Doctor Q Spring 2024

S PR I N G 2024

Health a priority in upcoming state election Meet Gordonvale GP Dr Lisa Fraser Surgical Wait List Roundtable Action Plan

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Contents Reports

Current Issues

5

Editor’s desk

7

21

Three AMA Queensland members honoured at AMA24

President report

8

26

AMA Queensland scorecard

Working with Health Minister to boost vaccinations

9

CEO report

27

10

Five AMA Queensland members elected to Federal Council

AMA Queensland in the media

32

37

Committee of General Practice update

Patient Care Facilitator trial in motion

39

Committee of Doctors in Training update

33

AMA Queensland calls for payroll tax exemption for private practices

72

AMA Queensland Foundation update

34

Features

Business 44

New legislation

46

Right to Disconnect

53

Finding the best tax structure for your practice

55

Should I provide my colleague with a character reference?

57

Are you properly protected by a public liability policy?

59

Three top ways to finance your practice

Decarbonising our health system one commute at a time

60

40

Physician’s assistants: the thin edge of a terrifying wedge

Annual review: top 10 legal matters to consider this financial year

47

New Federal AMA IMG Working Group

63

Here’s why international shares belong in our portfolio

48

65

Research round up

Why your medical gap cover matters

49

Transforming flow: towards a better experience for patients and clinicians

Lifestyle

24

State government addresses our advocacy priorities

28

Surgical Wait List Roundtable Action Plan

66

All about you

30

Election recommendations

68

Dr Matt Young – Punting the punt

42

Meet a member – Dr Lisa Fraser

69

Why celebrate old vines?

70

Tasmania

74

InPrint

People & Events 12

AMA Queensland Foundation Charity Gala

14

Junior Doctor Conference

16

Women in Medicine Cairns and Member Networking Cairns

18

AMA24

23

Sunshine Coast Member Networking Event

38

Resident Hospital Health Check visits

50

2024 events calendar

38

Resident Hospital Health Check

24

Addressing advocacy priorities

14

Junior Doctor Conference Spring | Doctor Q

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C P D AC C R E D IT E D | P R I VAT E P R AC T I C E S T R E A M | FA M I LY- F R I E N D LY

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Contact us for dates and rates.

Find out more Advertising and sponsorship

Contact us: advertising@amaq.com.au or 07 3872 2222

4

Doctor Q | Spring

Editor’s desk

Board of Directors Dr Nicholas Yim* President Dr Emilia Dauway* Vice President, Chair of Council Dr Eleanor Chew OAM* Chair of Board, Member Elected Director

Dr Sarah Coll Member Elected Director

Dr Ben Wakefield* Member Elected Director

Dr Erica Gannon* Member Elected Director

Craig Allen Skills Based Director Grant Dearlove Skills Based Director *on Board and Council

Council Dr James Allen Greater Brisbane Area Representative Dr Sanjeev Bandi Capricornia Area Representative Dr Sharmila Biswas Part-Time Medical Practitioner Representative

A/Prof Geoffrey Hawson Senior Doctors Representative

A/Prof Katie Panaretto Specialist Representative

Dr Wayne Herdy North Coast Area Representative

Dr Bhavesh Patel Specialist Representative

The state election is looming and we have put forward 17 priority areas for reform that will greatly benefit Queensland’s patients, doctors and the community.

Check it out on pages 30.

Dr Sandra Hirowatari General Practitioner Representative

Dr Rachael PeryJohnston Greater Brisbane Area Representative

Our Surgical Wait List Roundtable has identified practical, affordable actions the government can take to address inequities in access.

Dr Fiona Raciti General Practitioner Representative

May the party with the best health policies win.

Dr Kimberley Bondeson Greater Brisbane Area Representative

Dr Lee Jones Committee of General Practice Chair

Dr Maria Boulton Immediate Past President

Dr Sharon Kelly Committee of Consultant Specialists Chair

Dr Lisa Fraser General Practice Representative Dr Erica Gannon Specialist Representative Dr Alison Green Greater Brisbane Area Representative A/Prof Paul Griffin Full-time Salaried Medical Practitioner Representative

We have had some big events in the past few months and some more coming up too. We’re holding our first annual Trans-Tasman Conference in Tassie next year, just in time for the Easter school holidays.

A/Prof Alka Kothari Greater Brisbane Area Representative Lachlan McMillan Medical Student Representative A/Prof Ewen McPhee AM General Practice Representative Dr Robert Nayer North Area Representative

Dr Mikaela Seymour Doctors in Training Representative Dr Shiven Singh Gold Coast Area Representative Dr Sally Sojan Downs and West Area Representative Dr Ben Wakefield Greater Brisbane Area Representative Dr Elise Witter Committee of Doctors in Training Chair

AMA Queensland Secretariat Dr Brett Dale Chief Executive Officer Filomena Ferlan General Manager – Corporate Services

Paul Kulpa General Manager AMA Education and Training Institute

Editor: Michelle Ford Russ

Phone: Address: Email: Website:

Erin O’Donnell General Manager Policy

07 3872 2222 PO Box 123, Red Hill QLD 4059 amaq@amaq.com.au ama.com.au/qld

Follow us Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice.

Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.

Obituaries The following AMA Queensland members have recently passed away. Our sincere condolences to their families.

Dr David Shears BROWNE Obstetrician and Gynaecologist Late of Surfers Paradise Member for 46 years

Dr Charles Indra STEVENSON GP Late of Eastern Heights Member for 52 years

Dr Shirley Joy COGHLAN Physician Late of St Lucia Member for 61 years

Dr Catherine Sava THOMAS Opthalmologist Late of Cairns Member for 51 years

Dr Gerard Joseph MCCAFFERTY Surgeon Late of Bardon Member for 69 years

Dr Barry Roy Knox MCKEON GP Late of Gunnedah, NSW Member for 39 years (Passed away in 2022)

Check out all the features in our new Member Portal Have you jumped on to have a look at our new Member Portal? When you first log on, you will be asked to complete your profile to be included in the Member Directory.

If you have any troubles accessing the Member Portal, please email us on membership@amaq.com.au or call 07 3872 2222.

Member Portal

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1 This Offer is only available to companies that first insure with MIGA under its Practice Indemnity Insurance and Healthcare Entity Indemnity Insurance policies where cover with MIGA commences on or after 1 May 2024 and on or before 31 January 2025. This Offer is not available to current policyholders of Professional Indemnity Insurance for Healthcare Companies with MIGA, entities whose annual turnover is greater than $10,000,000, entities that do not meet the underwriting criteria or where the limit of cover required is less than $5,000,000 or the annual premium before discount is less than $1,200. The Offer only applies to the first 12 months of cover after which the premium will revert to MIGA’s standard annual pricing. This Offer is not available in conjunction with any other offer. MIGA reserves the right to withdraw or amend the Offer at any time, other than in relation to policies which have already commenced or written quotations that have not expired.

Full Ts & Cs at www.miga.com.au/practices-12for9-tc.

Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). The terms and conditions of the insurance provided by Medical Insurance Australia Pty Ltd are fully contained in the Policy Wording and any applicable endorsements. This document does not form part of the Policy Wording. Acceptance and pricing is subject to MIGA’s usual underwriting guidelines including satisfactory claims and practice history. © MIGA April 2024

Dr Nick Yim President

President report When I was given the great honour of being elected unopposed as AMA Queensland President earlier this year, I made a promise to effect real change in my first 100 days.

That milestone fell on 1 September, and I am pleased to update members on how I have been able to carry on the work of my predecessors in the interests of Queensland doctors and patients.

First, our Surgical Wait List Roundtable is ready to release its action plan for reducing regional elective surgery delays and rebuilding our workforce. The Roundtable has worked hard since April to develop a significant list of recommendations for the state government and Queensland Health, and I thank my Vice President, Dr Emilia Dauway, for her work as chair and all the clinicians who gave their time and experience to compile this important report. It will be launched in the coming weeks, and we will be providing it to both sides of politics to guide their policy promises in the weeks leading up to the 26 October state election.

Read more

We have also had some success in convincing the Premier and the Health Minister to make some changes in their language around satellite hospitals. While the name will remain, the Minister and Premier have made a point of emphasising the services provided at these centres – that they have Minor Injury and Illness Clinics, not emergency departments, and some outpatient services depending on the local community needs. We are continuing to work with the government on public education messaging about when to present to an ED, when to go to a satellite hospital, or when to see your GP. This will continue as the election campaign fires up, with the LNP opposition expressing concerns about Category 1 and 2 patients continuing to present at satellite hospitals.

Read more

The government has also redesigned its hospital performance website, making the interesting change to refer to ‘elective’ surgery as ‘planned’ surgery. This may assist the community to understand that elective surgery is necessary surgery. We continue to call for more transparency around waiting lists, ED admissions, patient off-stretcher times and median ambulance response times.

We continue to campaign for all private medical practices to be exempt from payroll tax when the amnesty ends in June 2025. Practices are small businesses and, while the government’s already announced reforms are workable for GPs, they are cumbersome and an added red tape burden.

They also do not automatically apply to non-GP private specialists. We continue to advocate for private practice to be treated the same way as public hospitals and some private hospitals and to be exempt from payroll tax. We do not want to see practices being hit with unexpected bills from mid next year.

Read more

We were alarmed to see a Queensland Health proposal to employ more physician’s assistants (PAs) in our public hospitals. Queensland has a critical shortage of doctors, nurses, and allied health practitioners. However, bandaid fixes like creating new and unproven roles like PAs have the potential to worsen this crisis and reduce patient safety. PAs in other countries usually perform tasks currently undertaken by our junior doctors as part of their essential training. We have put in a submission to Queensland Health on this proposal.

Read more

The upcoming state election and the formation of a new Assembly, no matter who wins, will naturally take up a lot of our attention over the next 100 days. In a sign of how effective our advocacy is, in July the Health Minister sent us a seven-page letter outlining where the government has met our calls in our Budget Submission and Advocacy Priorities 2024-26.

You can read it in full on our website

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ScoreCard

Supporting Queensland doctors, Creating better health

MEDIA

2024 Q2

01 Apr - 30 Jun

AMA Queensland

595 Mentions 120 Inquiries

18.4M Audience

90 New Members

1,085 Member engagements

13,33K social media followers

83

Ministerial, government and key stakeholder meetings

Policy 13 Submissions 54 Advocacy Industrial

2,099 member engagements relations Workplace

relations

Events

39 New employment contracts

248 member engagements 6 In person 2 online 628 Total Attendees

CEO report The October state election comes at a critical time for the Queensland healthcare system and workforce. Both major parties have made health a key campaign issue and AMA Queensland has been guiding them with policy proposals and action plans.

Surgical Wait List Roundtable Action Plan In June, we convened a Surgical Wait List Roundtable to focus on elective surgery inequities in regional Queensland. Clinicians from a wide range of specialties and regions met remotely every fortnight to identify the issues and make recommendations for short-, mediumand long-term actions to address workforce shortages and cut wait times.

The Roundtable reported in September with a 13-point Action Plan. You can read more on pages 28.

Election Priorities 2024 Also in September, we released our Election Priorities 2024 and urged both parties to endorse our 17 priority areas. Workforce remains number one – if we cannot recruit, train and retain doctors, nurses and other healthcare practitioners, we cannot treat patients.

We need training places and career pathways for our domestic and international medical graduates. We have also called for more investment in women’s health and an exemption from payroll tax for all private specialists. Read more on pages 30.

Minister’s letter It is a mark of successful advocacy when the Minister not only acts on our calls but writes a seven-page letter detailing the government’s specific response to priority items in our Budget Submission 2024-25. The letter is on our website and you can read a summary of it on pages pages 24.

Member profile – Dr Lisa Fraser During university, Lisa Fraser used her AMA Queensland Foundation Medical Student Scholarship to complete rural placements. Now a rural GP, Dr Fraser has come full circle with a Foundation GPTQ Bursary to support her further training in reproductive and sexual health. Read her story on pages 42.

Dr Brett Dale

Chief Executive Officer

Right to disconnect Our Workplace Relations Team has been busy fielding calls about the new federal ‘Right to Disconnect’ laws that came into effect in August. These changes to the Fair Work Act 2009 create a formal workplace right that allows employees to disconnect from work outside of their normal work hours. The change currently applies to employers with 15 employees or more, and will apply to small businesses from August 2025. See if you are affected on pages 46.

Resident Hospital Health Check AMA Queensland and ASMOFQ have been busy visiting hospitals across the state to encourage junior doctors to take the Resident Hospital Health Check survey. Armed with boxes of donuts, our tireless workers have been able to muster more than 700 responses to this important survey that collects information on hospital performance on workplace culture, hours of work and overtime, and access to professional development lead. See the photos on pages 38.

AMA Queensland Foundation Charity Gala We are pleased to report that the AMA Queensland Foundation raised $140,000 for family violence support services through our generous donors and monies raised on the night at the Charity Gala in August. Her Excellency the Honourable Dr Jeannette Young AC PSM, Governor of Queensland was in attendance to present the Foundation’s Medical Student Scholarships for 2024 and the GPTQ Bursaries for 2025. See the photos on pages 12.

Tasmanian conference Finally, I would like to extend an invitation to all members to consider attending our first Trans-Tasman Conference in Hobart. Scheduled for the 2025 Easter school holidays, this is a domestic version of our Annual Conference and is particularly aimed at earlier career doctors with young families. The program will have a focus on private practice and will be tailored to suit delegates, so register early.

Read more on pages 51.

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AMA Queensland in the media Satellite hospitals With small numbers of seriously ill patients presenting to satellite hospitals, AMA Queensland and Health Minister Shannon Fentiman have publicly agreed to work together on an education campaign around the new health services.

AMA Queensland President Dr Nick Yim and Minister Fentiman both told ABC Radio Brisbane that action will be taken to reduce the stress on patients and medical staff.

“We will absolutely work with the AMA and the community to make sure Queenslanders do understand the options they have available to them,” Minister Fentiman told ABC Radio Brisbane.

AMA Queensland has long been calling for an education campaign on the levels of care offered at health facilities around the state to reduce patient confusion and prevent delayed care.

“We are seeing an increasing number of unwell patients presenting to satellite hospitals - essentially a location

that doesn’t have the capabilities to treat them,” AMA Queensland President Dr Nick Yim told ABC Radio.

“Sometimes they need to be transferred to an emergency department or a tertiary hospital, and that delays treatment, and that utilises resourcing such as ambulances to transport them.

“We’ve got urgent care clinics, in October we’ll have nurse-led clinics, and now we have these satellite hospitals. What we need to do is have a new education campaign because it is quite confusing.”

The state government has already modified its language around satellite hospitals to emphasise that they are not designed for serious emergency treatment. ama.com.au/qld/news/SatelliteHospitalConfusion Confusion over satellite hospital services ama.com.au/qld/news/MinFentimanSatelliteHospitals Satellite hospital name to stay but education on the way

Physician’s assistants The proposed introduction of physician’s assistants to Queensland hospitals has raised many questions and concerns from health bodies around the state.

Dr Yim warned various ABC news outlets of the dangers of implementing band-aid solutions to fix the medical workforce shortage as opposed to long-term solutions that guarantee continuous care for patients.

“We have a workforce shortage in doctors, nurses, paramedics across the whole health service… Queensland needs to ensure it is recruiting and training doctors, as physician’s assistants are not the solution to our workforce shortage,” Dr Yim said.

“It might be a very short-term solution. However, what are the consequences in the long-term?

“So many of the roles currently for a junior doctor, a doctor in training, they will be performing a lot of roles, such as taking a history, doing a full examination, ordering these investigations, prescribing. What is the consequence for our workforce, say five years, ten down the track if the junior doctor doesn’t have those same experiences now?

As well as impacting the clinical experience of the current workforce, concerns also lie in the regulation, or lackthere-of, of physician’s assistants.

“Doctors, nurses, pharmacists – we’re all registered under Ahpra. To my understanding and to our knowledge, physician’s assistants won’t be regulated with Ahpra. The regulation is there for a reason. The regulation is there to ensure patient safety,” he said.

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Doctor Q | Spring

“There is no university that trains physician’s assistants…

So if we are going to import physician’s assistants into Australia, what is the regulation? Are we going to assess that competency? Are they equal? That’s something that we don’t know at this point of time.

“The key element here is we need adequate funding investment into our healthcare sector. We need to ensure that we are recruiting doctors and training doctors.” ama.com.au/qld/news/Concerns-remain-aroundphysician-assistant-proposal Concerns remain around physician assistant proposal ama.com.au/qld/news/PAs-won%27t-solve-ourworkforce-shortage PAs won’t solve our workforce shortage

Flu, COVID affecting elective surgery With AMA Queensland’s Surgical Wait List Roundtable in motion, Vice President Dr Emilia Dauway spoke to Today about how increasing hospitalisations from COVID and influenza are negatively affecting elective surgery waitlists.

“In terms of COVID and the flu, it’s pretty stable in comparison to previous years. But we are seeing a significant increase in RSV and whooping cough,” Dr Dauway said.

“Last month we had, between just COVID and the flu, 5,000 cases in Queensland and we have 500 people that are hospitalised currently.

“We’ve seen 20 kids per day hospitalised in Queensland, which is really concerning.

“That’s putting extreme pressure on our hospitals and particularly our emergency departments.

“What we don’t realise is when we ask the question why we can’t do elective surgery, this compounds that problem.

“So, the things that hospitals want to do in terms of our service capacity, if we don’t have bed capacity, are significantly reduced and compromised… we can’t do hernia, gallbladder surgeries or knee replacement surgeries.”

AMA Queensland has long been advocating to remove the economic barrier against vaccines, to protect the health of all Queenslanders and reduce preventable hospitalisations.

“One of the things that AMA Queensland has done is advocated to have the government provide [free] flu vaccinations for all Queenslanders that qualify from the age of six months onwards,” she said.

“Vaccines help to reduce the chances of you contracting the disease, but it also reduces the severity of the disease.

“Babies don’t qualify for vaccines. So, it’s important for adults to be vaccinated so that we can reduce the chances of our babies, our most vulnerable members of our community, our grandparents, the elderly and those who have medical conditions that cause their immune system to be compromised [from becoming ill].”

Flu, COVID affecting elective surgery

Get involved Get involved

If you’d like to put your hand up to speak to media on particular current issues, please call our Media Team on 07 3872 2222.

If you’d like to be a part of any upcoming social media campaigns, or would like us to highlight your workplace or practice, please call the Social Media Team on 07 3872 2222.

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AMA Queensland President Dr Nick Yim, Her Excellency the Honourable Dr Jeannette Young AC PSM, Governor of Queensland, AMA Queensland Foundation Chair Dr Dilip Dhupelia and Co-Chair, Queensland Government Domestic and Family Violence Prevention Council and Chair of the Allison Baden-Clay Foundation, Vanessa Fowler OAM.

Guests who won a key had the chance to open the jewellery box

Nicki Bosel, Mike Bosel, Kelly Hill and Linda Clifton

Dr Hasthika Ellepola, Dr Manoj Bhatt, Karen Quaile, Shane Quaile and Dr Janet Draper.

Drs Jaime Hurley, Michael Hurley and Srishti Dutta

Drs Jeannette Young (centre) and Dilip Dhupelia (right) with Medical Student Scholarship recipients from left to right: Goachagorn Darathai, Anna Duan and Taylor Edgely. Wylie Leeson was unable to attend.

Drs Aaron Chambers and Michael Clements

Read full article

Nerissa Wade and Paul Tommasini from InCommunity Inc with AMA Queensland Foundation Director Anna Jones

AMA Queensland Foundation Charity Gala Guests gathered at a unique venue converted from a 1920s bank and enjoyed drinks and Japanese-inspired canapes while having the chance to move around and mingle.

Drs Tammy White, Beth Exell, Brooke Leshin, Eleanor Jameson and Ellen Tucker

Our MC, Dr Oliver Wightman, Chair of One For Health Australia, tamed the rowdy crowd to introduce AMA Queensland Foundation Chair Dr Dilip Dhupelia who discussed recent achievements. Dr Dhupelia introduced keynote speaker Co-Chair, Queensland Government Domestic and Family Violence Prevention Council and Chair of the Allison Baden-Clay Foundation, Vanessa Fowler OAM. Her Excellency the Honourable Dr Jeannette Young AC PSM, Governor of Queensland presented awards to the GPTQ Bursary recipients (pictured left to right on the opposite page):

Dean Corless, Drs Ben Duke and Chris Zappala

Dr Lisa Fraser A/Prof Ewen McPhee Dr Rowan Gibbs Dr Naomi Penna The Governor also presented the Foundation’s Medical Student Scholarships to: Wylie Leeson Taylor Edgely Goachagorn Darathai Anna Duan Guests were able to bid on silent and live auctions on the night, all to raise funds for family violence support services. Everyone had the chance to go in the draw to win a key that could open a locked jewellery box containing a 14-carat white gold, white cultured pearl and diamond strand necklace worth $12,390.

Members of the Indian Medical Association of Queensland (IMAQ), with Dr Dilip Dhupelia, Dr Jeannette Young with IMAQ Medical Student Scholarship recipient Anna Duan, MC Dr Oliver Wightman and Dr Nick Yim

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Keynote speaker Prof Caroline de Costa AM

Bridget Henry and Lakmali Edirisinghe

Elecia Johnston, Rayana Mabshura Oeyshi and Adeena Thankakumar

Saturday night social at Hemingway’s

Dr Nick Yim AMA Queensland Memorial Prize to Jack Graham

Dr Nick Yim presents the AMA Queensland Medal of Achievement to Patrick Rosengren

Junior Doctor Conference Junior doctors and medical students from all over Queensland joined us for this year’s Junior Doctor Conference in Cairns.

This was our first-ever carbon neutral JDC, with a tree planted for each delegate, lanyards made from recycled plastic bottles, and Climate Calorie information on menus to indicate locally sourced and sustainably caught or farmed ingredients.

Committee of Doctors in Training Chair Dr Elise Witter opened JDC before Dr Renee Cremen spoke on behalf of our platinum sponsor, Cairns and Hinterland HHS. Local legend Prof Caroline De Costa AM spoke about her incredible career championing women’s reproductive rights and fiercely advocating for Indigenous health equity.

The delegates spent the afternoon speed dating the specialties before walking to Hemingway’s Brewery for the social function.

Sunday started with breakfast in the park before a trip to the outer Great Barrier Reef to check out the marine life.

We greatly rely on our partners and sponsors to make this event possible, so a huge thank you to our partners: Platinum sponsor Cairns and Hinterland Hospital Health Service Conference partner JCU Northern Queensland Regional Training Hubs Platinum Partner Cutcher & Neale Accounting and Financial Services A grateful shout out to our sponsors: ASMOFQ Doctors’ Health Fund

Dr Katrina Starmer talked about the world’s oldest telehealth service, the Royal Flying Doctor Service, before both doctors joined President Dr Nick Yim on a panel about opportunities in medicine.

Hillhouse Legal Partners

Robert Lamb from Hillhouse Legal Partners gave some legal tips before delegates split into groups to find out more about handling the unexpected with Doctors’ Health in Queensland, rural generalism with ACRRM and financial futures with Cutcher & Neale.

ACRRM

After lunch, delegates got hands-on with procedural skills sessions with Drs Robert Nayer and John Inderhaug, practical skills sessions about end-of-life care with Dr Yim and assertiveness with Dr Emma Hodge. Speaking as CDT Sustainability Working Group Chair, Dr Witter discussed practising medicine sustainably.

Doctors’ Health in Queensland

We were very pleased to present the AMA Queensland Medal of Achievement to Patrick Rosengren (JCU) and the AMA Queensland Memorial Prize to Jack Graham (UQ).

Townsville Hospital and Health Service

Maisie Stephen, Cassandra Croppo and Blair Shearwin

MDA National Saturday night social sponsor ADF Careers Avant RACGP Royal Flying Doctor Service Standout Medical Careers Wide Bay Hospital and Health Service

President Dr Nick Yim and Committee of Doctors in Training Chair Dr Elise Witter

Women in Medicine Cairns North Queensland’s medical women gathered together for this year’s Women in Medicine Breakfast in Cairns to celebrate and inspire each other.

Our knockout keynote speaker Dr Deb Lees started things off before our panel of speakers discussed inspiring change: Drs Sarah Coll, Tamika Ponton, Janet Bayley, Renee Cremen and Katrina Starmer. The panel talked about their career paths and paving their own way. Guests enjoyed the chance to catch up in the gorgeously warm Cairns sunshine.

Drs Catherine Meehan and Anusha Lazzari

Thanks to our sponsors who make these events possible:

Cutcher & Neale Accounting and Financial Services MDA National Doctors’ Health Fund Avant Mutual JCU: College of Medicine and Dentistry.

Keynote speaker Drs Deb Lees and Eloise Williams

Speakers Drs Sarah Coll and Tamika Ponton

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Doctor Q | Spring

Drs Mia Crous, Tereza Stillerova, Edward Benson and Jasraaj Singh

Celebrating Crazy Socks 4 Docs Day

Drs Lorraine Marshall, Carolyn Belonogoff, Renee Cremen and Katrina Starmer

Chair Dr Sarah Coll and panel members Drs Tamika Ponton, Janet Bayley, Renee Cremen and Katrina Starmer

Drs Eloise Williams, Lucy Atkinson, Lauren Moses and Lea Merone

Sophie Sproule, Clara Freeman, Olivia Morahan and Chloe Gane

Neha Ramesh, Bridget Henry, Jordyn Kindness, Merali Boyle and Marita Bolic

Fern Barbieri, Liz Deakin, Emma Drummond, Oona Westrheim and Dr Jude Corser

Member Networking Cairns Cairns members and guests joined us at sunset at the Crystalbrook Riley’s Calypso Club for drinks, platters and a discussion about local issues.

With an aim to meeting all our valued Cairns members while in town, AMA Queensland held the Cairns Networking Event on Friday 5 June.

President Dr Nick Yim gave a policy update and AMA Queensland Board member and Cairns Orthopaedic Surgeon Dr Sarah Coll lead a discussion on local issues.

Thank you to our sponsors for the event: Hillhouse Legal Partners, MDA National and Avant.

Drs Sharmila Biswas, Catherine Meehan, Renee Cremen, Sarah Coll and Donald Mackie

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Committee of Doctors in Training (CDT) Chair Dr Elise Witter and CDT Wellbeing Special Interest Group Lead Dr Emma Hodge

Drs Elise Witter, James Allen, Nick Yim, Dilip Dhupelia and Hasthika Ellepola

Drs Maria Boulton, Mikaela Seymour, Hash Abdeen and Sarah Coll

Olympian to Army Doctor Dr Jana Pittman

Keynote speaker Vanessa Turnbull-Roberts with Drs Simone Raye and Hash Abdeen

AMA Immediate Past President Prof Steve Robson and Dr Simone Raye (right) present Kealey Griffiths with the Indigenous Medical Scholarship

DiT of the year Dr Dr Amireh Fakhouri

AMA Immediate Past President Prof Steve Robson presents Prof Caroline de Costa with the 2024 AMA Gold Medal

AMA24 Inspiration surrounded us at the AMA National Conference this year. Two days of keynote speakers and lively breakout discussions were closed with a sparkling gala ball on Saturday night.

We raced off the starting line early on Friday morning with a keynote from the energetic Dr Jana Pittman. Dr Pittman shared her incredible story, from Olympian to Army Doctor, she shared ample experience and wisdom on facing our fears and turning our weaknesses into strengths.

Discussion panels throughout the day tackled tough issues such as scope of practice; trauma informed care; the gender pay gap and workplace culture. To finish the day, we were graced by the amazing Vanessa TurnbullRoberts, Aboriginal and Torres Strait Islander Children and Young People Commissioner and recipient of the Australian Human Rights Medal in 2019, yarning about her experiences and encouraging us to be cognisant healthcare providers.

Saturday morning began with efficiency and crisis response to warm us up to the discussion sessions.

Intensive discussions on the Medical Board’s Review of the specialist International Medical Graduate Pathway occurred, alongside decarbonising healthcare for future sustainability.

Specifically for Doctors in Training, discussions on research raised interesting debates on the purpose of research as part of training, and whether current college strategies achieve their intended purpose. AMA Queensland was pleased to see incoming federal CDT

Dr Mikaela Seymour

Deputy Co-Chair, Committee of Doctors in Training

Dr Ekta Paw

Deputy Co-Chair, Committee of Doctors in Training

chair Dr Sanjay Hettige discussing ways to reduce the CV arms race, and set realistic and meaningful research goals for trainees working full time. Interview preparation advice was welcomed by doctors at all levels with interactive practice helping us perfect our techniques. It was exciting to see CV and interview support will soon be available to all AMA members through AMA Victoria resources and we look forward to sharing these with our members as interviews kick off for 2025 jobs. We finished up with a future painted by Dr Catherine Ball imagining technology and healthcare working together.

Saturday night’s Gala Ball was chaired by our favourite medical-magician and media expert Dr Vyom Sharma. We also honoured an amazing set of award winners, including DIT of the year Dr Amireh Fakhouri who championed the class action for overtime payment and the fair pay of junior doctors.

It was fantastic to see a naturalised Queensland and GP Dr Dani McMullen ushered in as chair of the AMA for 2025-26 and we look forward to working with her. And finally a massive thank you to Dr Hash Abdeen, past chair of the CDT, who hosted the conference with his usual professionalism and enthusiasm.

New AMA President Dr Danielle McMullen, AMA Queensland President Dr Nick Yim and Immediate Past President Dr Maria Boulton

Independent. Concise. Evidence based.

For over 45 years, Australian health professionals have trusted Therapeutic Guidelines as the leading point-of-care clinical resource. The guidelines remain solely funded by subscribers and are written by leading Australian experts for the wider healthcare community.

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Three AMA Queensland members honoured at AMA24 Over the first few days of August the AMA took over the Gold Coast with its AMA24 National Conference.

The weekend featured a packed program of keynote speakers, networking opportunities and workshops, all leading up to the Gala Dinner where members from around the country were honoured for their contribution to healthcare.

Congratulations to the following members on their dedication to the profession and well-deserved recognition. They are pictured above from left to right.

Professor Caroline de Costa AM Professor of Obstetrics and Gynaecology and clinician Prof Caroline de Costa AM is recognised for her leadership in reproductive, Pacific and Indigenous health in regional Australia.

She has received AMA’s highest award for her long and dedicated career and extraordinary work in regional Queensland.

“As we see around the world the fight for reproductive freedoms is far from over. I hope this award might serve as a reminder that we must continue to ensure women are never seen only as vessels for birth but instead to ensure their care and agency is never subject to external decision makers,” Prof de Costa said.

Dr Dinesh Palipana OAM Dr Dinesh Palipana OAM, alongside Canberra-based Dr Clara Tuck Meng Soo, has been honoured for his outstanding contribution to advancing diversity, equity and inclusion in the medical field.

As an emergency doctor living with quadriplegia, he was the first quadriplegic medical intern in Queensland and the second person to graduate medical school with quadriplegia in Australia.

“The journey, coming to medicine from a country divided in ethnic and political wars to Australia, then sustaining a spinal cord injury in medical school, has been a personal reminder of the diversity of people in our world,” Dr Palipana said.

Professor André Van Zundert Anaesthetist, researcher and teacher Prof André Van Zundert has been awarded the 2024 AMA Excellence in Healthcare Award in recognition of his commitment to medicine, research, teaching and volunteering.

On top of his anaesthetist work, he volunteers to support Brisbane people experiencing homelessness, has served with NATO Peacekeepers as military medical director and has authored countless major textbooks, book chapters and scientific publications.

“Receiving the AMA 2024 Excellence in Healthcare Award feels like winning Olympic gold. It’s a moment of immense pride and validation, underscoring the crucial role anaesthetists play in delivering safe and effective anaesthesia,” Prof Van Zundert said.

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Sunshine Coast member networking event Councilllor Dr Wayne Herdy, Dr Roger Faint and President Dr Nick Yim

AMA Queensland and the Sunshine Coast Local Medical Association hosted the Sunshine Coast Networking Event in June.

Members and guests had the chance to catch up with colleagues, get a policy update, discuss local issues and taste some wines from Wine Direct.

AMA Queensland Council’s new North Coast Area Representative, Dr Wayne Herdy, also gave an update.

Thanks to our sponsors for the event: Wine Direct and Sunshine Coast Local Medical Association.

Chris Wilson and Dr Peita Wilson

Drs Angela Thomas and Clive Fraser, Prof Brett Emmerson

Drs Nathalia Gamez Ardila and Ronaldo Gallo Parra

Kirk Muddle, Drs Andrew Steele and Dr Kenneth Mitchell and Ben Stokes

State government addresses our advocacy priorities It’s a mark of successful advocacy when the Minister not only acts on our calls but writes a seven-page letter detailing the government’s response to specific priority items in our Budget Submission 2024-25.

The letter outlines “targeted investment in initiatives” set out in the Queensland Budget that Health Minister Shannon Fentiman says align with our identified priority areas.

Below is a summary of the Minister’s response to each priority area.

Priority 1 Workforce

$1.7 billion to retain the current workforce, build and attract new talent pipelines and innovate new ways to deliver healthcare.

This includes: $1.059 billion to recruit more than 700 extra doctors, 2,600 nurses and midwives and 1,000 more allied health staff. $24 million to bolster Queensland’s primary care services by incentivising trainees to undertake GP training.

You can read more about our calls for this here. $64 million to implement a new electronic workforce system for frontline staff.

‘Mapping of the medical workforce’ project to collate and integrate data on the full continuum of the medical workforce across Queensland.

Priority 2

Training Pathways $5.25 million to create additional training positions to support rural generalist GP trainees to undertake advanced training in anaesthetics.

Implementation of the Student in Medicine role to provide an alternate model of care to support the clinical workforce.

Implementation of an Aboriginal and Torres Strait Islander intern recruitment initiative to provide final year medical students the chance to undertake their internship at a hospital close to country.

Evaluation of the Townsville HHS Indigenous Interns Pathway Program pilot.

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Priority 3 Leadership

Two cultural safety workshops for clinical leaders across the system.

Priority 4 Wellbeing

Independent review of Sexual Assault Policies and Procedures in Queensland Health which we welcomed in March 2024. You can read our full response here.

Improved support mechanisms for the International Medical Graduate (IMG) workforce cohort, including the establishment of an IMG Working Group to ensure priority actions within Queensland Health are informed by expert advisers, including IMGs. Legislative obligations on HHS boards to promote a culture and implement measures to support the health, safety and wellbeing of staff in public health facilities.

Priority 5

Primary-Tertiary Integration $20 million over four years to enhance patient flow through hospital discharge initiatives.

Continued implementation of the Patient Care Facilitator initiative we recommended in our Ramping Roundtable Action Plan.

We are still awaiting implementation of two key recommendations from our Ramping Roundtable – having hospitals run at 90 per cent capacity and 24/7 operation of hospitals to allow for out-of-hours discharges.

We call on the Government to implement more of our initiatives set out in our Advocacy Priorities 2024-26.

Priority 6 Prevention

In line with our stance that access to high quality primary care is essential for preventative health and should be an investment priority, the government has:

Prioritised key social determinants of health in their First Nations First Strategy 2032 to improve the health and wellbeing of First Nations peoples in line with the National Agreement on Closing the Gap. Invested $135.9 million for the rollout of free vaccinations through the Meningococcal B Vaccination and Paediatric RSV Prevention programs, and to support the continuation of the free influenza vaccine.

We also called for free whooping cough vaccinations to protect those not currently covered under the National Immunisation Program.

Priority 7

Collaborative, Evidence-Based Practice The government has implemented initiatives to further improve patient flow and bed capacity. These include additional funding for senior doctors and nurses in emergency departments, patient care facilitators, rapid access services, a surgical rapid assessment unit, extended hours of medical imaging and timely patient transitions – most of which we recommended in our Ramping Roundtable Action Plan.

We also welcomed their recent announcement to roll out Brisbane’s virtual emergency department model across the state.

Priority 8

Digital Integration The Queensland Government has plans to work with the Federal Government on modernising the My Health Record. It has also committed $13.6 million over four years to ensure security capabilities and technologies are kept up to date with healthcare security needs. We will continue to advocate for more digital improvements in line with our Budget Submission and Advocacy Priorities in the coming financial year.

Priority 9

First Nations Health $324.7 million over four years to target health equity for First Nations Queenslanders.

Evaluation of the Townsville HHS Indigenous Intern Pathway.

Investment and support for the Institute for Urban Indigenous Health (IUIH) and the Queensland Aboriginal and Islander Health Council (QAIHC) to establish First Nations health and wellbeing hubs.

Priority 10

Women’s Health $247.9 million in new funds for women’s health report. $41.8 million to assist women to access information and termination of pregnancy care that meets their needs. $42 million over four years to bring maternity services closer to home for remote, rural and regional women.

Since receipt of the Minister’s letter, the government has announced four nurse-led, walk-in clinics as part of its Queensland Women and Girls’ Health Strategy 2032. These clinics will be available free to all Queenslanders. We continue to argue this funding would have been more valuably invested in supporting the employment of women’s health nurses in existing general practices around the state.

Priority 11

Climate and Sustainability The Office of Hospital Sustainability (OHS), which we successfully advocated for in 2022, continues to actively work with HHSs to guide and support the mitigation and reporting of carbon emissions generated through HHS operations.

The letter also highlights the OHS’s commitment to continue working closely with AMA Queensland to progress the sustainability agenda across Queensland Health. This includes hosting a sustainability summit for Queensland Health leaders in 2024.

Priority 12

LGBTQIASB+ Community In response to the work of our LGBTQIASB+ Working Group and calls for LGBTQIASB+ support, funding of $6.8 million is being allocated towards gender affirming care that is tailored and more accessible for LGBTQIASB+ communities.

The government has committed to delivering this through a combination of face-to-face, online and telehealth services that will provide targeted support for LGBTQIASB+ people.

Priority 13

Aged and End-of-Life Care Increasing the palliative care eligibility access period for all services from three months to 12 months and improving access to the Medical Aids Subsidy Scheme.

Investing $12.8 million over four years to continue Specialist Palliative Care in Aged Care (SPACE).

Investing an additional $18 million over four years to meet the demand of the Voluntary Assisted Dying Program.

Priority 14

Substance-Related Harm $1.645 billion over five years to improve mental health, alcohol and other drug services and suicide prevention initiatives. $211.8 million over five years to uplift alcohol and other drug service capacity and capability. $1 million for drug checking services.

Expanded Police Drug Diversion Program to include all illicit drugs, not just cannabis.

We appreciate the time and consideration that went into this letter and its clear recognition of AMA Queensland’s contribution to improving health policy in our state.

We look forward to ongoing collaboration with both sides of politics in the lead-up to the 26 October election to improve health outcomes for all Queenslanders.

Read the letter in full here

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Working with Health Minister to boost vaccinations

Minister Fentiman, Chief Health Officer John Gerrard and RACGP Queensland Chair Dr Cathryn Hester joined AMA Queensland Immediate Past President Dr Maria Boulton at her Brisbane practice on 23 August, to raise awareness about vaccinations.

Whooping cough cases have spiked in Queensland this year, with more than 7,000 cases by early August, compared to just 104 in the same period last year.

Young mother Rachel, who is pregnant with her second child, told journalists about her ordeal when her first child Vivienne was hospitalised with whooping cough at 12 months.

AMA Queensland and Health Minister Shannon Fentiman have joined forces to urge Queenslanders to take advantage of free vaccinations.

Rachel had been vaccinated during pregnancy and Vivienne was vaccinated at two months, but still contracted the infection.

Despite the state government making the flu shot free for all eligible people, only 1.7 million Queenslanders have been vaccinated against influenza this year, about 100,000 fewer than the same time last year and almost 400,000 fewer than in 2022 when free flu jabs were first introduced.

“The doctors told me that without the antibodies from our vaccinations, she could have died,” she said.

Queensland has recorded more than 61,000 laboratoryconfirmed cases of influenza A this year, more than double the five-year average.

“We have almost eradicated RSV for newborns here in Queensland - that is how successful this initiative has been,” Minister Fentiman said.

At the same time, the proportion of pregnant Queenslanders taking up their free whooping cough vaccine under the National Immunisation Program (NIP) has fallen to 70.7 per cent, down from 77.2 per cent two years ago.

“From February, babies have been having that immunisation and it has radically reduced RSV for very little babies, where they are the most vulnerable. So that is fantastic news for Queensland.

While childhood vaccination rates for whooping cough remain above 90 per cent, immunisation during pregnancy is crucial to protecting newborn babies.

26 Doctor Q | Spring

However, there is better news on the RSV front.

Queensland is one of only two jurisdictions to provide the RSV vaccine to newborn babies.

“I want to thank the RACGP and AMA Queensland who have worked with us to deliver that and the Chief Health Officer whose team has been driving that policy.

“Every other state and territory health minister is looking to Queensland and trying to secure more RSV vaccines for next season.”

Five AMA Queensland members elected to Federal Council Dr Sarah Coll

Clinically, he works across public and private practice, as well as teleradiology across Australia and New Zealand, where he has helped shape the development of the inaugural AMA Position Statement for Artificial Intelligence in Health Care 2023.

With 10 years of experience with the AMA at both state and federal levels, Dr Sarah Coll has been elected as the Practice Group of Private Specialist Practice Representative.

He hopes to continue his enthusiastic advocacy for radiologists, including for the safe and ethical use of digital health systems and emerging technologies, on Council.

Dr Coll is currently the President of the Australian Federation of Medical Women, member of the AMA Federal Fees List Committee and the AMA Queensland Committee of Consultant Specialists, a Councillor on the Royal Australasian College of Surgeons and a director on our Board.

Dr Jasmine Davis

A natural leader, she is working to support the well-being of specialists and advocate for effective remuneration of doctors in their private practice and engagement with insurance companies

During her time on Federal Council, she worked closely with the Committee of Doctors in Training (CDT) to prioritise important issues such as training bottlenecks, increasing interest in GP careers, and support for rural placements. She also worked to progress AMA’s stance on social justice issues, health equity and climate change while improving opportunities for women in leadership.

Congratulations to the following members who have been elected to Federal Council. They are pictured above from left to right.

A/Prof Gregory Duncombe Long-time AMA Queensland member A/Prof Gregory Duncombe has been elected as the Obstetricians and Gynaecologists Specialty Group Representative.

Dr Duncombe has spent much of his career, in all levels of private, public, academic and community practice, working in and advocating for the best health outcomes for women and families of all backgrounds.

His work extends nationally through his professional involvement in healthcare, research, education and training, and institutional assessment in all states, territories and many offshore facilities.

Dr Xavier Yu Chair of the RANZCR Victorian Branch and President of the Australian Doctors Orchestra, Dr Xavier Yu has been re-elected for the third year as the Radiologists Specialty Group Representative.

After serving as Federal Councillor in 2022 as part of her role as President of the Australian Medical Students’ Association, rural generalist intern Dr Jasmine Davis has been elected as an ordinary member of Council.

Dr Davis seeks to use her passion and expertise to continue advocating for doctors in training.

Dr Ekta Paw Oral and Maxillofacial Surgery Registrar and Deputy Chair of the AMA Queensland CDT, Dr Ekta Paw has also been elected as an ordinary member of Council.

Dr Paw has previously served as a member on the Council of Rural Doctors, Chair of AMA South Australia CDT and Chair of the CDT Policy Advisory Committee, where she dedicated extensive effort to reviewing policies with a progressive lens.

Her passion lies in improving access to medical and surgical care via health systems and policy and hopes to use her experience to do so as a Council member.

Spring | Doctor Q 27

Surgical Wait List Roundtable Action Plan Fundamental reform of how hospitals are run and funded is urgently needed to fix inequitable access to surgical services in our regional communities.

Summary of actions AMA Queensland Vice President and Surgical Wait List Roundtable chair Dr Emilia Dauway said the Roundtable’s Action Plan is a ready-made road map for the party that wins the October election.

Dr Dauway urged Labor and the LNP to commit to its implementation in the lead-up to the 26 October state election.

“We know patients in regional and rural communities have been suffering from inequitable access to elective surgery for too long,” Dr Dauway said.

“Patients in places like Rockhampton, Mackay, Hervey Bay and even outer-metropolitan hospitals like Caboolture, Logan and Ipswich are waiting long periods to get the surgeries they need.

1.

Queensland Health must restructure its governance frameworks to solve the current crisis in elective surgery in our regional areas. This must prioritise a shift to collaborative teams and fundamental reform of funding models to reflect regionality and remoteness in the Queensland context.

2.

Prioritise key locations in the short term – Central Queensland, Mackay, Wide Bay and West Moreton HHSs, and Caboolture, Redland, Redcliffe and Logan Hospitals.

3.

Prioritise key specialties and specialists in the short term – anaesthetics, obstetrics and gynaecology, urology, ENT, orthopaedics, plastics, ophthalmology and vascular. This includes incentives and flexible supports for partners and families willing to relocate to priority locations, particularly where partners are Queensland Health employees.

4.

Clear the elective surgery backlog in the short term, including increasing outpatient surgical activity to free up theatres for more complex cases and allowing treatment of private patients in public hospitals.

5.

Medium-term outsourcing reform and options, including linking emergency and elective work, feefor-service models and public-private partnerships.

6.

Establish a range of collaborative models tailored to different sized locations and enabling rotation of regional specialists through tertiary centres in addition to city specialists through regional and rural locations.

7.

Review current funding models that disadvantage regional areas such as Mackay, Rockhampton, Bundaberg and Gladstone and provide an immediate increase in funding for regional centres to reflect their true remoteness.

8.

Prioritise key locations in the medium-long term with a focus on locations with the longest wait times for specific services and specialties.

9.

Prioritise key specialties in the medium-long term by enabling specialist trainees to work in private facilities and increased specialist and sub-specialty training in regional Queensland.

“This can be particularly lengthy for those needing gynaecology, orthopaedic, urology and ENT procedures.

“Tragically, patients also have their surgeries delayed or cancelled because we just don’t have enough anaesthetists. You simply can’t do surgery without them.

“Doctors are increasingly distressed by their patients’ consequent poorer health outcomes and lack of concerted action to save our regional surgical services.”

AMA Queensland President Dr Nick Yim said Queensland is the most decentralised state and the Activity Based Funding model, which rewards hospitals for the amount of services they provide, only punishes regions where services are already unavailable.

“If a regional hospital does not have surgeons or enough anaesthetists, it can’t provide services. Elective surgery is necessary, planned surgery for serious conditions,” Dr Yim said.

“We must invest in our regional health workforce and shift to collaborative teams.

“The incoming government must support the regional doctors, nurses and other health professionals who provide the foundation for competent, safe and timely surgical services close to home.”

10. Develop and implement a long-term viability strategy to ensure public hospitals meet community demand.

11.

Funding reform so service need is not determined on current activity, which disadvantages areas where services are not available.

12. Data and digital technology to provide accurate data on outcomes across geographical areas, specialists per capita and waiting lists, particularly the ‘hidden wait list’ – the stage during which patients wait to see a specialist before they can be put on an elective surgery waiting list or access non-surgical treatments.

13. Policy reform to ensure alignment with interstate jurisdictions, particularly New South Wales, and improve wellbeing, culture and perceptions of regional practice among health practitioners.

AMA Queensland Surgical Wait List Roundtable Action Plan

Spring | Doctor Q 29

Election recomendations AMA Queensland has created a blueprint of 17 priorities for any new government to adopt after the 26 October election.

They include workforce, elective surgery wait lists, payroll tax and training pathways.

r“Queensland’s health workforce crisis has deepened on the back of the COVID-19 pandemic, due to the worldwide shortage of doctors, nurses and other healthcare practitioners,” AMA Queensland President Dr Nick Yim said.

“This has led to our own workforce shortages, elective surgery delays, ambulance ramping and growing financial pressures on general practice.

“These problems have been building for decades and while some are out of our control, there are levers we can pull to start fixing things.

“We offer our Election Priorities as a blueprint for all parties. We encourage whoever forms government after 26 October to commit to these reforms to improve the health of every Queenslander.

“Not only do we have chronic shortages of doctors in rural, remote and First Nations communities, but even large regional and some metropolitan areas are struggling to attract and retain staff.

“We need better workforce incentives, more doctor involvement in leadership decisions, and sufficient training places for our junior doctors and international medical graduates (IMGs).

“We must rebuild our regional specialist workforce so patients do not have to travel so far for treatment and pregnant families can have their babies at their local hospital.

“Payroll tax remains an ongoing concern for private medical practices, and we call on all parties to implement an exemption for all private practices, consistent with arrangements for public and most private hospitals.

“We are in a cost-of-living crisis and now is not the time to make seeing a GP more expensive for patients, many of whom are older with more chronic disease. We should be investing in preventive care, not taxing it.”

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1. Workforce Broader incentives to attract and retain doctors in regional, remote and rural areas, particularly First Nations doctors, more doctors employed with sustainable workload, and basic facilities for hospital doctors, including offices, workstations and IT systems.

2. Training pathways Queensland Health to work with the Medical Board, colleges and universities to ensure requisite training places are available for the number of doctors needed, and ongoing funding for the General Practice Trainee Grant Program.

3. Leadership Embed doctors in decision-making processes and leadership at senior levels in HHSs and Queensland Health, and implement all recommendations of the Wilson Review into whistleblower protection laws.

4. Wellbeing Reform of regulatory processes, reduced workloads for doctors in training, support for First Nations doctors and IMGs, and all HHSs to undertake exit interviews as a routine.

5. Surgical Wait List Roundtable Action Plan More support for regional doctors and nurses so Queenslanders have surgical services close to home, and fundamental reform of Queensland Health and funding models.

6. Primary-tertiary integration

14. LGBTQIA+SB community

Greater coordination between general practice and public hospitals to reduce ED presentations, establish a dedicated governance role for general practice within Queensland Health, and scale up the Patient Care Facilitators initiative currently being trialled in Ipswich and Logan.

Policy support and funding for the establishment of a voluntary suicide register, representation on key research and health bodies, and academic and consumer representation on the Australian Medical Council.

7.Payroll tax

Actively engage with the broader mental health sector to immediately implement programs under already-funded initiatives and identify crucial gaps in patient access.

Implement an exemption for all private practices and extend the amnesty to all medical practices to provide financial certainty for non-GP specialists and their patients.

8. Prevention Greater investment in high quality primary care, particularly general practice, and state government advocacy to the federal government to jointly address the underlying causes of poor health outcomes.

9. Collaborative, evidence-based care Undertake a joint Queensland Health/AMA Queensland PhD research project to identify tasks undertaken by doctors that can be safely performed by other health professionals to improve patient flow and care by having doctors spend maximal time working at the top of their scope.

15. Mental health

16. Aged and end-of-life care Ensure all unallocated funds from the $171 million investment announced in the 2022-23 budget are reinvested in end-of-life care, with a separate funding stream for Voluntary Assisted Dying (VAD) services.

17. Substance-related harm Additional funding for health services to treat the anticipated 17,000 people who will access drug diversion schemes, funded through allocating a proportion of the savings to our criminal justice system to Queensland Health.

10. Digital integration Invest in integrating digital systems in our primary care and tertiary systems to promote necessary informationsharing and continuity of care, and urgently rectify ongoing issues with systems including ieMR and QScript.

AMA Queensland Election Priorities 2024 nd doctors, Supporting Queensla creating better health

11. First Nations health Support programs advocated for by First Nations health organisations, including the Institute for Urban Indigenous Health (IUIH) and the Queensland Aboriginal and Islander Health Council (QAIHC), and invest in the underlying causes of poor health outcomes.

ama.com.au/qld

12. Women’s health Prioritisation and increased investment in maternity care, termination of pregnancy services, and alcohol and other drug treatment services.

AMA Queensland Election Priorities 2024

13. Climate and sustainability Reduce carbon emissions and waste production in hospitals and health services, including single-use items, biohazardous waste and high use of non-renewable energy, and implement environmental sustainability pilot programs in hospitals and GP clinics.

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Patient Care Facilitator trial in motion Health Minister Shannon Fentiman with new Patient Care Facilitator Vyapti Patel and Immediate Past President Dr Maria Boulton

Patients across Ipswich and Logan are now receiving coordinated support from general practice-based intermediaries post hospital discharge under the newly implemented Patient Care Facilitators (PCFs) trial.

“AMA Queensland came up with this wonderful idea to actually put nurses or clinicians in GP practices to help facilitate patient care when people are discharged from hospital,” Minister Fentiman told journalists.

AMA Queensland called for the introduction of PCFs in our Ramping Roundtable Action Plan and we commend Health Minister Shannon Fentiman and the Queensland Government for taking up our recommendation to reduce stress on hospital emergency departments.

“We know when you’re discharged from hospital, you get a lot of information about your medication, follow-up treatments and follow-up appointments with your GP, and it can be a really stressful, overwhelming time. So, that’s where this wonderful new program comes in.

The PCFs will work with the hospital-based discharge coordinator to identify eligible patients, review their patient information and ensure discharge summaries are received.

“Ipswich and Logan are two of the biggest, fastest growing communities in the southeast, and it’s really where we need this additional support.

AMA Queensland Immediate Past President Dr Maria Boulton joined Minister Fentiman on 6 September at Wellcare Medical Centre in Kingston to welcome the rollout of the trial.

“I’m really thrilled that we’ve listened to the clinicians in the community trying to support their patients, because we do see a lot of people representing to the emergency department following hospital discharge.

“We know from studies that if patients see their GP within seven days following hospital discharge, they are 33 per cent less likely to bounce back into hospital,” Dr Boulton said.

“And if we can be more proactive and reach out and make sure they get the care they need when they need it, we are going to prevent more people turning up to our busy EDs.”

“We also know how important it is for patients to have access to a regular GP for continuity of care, and this program will ensure patients are supported following hospital discharge.

“This program will not only facilitate that access, but it will also facilitate communication between the hospital and the patient’s GP so that their GP can continue to provide the brilliant care that we know keeps patients healthy and out of hospital.

Lead practice nurse Vyapti Patel has taken on the PCF role at Wellcare where she ensures patients feel safe and reassured that their condition is being supported after hospital discharge.

“For patients who have been in hospital with chronic conditions or patients who have been going to the hospital very regularly, we want to help prevent further hospitalisations,” Ms Patel said.

“It is fantastic to see the program commence in locations across Logan and Ipswich, and we hope to see it rolled out statewide.”

“We give them a call within four days after their discharge, we arrange an appointment with a GP, they come down, we do a follow-up care plan or any follow-up care required in terms of the medication they have been discharged with, and then we go from there.

The state government is investing $2.4 million into the program over the next two years to help connect newly discharged patients to their local GP.

“It’s something new. So far, it’s been good. The patients we have been seeing are appreciating the efforts and we are doing our best.”

The two-year trial includes 10 PCFs in Logan and seven in Ipswich, with plans to review their success and consider the programs expansion across the state.

32 Doctor Q | Spring

AMA Queensland calls for payroll tax exemption for private practices AMA Queensland is calling on all political parties to eliminate the patient tax by publicly committing to exempt all private medical practices from payroll tax.

This follows a parliamentary debate on the second last sitting day before the 26 October election, where both sides of politics agreed that imposing payroll tax on GPs would have a devastating impact on patients’ access to primary care.

The LNP moved a motion to revoke the Queensland Revenue Office’s Public Rulings that clarify that patient fees, including the Medicare rebate and any out-of-pocket expenses, will not be subject to payroll tax when they are paid directly from a patient to a GP for that GP’s services.

Treasurer Cameron Dick said revoking the rulings would lead to more doctors paying payroll tax.

“We have provided a ruling that sets out a pathway about how they can become compliant without having to pay payroll tax. Then we provided an amnesty, to give them the time and space to do so,” Mr Dick said.

“The LNP now seek to revoke those beneficial arrangements. This would potentially put every medical centre in default of their taxation arrangements at the expiry of the amnesty.”

But Shadow Treasurer David Janetzki said the government had not carefully considered the real-world impacts of its policy.

“Good governments do not drive up the cost of seeing a doctor in the middle of a cost-of-living crisis. Good governments do not increase the rate of presentations to emergency departments and drive down bulk-billing rates in the middle of a health crisis.

“Good governments certainly do not force doctors to be bookkeepers when they should be healing Queenslanders.”

LNP backbencher Jon Krause went further.

“There is a simple solution: not tax our GPs. Change the rules when it comes to payroll tax: exempt GPs,” Mr Krause said.

“Get rid of the patient tax and take the burden off Queenslanders who are already suffering enough in the cost-of-living crisis created by members opposite and the Albanese federal Labor government.”

The motion was lost along party lines.

AMA Queensland Immediate Past President Dr Maria Boulton said it was encouraging to see payroll tax being debated in parliament.

“This shows our politicians understand the threat of this new tax to patient costs and practice viability,” Dr Boulton said.

“We also support the Opposition’s solution to exempt GPs from this patient tax – something we have argued for since GPs started getting unexpected backdated bills in 2021.

“We now call on both parties to announce an exemption for all private practices before the 26 October state election.

“Every private practice must be given the same certainty so Queenslanders can continue to access medical care from their GPs and other specialists.

“The simplest way to solve this problem and keep quality private medical care accessible for Queenslanders is to exempt all medical practices from this patient tax, in the same way public and most private hospitals are exempt.

“At the very least, the amnesty should be extended to all medical practices to provide financial certainty for non-GP specialists and their patients.”

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Decarbonising our health system one commute at a time It’s no secret that our health system is under immense strain.

Between ambulance ramping, elective surgery backlog and the decline in bulk billing, it’s easy to point fingers at our workforce shortage.

While this is certainly a powerful force at play, Queensland has a system of demand akin to motorway congestion.

Invaluable advances in healthcare mean people are living longer, but our system is currently not set up to handle the increasing volume of chronic, and mostly preventable, disease as a result.

We relieve the pressures as best we can by recruiting more doctors and health workers or by further innovating our health care models.

However, this only works for a short period before we are swamped again, and the cycle continues.

Another force is the rising cost of providing health care.

As access to primary care continues to decline with the underfunding of Medicare and rising cost of living, patients are struggling to prioritise preventive health.

Underlying causes of ill health largely include housing pressures, mental health and the cost of a nutritious diet.

When patients can’t afford these things, let alone a visit to their GP, that’s when health begins to deteriorate.

We live in a system that is not conducive to a healthy lifestyle and we need to be having broader discussions about how we can foster a healthier community.

In June, the CSWG developed and finalised its Active Travel Position Statement, promoting active travel across transport systems, the health sector and individual clinics.

A large component of this work encourages people to use public transport, cycle or walk instead of driving to improve both the health of them and the environment by reducing greenhouse gas emissions.

National road transport emissions have increased by nearly 60 per cent over the past 23 years and now account for 19 per cent of Australia’s overall emissions.

Decarbonising transport in Australia is vital for the health of individuals, our communities and the environment.

The Queensland Government’s 50 cent fare trial for all state-owned public transport is a step in the right direction, and we hope to see it implemented long term.

Dr Katie Panaretto

Public Health Physician and AMA Queensland Councillor

Affordable public transport will not only ease congestion, but in doing so, will reduce emissions and bolster the health of our communities.

Fewer cars on the road means less pollution and a healthier planet, lungs and respiratory health. It also enables a less stressful trip for those who do needs to drive.

Using public transport also encourages more movement in a day, as people typically have short distance to walk on either side of their trip.

Getting out of our cars and spending more time outside is a key part of the roadmap to better community health. We need to see our governments and councils implementing further systems that not only enable active options for communities but encourages their uptake.

The myriads of benefits for preventive health are clear and AMA Queensland and the CSWG are seeking further collaboration with other health agencies and government bodies to keep the progress in motion.

AMA Queensland was proud to join with Queensland Health in August to hold a Sustainable Healthcare Leadership Summit to provide information on key climate change and sustainability concepts.

There are so many passionate clinicians working within Queensland Health who are already reducing their carbon footprint by making simple changes to their own work habits.

The Summit gave them an opportunity to promote sustainability initiatives currently in action to Hospital and Health Service Board Chairs and other senior executives.

Expanding the 50c fare program to maintain low public transport fees would be a great start, but our communities need more than a financial incentive to change their routine and leave their car at home.

These practitioners also showed how sustainability changes, even simple ones like switching to LED lighting, usually result in significant cost savings to hospitals that can be reinvested into the system.

Our communities need a variety of options that work for their unique lifestyle and health needs. This could be achieved by building better footpaths and cycle ways, extending active travel options beyond public transport.

We now need to see HHS executives respond with focus and a sense of urgency to fund and implement those and other sustainability measures across the entire health system.

Improving Queensland’s public transport infrastructure is a beast of its own, but from a health and environmental perspective, reducing the economic barrier to access is a great place to start.

Spring | Doctor Q 35

A medical practitioner could experience adversity at any stage in life...

MBAQ Can Help FINANCIAL ASSISTANCE FOR DOCTORS

(07) 3872 2222

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mbaq@amaq.com.au

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www.mbaq.org.au

Committee of General Practice update The Committee of General Practice is working around the clock as the workforce story continues.

In real time we’re seeing patients struggling to make timely appointments with their GP due to an imbalance between demand and access. However, the red flags signalling a struggling general practice workforce have been glaringly obvious for some time.

Statistically speaking, the number of medical school graduates choosing general practice as their specialty has decreased drastically from 50 to 15 per cent in the last four decades.

We’re finally starting to see tangible proposals from the state government to address the gaps in our workforce, but we have a lot of work to do before our problems become a distant memory.

State budget The state budget announcements from Health Minister Shannon Fentiman are great news for Queenslanders amid our current workforce crisis. The challenge we face now is implementation.

As a direct result of AMA Queensland advocacy, the Queensland Government introduced a $20 million incentive program in their budget announcement to give aspiring GPs $40,000 grants to undertake training in Queensland.

Under the program approximately 500 registrars will receive the grants over two years in attempt to replenish the general practice workforce.

While it is fantastic to see the state government invest in primary care and general practice for the first time, our concern lies in the details.

The general practice workforce is struggling nationwide, but even more so in our regional, rural and remote communities. Incentivising doctors to train as GPs is a start, but we must ensure they’re also incentivised to work in the areas they’re needed most.

The Government also announced $64 million to implement a new electronic workforce system for frontline staff and the continued rollout of the AMA Queensland Ramping Roundtable recommendations.

Dr Lee Jones

Chair, Committee of General Practice

Proposed expansion of doctors’ bags General practices are often a central point for patients during natural disasters. A truth only further exacerbated during ex-Tropical Cyclones Jasper and Kirrily.

As a GP and practice owner in Yorkey’s Knob, an area directly affected by these events, I experienced the impact on essential healthcare firsthand and recognised many gaps in the system.

Namely, the lack of access to emergency healthcare resources.

However, we also recognise that this is not a unique situation to natural disasters. In many rural and remote communities’ essential healthcare in emergency situations is not accessible year-round.

Through this ongoing conversation we have resolved to compile a list of inclusions to expand doctors’ scope of practice during natural disasters and in extremely remote communities. This would ideally function as doctors’ bags, not chargeable to the patient.

The committee also discussed the potential risks associated with the doctors’ bags including the supply of medications, wastage and the doctor-pharmacist relationship.

Despite their importance, the hope is that doctors’ bags don’t have to be used regularly. It would be unreasonable for products listed in short supply by the TGA to be included when they are in immediate demand elsewhere.

We also considered the coordinated management of inventory to ensure stock is rotated within the products use by date to ensure nothing goes to waste.

This is a work in progress with the goal of ensuring patient health and safety and the unique needs of rural communities, and we hope the Director-General recognises the important role GPs play in emergency situations.

State election As the state election nears, health is proving to be a major campaign issue, and AMA Queensland is carefully monitoring and analysing policies for their potential impact on our healthcare system.

We continue to work with both sides of politics for the betterment of primary care and guaranteed patient safety.

Spring | Doctor Q 37

Resident Hospital Health Check visits Thanks to all the junior doctors who have come out to visit us and support the 2024 Resident Hospital Health Check survey.

So far, we’ve visited the Sunshine Coast, Nambour, RBWH, Bundaberg, Rockhampton, Logan, TPCH, QEII, Gold Coast, Robina, Toowoomba, Caboolture, PAH, Redland and Mater hospitals.

The survey collects important data on: access to professional development leave hours of work and overtime hospital facilities workplace culture including bullying and harassment The data is used guide AMA Queensland’s advocacy work and ASMOFQ’s negotiations for MOCA and other workplace agreements.

Gold Coast University Hospital

QEII Hospital

Sunshine Coast University Hospital

Nambour Hospital

Logan Hospital

Caboolture Hospital

Toowoomba Hospital

Dr Elise Witter

Chair, Committee of Doctors in Training

Committee of Doctors in Training update

IMG orientation

Resident Hospital Health Check

CDT has also been busy forming a working group around IMG orientation and onboarding in collaboration with the Junior Medical Officers’ Forum of Queensland, with a plan to develop a blueprint for resources to support IMG doctors in training. If you are interested in joining in a focus group to help shape this work, please reach out to us! We would love to have your input.

Thank you to everyone who completed the 2024 Resident Hospital Health Check survey. It is a hugely valuable tool in identifying challenges and advocacy priorities and has directly contributed to policy and legislative change in the past.

The Wellbeing SIG is also curating a list of wellbeing resources to assist doctors in training in accessing support. We look forward to seeing the outcomes of these projects when they are complete, and continuing to advocate for doctors in training across Queensland.

Junior Doctor Conference

AMA24

It was delightful to meet so many enthusiastic doctors in training and medical students at our annual Junior Doctor Conference held in early June. Commencing with eminent obstetrician and gynaecologist, author and women’s rights advocate Professor Caroline De Costa AM and Royal Flying Doctor Service GP and emergency doctor Dr Katrina Starmer, the Saturday was filled with inspirational speakers, practical sessions and procedural skills stations enjoyed by all.

I was also fortunate to attend the AMA National Conference in August on the Gold Coast, where we welcomed the new incoming Federal AMA President and Vice President. We heard from a range of amazing speakers, and our own Dr Emma Hodge (AMA Queensland CDT Wellbeing SIG Lead) was recognised as an AMA Doctor in Training of the Year finalist for her fantastic work in promoting the wellbeing of doctors in training through innovative models and research in her role as Wellbeing and Medical Education registrar.

Congratulations to Emma!

Sunday featured a trip to the reef where I was fortunate to spot a turtle as well as the dazzling displays of coral and colourful fish while snorkelling. This reef trip highlighted a key theme of the conference, the importance of sustainability, and was a timely reminder of the role we all play in advocating for the environment and sustainable practice in healthcare.

Crazy Socks 4 Docs We also celebrated Crazy Socks 4 Docs with everyone putting their best foot forward and donning their craziest socks to raise awareness and destigmatise doctors’ mental health. It was heartwarming to see the number of colleagues at Hospital and Health Services across the state who got involved and showed their support.

Stigma can be a huge barrier for seeking help for mental health and we encourage anyone who is having a difficult time to reach out to a service such as Doctors’ Health in Queensland or your GP for support.

A range of issues facing doctors in training were highlighted, including the need for regulatory oversight of the colleges, workforce substitution, financial challenges including training fees and broader issues around LGBTQIASB+ community representation and governance of medical indemnity insurers.

We are continuing to progress with our ward call survey outcomes, with a position statement currently under development for approval at the next Federal Council.

We are also still seeking participants for our IMG focus groups to brainstorm minimum standards for onboarding and orientation for IMGs, with incentive payments of $50 vouchers available for participation – get in touch today if you are keen to get involved with this.

Contact CDT at cdt@amaq.com.au or call 07 3872 2222.

Spring | Doctor Q 39

Dr Antony Ji

Committee of Doctors in Training Industrial Relations Special Interest Group Lead

07 3872 2222 asmofqld@asmof.org.au

Physician’s assistants: the thin edge of a terrifying wedge The ongoing debate around the role of Physician’s Assistants (PAs) in our healthcare system has reached a pivotal moment. As Queensland Health pushes forward with its framework and guidelines to expand and integrate PAs into clinical settings, it’s imperative for us as resident doctors to understand the profound implications these changes will bring upon our training and healthcare landscape.

One of the most glaring issues with the current Queensland Health PA guidelines is the absence of a cap on the scope of practice. Coupled with a role description that essentially positions them as replacements for resident doctors, the thin edge of a terrifying wedge is manifest.

While proponents (...and the guidelines) may claim “physician’s assistants are not a substitute for doctors”, this is factually incorrect because they already see undiagnosed patients, perform a role and undertake tasks which otherwise a resident doctor would do. The reality is they do not bring any different skills or functions than that of a resident doctor.

40 Doctor Q | Spring

The training of PAs in the medical model has also been touted as though this rapid-fire training model promotes their utility and safety. This terminology is ironically nonstandard and unrecognised by the Australian Medical Council (AMC) when it comes to medical accreditation.

The medical model ostensibly refers to a framework where disease and illness are seen as deviations from normal wellbeing, with signs and symptoms serving as indicators requiring categorisation. This categorisation forms the basis of differential diagnoses and treatment, indicating that PAs are, in essence, trained as diagnosticians. Despite claims to the contrary, this training model inherently positions PAs as direct replacements for resident doctors.

Indeed, every implementation of PAs has highlighted concerns about their expanding scope of practice. Once PAs are integrated into the system, their roles tend to expand, diverting funds away from resident doctors and their training. Fundamentally, this is a shift in resources that could otherwise be used to support the training and development of resident medical professionals into advanced roles - which ironically could address the shortages currently faced now and into the future.

Evidence from the National Health Service (NHS) in the UK underscores the negative impact of PAs on resident doctor training. A significant 70.5 per cent of surgical trainees reported a detrimental effect on their training due to the presence of PAs. Additionally, 55 per cent of doctors in the British Medical Association survey indicated that PAs actually increased their workloads.

The regulatory body for PAs in the UK, the General Medical Council (GMC), now also faces legal challenges over the blurring of lines between doctors and PAs, further highlighting the inherent risks with this model of care.

Interestingly, many assert that PAs are intended to free RMOs from administrative tasks, yet there’s no corresponding mention of this in any guideline by Queensland Health. Instead, we have 32 pages of information about their clinical relationship with SMOs, their ability to specialise anywhere based on their experience, and their delivery services with infrequent and remote supervision. Never stated is any role or core duties with an intention to alleviate the workload of junior doctors, a significant red flag, and a subtle but very clear indicator about their intended implemention.

Supporting an RMO does not mean replacing them in tasks; it means making their workflow easier and more efficient. Offloading ‘simple’ tasks or presentations is a fundamental misunderstanding of how doctors learn. The IV cannula magically inserted in the most challenging of resuscitations is built on every cannula that came before.

Yet seemingly, the proposed solution to RMO workload is to instead create a two-tier medical system, by substituting less trained, higher paid PAs as a labour-forhire approach. This strategy overlooks the primary issue: the insufficient number of RMOs as a core strain on our healthcare system.

It almost appears the goal is to do anything to avoid hiring more RMOs; and while people may point to how RMO jobs go unfilled as a reason for this approach, the focus completely ignores why they are unfilled. No longer is there a hostage workforce barrelling toward the public health system being churned out of medical schools, and Queensland Health needs to recognise the challenges of recruitment which have long been known in the external private sector.

Modern RMOs are more than just about a job, and to attract, grow, and sustain our dedicated and hardworking RMOs Queensland Health needs to do so much more, to stay competitive as a workplace.

Finally, success of PAs in the USA is often cited in defence of their integration into our system. However, it’s crucial to note that the USA healthcare system lacks resident level doctors as a system. In the USA, PAs instead serve as the middle tier between nurses and senior doctors, a role that does not align with our existing healthcare structure.

Importing this model into our system risks disrupting the balance and efficacy of our medical workforce.

As this movement to follow the UK and USA gathers steam, we must draw a line in the sand. As future recipients of our healthcare system, it is vital to maintain the high standards we currently enjoy and avoid descending into the chaos observed in the UK or a twotier system seen in the USA, where access to doctors appears determined by wealth and geography.

As House Officers and Registrars, we must voice our concerns and advocate for a system that prioritises training and ensures the delivery of safe, high-quality care to all patients. If we do not make a stand now, then when?

Spring | Doctor Q

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Deciding to buy a practice was massive and still is massive in the sense that there are days where we are not sure if it was the right one. But when we look at what we’ve done, we know it was the right choice.

Meet a member

Dr Lisa Fraser Practice owner and rural GP Dr Lisa Fraser is passionate about addressing health inequities. Always seeking educational opportunities to best support disadvantaged communities, she has found fulfilment in Gordonvale, Far North Queensland.

Her journey into medicine began like so many – confused and uncertain. Driven by a sense of curiosity and an open mind, she found herself studying science, paving the way for her future career as a GP.

“We offer extended scope for nurses, palliative care, home visits, nursing home care, under 65s residential care support, corporate vaccination visits, community education and more.”

“Medicine was never something I thought I would go into, so I did an honours year after my science degree to buy myself some thinking time,” Dr Fraser said.

As the only medical service in her town of 10,000 people, Dr Fraser is proud to offer a holistic range of services to best support her community.

“From there it was either research or medicine, and the people that were doing medicine seemed to have an interesting life, so I decided to apply.”

“Something I never thought I’d be able to do is skin surgery – I hate blood, I hate procedures. But the skin cancer here is at crisis levels, so you just have to, or else people die. So I picked a course, found some mentors and just went and did it,” she said.

During her early years of study, Dr Fraser was awarded an AMA Queensland Foundation Medical Student Scholarship which supported her to complete rural placements – experiences that influenced her later decision to become a rural GP. “I joined AMA Queensland as a student as it looked like real people doing interesting things and making a difference,” she said.

“The scholarship came during my first or second year of medical school. I applied because I needed the financial support and I didn’t have any medical people in my family.”

Once she had a taste of rural medicine, returning to Toowoomba for training was easy.

“On the advice of my peers I chose Toowoomba Rural Clinical School for a good start in my training with practical skills and hands-on experiences. This was where I met many mentors who substantially shaped my career,” she said.

“I completed extended registrar placements in Toowoomba, Ipswich and tertiary hospitals in Brisbane, a few years on the RACP training program and six months of anatomical pathology before feeling confident to choose general practice.”

During her GP training Dr Fraser worked across McDowall, Inala and Springfield and held positions as the registrar liaison officer and a medical education registrar with General Practice Training Queensland.

A few years after completing her fellowship she felt a need to return to rural medicine and spent a year in Ingham before deciding to choose rural practice ownership.

“In 2018 my family and I took a sea change to Gordonvale, Far North Queensland, to see whether it was going to work or not,” she said.

Now nearly five years into ownership, Dr Fraser is certain it’s where she will be for the remainder of her career.

“It has been a life-changing experience – both exhilarating and deeply challenging, and I am very proud of our work,” she said.

“Deciding to buy a practice was massive and still is massive in the sense that there are days where we are not sure if it was the right one. But when we look at what we’ve done, we know it was the right choice.

“The Gordonvale community also includes significant lowincome families and 6 per cent of our population identify as Aboriginal or Torres Strait Islander.

“So, something we consciously do is talk about culture in the practice to try and bring First Nations culture forward.”

On top of her busy clinical schedule Dr Fraser is involved in many leadership and community organisations as avenues to effect positive change.

She is Chair of the North Queensland Public Health Network Clinical Council, a member of the local Chamber of Commerce and a rural representative for RACGP and AMA Queensland. She is also the Treasurer for General Practice Medical Education Incorporated where she assists in organising its annual conference.

As the General Practice Representative on AMA Queensland Council, she aims to bring the perspective of rural private practice and generalism to advocacy.

“I am passionate about improving the quality of GP training and the lived experience of GPs working in our current system through policy improvements,” she said.

“I want the big issues to be heard, to make sure that GPs don’t lose some core aspects of what we do.

“I think an important narrative for the future of medicine, the future of workforce and productivity, is how do we look after our people? How do we nurture our workforce from beginning to end? So, I want people to know what being a GP is like – both the good and the bad.”

Recognising Dr Fraser’s consistent dedication to education, the AMA Queensland Foundation recently awarded her a GPTQ Bursary to support her further training in reproductive and sexual health.

“My goal is to offer the best care to my community by meeting their specific healthcare needs, avoiding the need for referral where possible and managing issues through prevention and education,” she said.

“Contraception and women’s health is a huge area of need here.

“I hope that improving my skills in this area can reduce unplanned pregnancy and improve antenatal and postnatal care and the uptake of sexual health testing in my community.”

“Sometimes the work is not that visible because of what’s happening in the healthcare system, but there’s materially a lot of things that we’ve improved for the community and the business.

Spring | Doctor Q 43

New legislation Three new pieces of were introduced in August that will affect private practices.

Closing the Loopholes Legislation 2023-2025

The Closing of the Loopholes Bill 2023-2025 represents legislation aimed at creating a more equitable, transparent, and sustainable framework in Australia. By addressing and closing legislative loopholes, the bill aims to promote fairness, accountability, and compliance across various sectors.

This article is to inform you of the changes which came into effect on 26 August around the Right to Disconnect and Changes to Casual Employment.

Any change to legislation generally require the practice to consider their policy position or procedure in line with the changes. To understand that a little better it is helpful to understand the different between a policy and a procedure which are:

A policy is a high-level statement, it outlines the stance, rules, and expectations on a specific issue. It provides the guiding principles and the overarching framework within which decisions and actions are to be made. Policies are designed to influence and determine major decisions and actions and to ensure that they are consistent with the Practice’s goals and values A procedure, is a detailed, step-by-step description of how to perform a specific task or process. Procedures are practical guides that ensure tasks are carried out consistently and efficiently, according to the policy guidelines (if any). They provide the specific instructions needed to implement the policy effectively.

Let’s consider the key dates and timeframes below outlined by Fair Work and what the practice’s guiding principles would be.

The Workplace Relations Team has general policies and procedures on these amendments to legislation or if you require assistance in the drafting and implementation of policy or procedures, please reach out to us on 07 3872 2264 or email us at workplacerelations@amaq.com.au

44 Doctor Q | Spring

Changes to Casual Employment Legislation – August 2024 Since 26 August, under the recent Closing Loopholes legislation, significant changes to casual employment legislation in Australia have taken effect. These key changes aim to redefine casual employment and streamline the process for casual employees to transition to permanent employment. Let’s look at both of these key changes.

New Definition of Casual Employment An employee will be considered casual if there is no firm advance commitment to continuing and indefinite work. This assessment will consider the nature of the employment relationship, including: whether work can be accepted or rejected

Protections have been included to prevent employers from dismissing permanent employees to then re-hire them as casuals and from making false statement to influence employees into casual contracts.

These changes aim to provide greater clarity and security for casual employees while balancing the needs of the employers.

These changes came into effect on 26 August, however there will be a transitional period where the current casual conversion provisions will still apply to existing casual employees.

The Workplace Relations Team released the Rates of Pay Guide in July which aims to assist employers to determine the relevant Award and Classification an employee would be under. If you would like a copy, please contact us on 07 3872 2264 or email us at workplacerelations@amaq.com.au

the availability of future work and if the work is typically performed by full-time or parttime employees.

Please note a casual employee must always be paid the appropriate casual pay rate in accordance with the Award and their classification under it.

Casual to Permanent Conversion (Employee Choice Pathway) Previously, employers were required to offer permanent positions to casual employees after 12 months of regular work. Since the 26 August, the shift has moved to the employee who can notify their employers, in writing if they wish to transition to permanent status after six months of employment (12 months for small businesses).

Employers: must respond in writing within 21 days to the employee’s request must confirm in the response the employee’s work hours and effective date of change can only reject the request if the role still meets the definition of casual or there are operational grounds to do so

Employer obligations and protections Casual employees must continue to receive the Casual Employment Information statement, along with the Fair Work Information Statement, at the start of their employment and periodically thereafter if any changes have been made.

The AMA Queensland Workplace Relations Team offers three levels of support: Workplace Relations Support

offers general support and advice regarding questions related to Modern Awards, rates of pay and legislation.

This service is included free as part of your AMA Queensland membership.

Workplace Relations Toolkit

provides you with a 12-month subscription to up-to-date, relevant and practical support templates, handbooks, policies and procedures relating to all your employment matters. All the accessible resources and templates have been created by our Workplace Relations specialists with a focus on the medical industry.

Workplace Relations Tailored Services

is a comprehensive, tailored services on a fee-for-service basis in line with the level of risk identified or the complexity

For further information regarding any of the above, the Workplace Relations Team can be contacted on 07 3872 2264 or through email support at workplacerelations@amaq.com.au

Spring | Doctor Q 45

Right to Disconnect Changes to the Fair Work Act 2009 will create a formal workplace right that allows employees to disconnect from work outside of their normal work hours which came into effect on 26 August for employers with 15 employees or more and a year later for small businesses.

To date, legislation has touched on related issues such as reasonable additional hours under the National Employment Standards (NES) and under the Workplace Health and Safety legislation whereby employers have a duty to ensure the health and safety of the workplace including physical and psychological safety.

Considerations

However, there has been a need to change the Act as employees and employers have never understood what ‘reasonable additional hours’ actually means.

The employee right to disconnect prompts workplace discussions on availability and non-availability to strike the balance between the requirements of the practice and workers’ flexibility. The right is to ensure employees are aware when they can switch off and know what they are able to do when they are not working or being paid.

Australia is by no means pioneering the concept of the right to disconnect. Eurofound (2021), Right to disconnect: Exploring company practices, Publications Office of the European Union, Luxembourg explores the use of digital technologies whereby employees can carry out work at any time anywhere and the potential risk to health and well-being of employees and the blurred boundaries between work and private life.

At the time of their report in 2021, six countries had the right to disconnect: Belgium, France, Greece, Italy, Slovakia and Spain, with other countries exploring the option.

What does the right to disconnect mean?

The Fair Work Ombudsman statement, “Employees will have the right to refuse contact outside their working hours unless that refusal is unreasonable”, means that an employee can refuse to monitor, read or respond to contact from an employer or a third party.

The right also covers attempted contact outside of an employee’s working hours.

Several factors must be considered when determining whether an employee’s refusal is unreasonable. This includes: the reason for the contact whether the employee is compensated or paid extra for: being available to be contacted to perform work within a specific period, or working additional hours outside their ordinary hours of work the nature of the employee’s role and level of responsibility the employee’s personal circumstances, including family or caring responsibilities.

Source: Right to disconnect - Fair Work Ombudsman 46 Doctor Q | Spring

Different job positions may have varying requirements for after-hours communication and we must determine what is reasonable or unreasonable for each position and ways in which to manage out of hours communication.

The treatment and monitoring of working hours and overtime is already important; however, it becomes even more important for roles that enable an employee to work from home or another location other than the practice.

Using workplace data such as leave reports, turnover reports, feedback from exit interviews, performance appraisals and absenteeism rates up to when the legislation comes into effect can be used to provide the practice with a clear picture of the impact of the legislation in conjunction with employee’s wellbeing and practice productivity.

The benefits It is expected that there will be benefits in the following areas: Improved mental health: Constant connectivity can lead to stress, anxiety, and burnout. The Right to Disconnect allows employees to recharge, leading to improved mental health.

Increased productivity: Employees who have time to rest are more likely to be productive and engaged during their working hours.

Enhanced job satisfaction: Respecting personal time can lead to higher job satisfaction and lower turnover rates.

Clear boundaries: Establishing clear boundaries between work and personal life can help maintain a healthy worklife balance.

The Right to Disconnect is an important step towards ensuring employees can maintain a healthy work-life balance in an increasingly connected world. The ultimate benefit will be a more engaged, productive and satisfied workforce.

New Federal AMA IMG Working Group Overseas-trained doctors face many challenges in the workforce, including exploitation, discrimination and difficulties establishing themselves in the community without a support network.

Dr Maha Selvanathan

AMA International Medical Graduate Working Group Chair

In response to these challenges, the AMA has created an International Medical Graduate (IMG) Working Group. I am proud to have been elected as chair after the inaugural meeting in June 2024.

We want to ensure that once overseas-trained doctors arrive in Australia, that they stay here and enjoy their time here. In Armidale, we had six to eight doctors leave town two years ago, and this large gap has not yet been filled.

This is something I am extremely passionate about, and I hope this working group can be a real catalyst for change.

As the IMG Working Group chair, I look forward to being at the front of the AMA’s efforts to improve outcomes for all overseas-trained doctors and I hope I can encourage more IMGs to engage with the AMA at state, territory and federal levels to ensure we can create a better system for all.

Australia is suffering a considerable workforce shortage, especially in rural areas where IMGs are highly sought after to help address doctor shortages.

Rural healthcare is extremely rewarding, and as someone who has worked in Armidale for many years now, I am a strong advocate for it. It is challenging, of course, but extremely satisfying and rewarding.

Generally speaking, being a doctor in Australia provides great job satisfaction, better pay and conditions compared with other countries, and there are many opportunities to continue learning and improving.

But there are certainly major issues that must be addressed, and the IMG Working Group is dedicated to unearthing and pursuing solutions to these problems.

Australia is dependent on overseas-trained doctors to fill workforce gaps, but there’s no support system or safety net they can fall onto. IMGs are often placed into a job in a community with no orientation or guidance, and it can lead to burnout.

By establishing an IMG Working Group, the AMA is telling all overseas-trained doctors in Australia that they are extremely valued here, and that someone is looking out for them.

The AMA has long advocated for IMGs, but this working group will ensure this support is further solidified and that new policies and reforms will be pursued.

Reforming the pathways to employment for overseastrained doctors is an obvious place to start. All too often I hear about the red tape preventing IMGs from starting a career in Australia, and I’ve experienced it myself. I have a friend who is trained as a neurosurgeon but is currently working at a supermarket. These kinds of stories are all too common.

Visa processes and employment practices must be reviewed and efforts must be made to ensure IMGs have equal opportunities that lead to long-term employment, particularly in rural and regional areas.

Exploitation is one big issue we are urgently working to address. Many overseas-trained doctors will look past low wages and poor conditions, either because they have already struggled immensely to get their foot in the door in Australia’s health system, or because they are simply unaware what the benchmarks are.

Spring | Doctor Q 47

Research round up Research Review Australia has more than 50,000 health professional subscribers across Australia. It provides clinical research updates and webinars that qualify for CPD points.

The updates cover more than 50 clinical areas and feature 10 papers from global journals with commentary by a local expert on the impact to everyday practice.

Sign up for Australian health professionals at no cost is available at researchreview.com.au

Child immunisation status according to number of siblings and birth order Paediatrics Research Review Issue 48 Reviewer: Professor Nicholas Freezer, Paediatric Respiratory Physician

Primary tumor resection before systemic therapy in patients with colon cancer and unresectable metastases Colorectal Oncology Research Review Issue 47 Reviewer: Dr. Matthew Burge, Medical Oncologist and Staff Specialist at the Royal Brisbane and Women’s Hospital and a Visiting Specialist at the Rockhampton Base Hospital Combined results of the SYNCHRONOUS and CCReIV trials show no survival advantage to primary tumour resection over upfront chemotherapy in patients with colon cancer with synchronous unresectable metastases.

A higher incidence of serious adverse events was noted in patients who underwent primary tumour resection.

“Randomised trials are the only way to definitively answer clinical practice questions. Previously, studies had suggested primary tumour resection was associated with improved survival, but this was purely due to patient selection (fitter patients are more likely to get a resection).

In fact, primary tumour resection does not improve survival and can stop chemotherapy being given in a proportion of patients who do not recover well after surgery. The only place for intervention of the primary tumour - in the setting of unresectable metastases - is when complications from it such as obstruction or severe bleeding need to be addressed.” researchreview.com.au/au/Clinical-Area/InternalMedicine/Medical-Oncology/Colorectal-Oncology/ Colorectal Oncology Research Review, Issue 47 Colorectal-Oncology-Research-Review,-Issue-47.aspx

Current and back issues of Research Reviews can be found at researchreview.com.au. Australian health professionals researchreview.com.au can sign in and download copies.

48 Doctor Q | Spring

This cross-sectional study analysed survey data from 85 low- and middle-income countries (2010–2020) to determine risk factors for zerodose immunisation in children aged 12–35 months. Zero-dose prevalence was defined as the failure to receive any doses of the diphtheria-pertussistetanus vaccine. The number of siblings remained a strong risk factor when adjusted for confounders and birth order, but the reverse was not observed.

“Immunisation is one of the most effective preventive health measures. Vaccination programmes directly benefit the immunised child and indirectly benefit unimmunised persons through community (“herd”) immunity.

Community immunity occurs when the portion of the population that is immune to the infection is large enough to decrease the risk of transmission. Community immunity protects children who are too young for immunisation and persons with contraindications to vaccines. It relies on most of the population receiving routinely recommended immunisations. There are clusters of communities who refuse vaccines in each state in Australia with a refusal rate of up to seven per cent.” researchreview.com.au/au/Clinical-Area/Paediatrics/ Paediatrics Research Review, Issue 48 Paediatric-Vaccines/Paediatrics-Research-Review,-Issue-48. aspx

Transforming flow: towards a better experience for patients and clinicians Access block is a highly complex problem. Whilst access block can lead to ambulance ramping, how much does it really have to do with ambulances or the emergency departments where the ramping occurs?

How can we transform the way patients move through our hospitals downstream from the emergency department and back into their home and/or residential care setting?

These were the questions we put to more than 150 clinicians, consumers and healthcare leaders at our July meeting of the Queensland Clinical Senate, ‘Transforming flow: towards a better experience for patients and clinicians’.

The key message from the meeting was that access block is mainly related to inpatient bed capacity, with the main reasons that our inpatient beds are often full, related to the challenges to get patients home with integrated community services along with access to access aged and disability care.

Access block is not all about the emergency department.

Professor Clair Sullivan, the co-author of the Supa-Flow Study, spoke about why we can no longer ‘process mine’ emergency departments; it’s not an isolated area that needs fixing. It requires a shift from process mining to systems thinking, to an understanding of the complex interactions that a consumer has in the care system throughout their journey and across the many interjurisdictional and intersectoral boundaries.

Dr Tanya Kelly

Chair, Queensland Clinical Senate, and Senior Specialist Anaesthetist

Transforming flow is a huge topic and a hot topic – it is a priority for the system and the staff within the system, with plenty of genuine efforts across the healthcare sector, within our hospitals, primary care, community settings and beyond.

What it all comes back to is making sure our patients are receiving ‘The right care, in the right place, at the right time’ and that safe flow through care settings, particularly to supported care in the home, aged care and disability care should be the priority. Our recommendations will focus on how we can help make this happen through strong partnerships, particularly across care settings and jurisdisctions, and evidence-based change among a number of focus areas.

Recommendations When the recommendations are finalised, they will be available at the Queensland Clinical Senate website: Queensland Clinical Senate

Whilst patient flow issues primarily impact consumers, patient flow issues can also impact staff. Dr Liz Crowe, the Staff Wellbeing Specialist for the Royal Brisbane and Women’s Hospital explained that when our hospitals are at capacity, this can be distressing, stressful and disempowering for staff. Improvements to patient flow and access to care, are likely to improve care outcomes for consumers, and also contribute to workplace wellbeing.

Spring | Doctor Q 49

2024 events calendar October

Women in Medicine Breakfast Brisbane Thursday 17 October

November

Member Networking Event Brisbane Thursday 21 November Membership Milestone event Friday 15 November (invitation only) Intern Workshop Brisbane Thursday 28 November

December

Intern Workshops: Gold Coast Thursday 5 December

Townsville Wednesday 11 December

2025

Medical Careers Expo Saturday 8 March Trans-Tasman Conference Monday 7 - Sunday 13 April

Visit the AMA Queensland website for more information about our events: ama.com.au/qld/events

Free

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50 Doctor Q | Spring

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Join us on the Apple Isle for the AMA Queensland Trans-Tasman Conference, for members who like to travel a bit closer to home. We are thrilled to hold the first of many conferences in Australia, New Zealand and surrounding areas, with support from our corporate partner Orbit World Travel.

This family-friendly conference is a great chance to get away and visit the beautiful island state of Tasmania, known for its gourmet food, beautiful landscapes and unique wildlife while learning key issues facing the profession.

The CPD-accredited activity is for all doctors. We will have a breakout room focusing on building and supporting private practice. You will have the chance to hear from practice owners, GPs, specialists and industry leaders about the best ways to ensure the sustainability of your practice including financial strategies, technology, innovation, retention, workforce and environmental issues and solutions while improving healthcare quality and patient safety.

The activity will be refined and reshaped to best match delegates’ needs, so register early so your interests can be considered.

DATE LOCATION

Monday 7 April - Sunday 13 April 2025 Hobart, Tasmania

REGISTER NOW ama.com.au/qld/events/TransTasman2025

FOR REGISTRATIONS: ORBIT WORLD TRAVEL P 1300 262 885 E amaq@orbittravel.au

Spring | Doctor Q

51

Have an advisor who is as specialised in the medical industry as you are.

Our team takes care of you so you can take care of your patients.

Tap into our health industry expertise to improve your practice with confidence.

Whether you’re looking to develop or grow a successful practice, optimise your business structure, or secure your financial future, we’re here to guide you with practical and individualised support.

AMA Queensland members benefit from an initial complimentary consultation with our advisors. We’re here to help.

Discover all your benefits as a member.

We can help you with:

Payroll Tax and Doctor Agreement Reviews

Medical Practice Structuring

Effective Practice Service Entities

SYDNEY | BRISBANE | NEWCASTLE

1800 988 522 | medical@cutcher.com.au | cutcher.com.au

KPI Development and Practice Improvement

Xero and Cloudbased Record Keeping Support

Nicole Brown

Partner, Cutcher & Neale Specialist Medical Services

Finding the best tax structure for your practice Purchasing a medical practice premises is a significant investment in your financial future.

Getting it right from the beginning can limit your risk and minimise your tax implications.

Which entity you purchase your medical practice premises in is crucial and there are many factors to be considered when it comes to structuring and finance.

An individual Buying in an individual name can sound the most appealing; least expensive and complex to set up, with likely access to Capital Gains Tax (CGT) discounts and land tax threshold benefits.

However, buying in the medical practitioner’s name offers no asset protection. Despite holding insurances being a potential safeguard, medical practitioners should err on the side of caution when looking at holding assets in their own name.

A company A company can be a good vehicle for premises acquisition as access to the corporate tax rate of 30 per cent can aid debt reduction (less tax leakage).

Furthermore, holding assets via a company can provide a layer of asset protection not afforded if holding the premises in your personal name.

Companies do have access to the land tax threshold and a 30 per cent tax rate. Unfortunately, companies do not have access to the 50 per cent CGT discount, however, they may be eligible to access business CGT concessions (subject to eligibility criteria).

Unit trusts differ from discretionary trusts as beneficiaries’ interests are explicitly identified in the trust deed according to the proportion of ‘units’ they hold.

A trust’s capital gain can be given to beneficiaries, who can access a 50 per cent capital gains tax discount and may be eligible for small business CGT concessions if certain conditions are met.

A Self-Managed Super Fund A Self-Managed Super Fund (SMSF) can be a tax-effective vehicle for acquiring your medical practice premises.

Under the right circumstances and when executed correctly, this can be an efficient investment vehicle.

With a low tax rate of 15 per cent (when in accumulation phase), or tax-free to certain limits (when in pension phase), a SMSF certainly provides a concessional tax environment. A SMSF can also access a one third or 33 per cent discount on any capital gain made on the sale of an asset held for at least 12 months.

However, complex rules and restrictions apply, so it’s important to seek advice before making any significant investment decisions.

A discretionary trust

The transition to private practice and the potential finance requirements can initially appear a daunting process. Our medical specialist accountants can help you navigate the next step in your career. Get in touch with our trusted advisors today for personalised advice at 1800 988 522 or medical@cutcher.com.au.

Discretionary trusts provide strong asset protection as beneficiaries do not have a defined interest in the assets, ensuring high security. They also offer flexibility in income distribution. While not eligible for a land tax threshold as a ‘special trust’, this can be addressed by using a unit trust, which is usually eligible for the threshold.

The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account. You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Spring | Doctor Q 53

Should I provide my colleague with a character reference?

Given their position of trust in the community, it’s not uncommon for doctors to be asked to provide character references. It’s rare for a doctor to know a patient well enough to provide a character reference – but what about colleagues?

Dr White is an ED consultant in a public hospital. One of the senior registrars approaches Dr White and asks her for a character reference. They’ve worked together for about two years, and the registrar has always been professional, punctual and reliable. His clinical skills are excellent, and Dr White has never had any issues with him in the workplace.

What is a character reference?

Generally, a character reference is a letter that speaks to the subject’s positive attributes. Ideally, you should have known the subject for some time, and you must provide your honest opinion.

What will it be used for?

Common reasons for requests relate to: employment or rental applications court proceedings – including criminal, civil, family disputes and restraining orders disciplinary matters.

It’s important to know why the reference is being requested.

What should I say in a character reference?

Include information about how long you have known the person, and in what capacity.

Address your understanding of why you have been asked to provide a character reference.

Avoid using stock phrases such as “is of good character” or “an upright citizen”.

Janet Harry

MDA National

Your colleague may behave appropriately in the workplace – but not so much in the home environment, or under the influence of alcohol or other substances.

Be specific about positive attributes, but don’t shy away from addressing negative attributes, particularly if the person has taken steps to rectify this.

The wording should be factual, clear, fair and informative.

Are there any potential pitfalls?

Things you should think about before agreeing to write a character reference: You may be contacted for a verbal follow-up, so you should be prepared for this.

Would your hospital or employer think it is appropriate for you to author a character reference, particularly if it relates to a hospital disciplinary matter?

If you provide a character reference, and your colleague is later subject to adverse publicity in a very public forum, will your support of your colleague damage your own reputation?

If the matter is before the courts, be prepared to be subpoenaed as a witness.

Don’t address your letter “to whom it may concern”. A character reference should be addressed to a specific person, otherwise it could be used for a purpose you didn’t contemplate when you wrote it.

If you can’t genuinely speak to a colleague’s good character, it may be best to decline the request.

If in doubt, contact our Medico-legal Advisory Services team for advice.

The case study is fictitious. Any resemblance to real persons, living or dead is purely coincidental. 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 or medico-legal matters. Members can contact MDA National for specific advice on freecall 1800 011 255 or use the ‘contact us’ form at mdanational.com.au.

Spring | Doctor Q 55

Ensure your coverage fits you like a glove.

Your insurance needs are unique, just like you. But are your policies reflecting that? You might not be adequately covered or could be paying a premium you don’t need.

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SYDNEY | BRISBANE | NEWCASTLE

1800 988 522 | generalinsurance@cutcher.com.au | cutcher.com.au The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account.

You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Cutcher & Neale General Insurance is a Corporate Authorised Representative (No: 1260321) of McLardy McShane Partners Pty Ltd AFSL No: 232987 ABN: 14 064 465 309

Andrew Harrison

Are you properly protected by a public liability policy?

As a doctor, there’s no doubt that you’re thoroughly insured.

Medical Indemnity insurance is required for you to practise in Australia, so whether your employment is private or public, you’re covered.

But what about Public Liability insurance? If you’re a Sole Trader working as a contractor, chances are your contract has an ‘Indemnity Clause’ that states what insurance types you require and are responsible for, and, often this includes Public Liability.

What Is Public Liability Insurance?

Public Liability covers you for third-party death or injury where you are found liable for negligence not related to your profession as a medical practitioner. These kinds of claims are not covered by your Medical Indemnity insurance. If a claim is made that alleges you are responsible for a physical or financial loss to the claimant, your Public Liability policy can be used to cover the cost instead.

Why should contractors have their own cover?

Built into many insurance policies is the right of the insurer to recover costs. As a contractor, you are considered a separate legal entity to the practice, and its insurer may take legal action against you if you are considered liable for the original claim. This can result in you having to pay compensation to the practice’s insurer.

Case Study Leanne works as a GP contractor at ABC Health Centre and is running late for her shift. In her rush to get ready to see patients, she places her medical bag with her coat over it on the floor at reception, partially blocking the hallway and forgets about it.

Medical Insurance Adviser, Cutcher & Neale General Insurance

While Leanne is seeing her first patient of the day, an elderly patient trips on the bag and breaks his hip.

The patient ends up making a Public Liability claim against ABC Health Centre for his injuries and the costs associated with them, which is covered by the practice’s insurance.

As Leanne is responsible for the accident and working as a contractor for ABC Health Centre, the practice’s insurer enacts its cost recovery clause and files a legal claim against Leanne for the settlement amount.

Since Leanne does not have personal Public Liability insurance, thinking she was covered by the practice, she now must cover the unexpected cost of legal fees or settlement costs herself.

If you are not personally insured for Public Liability, such a situation could become an expensive accident.

Alternatively, if you own a medical practice, it’s good risk management to ensure all your contractors have obtained personal policies for both Medical Indemnity and Public Liability.

Regularly review your insurance policies to ensure adequate coverage. This proactive step can save you significant costs in the event of unforeseen circumstances.

Uncertain about your insurance needs? Speak to one of our Medical Insurance Experts to ensure you’re adequately protected.

Get in touch with us today at imedinsurance@cutcher.com.au or 1800 988 522.

The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account. You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Spring | Doctor Q 57

Achieve your dream practice sooner.

Whether you’re looking to commence in private practice or invest in commercial property for your practice, we can make it easier for you.

From practice purchases and medical equipment financing to fit-outs and vehicle acquisitions, we provide comprehensive commercial finance services to help you establish your dream practice. With our specialised expertise in commercial, SMSF, and asset finance, we can help you to achieve: 

Up to 100 per cent funding for purchase of practice premises.



Up to 90 per cent funding for practice premises purchase through Self-Managed Superannuation Fund (SMSF)



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Motor vehicle funding including electric car

Book your complimentary appointment with our finance experts today.

SYDNEY | BRISBANE | NEWCASTLE

1800 988 522 | finance@cutcher.com.au | cutcher.com.au The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account.

You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Cutcher & Neale Finance Pty Limited ACN 137 924 755 Australian Credit Licence 381084

Dean Menzies

Partner, Cutcher & Neale Residential & Commercial Finance

Three top ways to finance your practice Establishing your medical practice location is a critical decision. Whether to buy or rent your premises significantly impacts your financial future. Owning your practice can be a rewarding investment, but it’s a substantial financial commitment. This guide explores financing options for purchasing your practice premises.

Commercial Property Loan A common financing option for medical practice premises is a commercial property loan. These loans are specifically designed for buying commercial real estate. A commercial property loan can offer lower interest rates than other types of loans because the property itself is used as security for the loan.

When applying for a commercial property loan, it is important to have a solid business plan that includes projections for your practice’s future revenue and expenses. You’ll also need to provide detailed financial information about your personal finances, including your income and expenses, assets, and liabilities.

The huge advantage you have as a specialist medical practitioner is the ability to borrow up to 90 per cent of the property value through a Self-Managed Super Fund or 100 per cent plus through companies, trusts and personal names.

Self-Managed Super Fund (SMSF) Loans SMSF holders can leverage their superannuation to purchase practice premises through SMSF loans. These loans provide access to funds within your super fund for property investment. While offering potential tax benefits, SMSF loans are complex and require expert financial advice.

Doctors have the advantage of being able to borrow up to 90 per cent Loan to Value Ratio (LVR) through SMSF,

which means that you can purchase a practice premises with a much smaller deposit than is standard for this type of finance.

SMSF loans with such a high LVR are only available from a small pool of funders. Consider the potential impact on your SMSF’s investment portfolio and cash flow and seek professional advice from your trusted advisor or SMSF specialist before making any decisions.

Ultimately, whether an SMSF loan is suitable depends on individual circumstances, financial goals and risk tolerance.

Equipment and fit-out financing Other financing options available to you when purchasing a premises are equipment and fit-out financing.

Equipment financing can be used to purchase equipment for your practice, such as medical equipment, computers, and furniture.

Fit-out finance is used to make your practice premises fit for purpose and will be the facility that is used to pay builders and tradespeople for the improvements they make to the premises.

Equipment and fit-out financing are often a must-have addition to the finance arranged to purchase a practice premises.

If you’d like more information regarding financing your practice, please contact Cutcher & Neale on 1800 988 522 or visit cutcher.com.au The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account. You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Cutcher & Neale Finance Pty Limited ACN 137 924 755 Australian Credit Licence 381084

Spring | Doctor Q 59

Annual review: top 10 legal matters to consider this financial year Get ahead of the curve and prepare for the opportunities life or business throw at you this financial year.

We often find the practices that have the best results are those that are proactive rather than reactive in their management of various issues. With that in mind, we encourage you to invest the time now to review your legal matters to help you ride the highs and lows we see daily with our clients.

Generally, practices should engage in an annual review to determine where they are sitting on a number of ‘housekeeping’, financial, legal and strategic matters.

Practices that do this regularly will see fewer out of the blue problems and will be in stronger commercial negotiating positions with a wider range of options than those that wait until the last minute to deal with things or, even worse, wait until they have a problem which can be time consuming and expensive.

Here’s our recommended top 10 legal issues to consider as part of an annual review to help you make the absolute most of what comes your way.

60 Doctor Q | Spring

1. Corporate structure Has your business grown or significantly changed? If so, consider if the current structure is still the most suitable and tax effective. For restructuring or preparing for succession, we recommend seeking legal and accounting advice. Even if your structure is sound, it is worth checking that all of your fundamental structure documents are in place and up to date.

2. Supply agreements It’s important to review your suppliers regularly to ensure you are still getting the best product or service for a reasonable price. Service contracts on printers, IT and the like need to be reviewed to help you decide if you keep or change them. The terms of these agreements must be reviewed regularly to ensure they are compliant with the Unfair Contract Terms regime introduced in November 2023. Breaches of the regime carry significant penalties.

3. Premises You need to be aware of your lease option terms and the window for exercising those options. These timeframes are very strict and your option can be lost if you miss the exercise window. If there are no options, you should start negotiating a new lease with your landlord or looking for alternate premises. The further out from your option period or lease expiry you begin, the better you will be placed to find alternatives and improve your bargaining position. It’s also important to consider your premises’ state of fit-out and if it needs refurbishment or changes to suit the stage of your business.

Zac Herps

Managing Director hillhouse.com.au

4. Service agreements

8. Business succession planning

There have been recent significant developments in the application of payroll tax to medical practices. Even though laws are supposed to be harmonised nationally, each State has taken slightly different approaches so you need to be aware of best practice to take advantage of the rulings and exemptions or amnesties relevant to your State. We strongly recommend that practices seek legal advice and accounting advice as these matters can be very technical.

Regardless of how far away this event may be, it’s important to consider it when planning and setting business and personal goals. The more time, planning and thought is put into it, the better the results we see.

5. Employment agreements Employment legislation is always evolving and laws change often. We recommend that employers seek legal advice on the impact of these changes and ensure they are compliant. Other employment considerations include any performance management concerns, annual reviews, and incentives for retaining key employees like share schemes.

6. Privacy Ensure you have an up to date and compliant privacy policy on your website and are collecting, storing and using personal information in accordance with your obligations under the Privacy Act. Practices deal with health information, so their privacy and data handling controls are highly scrutinised. Failings on this front can present costly problems.

9. Personal financial matters in order Ensure you have a Will and keep it up to date when business or life circumstances change (eg children, life partners, business changes, planning major purchases or investments etc.) to protect your estate, wishes and loved ones.

10. Intellectual property It is vital to ensure relevant trade marks, designs, and patents are all protected. Registered trade marks are one of the best ways to protect the valuable intellectual property of your business. It is imperative that trade mark applications are filed to better secure those IP rights.

We encourage you to reach out to your professional advisory team to help you navigate your way through your annual review process confidently.

7. Shareholder agreements Is your current situation fully documented? It’s best to have a signed agreement rather than a perfect draft, so keep it to the point.

07 3220 1144 hillhouse.com.au

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SYDNEY | BRISBANE | NEWCASTLE

1800 988 522 | cnis@cutcher.com.au | cutcher.com.au The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account.

You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Cutcher & Neal Investment Services is a Corporate Authorised Representative (No: 260696) of Cutcher & Neale Financial Services Pty Ltd AFSL No: 433814 ABN: 22 160 682 879

Here’s why international shares belong in your portfolio Global share markets surged in the first half of 2024, driven by easing inflation and anticipated interest rate cuts.

However, performance varied significantly across different markets. The US economy thrived, leading to exceptional returns for US-based investments.

With many sectors within the US S&P 500 delivering doubledigit returns, it’s clear that investors without international exposure missed out on substantial growth opportunities.

For example, five out of 11 sectors in the US S&P 500 returned over 10 per cent in the first half of the calendar year.

Strong results so far The US Technology sector (+27.8 per cent) has been the standout, driven higher by the rapid development of artificial intelligence (AI) and data centre and cloud-related technologies.

Wade Johnson

Partner, Cutcher & Neale Wealth Management

WEALTH MANAGEMENT

Limited domestic exposure restricts access to global growth opportunities, such as AI advancements.

The key takeaways from international company results this year so far include: big technology names with AI continue to outperform company earnings guidance has been better than expected consumers remain healthy, despite reduced spending performance gaps have persisted between sectors and regions analysts predict broader earnings growth beyond AI and big tech in the coming year.

What this period has really shown is that it pays to diversify internationally.

Investing solely in the Australian market yielded a 4.2 per cent return compared to the global average of 14.4 per cent. While chasing returns is important, international diversification offers broader exposure to assets that perform well under varying economic conditions, enhancing overall portfolio performance and stability.

How do we compare?

Strategic international investments can significantly enhance portfolio performance by providing diversification and exposure to global growth opportunities. Our International Shares Model Portfolio outperformed the global market by 7.9 per cent, delivering 27.8 per cent compared to the 19.9 per cent provided by the global share market.

Part of this outperformance has to do with our investment process, which favours quality companies that are consistently growing profits, have strong balance sheets and maintain sustainable competitive advantages in their industries.

Our approach is also risk-aware. We tactically adjust the amount of cash held in the portfolio, the level of currency hedging being applied, and the geographies and sectors invested in based on global economic conditions.

The Cutcher & Neale International Shares Model has done well thanks to our rigorous investment process and active management of geographic, sector, cash and currency exposures, outperforming the global share markets.

Don’t miss out on the gains. Speak with one of our trusted advisors today to find out how you can benefit from international shares.

By looking at share markets, we can understand their differences and see why a diversified portfolio can benefit you.

Get in touch with us on 1800 988 522 or at cnis@cutcher.com.au.

For example, in Australia, our share market (ASX 200) is made primarily of the big four banks (21 per cent of the market) and major miners (14 per cent), with very few technology stocks (3 per cent). Conversely, the US share market is predominately made up of technology stocks (31 per cent), with very few miners (2 per cent).

The information in this publication contains general advice only. It has been prepared without taking your personal objectives, financial situation or needs into account. You should consider whether the information contained within this publication is appropriate for you. Where we refer to a financial product you should obtain the relevant Product Disclosure Statement or offer document and consider it before making any decision about whether to acquire the product.

Cutcher & Neale Financial Services Pty Ltd AFSL No. 433814

Better value hospital cover Join the only health fund made for doctors, their families, and the medical community.

We proudly offer market-leading medical gap cover up to AMA rates on our Top Cover Gold hospital cover, now with a $750 excess option.

Dr Luke Reid Member since 2007

Join on any combined hospital and extras cover by 31 October Plus, skip the two-month waits on extras

See how we compare 1800 226 126 doctorshealthfund.com.au *Terms and conditions apply. Must join by 31 October 2024 on combined hospital and extras cover to receive 8 weeks free and 2-month waiting periods on extras waived. New members only. Check eligibility in the full terms and conditions at www.doctorshealthfund.com.au/quickjoin.

IMPORTANT: Private health insurance products are issued by The Doctors’ Health Fund Pty Limited ABN 68 001 417 527, a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at www.doctorshealthfund.com.au/our-cover. MJN-1660 07/24 (ID-485)

1800 226 126 doctorshealthfund.com.au

Why your medical gap cover matters As a doctor, you know more than most the costs involved in providing medical care in Australia. To help cover these costs when care is provided in hospital, all private insurance hospital policies include medical gap cover. While we hope not to use it, understanding how your policy and private health insurance in general covers hospital and medical costs can be extremely beneficial. It should be of particular interest to doctors when it comes to treating your patients and looking after your own healthcare.

How does medical gap cover work?

As you may know, medical gap cover can help to cover the difference, in whole or in part, between 75 per cent of the Medicare Schedule Benefit (MBS) and a doctor’s fees.

It is ultimately up to treating doctors on how they charge for their services and whether they bill their services according to a policy’s medical gap cover. The amount they charge will determine how much your private hospital policy can cover. It’s always important to understand how your doctor charges for their services so you can make informed decisions about your healthcare.

Medical gap cover at Doctors’ Health Fund At Doctors’ Health Fund we offer two different types of medical gap covers and the type you have depends on the level of cover you choose.

Our entry-level hospital cover, Smart Starter Bronze Plus, and market-level gold hospital cover, Prime Choice Gold, include medical gap cover called Access Gap Cover.

This medical gap cover could be said to be comparable to medical gap covers provided by other health funds.

If your doctor chooses to bill according to this scheme, they can either charge at the ‘no gap’ fees or alternatively, charge a ‘known gap’ of up to $500. This gap amount is per practitioner for the episode of care, so each doctor involved in your surgery/treatment could charge $500, including your anaesthetist.

Top Cover Gold hospital cover provides medical benefits up to the AMA Fees List. This level of cover is unique to us, and this medical gap cover pays above the Medicare Benefits Schedule (MBS) and other medical gap schemes.

What are the benefits of having medical gap cover up to the AMA Fees List?

There are benefits to having medical gap cover up to the AMA Fees List compared to other medical gap cover schemes:

Minimal out-of-pocket expenses – benefits payable under this gap cover are above the MBS and other medical gap schemes. Patients are left with no out-ofpocket expenses for medical bills when doctors charge up to the AMA Fees List.

Less admin for doctors - unlike other medical gap covers, there’s no ‘opt in’ needed by treating doctors to charge AMA fees and for benefits to be paid. If you charge up to the AMA fees, we’ll pay them, and your patient will be left with no out-of-pocket costs for your services, giving more peace of mind on their and your part.

Benefits focus on the appropriate remuneration for a doctors’ services - Doctors’ Health Fund believe the AMA Fees List provide reasonable remuneration to doctors for their years of training, expertise, and experience.

Understanding the medical gap cover that’s included in private hospital cover can help when treating your patients and to reduce out of pocket costs when it comes to your own healthcare. ^ New Doctors’ Health Fund members only. Must join by 31 October 2024. Offer & policy terms and conditions apply, see www.doctorshealthfund.com.au/quickjoin for more details.

IMPORTANT: Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group.

Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at doctorshealthfund.com.au/our-cover.

Founded by AMA NSW in 1977, and offering rebates based on the AMA’s list of services and fees for some time, we are committed to ensuring doctor-patients and their treating doctors can feel confident and comfortable when it comes to the charging of fees. From 1 July, we introduced a new $750 excess option to Top Cover Gold, lowering the upfront premium you pay.

Plus, when you join Doctors’ Health Fund on any combined hospital and extras cover by 31 October, you’ll receive 8 weeks free and skip the two-month waits on extras.^

All about you

Watch Rebus

Read

The Chilling by Riley James

The new TV reboot of the famous Sir Ian Rankin novels reimagines Rebus as a younger man, played this time by namesake Richard Rankin.

An isolated research station. A storm approaching. There’s nowhere to run.

But so much to hide.

A detective sergeant, he is drawn into a violent criminal conflict after he finds out his younger brother Michael, a former soldier, is involved with the underworld.

Keen to flee the wreckage of her marriage, Australian scientist Kit Bitterfeld accepts a coveted winter research position at Macpherson Station in Antarctica. On the way there, Kit and her fellow researchers field a distress call from a nearby ship.

By the time they reach the vessel it is on fire and the crew has vanished. A lone survivor is found, but he can’t remember who he is or what has happened.

They bring the survivor, identified as geophysicist Nick Coltheart, to Macpherson but it’s clear that something is wrong. More and more of Kit’s colleagues are acting strangely. And she can’t shake the suspicion that Nick knows more than he’s letting on. With the winter darkness setting in, Kit must figure out the truth before they are completely cut off from the outside world. But is the danger lurking out on the ice, or is it closer than she thinks?

Win this book: Entries close 30 October

WIN

Fill out the online form

this book: The Chilling Entries close 30 October 2024

Save

Discounts on home appliances AMA Queensland has partnered with Blue Light Card Australia to offer members access to savings on home appliances.

Sign up for your Blue Light Card and tap into discounts on De’Longhi, Samsung, Big W, LG Electronics, Breville, KitchenAid and more.

Sign up now: ama.com.au/qld/member-benefits/blue-light-card

66 Doctor Q | Spring

You’ve got to love a good Scottish crime drama and John Rebus is as synonymous with crime drama as James Bond is with spy thrillers.

Outlander star Richard brings Rebus back to life after a break of more than 15 years.

John Hannah and Ken Stott have played Rebus previously and it’s probably best to watch with the subtitles on.

It’s not unusual to see a shot with a towering Edinburgh Castle in the background and might spur you to visit.

Rebus is now available on Netflix.

WIN

Fill out the online form

Dendy Cinemas tickets Entries close 30 October 2024

Les Contes D’Hoffman

Metropolitan Opera | Starts 19 October

Offenbach’s fantastical opera kicks off the 2024-25 season, starring French tenor Benjamin Bernheim in the title role of the tormented poet. Joining Bernheim is American soprano Erin Morley as Olympia, South African soprano Pretty Yende as Antonia, and French mezzo-soprano Clémentine Margaine as Giulietta to complete Hoffmann’s trio of lovers. Marco Armiliato conducts Bartlett Sher’s evocative production, which also features American bass-baritone Christian Van Horn as the Four Villains and Russian mezzo-soprano Vasilisa Berzhanskaya in her company debut as Nicklausse.

Grounded

Metropolitan Opera | Starts 9 November Two-time Tony Award–winning composer Jeanine Tesori’s powerful new opera Grounded, commissioned by the Met and based on librettist George Brant’s acclaimed play, wrestles with the ethical quandaries and psychological toll of 21st-century warfare. Mezzo-soprano Emily D’Angelo, one of opera’s most compelling young stars, portrays Jess, a hot-shot fighter pilot whose unplanned pregnancy takes her out of the cockpit and lands her in Las Vegas, operating a Reaper drone halfway around the world. As she struggles to adjust to this new way of doing battle, she fights to maintain her sanity, and her soul, as she is called to rain down death by remote control.

Met Music Director Yannick Nézet-Séguin oversees the Met premiere of Tesori’s kaleidoscopic score and a cast that also features tenor Ben Bliss as the Wyoming rancher who becomes Jess’s husband. Michael Mayer’s high-tech staging, using a vast array of LED screens, presents a variety of perspectives on the action, including the drone’s predatory view from high above.

Van Gogh: Poets & Lovers Exhibition on Screen | Starts 9 November

200 years after its opening and a century after acquiring its first Van Gogh works, the National Gallery is hosting the UK’s biggest ever Van Gogh exhibition. Van Gogh is not only one of the most beloved artists of all time, but perhaps the most misunderstood.

This film is a chance to reexamine and better understand this iconic artist. Focusing on his unique creative process, Van Gogh: Poets & Lovers explores the artist’s years in the south of France, where he revolutionised his style. Van Gogh became consumed with a passion for storytelling in his art, turning the world around him into vibrant, idealised spaces and symbolic characters.

Poets and lovers filled his imagination; everything he did in the south of France served this new obsession. In part, this is what caused his notorious breakdown, but it didn’t hold back his creativity as he created masterpiece after masterpiece. Explore one of art history’s most pivotal periods in this once-in-a-century show. Made in close collaboration with the National Gallery.

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Punting the punt Redemption. It’s a powerful concept. It draws us in and makes us feel better about life. Enduring, surviving and then ultimately succeeding are key ingredients to so many great literary tales and epic movies but when the story is seen firsthand it’s even more moving and impactful.

I had known Lucky for a few years, or more specifically a few seasons. We both spent many long summer afternoons and evenings, soaked in the smells of sweat, leather and Dencorub, at Souths Cricket club. He played first grade and we both coached the youngsters. He was young and at the height of his powers as a batsman.

He was affable, engaging and possessed charisma and confidence that made him a cult hero with the kids. He seemed to have the world at his feet. When he smiled, everyone smiled with him. When he laughed, we all did.

Everybody loved Lucky.

But Lucky’s charming smile belied his struggle. Beneath the veneer of happiness, he was in the grips of a silent, hidden demon. He was fighting off Australia’s secret scourge. The addiction that’s goes incognito. Not booze, not smoking, not illicit drugs. He was punting his life away.

The first I knew of his battle was a newspaper story, breaking the news of a young cricketer who had confronted his nemesis and then started up a support group (Punt the punt) for similarly afflicted young men.

Lucky had broken his silence, asked for help and was regaining control of his life. Then he altruistically decided that he wanted to help others out of the quagmire of gambling. He aimed to shed light on the evil truth of betting in Australia.

At the nets one afternoon, he opened up to me about his days of losing his week’s pay on the horses, hiding his habit from his loved ones, dodging social events because he was broke and some of the things that it had all cost him. Maintaining the web of deceit was an exhausting, fulltime practice. Financial losses seemed the least concern for him, behind the loss of relationships and especially the times he had lost with those he loved most, his family and friends. It had made an impact on his batting. The runs dried up and his cricket career trajectory stalled. Men that he had captained in junior rep teams were now playing for Queensland and Australia. He was not.

Things came to a head during a family event and, fortunately for Lucky, he had an incredibly supportive family who rescued him when he most needed it. Many young men are not so lucky. They alienate themselves from those who care most and end up isolated, alone and vulnerable. Depression and suicide are often the tragic outcomes. Thankfully for the young men in Lucky’s immediate sphere of influence, the silence is less deafening. Awareness and discussion about the problem and the lifelines available are being spruiked through his website and support group.

The next phase of the project has seen Lucky start a campaign to raise awareness about the perils of punting in the senior classes of some of Brisbane colleges, especially boys’ schools, where 17 and 18-year-old young men are brainwashed every weekend by the avalanche 68 Doctor Q | Spring

Dr Matt Young

General Practitioner, Inala Medical Centre

of sports betting adverts. You can’t watch a game of AFL, rugby union, rugby league, soccer or cricket without the incessant drone of myriad sports betting adverts, offering apps. All you need is an opposable thumb, a mobile phone and the right app and you can drain your bank account, lose your pay cheque and fritter away your family’s security, all from your loungeroom. The adverts percolate with quintessential Aussie themes, normalising gambling. It seems fun, sport, larrikinism and mateship are all enhanced by punting.

After spending many summers at the nets together, now Lucky and I have enjoyed spreading the gospel of punting the punt at some of Brisbane’s schools. It has been a thrill to see the phenomenal courage and rawness of Lucky telling his story to so many impressionable young men.

His honesty is inspiring and strikes a potent chord with the young men in the audience.

From a potentially tragic ending, Lucky has turned his life story into an epic saga of endurance, redemption and altruistic success. He is back in the runs and I am proud to know him.

Why celebrate old vines?

First of all, old vines are impressive as hell. They can live for well over 120 years, with the oldest known grape-producing vine in the world coming in at over four centuries old.

According to Wikipedia, the world’s oldest authentic continually producing commercial vineyard is believed to be the Shiraz vines at Turkey Flat in the Barossa Valley’s Tanunda, originally planted in 1847.

We reckon the fact that old vines are so resilient is worthy of celebration, but it’s not just their survival skills that make them so, well, gnarly.

As vines age, they produce less fruit. The tradeoff, though, is that the fruit they do produce is more concentrated, and generally of better quality.

This means that many producers are faced with the difficult choice of keeping precious old vines, which produce less, but better, wine, or pulling them in favour of new, more productive plants.

Thankfully, we’re lucky to still have significant old vine resources here in Australia, in spite of the vine pull scheme of the 1980s.

But making sure that people appreciate the quality of old vine wines, and the resources required to maintain them, is crucial to ensuring that they’re around for many, many years.

What about new vines?

Don’t worry; new vines haven’t been forgotten!

The Old Vine Project aims to preserve existing old vines, but they also want to ensure that younger vines, or vines planted in the future, will still be viable when old. A worthy consideration given climate change, which is threatening the world’s vineyard plantings.

Rosa Kruger, vineyard manager and founder of the Old Vine Project, shares a little on their website about ‘planting to grow old’, and the impact of climate change on vineyards.

“If we want to plant vines now that we want to grow old, we really need to know where the climate is taking us.

Climatologists predict that the world is getting warmer and drier at a rapid pace. Africa’s temperatures may increase at twice that rate compared to the global average. However, there are key actions that can be taken to become more climate resilient in viticulture: Plan and plant smarter; capture rainwater effectively; design new vineyards within correct contours; plant higher and cooler; build a biodiversity of plants, animals and insects; build soil health; and plant acid-retaining varieties or varieties that ripen before heat waves.”

Old Vine Day is about celebrating vineyards that have survived the strains and stresses of a changing environment, while looking to the future and making sure old vine wines are still viable for decades (and centuries!) to come.

How to find old vine wines We’re big fans of old vine wines, and we have plenty to choose from.

Phil Manser

Wine Direct 1800 649 463 phil.manser@winedirect.com.au

Tasmania When planning a holiday, most families look for a destination that offers a blend of adventure, relaxation and educational experiences. Tasmania, an island state off Australia’s southeastern coast, emerges as an ideal choice for families and individuals alike looking to create lasting memories amid stunning landscapes and rich cultural heritage.

Natural wonders await Tasmania is renowned for its pristine wilderness and breathtaking natural beauty. Embark on unforgettable adventures in places like Cradle Mountain-Lake St Clair National Park, where snow-capped peaks, ancient rainforests and crystal-clear lakes await exploration.

Hiking trails cater to all skill levels, ensuring that even young children can participate in guided walks or easy treks suitable for family outings or novice hikers.

For wildlife enthusiasts, Tasmania offers unique encounters with its endemic species, such as the Tasmanian devil. Sanctuaries and wildlife parks provide opportunities to observe these fascinating creatures up close and learn about ongoing conservation efforts.

Additionally, coastal regions like Freycinet Peninsula boast secluded beaches perfect for picnics and water activities, allowing you time to unwind amid breathtaking coastal scenery.

Cultural and educational experiences Beyond its natural wonders, Tasmania is steeped in history and culture. Hobart, the capital city, features historic sites such as Port Arthur, a former penal colony rich in convict heritage. Guided tours provide insights into Tasmania’s colonial past, offering educational opportunities that are both informative and engaging for children and adults alike.

Salamanca Market, held every Saturday in Hobart, presents a vibrant showcase of local crafts, art, and gourmet delights. Families can stroll through stalls offering handmade souvenirs, sample artisanal foods, and enjoy live music performances—a perfect way to experience Tasmania’s creative spirit and community warmth.

Accommodation variety There is such a variety of options when it comes to accommodation options across Tasmania, such as luxury lodges, cozy cottages and beachside cabins, eco-friendly lodges nestled within national parks and hotels of all standards. Many establishments offer family rooms or self-contained apartments with kitchen facilities, ideal for families seeking flexibility and comfort during their stay.

Adventure awaits For those looking for adventure, Tasmania presents a playground of outdoor activities. Kayaking along tranquil rivers or sea kayaking in sheltered bays provides a thrilling perspective of Tasmania’s rugged coastline and abundant marine life. Cycling enthusiasts can explore scenic trails like the Tasmanian Trail or mountain biking routes through diverse landscapes, offering exhilarating experiences for all ages.

Seasonal delights Each season brings its special and unique rewards, but I love April. It is such a great time to visit Tasmania when autumn transforms the island into a tapestry of vibrant hues. Perhaps it is being from the Sunshine State, but witnessing the changing colours of deciduous trees against dramatic landscapes I think adds a touch of magic. Whether exploring vineyards in the Tamar Valley or strolling through botanical gardens, there is something truly special about this time of year.

After the success of the 2022 Annual Conference in the Northern Territory, AMA Queensland is presenting its first Trans-Tasman Conference in Hobart from 7 to 13 April 2025. This event will include streams focusing on building and supporting private practice. You will have the chance to hear from practice owners, GPs, specialists and industry leaders about the best ways to ensure the sustainability of your practice. Ideal for anyone already in or considering a move to private practice. As a special inclusion, this conference also offers kids’ club activities for our junior family members.

Register early and let us help plan your visit to the Apple Isle!

Ros Chillingworth

Orbit World Travel 1300 262 885 amaq@orbittravel.au

70 Doctor Q | Spring

Spring | Doctor Q

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GPTQ Bursaries awarded Her Excellency the Honourable Dr Jeannette Young AC PSM, Governor of Queensland attended the AMA Queensland Foundation Charity Gala to present the Foundation’s Medical Student Scholarships and to award the GPTQ Bursary recipients for 2025.

This is the second year these bursaries have been awarded with funding following the dissolution of General Practice Training Queensland (GPTQ).

The four bursaries of $20,000 are for GP Fellows or Registrars seeking to undertake training initiatives or research relevant to general practice.

Associate Professor Ewen McPhee and Drs Lisa Fraser, Rowan Gibbs and Naomi Penna are this year’s recipients.

A/Prof Ewen McPhee Practice owner and long-term Emerald resident GP, A/Prof Ewen McPhee has received a bursary to support his exploration in Artificial Intelligence (AI) as a tool to support doctors to better utilise their time.

Since arriving in Emerald in 1989, he has served the diverse and changing health needs of the growing and largely disadvantaged community.

“Access to services is difficult, medication costs high, GP numbers low, and infrequent bulk billing options mean delays in seeking care and increased late presentations,” A/Prof McPhee said.

“With GPs being increasingly involved in higher level complex patients, risk assessment tools become critical and there is a need for real time AI analytics to assist the GP at point of care.”

Dr Lisa Fraser

Dr Rowan Gibbs

Dr Naomi Penna

Rural GP and practice owner Dr Lisa Fraser has been awarded a bursary to complete further training in reproductive and sexual health.

Former commercial fisherman turned GP Registrar Dr Rowan Gibbs has been awarded a bursary to support his training in critical areas for rural health.

Rural GP registrar Dr Naomi Penna has been awarded a bursary to support her research in the postpartum support available to mothers in rural and remote North Queensland.

Passionate about addressing health inequities, she is always seeking educational opportunities to better support her community as the only medical service in Gordonvale, North Queensland.

“My community has a large proportion of vulnerable people including Aboriginal and Torres Strait Islanders, those with disabilities, unemployed and elderly, and access to healthcare is limited by distance, availability and cost,” Dr Fraser said.

“Contraception and women’s health is an area of poor health status and outcomes in rural areas. I hope that improving my skills in this area can benefit my community.”

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Motivated by his time working in remote communities across Cape York and the Gulf Country, his goal is to advance his medical expertise and operate outreach clinics that bring both healthcare and hope to those in rural and remote areas.

“In rural settings, where each medical professional’s impact is magnified, the general practitioner’s role extends beyond the clinic walls, becoming a cornerstone of community wellbeing,” Dr Gibbs said.

“Through this bursary, I seek not only financial support but also partnership in a vision to make a tangible difference in the lives of Australians who are often forgotten.”

“I am working part-time in a few clinical and non-clinical roles while raising our two-year-old son with my husband on our family owned MM7 mixed cropping and cattle farm 100km west of Charters Towers,” Dr Penna said.

“Given our family situation, I am committed to completing my Rural Generalist Training in the Charters Towers Region and working there indefinitely post fellowship.”

She hopes this research will support the development of a holistic postnatal care program, specifically for rural and remote mothers, to offer the support she never received herself as a new mother living remotely.

Her Excellency the Honourable Dr Jeannette Young AC PSM with IMAQ Medical Student Scholarship recipient Anna Duan, IMAQ President Dr Cyril Fernandez and Foundation Chair Dr Dilip Dhupelia

Indian Medical Association Queensland Medical Student Scholarship The AMA Queensland Foundation Medical Student Scholarships are for students at risk of not finishing their medical degree because of financial hardship.

This year, through our End of Financial Year Tax Appeal, our generous donors donated $30,000 and we were able to award three scholarships.

The Indian Medical Association Queensland (IMAQ) raised $10,000 and were able to support another dedicated student, Anna Duan.

Fourth-year medical student Anna Duan migrated to Australia with her family at the age of five. Her experience as a first-generation immigrant has largely motivated her pursuit of medicine in public health.

“Growing up there were three of us kids and we faced things like physical violence, discrimination and a lot of mental and physical health issues,” Anna said.

Dr Dilip Dhupelia AMA Queensland Foundation Chair

“I have been guided all my life by a strong sense of justice and love. Although this may sound naive or even foolish in a world as harsh as ours, this has guided me as I aspire to become a public health physician and a rural generalist, rooted deeply in my family’s origins from rural North China – a world away from where I stand today as a fourth-year medical student in tropical Far North Queensland.”

The scholarship enables her to focus on her studies, extracurriculars and placement opportunities without the constant pressure of needing to find additional work to meet basic needs while she recovers from chronic health issues of her own.

Coming up Yes, I want to give a tax deductible donation.

All donations over $2 are tax deductible.

Donate today

amaqfoundation.com.au

amaqfoundation.com.au

Later this year, the AMA Queensland Foundation will run its annual Christmas Appeal to raise funds to be made available to family violence support services.

amaqfoundation.com.au 07 3872 2222 amaqfoundation@amaq.com.au

Spring | Doctor Q 73

InPrint The Foundation and Art of Robotic Surgery The first multimedia medical text of its kind presenting the most comprehensive and up-to-date full-colormaterial about robotics in General Surgery. The Foundation and Art of Robotic Surgery facilitates the learning of surgery while applying robotic technology in multiple anatomicallocations, using a comprehensive, concise and practical

description of each standardised surgical procedure. The book provides clear descriptions of the instrument requirements, indications and relative contraindications to the robotic approach, preoperative phases including trocar placement, patient positioning, OR set-up, and a detailed description of the operative steps. Each operation is divided into steps with specific timeframes, for learning and teaching purposes.

Win this book: 30 October

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this book: The Foundation and Art of Robotic Surgery Fill out the online form. Entries close 30 October

InPrint book winner

Winners

Jasmine Blight won a copy of Katzung & Trevor’s Pharmacology Exam and Board Review, thanks to our friends at McGraw-Hill Education.

Dr Mitesh Gandhi Jasmine Blight Dr Barbara Woodhouse Dr Leonie Mitchell Dr Ekta Paw

Dr Ekta Paw has won a copy of Hurdy Gurdy

by Jenny Ackland, thanks to Allen and Unwin Publishing.

Novel winner

Refer 1 member 25% discount*

Want a discount on your membership rate for 1 year?*

Refer 2 members 50% discount*

Refer a member today.

Refer 3 members 75% discount*

Read more *T&C apply

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Doctor Q | Spring

Refer 4 members 1 year complimentary*

AMA Queensland is now part of something bigger at Officeworks.

Officeworks has partnered with AMA Queensland to provide you with the best products, services and solutions to help make bigger things happen for your business.

Register now for a 30 Day Business Account at officeworks.com.au/ ama-queensland

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