to the increasing challenge of heart and lung failure. My job is to lead, come up with ideas, kick down barriers when they arise and apologise later,” he grins. “The Health Research Fellowship that I received from Queensland Health and the support from Ken Whelan at Metro North HHS allowed me the time to devise research plans, obtain pilot data, and start to collaborate with the world leaders in this field. We can achieve so much more working together – it’s a global problem, so it seems reasonable to approach it with a global team.” Q

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Doctor Q Spring | 39

CURRENT ISSUES

EMERGENCY ACCESS ON TARGET IN QLD Dr David Rosengren, Chair of the Queensland Clinical Senate, says new research on timebased emergency access targets addresses long-held clinician concerns.

There is no doubt that emergency access targets have improved wait times for patients who present to our hospital emergency departments (EDs).

deaths of patients admitted through an ED. The results were published in the Medical Journal of Australia on 16 May 2016.

Since the National Emergency Access Target (NEAT) was introduced in 2012, the number of patients being seen, treated and then admitted or discharged from Queensland EDs has increased from 60 per cent to 80 per cent by January 2016.

THE STUDY CONFIRMED A DIRECT RELATIONSHIP BETWEEN IMPROVED NEAT PERFORMANCE AND QUALITY PATIENT OUTCOMES BUT ALSO IDENTIFIED THAT THE NECESSARY IMPROVEMENTS OCCUR AT A LEVEL BELOW 90 PER CENT.

Queensland’s significant improvement, which was the greatest against all jurisdictions, was the result of a whole-ofhospital reform program to improve performance and meet the national targets. Introduced in response to concerns about increased morbidity and mortality due to inpatient bed ‘access block’ and ED overcrowding, NEAT challenged hospitals to meet a 2015 target of 90 per cent of patients either being admitted or discharged from ED within four hours of arrival. Despite significant improvement in EDs across the country, very few hospitals have ever achieved the proposed end target of 90 per cent. In fact, many clinicians were concerned about the target, as there had never been evidence to support improved patient safety at that level. International experience suggested that patient outcomes might be jeopardised by attempts to rush patients through the ED too quickly. In 2014, the Queensland Clinical Senate – the state’s peak clinician advisory body - considered the future sustainability of NEAT and recommended Queensland lead a national review into the safety and effectiveness of the target. The Collaboration for Emergency Admission Research and Reform (CLEAR) Project was established to complete this work. Queensland Health funded the project, which involved collaboration with CSIRO and Health Round Table. The research team analysed data captured between 2010 and 2014 from major hospitals across Australia, including: more than 12 million ED presentations, four million hospital admissions via emergency and 460,000

40 | Doctor Q Spring

Scientific modelling suggests that pushing the NEAT target beyond 80 per cent may lead to a worsening of clinical outcome reflecting the need for some ED patients to have a longer period of specialist emergency medicine care. Recognising the significance of this peer-reviewed evidence, the Queensland Government has adjusted the performance target for Queensland public hospital EDs. The recently announced Queensland Emergency Access Target (QEAT) of 80 per cent was effective from 1 July 2016. This does not mean the importance of efficient care in the ED is being diluted. The expectation remains for the majority of patients to receive specialist care and have left the ED within four hours. Importantly, emergency staff will not feel pressured to move those patients from ED whose clinical condition would benefit from more time under the care of a specialist emergency physician. While it is yet to be seen whether other jurisdictions will align their emergency access targets with this research, the Queensland Clinical Senate has clearly demonstrated that strong clinician leadership around strategic health policy is essential to ensure that patients receive the best quality care in an efficient and sustainable way.

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Doctor Q Spring | 41

PEOPLE & EVENTS

Research published in the American journal Pediatrics has shown that GPs have an important role to play in countering the health effects of poverty by helping parents build resilience in their children.

RESILIENCE CONTRIBUTES TO BETTER CHILDHOOD HEALTH

American paediatricians found that evidence-based parenting programs like the Triple P – Positive Parenting Program can help to reduce the negative effects of poverty on children’s health. Triple P Queensland Program Director Carol Markie-Dadds said the program gave parents the tools to help their children adapt to adversity and cope with stress. “Parenting is an often overlooked factor in the web of influences that affect a child’s development,” Ms MarkieDadds said. “Building resilience in children can have positive effects on their overall health and wellbeing. Triple P has been shown to reduce child conduct problems, to lower the use of ineffective discipline and to reduce levels of parental stress and conflict.” Queensland parents have the unique advantage of being able to access the Triple P program for free as a result of a State Government decision to provide more support to parents. “Queensland parents can now access parenting support when and where they need it through a dedicated website which lists what seminars and group programs are currently available in different parts of the state,” Ms Markie-Dadds said. “We’re now at the halfway point of this project and already we’ve seen a fantastic response from Queensland parents. Around 18,000 parents and carers have already taken part in Triple P 42 | Doctor Q Spring

seminars and courses, picking up valuable new skills and confidence in their parenting ability. We’ve also trained more than 500 early childhood educators, teachers, nurses, guidance officers, psychologists and counsellors to provide free group and individual support to parents.” Having done Triple P Online (TPOL) himself, Broncos captain and dad-of-four Corey Parker said Triple P helped parents raise happy, resilient families. “Having kids brings a lot of joy to your life, but there’s no doubt parenting can also be frustrating and challenging at times,” he said. “It makes sense to learn as much as you can so you can prevent

small issues from becoming major problems.” As part of the state-wide rollout, Queensland GPs and general practice nurses can also access free Triple P training and resources to help them meet the needs of patients seeking help with parenting issues. Primary Care Triple P - which gives GPs the tools to provide brief consultations on specific issues over a four to six-week period – is particularly suited to a clinic environment. GPs who undertake Primary Care Triple P training receive a certificate of accreditation from the University of Queensland, and may be eligible for professional development points through the RACGP.

In addition to GP-based support, parents can also attend one of the many free seminars and courses currently being held around Queensland, or sign up for Triple P Online (TPOL). To register your interest in free Triple P training and resources or to order free brochures and posters to promote Triple P to parents at your workplace, please email qld@triplep.net. Parents and carers can book in for seminars, online support, group programs and oneon-one consultations by going to www.triplep-parenting.net. Q 1. Pascoe, J.M., Wood, D.L., Duffee, J.H., Kuo, A. (2016). Mediators and adverse effects of child poverty in the United States. Pediatrics 137 (4) e20160340

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reviveoceanside.com.au 07 3630 4570 Doctor Q Spring | 43

PEOPLE & EVENTS

WHAT’S ON

AMA QUEENS LAND P R ES ENT S

Annual AMA Queensland Conference 17 – 24 September India - Delhi, Agra, Jaipur Themed Research - turning it into reality, this year’s conference will focus on navigating the challenges and complexities of the medical research process. A progressive dinner of sorts, the conference will take place in Delhi, Agra and Jaipur.

Private Practice and MedicoLegal Conference 28 - 29 October Brisbane Convention and Exhibition Centre AMA Queensland has combined and revamped two of our flagship conferences. There are two streams available for those wanting to commence private practice, and those already in private practice, and attendees can also choose between private practice and medico-legal content.

Gold Coast Intern Readiness Workshop 16 September Southport Sharks

Brisbane Intern Readiness Workshop

Private Practice and Medico-Legal Conference

13 October Brisbane Convention and Exhibition Centre Free for fourth-year student members. Presented by doctor in training representatives, this free workshop will cover the essentials for your internship: ward call, prescribing, paperwork, exams, your working rights and final exam tips.

Breakfast with the Minister 22 November Novotel Cairns Free event for AMA Queensland members

Friday 28 - Saturday 29 October 2016

Join AMA Queensland and MDA National for breakfast where the Minister for Health Cameron Dick will discuss current Queensland Health initiatives and directions to support local doctors and their patients in Far North Queensland. The Minister will be joined by Dr Steve Hambleton and MDA National’s Deborah Jackson, who will discuss the latest in e-health.

Brisbane Convention and Exhibition Centre, South Bank

For more information about these events and registration details visit the events calendar at www.amaq.com.au

S U P P O RT I N G Q U A L I T Y H E A LT H C A R E

44 | Doctor Q Spring

LOCAL MEDICAL ASSOCIATION ROUND UP Sunshine Coast

Bundaberg

Gold Coast

Contact:

Jo Bourke

Contact:

Dr Daud Yunus

Phone:

0419 780 505

Phone:

(07) 5479 3979

Phone:

(07) 4152 2888

Email:

info@gcma.org.au

Meetings:

Phone:

daud.yunus@gmail.com

Web:

www.gcma.org.au

22 September

Brisbane Northside

27 October

Contact:

Dr Graham McNally

24 November

Phone:

(07) 3265 3111

20 October

Web:

www.northsidelma.com

18 November

Cairns Contact:

Dr Sharmila Biswas

Phone:

(07) 4036 4333

Mackay Contact:

Dr Bill Boyd

Phone:

0419 676 660

Meetings:

Meetings: 15 September

Fraser Coast

11 October 13 December

Redcliffe and District

Contact:

Drs Thomas Dunn and Paul Neeskens

Phone:

0409 623 009

Ipswich and West Moreton

Contact:

Margaret McPherson

Phone:

(07) 3121 4043

Contact:

Dr Thomas McEniery

Central Queensland

Web:

www.rdma.org.au

Phone:

(07) 3281 1177

Contact:

Dr Michael Donohue

Meetings:

Phone:

0419 715 658

13 September

18 November

Toowoomba and Darling Downs Contact:

info@tddlma.org.au

Web:

www.tddlma.org.au

26 October

CANâ€™T FIND YOUR LOCAL AREA?

If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au. Doctor Q Spring | 45

REPORT

APRIL Interns Dr Paras Jain Dr Sara Sharma Dr Lisa John Doctors in training

Dr Andrew Barrett Dr Brigid Flanders

Dr Gabrielle Webb

Dr Jane Lovell

Dr Sonali Basu

Dr Katie Ilott

Dr Osman Mohamed

General practitioners Dr Suhana Raju

Dr Annabel Cavanagh

Dr Evan Coppin

Dr Farhana Sharmin

Dr Christiaan Mostert

Dr Yasser Arafat

Dr Paddy Mclisky

Dr Tarana Lucky

Dr Ram Mohan Rao Dammalapati

Dr Manjinder Singh

Dr Raj Kudikyala

Dr Jodi Stevenson

Dr Pooja Sanghi

Dr Vu Pham

Dr David GutierrezBernays

Specialists

Dr Robyn Cooke

Dr Melanie Voigt

Dr Madeleine Hanly

Dr Saibal Guha

Dr Ryan Bell General practitioners Dr Muhammad Rafiq

Dr Chris Hickey

Dr Paul Bennett

Dr Ashok Gangasandra Basavaraj Dr Arun Kaul Dr Kemal Akbiyik

Dr Michael Kreltszheim Dr Matthew Ostwald General practitioners Dr Harpreet Sawhney Dr George Marsden Dr Ann Masjakin Dr Dushyant Singh Dr Clare Maher Dr Jamie Sutherland Dr Ihsaan Peer Dr Maria AdanBautista Dr Mohammed Latif

Dr Tania Widmer

Specialists

Dr Shane Mitchell

Dr Robert Whiting

Dr Anna Brookes

Salaried medical officers

Dr Gertrude Mutika

Dr Rajendra Moodley

Dr Melissa Buttini Dr Tarun Sehgal

Dr Kenneth Clark

Dr Hamish Macintyre

Dr Michael Tremellen

Dr Charles Mutandwa

Dr Hannah Bourke

Dr Akhlaq Khan

Dr Bradley Otto

Specialists

Other Dr Heather Mcnamee

Dr Paul Henderson

Dr David Martin Dr Sheree Moko Dr Frank Howes

Dr Alok Kumar Gupta

Dr Liza Siebuhr

Dr Abra Fransch

Salaried medical officers

Dr Sahar Mourssi

Dr Russell Canavan Other Dr Paula Heggarty Dr Rebecca Jorgensen

MAY Interns Dr Thomas Clarke Dr Anna Walch Doctors in training Dr Lisa Diamond Dr Jessica Shapiro Dr Ishani Jayawardena

Dr Liz Erskine

JUNE Interns Dr Safiyyah Abbas Dr Nigel Kwok Dr Delara Javat Dr Maggie Keys Dr Kristen Gibson

Salaried medical officers Dr Vikas Saxena

Dr Sunelle Engelbrecht Dr Umesh Shah Dr Tahir Mir Dr Caroline Cooper Dr Viraj Wijeyewickrema Dr Donald Angstetra Other Dr Maarit Harden Dr Richard Thomas

Dr Tito Prasetio

Dr Stephanie Hadikusumo

Dr Susan Dragone

Dr Gabrielle M Dellit

Dr James Powell

Dr Steven Koh

Dr Konrad Lemke Doctors in training Dr Sarah Thang Dr Anna Waldie Dr Harry Martin

46 | Doctor Q Spring

FREE MEMBER RESOURCES Essential GP Toolkit The AMA Council of General Practice has developed a resource that brings together in one place all the forms, guidelines, practice tools, information and resources used by general practitioners in their daily work. The GP Desktop Practice Support Toolkit, which is free to members, has links to around 300 commonly-used administrative and diagnostic tools, saving GPs time spent fishing around trying to locate them. The Toolkit can be downloaded from the AMA website to a GPâ€™s desktop computer as a separate file, and is not linked to vendor-specific practice management software. The Toolkit is divided into five categories, presented as easy to use tabs, including: online practice tools that can be accessed and/or completed online; checklists and questionnaires in PDF format, available for printing; commonly-used forms in printable PDF format;

clinical and administrative guidelines; and information and other resources. In addition, there is a State/ Territory tab, with information and forms specific to each jurisdiction, such as WorkCover and S8 prescribing. The information and links in the Toolkit will be regularly updated, and its scope will be expanded as new information and resources become available. Members are invited to suggest additional information, tools and resources to be added to the Toolkit. Please send suggestions, including links, to generalpractice@ama.com.au AMA Career Advice Service And Resource Hub (ama.com.au/careers) You may have heard about, or seen, the recently newlylaunched AMA Career Advice Service and Resource Hub. The website content has recently undergone a major makeover and you are invited to visit the website to see for yourself what is available to assist you in your career or career progression.

With pages providing enhanced and expanded information to those wanting to study medicine, doctors in training and international medical students and graduates, as well as new pages on caring for yourself and global health opportunities, as examples, with better and easier access to AMA practical resources, the site provides a more comprehensive suite of resources than ever before. AMA Fee List Update The AMA List of Medical Services and Fees (AMA List) was updated on 1 July 2016 to amend existing items and include new items. These items are provided in the Summary of Changes, which will be available from the membersonly area of the AMA website. The updated AMA Fees List Online will be available from http://feeslist.ama.com.au. Members can view, print or download individual items or groups of items to suit their needs. The comma delimited (CSV) ASCII format (complete AMA List) is available for free download from the membersonly area of the AMA Website (www.ama.com.au).

To access this part of the website, login by entering your username and password located at the top right-hand side of the screen and follow these steps: 1) Once you have entered your login details, from the home page hover over Resources at the top of the page. 2) A drop-down box will appear. Under this, select Fees List. 3) Select first option, AMA List of Medical Services and Fees â€“ 1 July 2016. 4) Download either or both the CSV (for importing into practice software) and Summary of Changes (for viewing) detailing new, amended or deleted items in the AMA List. If you do not have internet access, call (02) 6270 5400 for a copy of the changes. Q

Email: Careers@ama.com.au Web: www.ama.com.au/careers Doctor Q Spring | 47

PEOPLE & EVENTS

PRIVATE PRACTICE AND MEDICO-LEGAL CONFERENCE SPEAKERS SHOWCASE While all practitioners have an ethical and legal responsibility to their patients, private practice presents further challenges around record-keeping, marketing and managing risk. Further, shifts in the health system, such as the extension of the Medicare rebate freeze and development of the Office of the Health Ombudsman, underpin the complications of navigating the ever-changing health landscape. With this in mind, AMA Queensland has merged these two conferences to bring delegates a more customisable conference experience – with

something to appeal to doctors across all specialties and career stages.

COLLEEN SULLIVAN OAM

DR BILL COOTE

DR PAUL LANE

ASSOCIATE PROFESSOR ASSOCIATE PROFESSOR DAVID MORGAN OAM LOUISE NASH

Practice Consultant

Deputy-Director, Intensive Care Unit (ICU), Townsville Hospital and Health Service; Medical Director, Townsville Skills Centre; Co-designer Ten Cs Resilience Model 48 | Doctor Q Spring

Featuring a range of experts from the medical, business and legal fields, AMA Queensland’s Private Practice and Medico-Legal Conference will help build strong foundations of ethical practice management and medical leadership. The conference boasts an impressive line up of speakers, such as these shown below. See the enclosed brochure or visit www.amaq.com.au for more information. Q

Director, Professional Services Review Agency (PSRA)

Medical Practitioner Member, Queensland Board of the Medical Board of Australia

DR STEPHEN WALKER

Associate Medical Director, Cognitive Institute

ROSE KENT

State Manager, Australian Health Practitioner Regulation Agency (AHPRA)

Associate Director Teaching and Learning, Brain and Mind Research Institute, Faculty of Medicine, University of Sydney

WOULD YOU LIKE TO REMOVE THE DOCUMENTATION BURDEN FROM YOUR DAILY ROUTINE? DO YOU FACE THESE CHALLENGES?

Increased patient load for doctors to see in the same time

Time poor: Longer doctor hours, reduced time with family

Problems with poor or incomplete documentation

Lost revenue due to missed/ incomplete billing

IMAGINE AN ENVIRONMENT WHERE DOCTORS...

Have more time to practice medicine

Spend less time on clerical duties

Enjoy an improved work/life balance

POSSIBLE? ABSOLUTELY! MEDSCRIBE is a medical scribe staffing company, established by a doctor to help fellow doctors improve the quality of their working lives. We will not only lighten your documentation workload and improve your bottom line, but most importantly give you something you can never get back - YOUR TIME.

Practice more medicine

Dr Phebe O’Mullane, Emergency department doctor and founder of MEDSCRIBE

To find out how scribes can help you, please contact Dr. Phebe O’Mullane: phebe@medscribe.com.au.

WWW.MEDSCRIBE.COM.AU | 0421 372 494 Doctor Q Spring | 49

BUSINESS TOOLS

MORE SUPER CHANGES TO COME? ROSS NOYE

Macquarie Private Wealth P: (07) 3233 5805 M: 0438 779 955 E: ross.noye@ macquarie.com

In the 3 May budget, the government has proposed introducing a $500,000 lifetime cap for non-concessional (after-tax) superannuation contributions (NCC). This is a big change from the current limit of $180,000 per year (or $540,000 every three years for individuals aged under age 65). Of all the proposed changes to super, the $500,000 lifetime cap on non-concessional contributions has caused the greatest concern and is seen by many as a retrospective measure. The change, which took effect from budget night on 3 May, did not include any grandfathering provisions and may affect investment strategies that have already been implemented. The argument around the retrospective aspect of the NCC cap would be removed if the measure simply took effect from budget evening. The government has indicated it is worth looking at. To make sure you don’t exceed the new cap, you will need to contact your super fund, accountant or the Australian Tax Office (ATO) to confirm what NCCs have been made into super fund accounts from this date. For superannuants with multiple super accounts, the ATO may be your best bet. Concessional contributions made before commencement of the new rules cannot result in an excess. If the total of your NCCs made from 2007 onwards is greater the proposed $500,000 NCC cap before the budget announcement on 3 May 2017, you won’t be required to withdraw the excess NCCs above the $500,000 cap from the super system - you just won’t be able to put any more in. Other areas causing concern include lowering the cap on the maximum concessional contributions to $25,000 a year from the current $30,000 for those aged under 50 and $35,000 for those over 50. Many are concerned this will make it too hard for people to accelerate retirement savings late in their working life and there is also pressure for this to be relaxed.

Disclaimer: This information has been prepared by Macquarie Private Wealth, a division of Macquarie Equities Limited ABN 41 002 574 923 AFSL 237504. It 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.

50 | Doctor Q Spring

The $1.6 million cap on the amount that could be held in tax-free retirement accounts is also seen to punish investment decisions that many retirees had already implemented. People with more than that amount in their retirement accounts on 1 July 2017, will be forced to transfer the excess into an accumulation account where earnings would be taxed at 15 per cent.

THIS IS SEEN BY MANY TO MAKE IT TOO HARD FOR PEOPLE TO ACCELERATE RETIREMENT SAVINGS LATE IN THEIR WORKING LIFE Briefly, the main changes are: reduced maximum annual concessional contributions - $25,000; catch-up contributions for account balances under $500,000; elimination of the work test rule; spouse contributions to attract spouse tax offset; lower threshold for 30 per cent contributions tax; $1.6m retirement account cap; transition to retirement (TTR) assets to be taxed at 15 per cent; and rules on lump sum withdrawals to be tightened. Many members missed making critical changes to the way their super benefits are structured prior to the budget and it has cost them dearly. We have strategies designed to minimise the tax effects of the changes on your super benefits. You should consider implementing these.

Take control of your financial future

The best decisions are made when you have all the facts Macquarie financial advisers provide expert guidance and keep you informed, so you can take control of your financial future with confidence.

To access the tools, insights and expertise you need to help make important decisions contact us today.

Call Ross Noye on 0438 77 99 55 or Warren Acworth on 0410 51 50 99 macquarie.com Macquarie Private Wealth’s services are provided by Macquarie Equities Limited ABN 41 002 574 923 (MEL) participant of Australian Securities Exchange Group, Australian financial services licence No.237504, 1 Shelley St, Sydney NSW 2000. MEL is not an authorised deposit-taking institution for the purposes of the Banking Act 1959 (Cth), and MEL’s obligations do not represent deposits or other liabilities of Macquarie Bank Limited ABN 46 008 583 542. Macquarie Bank Limited does not guarantee or otherwise provide assurance in respect of the obligations of MEL. This information which does not take into account your objectives, financial situation or needs and before acting on this advice you should consider whether it is appropriate to your situation.

Doctor Q Spring | 51

BUSINESS TOOLS

RISK MANAGE YOUR REVENUE CHRIS MARIANI

Director, Medical & General Risk Solutions P: 0419 017 011 E: chris@mgrs.com.au www.mgrs.com.au Authorised Representative No. 434578

What are the top 10 risks in your practice? This is often a difficult question for medicos and practice managers to answer – as the modern medical practice is exposed to a host of complex risks. In running a number of risk workshops for medical practices, I’ve found it helps to think in terms of two areas: Firstly, what could go wrong where the event triggers an impact to your: assets; liabilities to third parties; revenue; reputation; registration / licences; compliance with legislation.

Secondly, what are you reliant on in order to run a successful medical practice? Is it your: rooms or a hospital or other location/s; IT system (including any third-party such as a data centre or the cloud); key medical equipment; key people including staff, doctors; and patients, suppliers or referrers. A key area we often find missing in the insurance programs for practices is the identification of events which could trigger a significant loss of revenue. Not every risk is insurable – e.g. a key risk is the loss of medical registration, so mitigating this risk is essential. The same largely applies to your reputation. While some insurance policies cover public relations expenses for certain events, they will not cover lost revenue when patients simply stop turning up.

So what insurances cover loss of revenue? There are a range of policies available that cover a loss of revenue following an ‘insured event’. Common policies which medical practices should think about:

Disclaimer: Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. 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.

52 | Doctor Q Spring

Policy

What does it cover

‘Business interruption’ (under a business package or commercial property policy)

Lost revenue as a result of an ‘insured peril’ at your premises - such as fire, storm, water damage, theft, loss of electricity – which prevents you from practising for a period of time. Cover can also extend to lost revenue as a result of a key supplier having an insured peril event at their premises (e.g. a hospital).

Equipment breakdown

Business Interruption policies (as above) generally do not cover lost revenue as a result of a breakdown of key equipment. A specialist equipment breakdown policy can cover repair/replacement following breakdown, plus any subsequent lost revenue.

Cyber

Most medical practices are reliant on IT systems. In the event of a cyber event (say your system is infected with the cryprolocker virus) many cyber insurance policies provide cover for lost revenue (usually with a 1-2 day waiting period before you can claim).

Income protection

Lost income of the insured person from accident or illness. Speak to a financial planner or life insurance advisor.

Your particular circumstances will dictate whether you have an exposure to certain risks. For example, many specialists are not reliant on their consulting rooms and often see patients from multiple locations, so a fire in one location is unlikely to lead to significant loss in revenue.

The above list of policies is not exhaustive. It provides some common policies to consider. Conduct your own risk self-assessment. Once you have identified your risks, then decide the appropriate action – this may be insurance, or it may involve other risk management measures.

One less thing on your to-do list Specialist risk and insurance solutions for medical practitioners and healthcare businesses. We can identify your key risks and protect you with the right insurance program, all managed by your own expert insurance adviser: • • • • • •

Medical Indemnity Practice Indemnity Management Liability Business Rooms Insurance Cyber Risks Personal Insurances

Free insurance health check

Call us on 1300 883 059

or speak directly to one of our experts: Chris Mariani 0419 017 011 chris@mgrs.com.au

James Warwick 0402 042 116 james@mgrs.com.au

www.mgrs.com.au

Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687

Doctor Q Spring | 53

BUSINESS TOOLS

TREVOR ROBERTSON

BOQ Specialist

P: 1300 160 160 E: trevor.robertson@ boqspecialist.com.au BOQ Specialist offer a range of financial products and services specifically tailored to the medical sector. Trevor Robertson is the Head of Residential Lending.

WHAT TO LOOK FOR WHEN BUYING OR FINANCING A PROPERTY Regardless of your stage of life, buying a home is a big financial decision. BOQ Specialist’s Trevor Robertson and real estate company NG Farah’s Chief Market Strategist Peter McGuire distill the key factors to consider when matching a home loan to your stage of life. Hint: rates are merely one piece of the complex puzzle.

GROWING FAMILY

Weigh up whether you should move or stay As your life changes, you’re likely to need different things from your home and moving to a bigger property might be on your agenda. However, it’s worth considering what you can do with renovations to fulfil your needs. Moving might make sense if you want to experience a new area or if planning restrictions are a limitation on your renovation aspirations. Renovate if you can

FIRST HOME BUYER

Calculate your budget correctly To estimate your borrowing capacity accurately, you will need to consider what your total costs will be, the size of deposit you can afford and how much you can comfortably repay. Understand the property and area The location of your first home is important, but it is also worth remembering that your initial home is your first step on the property ladder, which can provide you with financial opportunities in the future. Disclaimer: 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 make no representations or warranties. BOQ Specialist recommends that you obtain independent financial and tax advice before making any decisions.

54 | Doctor Q Spring

Check out schools and other amenities the local area has on offer, plus what’s on the drawing board over the coming decades, for example, upgrades to infrastructure. Look out for hidden expenses It’s important to consider hidden expenses that might appear once you have bought your property. Things to look into thoroughly include roof leaks, substantial cracks, leaking pipes, drainage issues, roof damage, floor damage and asbestos. Forecast capital growth Don’t be afraid to look at capital growth forecasts and rental yields. Consult industry research firms that specialise in quantitative analysis as this will assist you in understanding the key drivers for your chosen location.

If you decide to stay in your home and make renovations, there are plenty of aspects you can update to maximise resale value, such as a new timeless design, extending out as a cheaper alternative to extending up, and added features such as swimming pools. Consider the costs of moving Be conscious of the costs associated with moving and relocating, such as state stamp duties, real estate agent fees and marketing your property for sale.

EMPTY NESTER

Consider an investment property You might now be at the stage where you have significant savings and a higher income to invest in an additional property. Before you start looking, make sure you know what you want to achieve. Are you seeking capital gains from a make-over and re-sell, or would you like a steady income from rent? Think about size and accessibility If your children have moved out of home, and you don’t need the space you once did, downsizing offers an opportunity to free-up some of your assets and can give you a more manageable home in your retirement. Refinance your home loan Things change. Time moves on. Your circumstances are unique and interest rates should be just one of the factors considered when searching for the right mortgage. If you match a home loan to your lifestyle and goals, it stops being just a mortgage and becomes part of your long-term plan.

Take the pain out of health fund claiming with HealthPoint. Commonwealth Bank now offers AMA Queensland members on the spot claims, rebates and payments. Commonwealth Bank provides AMA Queensland members with a new range of market leading heath fund claim solutions. Process private health fund rebates, Medicare benefits and gap payments with one easy terminal and get your EFTPOS funds in your Commonwealth Bank account on the same day, every day*. Faster claims processing: •

Simplify processing: Process Medicare Easyclaim and private health fund rebates on the spot. No more invoicing or missed payments – just fast, easy card transactions.

•

Reduce admin: Cut paperwork for your patients and your practice, reducing the load on your staff, freeing them up to focus on higher quality service.

•

Faster payments: Receive your EFTPOS settlement funds into your Commonwealth Bank business account on the same day, every day*.

•

Peace of mind: With specialised training and 24/7 phone support for you and your staff, you can be confident that your are in good hands.

To take advantage of our special rates and fees, please call AMA Queensland on 0477 744 775 or email marcus.shaw@cba.com.au and start saving today.

Important Information: *Available to eligible customers with a Commonwealth Bank business transaction account and a linked Commonwealth Bank eligible merchant facility. ‘Same day’ includes all card sales made up to until 10pm (AEST). Third party products not included, which includes payments from Medicare and private health funds for claims processed. Everyday Settlement applies to EFTPOS and gap payments, which are treated as normal credit/debit transactions (for Commonwealth Bank account holders). Funds received by a practice for Medicare and private health funds claims are processed by the relevant organisation (Medicare or private health fund) and are processed according to their timeframes. Applicants for this offer consent to their name and merchant identification being provided to AMA Queensland to confirm their membership and eligibility for the offer. AMA Queensland may receive a fee from the Commonwealth Bank of Australia for each successful referral. Referral Fees are not payable on referrals from existing relationship managed customers. This has been prepared without considering your objectives, financial situation or needs, so you should consider its appropriateness to your circumstances before you act on it. Full fees, charges, terms and conditions are available on application. Commonwealth Doctor Q Spring Bank of Australia ABN 48 123 123 124.

| 55

BUSINESS TOOLS

ANGELA JEFFREY

William Buck

P: (07) 3229 5100 E: Angela.Jeffrey@ williambuck.com Angela Jeffrey is Business Advisory Director at William Buck Chartered Accountants and Advisors.

MEDICARE FREEZE CHANGING THE FACE OF GP PRACTICES William Buckâ€™s latest benchmarking data has revealed that general practices have continued to be profitable in spite of the freeze. The face of primary health care is changing. The days of the cottage industry and small one-doctor practice will fade into history. The reasons for this are mainly economic and administrative: A doctor who runs a solo practice can make, on average, 30 per cent more by simply working in a larger practice than staying on their own. For those doctors who are not financially motivated, the administrative and compliance burden of running their own business is enough to deter them from sole practice. Because of the above two factors, new small one-doctor clinics are almost never likely to open. Older doctors in solo practice cannot find doctors to take over their businesses and are either closing the doors or joining larger practices. The above changes were already happening before the freeze in the Medicare rebate. The freeze is, however, making some doctors think more about the financial side of their business and the sustainability of smaller practices. Practice owners have to become innovative and offer new services. If you doubt this consider: after-hours doctor services which bulk-bill to patients and even come to their homes;

Disclaimer: The information contained in this summary is general in nature and should not be applied or relied upon without seeking additional professional advice. William Buck (QLD) has a dedicated team of superannuation and taxation experts who are happy to speak with you regarding your self managed superannuation fund or any other issues regarding superannuation you may have.

56 | Doctor Q Spring

extended hours in general practices, weekend trading and opening later into the evenings; and additional services in practices such as skin treatments, cosmetic services and travel medicine. These innovations are a result of practices looking to become more competitive in the market and differentiate themselves from competitors. All of the above have, on large, been positives for patients.

William Buck has recently completed a national benchmarking survey and analysis of general medical practices on financial data for the year ended 30 June 2015. Key figures: The average practice has five full-time equivalent doctors on their roster. The average practice has 6.81 consult rooms and generates $307,238 per room, a marginal increase on last yearâ€™s average of 7.32 consult rooms and $305,054 per room. The average consult fee, including bulk billing practices has increased slightly from $61.71 to $63.91, which shows that in spite of the rebate freeze, practitioners are able to charge more for their time. The average consult time remains around 14 minutes. Over 40 per cent of practices operate extended hours, allowing them to access higher after-hours Medicare rebates. Practices on average receive $129,308 in incentives and subsidies per year. An important statistic the benchmarking report showed was the declining percentage of patient fees being paid to doctors. This percentage is not a result of reduced income levels. Rather, while income levels of experienced GPs remains around 65 per cent to 70 per cent of patient fees, the increasing use of registrars in general practices is bringing the overall average down below 64 per cent. This represents a significant financial windfall to practice owners. With an increasing number of doctors graduating from Australian universities, the gradual reduction in income levels for general practitioners is expected to continue. The final point to consider is that the number of general practices bulk-billing is continuing to rise. This has been a consistent trend over time. Doctors are free to set their fees and are choosing to bulk-bill and, in many cases, not implement gap fees or mixed billing to patients. So, the end of general medical practices is not nigh. The look of the medical centre may change but that is because they are striving to become more efficient, and maintain profit levels while still providing the best quality patient care possible.

SPECIALIST

ADVISORS TO THE MEDICAL

INDUSTRY WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK CAN HELP YOU STRUCTURE YOUR PERSONAL INVESTMENTS TO ACHIEVE THE AFTER-HOURS LIFE THAT YOU WANT. William Buck is experienced at structuring personal investments such as property or self managed superannuation funds, and can assist you with the following: — Advice on setting up appropriate investment structures — Comprehensive assistance with your personal taxation affairs — Develop strategies to help you make the most out of your superannuation and investments, including assessing the taxation consequences — Securing your financial freedom with business and retirement planning CONTACT PAUL COPELAND OR ANGELA JEFFREY FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION

Phone: + 61 (7) 3229 5100 Paul.Copeland@williambuck.com Angela.Jeffrey@williambuck.com

Doctor Q Spring | 57

WEâ€™VE GOT YOU

COVERED Experien is the preferred life insurance provider to AMA Queensland and one of the few national brokers that specialise in the medical sector.

We feel so confident that we can improve your cover, that if you are unsatisfied with our recommendation we will provide you with a cash back of $150. For a complimentary review or consultation, contact Craig on 0488 273 399 or craig.wright@experien.com.au, or Justin on 0419 994 123 or justin.tyne@experien.com.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. This rebate is only valid until 31 November 2016. One rebate is valid per person, this offer is only valid for current AMAQ members. In order to receive the rebate each client must first provide Experien with enough information to be able to complete a full Quotation and Statement of Advice and agree to an in person meeting where this can be presented. The rebate will not apply if insurance cannot be obtained because of age, pre-existing illness or other rating factors beyond the control of EIS.

58 | Doctor Q Spring

Why use Experien as your broker? • • • •

Specialist broker to doctors Full claims support Free annual reviews Access to preferred pricing at certain insurers

Doctor Q Spring | 59

BUSINESS TOOLS

DR PATRICK MAHAR OAM

MDA National Mutual Board Member P: 1800 011 255 E: peaceofmind@ mdanational.com.au Dr Mahar is a Melbournebased dermatology registrar and a lecturer for the Department of Medicine, University of Melbourne and the Department of Surgery, Deakin University, having obtained doctorates from both institutions.

Preferred Medical Indemnity Provider

THE IMPORTANCE OF MEDICAL INDEMNITY FOR JUNIOR MEDICAL STAFF Medical indemnity insurance is rarely high on the doctor in training list of priorities. Exams, money, exercise, relationships and future work prospects tend to come first. As a junior doctor though, medical indemnity can and should be a serious consideration. As a medical student, my first encounter and exposure to medical defence organisations (MDOs) involved joining numerous providers during the orientation week at university. We were invited to sign up for free, and so we did. As we moved through postgraduate years and were required to pay for professional indemnity, it became more about choosing the right MDO to best fit our needs. As with any kind of service industry, cost is often a primary determinant, but you will also need to take into account the type and quality of services offered and how this matches your needs.

IT’S WHEN YOU ARE FACED WITH PROBLEMS, AND THREATS TO YOUR CAREER AND PROFESSIONAL STANDING, THAT YOU REALISE THE TRUE VALUE OF BEING PART OF AN MDO THAT CARES ABOUT YOU Real value The importance of medical indemnity on your career can be overlooked by clinicians who, appropriately, are more concerned about the health of their patients and personal career progress than which MDO to be involved with. However, medical indemnity serves more purposes than simply protecting your career reputation if and when things go wrong. Disclaimer: 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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Importantly, in a mutual organisation like MDA National, you are a highly valued voting member – what you think and the support you need matters. MDA National advocates on behalf of members on key medico-legal matters that have an impact on our profession. So,

providing feedback and taking an interest in the legislative submissions MDA National is involved in means you can have more influence on policies and decisions relating to junior doctors today. Support when you need it Engaging with your MDO can be of great importance, especially when things go wrong and you need medico-legal support – in which case, call early rather than later. The majority of clinicians, particularly during their junior years, don’t take advantage of the services offered by their MDOs. Sometimes it’s because they genuinely don’t need to, and sometimes because they don’t know what’s available. It’s when you are faced with problems, and threats to your career and professional standing, that you want the highest quality of service you can get. This is when you realise the true value of being part of an MDO that cares about you. As an intern, I called my medical indemnity provider two or three times when I found myself in tricky situations. I was a curious law student at the time, on a rural rotation with no outlet for entertainment, and would actually call different MDOs and compare advice and service to determine which I thought was the most useful. Whilst I don’t necessarily recommend doing that, it helped me determine which MDO I would later choose. Your involvement matters The quality of clinical practice as we know it today and the relative strength of the medical workforce is, in part, due to the actions and perseverance of a number of key individuals and organisations within the medical indemnity profession. These men and women lobbied and fought hard to achieve aspects of tort law reform and to ensure indemnity insurance was affordable during the late 1990s and early 2000s, and many are still doing similar work today. Your involvement with your MDO can have a real impact on MDOs’ professional indemnity insurance policies – with a possible flow-on effect that can influence medical students and doctors, both junior and senior – ultimately benefiting you in your career pathway.

Doctor Q Spring | 61

BUSINESS TOOLS

TREATING FAMILY MEMBERS KATHARINE PHILP

TressCox Lawyers Partner

P: (07) 3004 3536 E: Katharine_Philp@ tresscox.com.au

Whilst there is no prohibition for a doctor to treat family members, including prescribing and/or administering medications, it is not considered appropriate by the Medical Board of Australia (MBA). Section 3.14 of the MBA’s Good Medical Practice: a code of conduct for doctors in Australia states:

inappropriate referral to a plastic surgeon for liposuction; and

3.14 Personal relationships

failure to involve an independent GP to consider weight loss treatments.

Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues. A recent decision of the New South Wales Civil and Administrative Tribunal – Occupation Division (the Tribunal) considered whether a doctor who treated family members was guilty of professional misconduct. In the matter of Health Care Complaints Commission (HCCC) v BXD (No 1) [2015] NSWCATOD 134, Dr BXD admitted all particulars of the complaints made by the HCCC including: Daughter A, who had significant history of mental health problems and drug dependence inappropriate prescription over a period of approximately two years; failing to inform daughter A’s treating practitioners (including a treating psychiatrist) of the nature and extent of her prescribing; failing to ensure safe keeping of her prescription pad; inappropriately or improperly completing a Centrelink medical certificate; making a false or misleading statement as to her treating relationship with daughter A; inappropriately issuing pathology requests; and inappropriately writing referral letters to a psychiatrist and for admission to hospital. Daughter B, who had concerns over her weight inappropriate prescription over a period of approximately two years; 62 | Doctor Q Spring

Husband inappropriate prescription for a period of approximately two years. Self-prescription issuing prescriptions in the name of her husband and consuming the medications. While Dr BXD admitted all of the particulars she argued that her conduct constituted unsatisfactory professional conduct, not professional misconduct. In considering the matter, the Tribunal considered the following observations of Kirby P in the decision of Pillai v Messiter (No 2)(1989) 16 NSWLR 197 at 200): “The statutory test is not met by mere professional incompetence or by deficiencies in the practice of the profession. Something more is required. It includes a deliberate departure from accepted standards or such serious negligence as, although not deliberate, to portray indifference and an abuse of the privileges which accompany registration as a medical practitioner …” The Tribunal was firmly of the opinion that the conduct met the higher threshold required for the finding of professional misconduct. Whilst the conduct was confined primarily to the family circle, it was diverse in character, involved deceptive conduct towards third parties such as treating doctors and Centrelink, was spread over a long time and only ceased when discovered by Pharmaceutical Services Unit investigators. The Tribunal stated that the ethical standards relating to self-treatment and treatment of family members would have been well known to a doctor of Dr BXD’s experience. The Tribunal found that the doctor’s conduct reached the threshold for professional misconduct. Dr BXD was reprimanded and conditions were placed on her registration, including the appointment of a psychiatrist as her professional mentor.

Look no further...TressCox Lawyers can assist you At TressCox we make it our business to know about Health and Aged Care. We can help guide you through the increasingly complex operational, legislative and policy framework. We can provide you informed legal advice on litigious, disciplinary and commercial issues at all levels. With considered legal advice we can assist you to operate a commercially viable business that complies with the health services industryâ€™s unique and ever changing regulatory environment. We can help you with:

Employment Contracts General practice and specialist practice issues Dispute resolution and litigation Regulatory investigations and proceedings Medicare Australia investigations Estate Planning and Wills

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Brisbane P. (07) 3004 9530 M. 0422 785 006 Robin_Lonergan@tresscox.com.au

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Brisbane P. (07) 3004 3545 M. 0422 044 210 Tony_Mylne@tresscox.com.au

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LIFESTYLE

ALMEIDA THEATRE: RICHARD III 10 September 1pm, 11 September 1pm and 14 September 10am Ralph Fiennes returns to the Almeida after 16 years to play Shakespeare’s most notorious villain in a new production directed by Almeida Artistic Director Rupert Goold (American Psycho; King Charles III; Medea). Vanessa Redgrave makes her Almeida debut as Queen Margaret.

NATIONAL THEATRE LIVE: WAR HORSE 24 September 1pm, 25 September 1pm Since its first performance at the National Theatre in 2007, War Horse has become an international smash hit. War Horse takes audiences on an extraordinary journey from the fields of rural Devon to the trenches of First World War France. Filled with stirring music and songs, this powerfully moving and imaginative drama is a show of phenomenal inventiveness. At its heart are astonishing lifesized puppets by South Africa’s Handspring Puppet Company, who bring breathing, galloping, charging horses to thrilling life on stage.

UPCOMING MOVIES* 8 September

The Secret Life of Pets Captain Fantastic Sully

15 September

The Confirmation Bridget Jones’ Baby The Woods Pete’s Dragon

22 September

Red Turtle

29 September

Miss Peregrine’s Home for Peculiar Children

Storks

*Please note upcoming films are subject to change

ROYAL SHAKESPEARE COMPANY: CYMBELINE 22 October 1pm, 23 October 1pm, 26 October 10am Cymbeline is a ruler of a divided Britain. When Innogen, the only living heir, marries her sweetheart in secret, an enraged Cymbeline banishes him. But a powerful figure behind the throne is plotting to seize power and murder them both. Innogen embarks on a dangerous journey that will reunite Cymbeline with a lost heir and reconcile the young lovers. Melly Still directs Shakespeare’s rarely performed romance.

KENNETH BRANAGH THEATRE LIVE: THE ENTERTAINER 19 November 1pm, 20 November 1pm, 21 November 6pm, 23 November 10am Since its first performance at the National Theatre in 2007, War Horse has become an international smash hit. War Horse takes audiences on an extraordinary journey from the fields of rural Devon to the trenches of First World War France. Filled with stirring music and songs, this powerfully moving and imaginative drama is a show of phenomenal inventiveness. At its heart are astonishing life-sized puppets by South Africa’s Handspring Puppet Company, who bring breathing, galloping, charging horses to thrilling life on stage.

WIN MOVIE TICKETS FOR TWO! Name:

Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

64 | Doctor Q Spring

Telephone:

Member no:

Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 30 SEPTEMBER

DO YOU HAVE A PATIENT THAT NEEDS FINANCIAL SUPPORT FOR THEIR MEDICAL CONDITION? The AMA Queensland Foundation welcomes funding applications from the medical community that align with the Foundationâ€™s objectives of relieving sickness, suffering and disability among Queenslanders in need and meet the following criteria: Vital or essential services Relieve sickness by providing support of various kinds to disadvantaged and needy individuals for life-saving medical services and treatment Provide financial assistance to individuals in remote and rural regions to enable provision of medical services in those regions Provide funding to disadvantaged students wishing to undertake medical training but unable to do so due to financial hardship Financially support individuals providing emergency medical assistance in the case of declared natural disasters Incidental support services Assist in the development and promotion of the Medical Benevolent Association

Queensland Queensland Doctorsâ€™ Health Programme Provide funds for medical research projects approved by AMA Queensland Provide a coordinated medical advice service to other not-forprofit organisations or to any government or governmental body or authority Promote and assist with the training of doctors in Queensland through the support of education programs, scholarships, fellowships and other initiatives with financial support and expertise The Expression of Interest for Funding Form can be downloaded from www.amaqfoundation.com.au Questions and applications should be forwarded to: AMA Queensland Foundation PO Box 123 Red Hill 4059 T: (07) 3872 2222 E: amaqfoundation@amaq.com.au Q

THANK YOU TO OUR WONDERFUL DONORS! The AMA Queensland Foundation sincerely thanks all donors who recently supported our end of financial year appeal. Thanks to your generosity, we raised over $60,000 - an incredible result! These funds will help support the next round of ear, nose and throat surgery for remotely-based Queensland children who face logistical challenges accessing treatment. We look forward to sharing their stories with you so that you may see first-hand what an amazing difference you have made to their lives. On behalf of their families, thank you again for your compassion, generosity and ongoing support of the important work of the Foundation. Your contribution is truly appreciated. Doctor Q Spring | 65

LIFESTYLE

MCLAREN VALE, SOUTH AUSTRALIA McLaren Vale (or ‘Southern Barossa’ as cheekily coined by the mob up North) has enjoyed a meteoric rise in popularity over the past decade. Both the wine and the explosion of food culture make it a must see when next in South Australia. Less than 40km south of Adelaide, McLaren Vale is another one of South Australia’s renowned shiraz producers, accounting for roughly 50 per cent of grapes crushed annually. The climate is markedly different from the Barossa, being much more Mediterranean, with four clear seasons and higher rainfalls. McLaren Vale reds reflect this, showing deep complexity and power along with the ability to cellar for decades. While Shiraz grabs the most attention, chocolate-rich cabernet sauvignons, chardonnays and viogniers are worth sampling. The climate is influenced by ocean breezes coming in from the Gulf of St Vincent to the west and the altitude of the Sellicks Hill Range to the south. Soil type is varied, ranging from red-brown loam and sand to dark clay and the often-mentioned terra rosa. A misspell of the Italian phrase terra rossa, meaning red soil, this ruddy-red stuff is left behind when limestone breaks down, and any viticulturist will tell you it’s great stuff to grow vines in due to the way water drains into it. All you need to know is it makes for good fruit, and the Vale produces

lots and lots of good fruit. So drink up! (But responsibly, of course.) History Initially a region of cereal crop growers, we can thank John Reynell and Thomas Hardy (who began Hardy wines) for planting vines in 1838. That legacy remains, with some vines providing fruit to the area’s 80odd cellar doors over 100 years old. Visiting A popular tourist spot, the Vale is spoiled for choice of cellar doors. Wirra Wirra, Coriole, Penny’s Hill, Leconfield and D’Arenberg; it’s hard to go wrong, and when the tummy wants something solid, take a break at Market 190 for a snack or better yet take in the views at the Victory Hotel for a long lunch and browse through their amazing underground cellar. It’s fantastic! Before your next trip to SA, drop me a line and I’ll list some ‘off the grid’ places as well to make the experience even more special. Q

PHIL MANS Wine Direct

9 463 P: 1800 64 ct.com.au ser@winedire E: phil.man

66 | Doctor Q Spring

CUBA Ros Bulat from AMA Travel Queensland explains that with flights opening up from Miami to Havana, itâ€™s a great time to visit Cuba before it becomes the next tourist Mecca. When Fidel Castro and his group of revolutionaries seized power of Cuba in 1959, it almost made life stand still for this magical Caribbean Island. After initially recognising Castroâ€™s government, the US very quickly responded to what they saw as unfriendly behaviour with a tit-for-tat type of relationship. By 1961, diplomatic ties were severed and the American Central Intelligence Agency (CIA) started hatching what we now know as the botched Bay of Pigs invasion. At the same time, the Cubans were hatching their own plans for the Soviet missile base. The rest is history! Well, times have changed and all seems to be friendly again for the US and Cuba. While Australians have been able to travel to Cuba, it has posed difficulties for Americans, hence access has never been that easy. Cuba may be just 90 miles off the coast of Florida but it really is a world away. Flights are now operating from Miami to Havana, opening up the country to tourism. The smells and tastes will heighten your senses and the constant but subtle background music will add a depth to your experience. While the Buena Vista Social Club may have closed in the 1940s, the atmosphere lives on.

The heart-warming hues of Havana will draw you into a time almost forgotten. The vibrant classic 1950s cars bring a certain nostalgia, but it is the people that will open your heart to this country, where a lively culture is teamed with a welcoming hospitality. A great experience while in Cuba is to visit a Paladares for a dinner. Paladares is a new wave of private restaurants that are cropping up all over Havana, the Cuban capital. The standards vary from local family-run venues up to very stylish operations. Often located in old mansions, the locations can be very quaint and offer amazing ambience at affordable prices. There is more to Cuba than Havana. In just a short seven-day introduction to Cuba, you can experience the waterfalls of Soroa, the hills of Vinales and their tobacco fields, Trinidad and some of the most pristine beaches of the Caribbean. The culture and history will surprise you. Cuba is a country in motion, moving forward to join the rest of the western world. Make sure you see it soon, before it gets crowded. Q

call or email Ros For more information d. slan een Qu vel Tra at AMA ) 5556 7200 (07 F: 885 262 P: 1300 .au E: travel@amaq.com el.com.au trav orld q.w ma w.a ww

Doctor Q Spring | 67

LIFESTYLE

ALL ABOUT YOU CHARLOTTE BRONTË: A LIFE

BLACKFISH

Claire Harman

Check out the documentary Blackfish on Netflix or iTunes to hear the story of Tilikum, a performing killer whale that killed several people while in captivity. Back in the 1960s, someone in the US thought it would be a great idea to catch some killer whales, keep them in captivity and have them performing tricks. Turns out killer whales are highly intelligent, enormously sentient and called killer whales for a reason.

This beautifully-produced, landmark biography is essential reading for every fan of the Brontë family’s writing, from Jane Eyre to Wuthering Heights. It is a uniquely intimate and complex insight into one of Britain’s best loved writers. Charlotte Brontë was a literary visionary, a feminist trailblazer and the driving force behind the whole Brontë family.

BEACH VOLLEYBALL

LIPTEMBER

Now that the weather is bit warmer, why not grab a few friends and join a beach volleyball team at your local sports club? While traditionally played with two-a-side, some clubs have competitions for four and six-a-side to make it a bit easier. It’s a great team sport where you need to work together closely, it’s low on impact and the sand is great for a bit of extra resistance.

Liptember is a campaign raising funds and awareness for women’s mental health during the month of September. Women are urged to purchase a Liptember lipstick from participating retailers and register online, gaining sponsorship for wearing the lipstick throughout the month of September. Funds raised go to the Centre for Women’s Mental Health and Lifeline.

CHICKEN AND CASHEW STIR-FRY WITH CAULIFLOWER RICE Recipe from Queensland Health’s Healthier. Happier website at www.healthier.qld.gov.au 2 cloves garlic, crushed 3cm knob of raw ginger, peeled and grated 1 tablespoon reduced salt soy sauce Freshly ground pepper 350g lean chicken meat, cut into thin strips 3/4 cup unsalted cashew nuts 2 teaspoons olive oil 1/2 head cauliflower, pieced into small florets, stem cut thinly 1/2 head broccoli, pieced into small florets, stem cut thinly 2 tablespoons honey 2 tablespoons oyster sauce 1 1/2 cup snowpeas, sliced 1 can (425g) baby sweetcorn, rinsed and drained, sliced 4 small stalks spring onion, sliced 68 | Doctor Q Spring

Combine garlic, ginger, soy sauce, pepper and chicken in a small bowl and set aside in refrigerator to marinate for at least 30 minutes. Heat a non-stick wok or large fry pan to high. Add cashews and dry fry for only one minute, remove from pan and set aside in small bowl. Chop cauliflower very finely or process in a food processor with blade attachment until it looks like couscous. Transfer to a large microwave safe bowl and cook on HIGH for 6-8 minutes. Keep covered and set aside. Meanwhile, brush pan with oil and heat to high. Add half of the marinated chicken and stir-fry for two minutes until browned. Set aside and repeat with remaining chicken. Rebrush pan, add broccoli and stir-fry for three minutes, until just tender. Add honey, oyster sauce and two tablespoons of water to pan, along with snow-peas, corn, spring onions and chicken, including any juices. Stir-fry for another three minutes until heated through. Divide cauliflower and chicken stir-fry between plates and serve sprinkled with cashews.

YOU’VE GOT TO HAVE MATES Our ocker doctor, Dr Matt Young, reflects on changes in teaching medical students and wonders if modern teaching may lead to a lack of much needed collegiality. The great thing about having medical students around is that they always seem to have something interesting to say. Young students with lots of fascinating interests that help me broaden my ageing horizon. Recently I was having a yarn to my current medical student and I was told that for the entire two months that he was with me for his general practice term, he would be doing lectures that were not given at any great austere lecture hall, delivered by some learned professor (perhaps kitted out in some traditional Grecian Hippocratic sheet arrangement) and surrounded by keen young students inspired by youthful enthusiasm. Instead, the whole lecture syllabus was on a disc and he would listen to every lecture on his computer, in his room, alone. I lamented the fact that the modern generation of medical students might be missing out on that tremendous collegiate fellowship that I had enjoyed.

When I was a young bloke the whole year of medical students would gather together for lectures. Even though I might not have known every person well, I at least knew their names and faces. It is easy to dismiss benefits of this sort of camaraderie but I reckon it did wonders for my medical life. As a GP, I know that my patients judge me by the specialists to whom I send them. When I was starting out in general practice, it required some important consideration to establish my ‘list’. I am very lucky to be able to base my referral decisions on having a long history of friendship with the specialists I utilise. We’d sat through years of lectures together. Had lunch together. Played sport together. And maybe even had a few beers together. There’s Big Johnny, my mate the urologist, who was a gun soccer and touch footy player. He was (and is) a champion bloke and

a team man who never gave up when the chips were down. The sort of bloke that you’d want beside you in the trenches of the Somme. It was also handy that he won a University Medal. I knew he would do the right thing by my patients. I also had a mate, Mark, who used to spend several minutes before heading out for any sort of social event lathering himself into a slippery, greasy, white frenzy with his ever-present bottle of factor 15. I should have known then that he’d head into dermatology. With that sort of passion for sun protection, I knew he’d be at the top of his profession. Gezza was always incredibly neat. He dressed well, his hair was always just right and his facial hair always immaculately manicured. Of course, plastic surgery was his calling and, besides his eye for the aesthetic, he was always a great touch footy player and had a real way with people. We seemed to lose a lot of touch footy grand finals together and, through that hardship and devastation, I saw that he was a caring sort of bloke and we became great mates. I knew I could trust him to cure my patients. Kathy had a heap of brothers and always played sport hard. She didn’t mind swinging a few punches when the heat was on, either. We played volleyball, soccer and even touch footy together, and now she channels her ruthless combative and competitive streak into curing liver diseases. It is a treat to be able to send my patients her way.

As I have reached a more venerable age and had to have a few trips to doctors myself, I have really had to test the courage of my convictions. The bloke who has always taken care of my gastrointestinal patients, now violates me with his endoscope, top and bottom every few years. We didn’t always get along. John and I played footy together. Sometimes we played on the same team and sometimes we were opposed. He was ruthlessly competitive, loved winning, was an intuitive sledger and used to have a talent for getting under my skin. It was like playing against myself. Well thirty years later, he now gets a lot deeper than just under my skin. We get on much better now and I suppose I have to admit his colonoscope ends up with the last word on any disagreements that we might have had in the past. Dangerous Dave, the eye man, and Scottie, the orthopaedic legend I met in the Army, Ray, the general surgeon at a wedding, and Louise the cardiologist, when we worked together as youngsters. They are all tremendous people as well. The sort of people you want treating yourself and your family. I feel very fortunate to have befriended these people in my younger days and I feel sad for my medical student. I hope he manages to enjoy the sort of collegiality that my generation of doctors enjoyed and I hope he gets to nostalgically reflect on his med school days the way I like to do. Q

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IN PRINT

MURTAGH’S PRACTICE TIPS Murtagh’s Practice Tips is the trusted resource that provides tips for GPs and other medical practitioners drawn from Emeritus Professor John Murtagh AM’s extensive experience in practice. It is the essential guide for tried-andtested approaches to treatment and improvisation methods, using convenient tools and readily available equipment to treat patients as effectively as possible. Content throughout the resource has been updated for this seventh edition, providing essential information and step-by-step instructions on how to deal with conditions encountered by GPs around the world in everyday practice.

WIN THIS BOOK Name:

Member no:

Doctor Q has a copy of Murtagh’s Practice Tips – seventh edition to give away. Fill out the form to the left and fax it to (07) 3856 4727 or email competitions@amaq.com.au. ENTRIES CLOSE 30 SEPTEMBER2016

To purchase any of Professor Murtagh’s texts, visit: www.mheducation.com.au Q

DENDY WINNERS

Janice Marshall

Oreste Theodoratos

Ian Mottarelly

John O’Sullivan

Michael Williams

Nigel Dore

Mitesu Gandhi

Matt Young

88 L’Estrange Terrace, Kelvin Grove QLD 4059

Lauren Exelby

James Kang

PO Box 123 Red Hill QLD 4059 P: (07) 3872 2222

BOOK WINNER Dr Shona Scadel won a copy of Harrison’s Manual of Medicine, 19th edition, thanks to McGraw-Hill Education.

E: amaq@amaq.com.au W: amaq.com.au

Join our online communities Don’t forget to enter in this Doctor Q edition to win. 70 | Doctor Q Spring

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ESTABLISHED IN 1987 100% BULK BILLING

For more information contact: Paul Copeland or Asif Joowalay on 07 3229 5100 Qld.Marketing@williambuck.com

PSYCHIATRIST REQUIRED FOR PRIVATE PRACTICE IN CAPALABA We are looking for a Consultant Psychiatrist to join our friendly team in a well supported modern private practice. We will provide not only a consulting room but the equivalent of at least five to eight sessions with patients to fill your initial private practice needs.

Minimum requirements: Applicants must have FRANZCP and specialist registration with AHPRA. Our practice is well established and has been providing services in Capalaba for the last five years and offers both Psychiatric and Psychology services.

The centre has excellent purpose built rooms and ample parking, is close to public transport and major shopping centres. The position has excellent potential to be both personally and financially rewarding. !

Please contact principle psychiatrist Dr Yasin by email: yasinps@outlook.com or by mobile on 0477 017 070

Part-Time Skin Cancer Doctor position is now available at My Skin Cancer Clinic located in Taringa in the Western Suburbs of Brisbane. My Skin Cancer Clinic is a long established practice, conveniently located between two of Queensland’s most popular shopping precincts - Indooroopilly Shopping Centre and Toowong Village. We are positioned along Moggill Road and only a 5 minute walk from Taringa station.

Please express your interest to our Practice Manager Sally on 3871 3437

FRACGP preferred, must have unrestricted right to practice as GP. Flexible hours are available with the potential to build to a full time position. Previous experience and qualiﬁcations in skin cancer management is desirable.

Doctor Q Spring | 71

Considering the work you do, we feel you deserve special treatment We’ve worked closely with medical professionals for over 25 years. We’ve studied your suppliers, attended your trade shows and tailored products and services to meet your specific needs. So, if you’re buying a home, you may borrow up to 100% LVR without paying Lender’s Mortgage Insurance and you can reduce the interest payable even further by taking up the option of an offset account on variable loans. For an annual fee of only $395 we can offer a banking package that comes complete with a home loan, credit card and an everyday banking account. Rest assured that while you’re looking after your patients, we’ll be looking after you.

Visit us at boqspecialist.com.au or call 1300 131 141

Equipment and fit-out finance / Credit cards / Home loans / Commercial property finance / Car finance / Practice purchase loans SMSF lending and deposits / Transactional banking and overdrafts / Savings and deposits / Foreign exchange The credit provider and issuer of these products and services is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence no. 244616 (“BOQ Specialist”). Terms and conditions, fees and charges and lending and eligibility criteria apply. All BOQ Specialist Banking Package benefits are subject to the BOQ Specialist Banking Package Terms and Conditions and relevant product terms and conditions referred to therein.

72 | Doctor Q Spring

AMA Queensland

Published on Sep 2, 2016

DoctorQ Spring 2016

Published on Sep 2, 2016

amaqueensland

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