SUMMER 2017 | VOL. 105 Codeine rescheduling update MOCA 5 preparations before bargaining begins Resilience on the Run rolls out around the state
Queensland Election 2017 AMA Queensland’s focus on regional healthcare
Doctor Q is free to AMA Queensland Members
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CONTENTS
24
QUEENSLAND
ELECTION 2017 -
32
M O C A 5 P R E PA R AT I O N S
BEFORE BARGAINING BEGINS
38
CODEINE RESCHEDULING
U P D AT E
AMA QUEENSLAND’S FOCUS ON R E G I O N A L H E A LT H C A R E
REPORTS 6
Editor’s desk
10
President’s report
12
CEO’s report
48
Member news
72
Foundation news
F E AT U R E S Queensland Election 2017 AMA Queensland’s focus on regional healthcare
56
When overseas travel turns bad
58
Income splitting
32
MOCA 5 preparations before bargaining begins
61
Where to park cash from your business
38
Codeine rescheduling
62
Prescribing for self and family what could go wrong?
64
Business of medicine
24
PEOPLE & EVENTS
CURRENT ISSUES 26
Resilience on the Run program funded to roll out to all interns
BUSINESS TOOLS
LIFESTYLE
14
Annual Conference wrap up
54
The Deep South
16
Women in Medicine wrap up
66
Homage Restaurant - Spicers, Hidden Vale
18
Private Practice and Medico-Legal Conference wrap up
68
Real wine
20
Health Hub and Workplace Relations webinars
69
Life gems
22
Intern Readiness wrap up
70
All about you
71
Cinema
74
InPrint: Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, eighth edition
28
Upcoming legislation changes
30
Innocent until proven guilty
31
Medical Board update
34
Partnership with RSL helps veterans
36
Medical leadership and management development
46
Events calendar
40
New council members
51
Local Medical Association round up
42
Why leadership is so important
52
A day in the life of a plastic and reconstructive surgeon
43
QDHP is here for you Different approach needed to close the gap
60
44
Patient referral spotlight: Lung Foundation Australia
Editor’s Desk AMA Queensland has released its five-point election platform in the lead up to the state election. Have a read before the election on 25 November (p24). Another big ongoing issue is the MOCA 5 preparations before the bargaining period begins in January 2018 (p32). Chief Health Officer Dr Jeannette Young has given us an update on codeine rescheduling and how this affects our members (p38) and you’ll see a comprehensive list of achievements ahead of our renewals campaign for 2018 (p50). We’ve got your back.
OBITUARIES
The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr John Dermod BRENNAN General Practitioner Late of Ashmore Member for 62 years
Dr Anthony ARDEN Psychiatrist Late of New Farm Member for 54 years
Dr Keith Mortimer HIGLETT General Practitioner Late of MacGregor Member for 72 years
We hope all our members have a Merry Christmas and a Happy New Year. The AMA Queensland office will be closed over the Christmas period from 4pm on 21 December and will re-open on 2 January 2018.
Editor: Michelle Ford Russ
Doctor Q is published by AMA Queensland
Graphic Designer: Aleisha Coffey
Phone:
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Dr Jim Finn Vice President Dr Shaun Rudd Chair of Board and Council
(07) 3872 2222
Address: PO Box 123, Red Hill QLD 4059 Email:
amaq@amaq.com.au
Print Post Approved PP100007532
Dr Dilip Dhupelia Member Appointed Director
Dr Bav Manoharan Member Appointed Director
Peter Isdale Skilled Director
Dr Mellissa Naidoo Member Appointed Director
Ben Hancock Skilled Director
COUNCIL Dr Kimberley Bondeson Greater Brisbane Area
Dr Katherine Gridley Greater Brisbane Area
Dr Paul Bryan General Practitioner Craft Group
Dr John Hall Downs and West Area
Dr Michael Cleary Greater Brisbane Area
Associate Professor Geoffrey Hawson Retired Doctors Craft Group Dr Wayne Herdy North Coast Area
Dr Michael Clements North Area
Dr Scott Horsburgh General Practitioner Craft Group
Dr Sarah Coll Specialist Craft Group
Dr Viney Joshi International Medical Graduate Craft Group
Haydn Dodds Medical Student Craft Group Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group
CHRISTMAS CLOSURE
Advertising: Louise Glynn
Dr Bill Boyd President
Dr Matthew Cheng Doctors in Training Craft Group
Michelle
Journalist: Chiara Lèsevre
BOARD OF DIRECTORS
Dr Sam Kim Greater Brisbane Area Professor Steve Kisely Greater Brisbane Area
Clare Mahon Medical Student Observer Dr Bav Manoharan Greater Brisbane Area Dr John F. Murray Specialist Craft Group Dr Alex Ritchie Specialist Craft Group Dr Siva Senthuran Full-time Salaried Medical Practitioner Craft Group Dr David Shepherd Far North Area Dr Stephen Withers Gold Coast Area Dr Nicholas Yim General Practitioner Craft Group Dr Chris Zappala Immediate Past President
AMA QUEENSLAND S E C R E TA R I AT Jane Schmitt Chief Executive Officer
Filomena Ferlan General Manager Corporate Services
Holly Bretherton General Manager - Member Relations and Communications
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.
THE ULTIMATE LUXURY PAIRING PURCHASING A NEW LEXUS HAS NEVER BEEN SO RELAXING. In a quest to always find new ways to put our customers first, we have created a vibrant culture of service that always treats our customers as guests. That is why we are excited to announce our new luxury pairing with Spicers Retreats. As an AMA Queensland member, receive a two night luxury stay at a Spicers Retreat property of your choice1 when you purchase your new Lexus. Now is the time to experience another benefit of owning a Lexus. The hardest part will be choosing where to go.
LEXUS CORPORATE PROGRAMME Lexus represents an incomparable driving experience and the Lexus Corporate Programme builds upon this by providing a service uniquely tailored to our corporate clients. It is with pleasure the Lexus of Brisbane Group offers the Lexus Corporate Programme to AMA Queensland members across the entire Lexus range including luxury sedans, coupes and SUVs. CORPORATE PROGRAMME BENEFITS INCLUDE: — Preferential Corporate Pricing 2 — 3 year/60,000km complimentary scheduled servicing 3 — Reduced dealer pre-delivery fee of $995 (ex GST) — Competitive total cost of ownership — Access to Lexus Corporate Evaluation Vehicles — Priority ordering and allocation ADDITIONAL BENEFITS FOR AMA QUEENSLAND MEMBERS — Priority invitations to Lexus of Brisbane Group corporate events — Dedicated Lexus of Brisbane Group representative for all enquiries — Access to the Lexus of Brisbane Group’s Airport Valet Parking, collection and return service from Brisbane Airport 4 — Spicers Retreat Experience1
LEXUS OF BRISBANE lexusofbrisbane.com.au LEXUS OF INDOOROOPILLY lexusofbrisbane.com.au
LEXUS OF SOUTHPORT lexusofsouthport.com.au
LEXUS OF SPRINGWOOD lexusofspringwood.com.au
LEXUS OF MAROOCHYDORE lexusofmaroochydore.com.au
Encore Programme Benefits: — Service loan cars or complimentary pick-up/drop off during servicing — Lexus DriveCare providing 24-hour roadside assistance — Lexus Exclusive Events To discuss these benefits offered to you phone or SMS our dedicated Lexus of Brisbane Group representatives today. DEREK KLETTE | GROUP SALES MANAGER
derek.klette@lexusofbrisbane.com.au | 0419 723 937 GAVIN SCHIERMEIER | GROUP GENERAL MANAGER
gavin.schiermeier@lexusofbrisbane.com.au
Offer applicable to Private and ABN buyers, who are current members of AMA Queensland, on all new vehicles purchased between 1st November 2017 to 31st December 2018 and delivered by 31st December 2018. The Lexus of Brisbane Group reserves the right to extend any offer. Excludes demonstrator and pre-owned vehicles. Spicers Retreats Certificate is valid for period of 12 months and cannot be exchanged or redeemed for cash. Spicers Retreats two night luxury stay is available at the following properties only: Spicers Hidden Vale, Spicers Balfour, Spicers Clovelly, Spicers Tamarind, Spicers Potts Point and Spicers Vineyard Estate. Subject to Spicers Retreats availability. Upgrades or additional nights available to purchase. See https://spicersretreats.com/ for more details on properties. See your Lexus of Brisbane Group dealer for full terms and conditions. 2 Complimentary scheduled servicing expires at 3 years or 60,000km from the date of first registration, whichever occurs first. Conditions apply. See your Lexus dealer for further details. 3 Eligible employees must provide such documentary evidence as Lexus or the Lexus Dealer may require to confirm entitlement to receive preferential pricing. Terms and conditions apply. See your Lexus dealer for further details. 4 Visit http://www.lexusofbrisbane.com.au/about/about-us/benefits for full terms and conditions.
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President’s report DR BILL BOYD
If you live in a regional, rural or remote part of Queensland, you may have seen an email from AMA Queensland pop into your inbox around the middle of the year asking you to complete a survey into regional, rural and remote workforce issues. If you were one of the nearly 200 people who returned our survey, we thank you very much and I want to let everyone know what’s happening with the data you took the time to give us. Based on your responses, we have put a spotlight on healthcare in regional, rural and remote Queensland and AMA Queensland is calling for the Health Minister to be supported by an Assistant Health Minister, who we propose be regionally located, to better understand and respond to issues specific to each area. Have a look at our top five priorities for this state election on p24. The AMA Queensland Rural, Remote and Regional Workforce Group has analysed the data, which has produced some interesting results. For example, whereas the conventional wisdom suggests we should be trying to recruit more rural generalists into rural areas, over 43 per cent of responses to the question of “What medical staff does your region most need” said that specialists were the most needed medical staff. This is the state-wide result to this question but the local results obviously vary from Hospital Health Service (HHS) to HHS. 10 Doctor Q Summer
The working group will further examine this data to develop a discussion paper, which will help us to develop a suite of policy solutions, which we will take to the Queensland Government upon the paper’s release. We also aim to develop documents specific to each HHS to show the local results and what individual HHSs could be doing to improve recruitment and retention in their local workforces. The Federal Government has appointed Professor Paul Worley of Flinders Medical Centre to the new position of National Rural Health Commissioner. If, like me in Mackay, you live in a regional centre and particularly if you have the chance to visit rural and remote colleagues you will be well aware just how big the workload for Paul Worley is going to be and we wish him well. I have already written to him to congratulate him and look forward to an opportunity to meet with him on behalf of all country colleagues. Certainly in Queensland much of the work done out with the main centres falls to International Medical graduates. For some of these doctors it is a very lonely road indeed where isolation is visited upon them in in many forms. AMA Queensland is well placed to help those doctors and if you know of someone who is a non-member but who might benefit from being a member, please do speak to them.
When vision loss affects her daily life, it’s time to refer to Vision Australia. The allied health team at Vision Australia complement the work of eye care professionals. Our vision loss experts help patients use their remaining vision to get the most out of life. Your patients can also get help to access NDIS and My Aged Care funding. When to refer • Upon diagnosis of a permanent, non-correctable or progressive eye condition • Vision loss starts to impact everyday activities • Glasses no longer correct vision. To refer online or download free vision loss resources go to visionaustralia.org/AMA or call 1300 84 74 66 Gold Coast | Brisbane | Maroochydore | Townsville | Cairns
Sarah, Vision Australia client
Doctor Q Summer 11
CEO’s report
JANE SCHMITT QUEENSLAND ELECTION 2017 – AMA QUEENSLAND’S FIVE-POINT PLAN FOR B E T T E R H E A LT H In response to the announcement of the 2017 Queensland State Election, we have provided our Election Platform to the political parties and to our stakeholders. Our five-point plan identifies and addresses the areas that the next Queensland Government must target to help improve the health system for doctors, patients and the broader Queensland community. Key recommendations include: appointing an Assistant Minister for Health dedicated to regional health; increasing funding for Queensland’s palliative care sector; appointing a dedicated Chief Medical Officer (CMO) to enhance medical leadership within the public health system and nurture cultural change; ensuring the resilience of our medical workforce by extending funding for the Resilience on the Run program to improve the well-being of senior medical officers as well as junior doctors; and preserving Queensland’s new alcohol laws and allowing them to be fully evaluated before considering further legislative changes. See p24 for further information on the 2017 Election Platform.
PA RT N E R S H I P T O B R I D G E THE GAP BETWEEN GPS AND VETERANS We have recently joined forces with RSL Queensland to improve veterans’ access to quality health care across the state (see p34). Our affiliation will enable GPs who have served in the Australian Defence Forces (ADF) or who have experience in veteran-related health issues to be referred to veterans, current serving ADF personnel and their families through a database being developed by RSL Queensland. If you have experience in treating veterans or you have served in the Australian Defence Force and wish to be included in the database and listed on the AMA Queensland and the RSL Queensland websites, please email membership@amaq.com.au.
MEMBERSHIP RENEWAL With the Medical Officers’ Certified Agreement 5 (MOCA 5) negotiations about to begin and ongoing change in the health environment, there has never been a more important time to renew your membership. Each and every membership strengthens our collective voice. In 2018, members will receive post nominals as part of their membership and you will be introduced to a Membership Rewards program, which will provide discounts on member fees and many other benefits. On-time payment of your renewal will award you with bonus points. 2018 membership is due by 31 December and can be paid via BPAY, online or over the phone (see p48 for more information).
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REAL-TIME PRESCRIPTION MONITORING AND CODEINE AMA Queensland has recently called on the State Government to fast track a real time prescription monitoring (RTPM) system in Queensland ahead of a national system due to be established in around five years or possibly more. We recommended a staged approach to the implementation of a RTPM system in Queensland, which would eventually see a software-based solution that would allow pharmacists to scan information directly into the Queensland drugs monitoring database when they dispense, which would then be viewable directly on a GP’s desktop computer. A similar model has been used in Tasmania and has eliminated doctor shopping there. AMA Queensland will be following this up with the government postelection so that the rise of accidental opioid overdoses in recent years can be curbed.
NEW BOARD AND COUNCIL MEMBERS I am delighted to announce two new appointments to our Board of Directors, Peter Isdale and Ben Hancock as Skilled Directors. Peter and Ben bring a wealth of experience in strategic financial planning, business development, and investment assessment. We thank outgoing Board members Drs Kirsten Price and Richard Kidd for their work and valuable contributions over many years. I also welcome our enthusiastic new Council members Drs Sam Kim, Stephen Withers, Siva Senthuran and our new Medical Student Representative Haydn Dodds. To read more about our new Councillors, please see page 40.
Noticed your energy rates going up? We could help yours go down.
On 1 July, some Australian energy retailers increased their rates by up to 20%. This means your business could now be paying too much for your energy. As the official energy partner of AMA Queensland, Make It Cheaper provides a free energy comparison service. You’ll either find a better deal on electricity or know for sure you’re already on a great rate. Win-win.
How much could your business save? Call the AMA Queensland Members Hotline directly on (02) 8077 0159 or Visit the website to upload a recent energy bill www.bit.ly/MiCAMAQ Note: This service is only available for members in the Energex network (not ERGON)
The theme, Personalised health care evolving health care needs through the cycle of life, was investigated from a variety of angles at this year’s Annual Conference in Rome.
AMA QUEENSLAND’S ANNUAL CONFERENCE
A line-up of speakers of world-renown educated and entertained delegates, with every session packed with enlightening presentations and generating enthusiastic discussion and debate. Keynote speaker Professor Francesco Curcio delivered two presentations on Precision Medicine and The appropriate use of lab tests in the era of molecular medicine. Dr Katriona Munthe gave a most entertaining session on Images of Healing through the cycle of life and Dr Elda Righi presented on Advances in infectious diseases management. Professor Gian Battista Parigi gave a unique insight into health care during the formative years, including foetal surgery. Professor Andrea Grignolio spoke about the Neuro-Evolutionary roots of social resistance to vaccination, while Professor Roberto Verna spoke on the Importance of Mental and physical fitness throughout life and Prevention to reduce health spending. Professor Pablo Requena covered the tough subject of Ethical and medical issues regarding end of life care. Australian speakers to present were Colleen Sullivan, on the Life cycle of your practice, Dr Bob and Carmel Brown covered Electronic Health Records and Dr Beres Wenck spoke on the Digital age and its effect on health care needs.
SPONSOR PROFILE: TRESSCOX LAWYERS LY N E T T E REYNOLDS
OUR SPONSORS We were most fortunate to have the support and company of Lynette Reynolds (TressCox Lawyers), Allison Scifleet (Lexus of Brisbane) and Julie Brooke-Cowden (MDA National). Lynette gave a presentation (see right) and Julie spoke about the Refusal of medical treatment and futile medical treatment. Thank you to sponsor Macquarie. Finally, a big thank you to AMA Travel Queensland, Ros and Andrea, for yet another successful and co-operative event. 14 Doctor Q Summer
Partner, TressCox Lawyers (07) 3004 3555 Lynette_Reynolds @tresscox.com.au Lynette presented on the topic of Preparing to exit from your Practice. It is recommended that you commence the process of preparing for the sale of your practice at least two years before you are ready to sell. This will give you
AMA Queensland President Dr Bill Boyd spoke on the history of malaria in early Rome and current global issues and CEO Jane Schmitt gave two important sessions on the Complaints System in Queensland and Leadership. Associate Professor Noel Hayman updated delegates on a case study involving The use and success of nurse-led case management in Aboriginal and Torres Strait Islander primary health care settings. The final conference session was an open issues forum chaired by Dr Bill Boyd. Issues significant to the future of medicine were addressed and hotly debated.
2 EXPLORING ROME AND BEYOND Outside the conference sessions, delegates had opportunities to explore this wonderful city and regions beyond. Highlights in Rome included a walking tour to explore the charming squares, beautiful fountains, ancient bridges, medieval quarters and splendid palaces. There were plenty of opportunities to visit the Colosseum and Roman Forum, Vatican Museums, the Sistine Chapel and St Peter’s Basilica, as well as the Tivoli Gardens. Outside Rome, a true highlight of the conference was our trip to the excavations of Pompeii and fascinating Sorrento. 1. AMA Queensland CEO Jane Schmitt and Australian Ambassador to Italy Dr Greg French. 2. Drs Bob Brown and Graham McNally, Carmel Brown, Sue Adsett and Dr Geoff Adsett.
1 time to work with your accountant to ensure that your financial records are up-to-date and complete and may allow the value of your business to be increased by taking sensible first steps. These include: ensuring internal processes are documented; removing any personal assets from the accounts; and ensuring related entity transactions are occurring at true market value. Other pre-sale steps include a review of your existing contracts including arrangements with customers, suppliers, staff, contracting doctors and any occupancy or lease arrangements. You should also obtain accounting
advice about the best way to structure the sale and the taxation and duty consequences for you. When the time comes to enter into a contract for the sale of your business, the negotiation of the contract terms will take some time. The contract will need to properly address the transfer of obligations under all of your existing contracts and transfer of employee entitlements, lease obligations and similar arrangements. The buyer will want to carry out an extensive due diligence, including an examination of your financial records, insurance, staff contracts and other relevant assets. If you are receiving a payment for goodwill, the buyer will require
you to agree not to set up practice in competition for a period of time. We are increasingly seeing earn outs (where payment of part of the price is delayed until after completion and conditional upon continued financial performance). You will need to discuss and understand the risks and benefits associated with earn outs with your lawyer and accountant before committing to an earn out agreement. The presentation contained examples of a few of the major contract issues which arise and delegates were reminded of the importance to seek both accounting and legal advice before commencing the sale process or entering into a sale contract. Doctor Q Summer 15
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“FANTASTIC SELECTION OF SPEAKERS I N S P I R AT I O N A L S T O R I E S T H AT W E R E WELL TOLD”
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“THE WOMEN IN MEDICINE BREAKFAST LEFT M E F E E L I N G M O T I VAT E D T O K E E P W O R K I N G HARD AND DOING MY BEST FOR THE GOOD O F M Y PAT I E N T S ”
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“I H AVE BEEN TO THESE EVENTS A FEW TIMES NOW AND LOVED THE FACT THESE W E R E I N S P I R A T I O N A L W O M E N A C T U A L LY IN MEDICINE.”
“ I W A S S O I M P R E S S E D T H AT I A M G O I N G TO RESUME AMA MEMBERSHIP DESPITE C U R R E N T LY N O T W O R K I N G S O I H A D L E T MEMBERSHIP LAPSE. WELL DONE AND THANK YOU”
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“A M A Q U E E N S L A N D I S A H E A D I N T E R M S O F SUPPORTING WOMEN IN MEDICINE WITH T H I S E V E N T. ”
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1. Sharon-Anne McAuley, Drs Michelle Thompson, Fiona Thomson, Katina Breeze, Kate McLean, Sonja Gustafson and Ruth Barker. 2. Krissy Jergovski and Abigail Reugebrink. 3. Drs Dominique Carroll and Cariad Wratten. 4. Speaker Dr Bronwyn King. 5. Conference room. 6. Drs Maria Heves and Nadine Garraway and Therese Gattas. 7. Drs Hannah Burns, Sarah McMahon, Melissa Naidoo and Susan O’Dwyer. 8. Speakers Drs Bronwyn King, Nikki Blackwell and Homa Forotan; AMA Queensland CEO Jane Schmitt and MC Mellisa Watter. 9. Drs Annabelle Chalk and Charlotte Durand.
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Women in Medicine Around 250 women in medicine joined us on 7 September at the Brisbane Convention & Exhibition Centre for an inspired panel discussion featuring Radiation Oncologist and Tobacco Free Portfolios Founder and CEO Dr Bronwyn King, Humanitarian Emergency Doctor Dr Nikki Blackwell and Refugee Advocate Dr Homa Forotan. AMA Queensland extends a sincere thanks to the generosity and support of our presenters Bronwyn, Nikki and Homa and sponsors BOQ Specialist, William Buck, TressCox Lawyers, MDA National, Doctors Health Fund and Lexus of Brisbane. Save the date for Wednesday 23 August 2018 for the next Women in Medicine breakfast. If you have an idea on who you would like to present at the breakfast next year, please email registrations@amaq.com.au.
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Private Practice and Medico-Legal Conference Members who are either starting or growing their private practice joined us at the 2017 Private Practice and Medico-Legal Conference in October. The program addressed some of the most challenging decisions doctors face in the workplace, including e-health, passing accreditation, exploring new income streams for private practice, digital marketing and managing emerging risks in practice.
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5 1. Joanne Todd and Laura Mercer 2. Dr Kim Favier, Michael Jones and Deborah Boyd 3. Drs Stephen Shorey and Rachael Gray 4. Panel members Chief Health Officer Dr Jeannette Young; Senior Medical Advisor to the Chief Health Officer Sue Ballantyne; Dr Tony Gill, Director, Medicine Shortages Centre; and Julie Brooke-Cowden, Manager, Claims and Advisory Service, MDA National 5. Dr Toby Ford 6. Dr Michael Clements 7. Dr Eleanor Chew, AMA Queensland CEO Jane Schmitt and Colleen Sullivan.
Presentations and discussions were held on difficult ethical decisions, compliance with ever-changing legislation and the day-to-day difficulties of managing a practice. Key topics of the conference included the importance of practice culture, the accreditation process, practice incentive payments, patient records, HR essentials and considerations surrounding prescribing medical marijuana. A hearty thank you to our generous sponsors for the event: William Buck, MGR, TressCox Lawyers, BOQ Specialist, Macquarie, MDA National, Lexus of Brisbane and Doctors Health Fund. Save the date, 7 - 8 September 2018, for next year’s Private Practice and Medico-Legal Conference. If you have any preferences for content or speakers, please email us at registrations@amaq.com.au.
1. Joanne Todd and Laura Mercer.
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AMA Queensland Toowoomba Health Hub Visitors to Toowoomba’s Carnival of Flowers were able to undergo a free health check when AMA Queensland held one of our always-popular Health Hubs at the James Street PCYC Markets on Sunday September 17. AMA Queensland’s Health Hubs are regularly held across the state to raise awareness of the importance of undergoing an annual health check with a GP. Dr John Hall and his colleagues from Downs Rural Medical were on hand to carry out free health checks – including blood pressure, blood sugar and BMI tests¬ as well as offering advice on healthy living.
The AMA Queensland team also conducted skin cancer checks, as the disease is a particular risk for farmers and others working in the agricultural sector. “One in five Queenslanders do not see a GP every year, needlessly putting their health at risk,” Dr Hall said. “Accessing a GP in rural areas is not as easy as it is in Brisbane or Toowoomba, so our aim with holding a Health Hub in Toowoomba was to give carnival visitors from out west the opportunity to visit the Health Hub.” As well as blood pressure tests, blood sugar checks and weigh-ins, the Health Hub was also able to carry out thorough skin checks.
Workplace Relations webinars The Workplace Relations Team is getting ready to answer all your social media misuse questions at next month’s final Workplace Relations webinar. The webinars assist general and specialist private practice. The first webinar in July was on personal, carer’s and compassionate leave, while the second in September covered managing underperformance. Don’t miss out on the last webinar of the series on employee misuse of social media. Webinars one and two are also available for purchase. Email registrations@amaq.com.au for a copy now.
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“Skin cancer is a major health risk to farmers and farmworkers and they need to be especially vigilant. A brief skin check by a GP can save lives.”
SOCIAL MEDIA IN THE WORKPLACE Friday 1 December 9 – 10am
Drs Eriko Yamishita and John Hall with Kristal Parmenter (Queensland Respiratory).
Intern workshops More than 300 final-year students turned out for AMA Queensland’s Intern Readiness evenings in Brisbane and on the Gold Coast, to get clued in on the do’s and don’ts for their upcoming internship. Topics included surviving night shift, ward call, and the RMO application process for 2018, along with valuable lessons from our Doctor in Training representatives on resilience and navigating the early stages of your career. AMA Queensland would like to thank our sponsors TressCox Lawyers, MDA National, BOQ Specialist, Avant, MIPS, Doctors Health Fund, Brisbane BMW, and MGR for supporting this informative free event for participants. James Cook University final year students - don’t miss our Intern Readiness workshop in Townsville on Monday 18 December. Further details available soon.
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1. Savini Liyanagama, Tee Indawongse, Xiang-Yan Lee, Amy Tay and Stephanie Zhu 2. Fathima Cassim and Stephanie Omage 3. Jordon Lavigne and Robert Welsh
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Queensland Election 2017 -
AMA Queensland’s five-point plan for better health At this election, like most elections, health will be an important issue. This is why AMA Queensland has developed an election platform, which we have delivered to the Health Minister and his Opposition shadow, requesting that they consider committing to a number of policy solutions in the next term of government. We recommend you read the full platform at www.amaq.com.au.
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APPOINT AN ASSISTANT M I N I S T E R F O R H E A LT H
Anyone appointed the Health Minister in Queensland will always face an enormous and daunting challenge. Queensland’s Health Minister must be the steward to a health system comprised of 169 public hospitals, 108 private hospitals and which provides 10.5 million occasions of service and two million admitted patient episodes of care each year.
2
A P P O I N T A D E D I C AT E D CHIEF MEDICAL OFFICER (CMO) TO IMPROVE MEDICAL LEADERSHIP AND NURTURE C U LT U R A L C H A N G E
With a state that sees 66 per cent of its population reside in the south-east corner, it is also a political reality in Queensland that a Health Minister is almost certainly likely to come from South East Queensland (SEQ).
AMA Queensland believes medical leadership is important in improving patient outcomes, ensuring the efficient use of limited health resources and improving the culture of Queensland Health. However, while Queensland Health has a Chief Nursing Officer and a Chief Allied Health Officer, it does not have a CMO who can speak for doctors and lead strategy and policy impacting doctors at the highest levels of the organisation.
AMA Queensland believes the enormity of the task of leading our health system and the inevitability of a SEQ-based Health Minister could be countered with the appointment of an Assistant Health Minister, who would ideally be based in a rural, regional or remote (RRR) seat.
Queensland’s Chief Health Officer (CHO), Dr Jeannette Young, also holds the title of CMO. While we have the utmost appreciation for Dr Young and the work she does in her role as the CHO, it is our view that the job of CMO should not be a sub-portfolio of a much larger role.
AMA Queensland wants both major parties to commit to the establishment of an Assistant Health Minister who would act as a rural health champion.
AMA Queensland believes a senior doctor should be appointed as CMO in Queensland to lead and help develop medical leadership programs in our public health system. With greater medical leadership in our public health system, led by a respected senior doctor who understands the needs of both patients and the doctors who treat them, this will enact a natural cultural change to help reduce elements such as bullying and sexual harassment, leading to a happier, healthier public health workforce.
3
ENSURE THE RESILIENCE OF OUR MEDICAL WORKFORCE AMA Queensland’s successful Resilience on the Run program for junior doctors focuses on skills such as resilience and mindfulness, managing interpersonal relationships, navigating difficult scenarios on the job and practical steps for asking for help. In recognition of the strong results achieved by this program, the 2017/18 Queensland Budget provided funding for the next two years, a decision AMA Queensland strongly welcomed.
AMA Queensland calls on all parties to commit to extending funding for Resilience on the Run to improve the well-being of senior medical officer as well as junior doctors. This is an investment in individual clinicians and to the broader system in supporting doctors’ health and well-being. Queensland patients would be the ultimate beneficiaries through healthier treating physicians. 24 Doctor Q Summer
4
RETAIN QUEENSL AND’S ALCOHOL LAWS
The Queensland Government introduced new alcohol laws on 1 July 2016 in an attempt to reduce violence in our entertainment precincts. Although these laws had the clear and strong backing of the medical community, including AMA Queensland and the Queensland Coalition for Action on Alcohol (QCAA), the introduction of these laws was controversial. Perhaps as a result of this controversy, the Queensland Government amended these laws less than a year later, removing the lockout provisions of the original legislation which had been delayed as a compromise deal made to secure the legislations passage through the parliament. Although we acknowledge the evidence showed the lockouts were the least essential element of the legislation, we believe it was premature to repeal the lockouts before they had a chance to prove their effectiveness in the Queensland context.
5
I M P R O V E C A R E AT T H E E N D OF LIFE AMA Queensland believes a strategic funding injection is required to help ensure Queensland’s struggling palliative care sector is meeting demand.
AMA Queensland upholds the need for a culturally sensitive approach to the provision of palliative care to Aboriginal and Torres Strait Islander communities and people from culturally and linguistically diverse backgrounds. Designated multi-disciplinary specialist palliative care service units would be responsible for a specific geographic region. These units should implement community-based palliative care models, providing education and training, consultation and respite resources for community and otherhospital based palliative carers, as well as each providing a domiciliary visiting team to support general practitioners and domiciliary nurses within their designated community.
Emboldened by the relaxation of alcohol laws both here and in New South Wales (NSW), many opponents of the lockout laws will see this election as an opportunity to campaign for further amendments or a complete repeal of these laws, which would be a disaster for the Queensland community.
Community care should be provided by integrated teams of community-based carers, led by a well-trained, palliative care medical officer and consisting of appropriately trained and experienced nursing, allied health and volunteer staff with access to specialist palliative care.
AMA Queensland calls on all sides of politics to prove otherwise by committing to keeping the laws following the election to provide enough time for a full, frank and fair evaluation of their effectiveness. Ending alcoholfuelled violence should be a bi-partisan issue and we urge every candidate to support these laws at every available opportunity. The families of the victims of alcohol-fuelled violence would all agree that this is too important an issue to play politics with.
Care should be provided in the location of choice wherever possible. Within that environment, there is a place for inpatient palliative care units, which are attached to hospitals due to the complexity of medical management and the need to involve a variety of clinicians in order to attain effective symptom management. Each major training hospital should be resourced to set up a specialist palliative care team within a dedicated Palliative Care Unit, according to the interconnected requirements of existing Clinical Service Capability Frameworks. Although hospital-based, these teams should support and work within the framework of the community-based palliative care model.
Doctor Q Summer 25
Resilience on the Run program funded to roll out to all interns More than 300 interns around the state have learnt lifelong skills as part of AMA Queensland’s Resilience on the Run program. The program is now funded by Queensland Health and will be delivered by AMA Queensland to all Queensland-based intern doctors from 2017 - 2019. The program was initially developed following the 2013 release of beyondblue’s National Mental Health Survey of Doctors and Medical Students. In response to these findings, AMA Queensland’s Council of Doctors in Training asked Breeze Life Coaching’s Psychiatrist and Life Coach Dr Ira van der Steenstraten to develop a resilience program to better equip young doctors to cope with the transition from medical school to the workforce. Dr van der Steenstraten said the program was aimed at improving coping strategies and wellbeing in junior doctors. “One of the things I address in the program is mindfulness, which nowadays we know there is science behind it and we have a lot of excellent research showing the benefits of mindfulness both on mental health wellbeing and attention,” she said. “We also address interpersonal communication skills as well as where and when to get help, signs of burnout, compassion fatigue, when to recognise it and how to approach it.” Aliastair Quinn, a first year doctor at the Rockhampton Base Hospital, said the transition from university to hospital could be difficult.1
26 Doctor Q Summer
“Suddenly you’re expected to know so much and you’re expected to have clinical judgement, your advice becomes medical advice and as a result it can be very stressful,” he said. “We have high standards we expect of ourselves and our profession that we will be caring and kind but also professional and knowledgeable and sometimes those standards can be very difficult to live up to.” Dr Quinn said taking part in Resilience on the Run had already helped him. “We’re so used to giving advice that sometimes it can be difficult to receive it, and sometimes it can be difficult to put up your hand and say you’re struggling ... junior doctors are under a lot of stress and a lot of pressure and I think we need to realise that we’re humans.” Rockhampton clinical training director Annette Turley welcomed the project but said it could be rolled out even further. “I think it gets harder for senior doctors to put their hand up and say they’re felling burnout and fatigue and so having something available that would take them through some skills testing and learning would be useful for them as well,” Dr Turley said.
Queensland Health has provided funding to roll out Resilience on the Run to all Queensland interns. Chief Health Officer Dr Jeannette Young with AMA Queensland CEO Jane Schmitt. “We all get overwhelmed with the emotional aspects of people’s health. It’s often a difficult job you’re telling people what they don’t want to hear and you don’t want to say. “There’s a lot of evidence about compassion fatigue in the medical community at the moment, where the long hours, the number of patients going through that are sick and utilise your emotions or trigger emotions within you can drain you and you get burnout.” A further 300 interns are scheduled to complete the training soon. 1. Edwards, A. Resilience on the Run: New program helps junior doctors recognise emotional fatigue and pressures. ABC News. 2 October 2015.
Course facilitator Dr Ira van der Steenstraten leading a Resilience on the Run Workshop
Wherever the art of medicine IS LOVED, There is also a love of HUMANITY. (Hippocrates)
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Doctor Q Summer 27
MODERN AWARDS CASUAL CONVERSION
Upcoming legislation changes As the final months of the year approach us, it is an excellent time for you to review and update your practices policies and processes. In 2018, private practices will be faced with changes to both the modern awards and the privacy provisions around notifiable data breaches (NDB). It is important that you are aware of these changes and how they affect your practice.
28 Doctor Q Summer
Casual staff will be given the right to convert their employment to a part or full-time status after a recent decision from the Fair Work Commission. Both the Health Professional and Support Services Award 2010 and Nurses Award 2010 will see the introduction of a casual conversion provision in 2018. If you engage casual staff whom: have completed a qualifying period of 12 months; have worked a period of employment that demonstrates a regular and consistent pattern of work over a 12 month period; and who could transition to a part or fulltime employment without significant adjustment. If you have acknowledged the points above, your casual staff would have the right to request a change in employment status. To prepare yourself for this change, George Sotiris – Workplace Relations Manager will be providing an in-depth and practical break down on how this conversion will impact practices. The Regional Private Practice Series began in late October, but workshops in Hervey Bay, Bundaberg, Rockhampton, Mackay, Townsville and Cairns are still to come.
PRIVACY AMENDMENTS N O T I F I A B L E D ATA BREACHES If your organisation is covered by the Privacy Act 1988, you will be subject to the new NDB scheme being introduced on 22 February 2018. This new scheme will require organisations to notify any individuals likely to be at risk of serious harm by a data breach. Practices will need to be aware of their obligation to notify the Office of the Australian Information Commissioner (OAIC) if a NDB occurs and have a system in place that shows how the breach was handled. A data breach may include: if a database containing personal information is hacked; personal information is mistakenly provided to a wrong person; or if medical records or devices containing such information are lost or stolen. Please note that not all data breaches are notifiable to the Office of the Australian Information Commissioner – (OAIC); the NDB Scheme only requires organisations to notify when there is a data breach that is likely to result in serious harm to any individual to whom the information relates.
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Innocent until proven guilty The Commonwealth Government recently made changes to the national law which allows the Medical Board to suspend or impose conditions against a registered health practitioner if doing so is considered to be in the ‘public interest’. AMA Queensland opposed this change in our submission to the Parliamentary enquiry examining the law, arguing the term ‘public interest’ was far too broad and vague a term. The department stated the current threshold for immediate action may “constrain a National Board from taking swift action where it is warranted to protect public health, public safety or the public interest”. The department provided the following example:
Medical Observer, the experience of Dr Denise Jane Lee was outlined, showing how the public interest test has failed in NSW. The article explained that Dr Lee, a radiologist, had been accused of stalking her former partner through “thousands of text messages and emails.” Dr Lee denied the allegations. The NSW Medical Board met shortly after she was charged and decided to suspend her under the public interest clause. The council pointed to the “malevolent” nature of the emails Dr Lee allegedly sent, claiming there was a “significant risk that she has acted in ways that damage the standing of the medical profession.”
Dr Lee appealed to the NSW Civil and Administrative Tribunal, which ultimately ruled the Medical “… if a practitioner has been charged with a serious Board’s actions crime, and the relationship between the crime and were unfair. the practitioner’s practice is not yet well established, It lifted her the ‘public interest’ may require a National Board to suspension and constrain the practitioner’s practice until the criminal allowed her to matter is resolved, both for the protection of the public return to work stating:
and for public confidence in the health profession.” The National Boards’ powers to take immediate action are also now mirrored in the Health Ombudsman (HO) Act. Under the HO Act, the Health Ombudsman may take immediate registration action (e.g. suspend or impose conditions) against a registered health practitioner or issue an interim prohibition order to an unregistered health practitioner prohibiting them from providing health services or restricting their practice. The department advised that a decision to take immediate action in the public interest would be subject to a ‘show cause’ process and is subject to appeal to the appropriate responsible tribunal. The department also advised that a similar ‘public interest’ test applies in NSW under their coregulatory model. The NSW model is particularly important to note. In a recent article of 30 Doctor Q Summer
“Until [the allegations are] proven, [Dr Lee] is entitled, in respect of such charges, to the presumption of innocence. At the present stage, the allegations [against Dr Lee] rise no higher than allegations: there has been no conviction for any offence. In these circumstances, the tribunal is satisfied that [Dr Lee] in the absence of any real risk to any patient or to the public, should be permitted to practise as a radiologist until the determination of these proceedings. The competence of [Dr Lee] is not an issue and her former employer described the applicant as a ‘fantastic radiologist’.” The amendments ultimately passed the Queensland Parliament, which is the host jurisdiction for the National Law, and apply immediately in Queensland and all other states and territories except SA and WA, which will put amendments to their respective parliaments soon.
Medical Board update Dr Susan O’Dwyer, Chair, Queensland Medical Board of Australia and Medical Board of Australia In January 2017 I took up the position as Chair of the Queensland Board of the Medical Board of Australia (QBMBA). I had served as a practitioner member of the Queensland Board from 2014-2016. I am also currently the Queensland Practitioner member on the National Medical Board of Australia (MBA). For the last sixteen years, I have worked in medical administration and am currently the Executive Director, Medical Services, Metro South Health. Prior to medical administration, my clinical work included a brief stint in obstetrics and gynaecology. The primary purpose of the MBA and Australian Health Practitioner Regulation Agency (AHPRA), as defined in the National Law1, is protection of the public. We take this purpose seriously and it guides our entire decision-making. Through this work, we are aware of the health issues affecting practitioners and students. The MBA has funded external health programs through AMA. In Queensland, the Doctor’s Health Programme provides free, independent, confidential, colleague-to-colleague advice for doctors and students. I encourage you to support the program.
The Board currently comprises twelve members, seven practitioner members and five community members. We welcomed new practitioner and community members this year. There has been significant policy and process work undertaken by the Board and its partner AHPRA in the last year that is important to medical practitioners. In February this year, Professor Ron Paterson completed his Independent review of the use of chaperones to protect patients in Australia. This review was commissioned by the MBA and AHPRA in the wake of allegations of indecent assault on multiple male patients by Melbourne neurologist Dr Andrew Churchyard. I encourage you to read his report and the recommendations which found the use of chaperones was, on the whole, not effective in protecting patients and recommended moving away from chaperones to gender-based restrictions on practice. All recommendations were accepted, resulting in the establishment of a National Sexual Boundaries Notifications Committee. Two Queensland Board members have been appointed to this committee, a community and a practitioner member.
Past President Dr Chris Zappala presented at the state inquiry into the performance of the Office of the Health Ombudsman, along with AHPRA and the MBA. The practitioner experience of the notifications process, amongst other matters, has been repeatedly highlighted as having a negative effect on practitioners. Recommendations were made to improve the practitioner experience through greater clinical input at earlier stages in the process, which will in turn improve timeliness. AHPRA and the MBA have commenced recruitment to clinical advisor positions (medical officers) who will be employed to provide guidance and direction to the AHPRA staff involved in the management and investigation of notifications. In the near future, we anticipate the clinical advisors will be involved in early clinical discussions with practitioners, the subject of the notification, to work through the notification. This has been trialled in South Australia and has great practitioner (and MDO) support and acceptance. 1 The Health Practitioner Regulation National Law is in force in each state and territory
There has been interest from government at a state and national level into the performance of the complaints/notifications system through several inquiries. AMA Queensland Immediate Doctor Q Summer 31
MOCA 5
negotiations progress In partnership with AMA Queensland, our affiliate union partner ASMOFQ is gearing up to negotiate the next round of the Medical Officers’ Certified Agreement 5 (MOCA 5) with Queensland Health. This agreement impacts your pay, terms, and conditions. Ahead of the formal negotiation period commencing in January 2018, our Workplace Relations Team are currently consulting with members from the lead negotiating team to formalise the MOCA 5 bargaining strategy and finalise the log of claims which will be presented to Queensland 32 Doctor Q Summer
Health in December 2017. The lead negotiating team includes Senior Medical Officers and Registered Medical Officers who will be your voice at the bargaining table. The lead negotiating team will not only decide on the bargaining strategy, they will also set and confirm the critical items, which will form part of your Log of Claims. Once this has been finalised members will be consulted and further feedback sought on these items. This will ensure you have a say in relation to your Log of Claims.
As part of this round of negotiations, it is vital that our membership is strong and continues to grow. Without maintaining our strong membership our bargaining power diminishes. It will take our collective might to win improved pay and benefits in MOCA 5. If you would like to voice specific details regarding the MOCA 5 negotiations, please contact the Workplace Relations Team directly on (07) 3872 2222 or via email at MOCA5@amaq.com.au.
Moca 5 - laying the foundation for cultural change “The certified agreement protects the most vulnerable among us. It is the standard that the hospitals must reach when deciding how we are treated. That’s why it’s so essential that we get it right.”
r e t s i reg Doctors in Training webinar – Thursday 30 November, 6.30pm
Ensure your membership is up-to-date. Having a strong and united medical workforce behind the MOCA 5 negotiation team ensures your voice is heard at the negotiating table. Keeping your AMA Queensland and/ or ASMOFQ membership current ensures the department knows the medical officers’ log of claims is backed by 100% of the workforce. Renew now and encourage colleagues to join and you will also receive a referral discount of 25% off next year’s membership. Contact details: P: (07) 3872 2222 W: www.amaq.com.au E: MOCA5@amaq.com.au
Register for our upcoming free member webinars to hear what we are working on to better support you in this round of negotiation, and to have your say on what you want to see as the outcome. Senior Medical Officers webinar – Wednesday 13 December, 6.30pm
register online via the events calendar at www.amaq.com.au
As you recall we wrote to all members covered by the current MOCA 4 seeking expression of interest (EIO) in becoming a Local MOCA Representative back in October. This role is vitally important in ensuring that we achieve the best possible ‘wins’ at the negotiating table and increase membership.
Is our membership concentrated in only a few departments or evenly spread?
As part of the growth plan around the MOCA 5 negotiations the following areas are being considered:
Are we appealing to every grade/ discipline of eligible staff?
How does the membership in different work areas compare with staffing in such areas?
Moca 5 - Membership matters
Where do we lack reps? What is the profile of our reps? Are we recruiting men and women in proportion to their presence in the site/workplace/department/unit?
Also, meetings with senior members from the lead negotiating team have taken place to formalise the MOCA 5 bargaining strategy and the draft Log
of Claims. The lead negotiating team includes SMOs and RMOs who will be your voice at the bargaining table. As part of this round of negotiations, it is vital that our membership is strong and continues to grow. Without maintaining our strong membership our bargaining power diminishes. As we head towards MOCA 5 negotiations we will be visiting workplaces and members, running webinars and posting updates via the ASMOFQ website. If you have any questions and/ or want to become a Local MOCA Representative email us at MOCA5@amaq.com.au with your EOI. Your involvement increases our success at the negotiating table. Doctor Q Summer 33
Partnership with RSL Queensland helps veterans AMA Queensland has partnered with RSL Queensland to provide general practitioners access to cutting-edge research into veteran health issues and specialist programs. Announced in Townsville during Veterans’ Health Week, the affiliation will highlight the unique needs of veterans and the support offered by RSL Queensland that can complement the clinical aspect of treatment. RSL Queensland Veteran Services Manager Rob Skoda said the changing face of veterans made it even more important to keep abreast of their health issues and needs. “There is a stereotype of veterans as elderly gentlemen but this is not the reality,” Mr Skoda said. “More than half of all veterans who approached RSL Queensland for assistance last year were under the age of 50. The increase in gender diversity in the Australian Defence Force (ADF) is also reflected in the veterans we are seeing. “And although the extremely important issue of veteran mental health often leads in the media, we also know that
34 Doctor Q Summer
tinnitus, sensory-neural hearing loss and degenerative spinal discs are included in the top five most common health problems affecting service personnel when they return home1.”
“RSL Queensland has a host of programs for veterans and current service people, including family surf days, off-road racing, trekking and rural retreats,” Mr Skoda said.
As well as 150,000 veterans, Queensland is home to 21,500 current serving men and women. The total military community, including families of ADF personnel, is estimated to be close to half a million people.
“We also provide seminars for partners and spouses to help them meet the challenges of the military lifestyle, such as relocations and deployments.
Townsville GP and AMA Queensland North Area Representative Dr Michael Clements served in the Royal Australian Air Force for 13 years and remains a member of the RAAF Specialist Reserve. He said he welcomed a closer working relationship with RSL Queensland. “Because of my military service, I am keen to support ex-service personnel as well as family members of those who are currently serving,” said Dr Clements. “I see a lot of veterans with musculoskeletal injuries from their service as well as those who are struggling mentally to read just to civilian life.” At a function in Townsville to announce the affiliation, Townsville GPs and allied health professionals discussed the current issues affecting the defence community and heard about RSL Queensland’s services. As well as assisting veterans with claims to the Department of Veteran Affairs, RSL Queensland provides a range of health and wellbeing programs aimed at providing rehabilitation, boosting resilience and fostering social connections.
“Over the past four years, we have committed $7 million in research into veteran mental health issues through a partnership with the Gallipoli Medical Research Foundation. This includes ground-breaking research into PTSD which has been developed into an online GP education program via ThinkGP. “And of course, there is also Mates4Mates, which was set up by RSL Queensland specifically to provide assistance to wounded, injured and ill veterans and current serving ADF personnel,” he said. Mr Skoda said RSL Queensland hoped the affiliation would assist in linking up service personnel with doctors who either had served in the ADF or had experience in treating veteran health issues. “Veterans are often reluctant to open up to doctors who have no experience of being deployed to a war zone or to facing the challenges of transitioning back into civilian life,” Mr Skoda said. “Through this affiliation, we hope doctors and RSL Queensland can work together to ensure veterans who need help can find an experienced GP or specialist early so they can get on with leading happy, fulfilling lives.” 1. https://www.dva.gov.au/sites/default/files/ Top20_Mar2017.pdf
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Medical leadership and management development I have been overseeing this significant expansion in the delivery of clinician leadership and management development programs and consultancy. A compelling case exists for increased clinician engagement, collaboration, innovation and leadership to drive improved service delivery and deliver sustainable system change. Queensland Health recognises that investing in clinician leadership delivers significant benefits for patients and staff.
Jan Phillips, Executive Director, Centre for Leadership Excellence, Queeensland Health Over the past two years, Queensland Health has been leading the nation in the leadership and management development of its clinical workforce, and in particular its medical workforce. Since 2015 almost 800 clinicians, including over 300 doctors have completed transformational longterm leadership and management development programs delivered by the Department of Health’s Clinical Excellence Division. In the current 2017/18 financial year, a further estimated 945 clinicians (more than the total of the past two years), including another large component of medical staff, are expected to complete the career ranging suite of state-wide clinician leadership and management development programs. In addition, the Clinical Excellence Division will be delivering leadership and management development consultancy services to a number of high priority Hospital and Health Services, and is also working in collaboration with the Metro South Hospital and Health Service in the state-wide delivery of the highly regarded Clinician and Medical Managers Orientation Program. 36 Doctor Q Summer
The suite of career ranging clinician leadership and management development programs to be delivered by the Clinical Excellence Division include:
Learn2Lead Program for junior doctors, which is a three month program that develops personal leadership style and potential, and increases personal resilience; Step Up Leadership Program for early/mid-career clinicians, which is a 3 month multidiscipline program that develops and strengthens the skills clinicians need to motivate and lead a healthcare team; Manage4Improvement Program for clinician managers and directors, which is a 6 month multidiscipline program that builds leadership and management capabilities to support Improvements in health service delivery; High Impact Leadership Program for pre-executive level clinicians (currently under development and expected to be launched in November this year) which will be a 6 month multidiscipline program that builds capability to drive a culture of collaboration, service excellence, and service improvement, and supports executive succession for senior clinicians.not generally permitted. In Victoria, S4 or S8
self-prescribing is NOT allowed under any circumstances. All of the programs delivered by the Clinical Excellence Division accommodate different learning styles and experiential learning, adopting a blended approach that includes face-to-face workshops, leadership coaching and project challenges that promote learning in the workplace. Collaborative learning is an essential feature of the program designs, which require the active contribution of all participants. Feedback from a recent participant of the Learn2Lead Junior Doctors Program exemplifies the benefits of the programs: “The program focused on helping us to understand how to effect change by leadership. We worked right from having the idea through to the details of whom and what was required to make change happen. This was invaluable to me as a junior doctor, especially in the Mount Isa setting, where the number of clinicians is small and junior doctors have a great opportunity to introduce change for the better. The program gives you the confidence to tackle problems you have recognised but were unsure how to proceed with.� Enquiries regarding the programs and services delivered by the Clinical Excellence Division can be directed to the Centre for Leadership Excellence email address: Leadership@health.qld.gov.au
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(07) 3056 3221 info@completeent.com.au 1/135 Wickham Tce BRISBANE QLD 4000 www.completeent.com.au
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Dr Jeannette Young, Chief Health Officer and Deputy Director General, Prevention Division, Queensland Health
Codeine rescheduling:
and Dr Sue Ballantyne, Senior Medical Advisor to the Chief Medical Officer, Queensland Health
P H A R M A C I S T O N LY T O PRESCRIPTION MEDICINE W H AT I S C H A N G I N G AND WHY? In December 2016, the Therapeutic Goods Administration (TGA) announced the final decision that over-the-counter (OTC) medicines containing low-dose codeine, such as Nurofen Plus, Aspalgin and cold and flu tablets, will become prescription-only products from 1 February 2018. Research has repeatedly shown that the low dose of codeine available OTC provides no more pain relief than products with paracetamol or ibuprofen alone. In addition, because codeine is an opioid medicine, breaking down into morphine in the body, there is the possibility of substantial harms associated with long-term regular, or excessive use which can lead to tolerance, dependence, toxicity and in high doses, death. Many of the deaths and complications from excessive use of codeine-related products are primarily due to the coformulated ingredients, particularly paracetamol and ibuprofen. Overdose of paracetamol can result in liver damage and long-term or high dose ibuprofen use can lead to internal 38 Doctor Q Summer
bleeding, kidney failure, elevated blood pressure, heart attack and stroke. Furthermore, evidence shows that long term use of opioids can make chronic pain worse by causing hyperalgesia. Research conducted by the National Drug and Alcohol Research Centre at the University of New South Wales* indicated that the rate of codeinerelated deaths in Australia more than doubled between 2000 and 2009, driven primarily by an increase in accidental overdoses. Within Queensland there has been a steady increase in the number of people entering the Queensland Opioid Treatment Program with codeine as their main drug of choice.
The latest Australian Institute of Health and Welfare (AIHW) study, undertaken in 2016 showed that 3 in 4 recent painkiller/opioid misusers reported misusing an OTC codeine product in the past 12 months. The next most commonly misused painkiller/opiate among misusers of pharmaceuticals was prescription codeine products such as Panadeine Forte.
Types of pain-killers/opiates misused, recent(a) users of pain-killers/opiates aged 14 and over, 2016 (%)
(a) Used in the past 12 months.
HOW WAS THIS DECISION REACHED?
W H AT C A N I N D I V I D U A L DOCTORS DO?
The scheduling of medicines is managed by the TGA who administers the Commonwealth Therapeutic Goods Act. The process is an independent risk benefit analysis that prioritises public health and safety and is conducted by applying a national scheduling framework that is agreed to by all state health ministers.
The re-scheduling provides an opportunity for doctors to engage with their patients and have a discussion about alternative pain management options, risks associated with use of codeine containing products and the development of treatment plans for patients with chronic pain or dependency issues.
The final decision to reschedule codeine was made via a lengthy and robust process over a two year period. The process included a National Regulatory Impact Statement, an independent report from KPMG, a codeine safety review, lengthy public consultation and advice from the Advisory Committee on Medicines Scheduling (the ACMS).
Clinically, there is little indication for the use of low-dose codeine – it has minimal, if any, analgesic properties. There are now safer and more effective options available to help manage cold and flu symptoms and acute pain, both pharmacological and non-pharmacological, many of which are available in the pharmacy.
There have been some concerns raised about the re-scheduling decision and what implications it might have for certain key stakeholder groups. This was highlighted in a recent letter from the State and Territory Health Ministers (except South Australia) to the Federal Minister for Health. Queensland’s Minister for Health Cameron Dick has particularly raised the issue of regional and remote stakeholders. Queensland Health formed the Queensland Codeine Re-scheduling Implementation Group (QCRIG) in June 2017, with a wide membership including, AMA Queensland, Pharmacy Guild of Australia, general practice representation and consumer groups to develop local strategies to ensure that consumers and health professionals in Queensland are informed of the changes. This group participates in, and provides reports to, a nationally coordinated group, formed by the TGA to develop strategies and resources that can be used nationally. The information websites at the end of this report include work that has been undertaken as part of these groups and are useful resources for medical practitioners.
Although the re-scheduling is due to occur on 1 February 2018, there may already be a shortage of products in pharmacies. Therefore, it is important for doctors to start the conversations with their patient now, so that treatment options can be explored before products are moved off the shelves. Doctors are encouraged to consider the following: When reviewing a patient’s medication history, ask specifically about OTC medications, and discuss their current use with them. This may assist in identifying people with unmanaged chronic pain or dependency issues and provide opportunity for ongoing treatment planning. It is understandable that time constraints make in depth conversation difficult, so you might like to consider asking your patients to make a follow-up appointment in order to discuss these issues. Know how to manage acute pain without reliance on opioids. The new formulations of paracetamol and/or ibuprofen available in the pharmacy will provide analgesia for acute pain conditions such as dental pain and headaches. Encourage patients to use these medications as a first line therapy for short-term acute pain episodes. Develop practice policies for prescribing opioids, including codeine containing products,
for chronic pain. Ensure all non-pharmacological methods of managing the pain have been tried before prescribing any medications - especially opioids. It is recommended that these policies do not allow for immediate substitution of codeine containing products with other opioids including Panadeine Forte, Tramadol or Endone. Ensure patients are aware of the policies for the practice. Understand the risks associated with long term codeine/opioid use and advise your patients. Know how to recognise dependency issues and refer your patient or work with them to develop a treatment plan. If possible discuss options for advice or referral with your local Alcohol and Drug service. Be aware of your obligations in the Health (Drugs and Poisons) Regulations 1996 (HDPR) when treating a person who you believe is drug dependent (see s122 of the HDPR). 13S8INFO (137846) line is available for all medical practitioners to seek information about a patient’s S8 dispensing history. Available 7 days-a-week, 8am-8pm. WHERE CAN I GET MORE INFORMATION? • The Queensland Health Codeine page: https://www.health.qld.gov.au/clinicalpractice/guidelines-procedures/medicines/ medicines-containing-codeine • The TGA Codeine Hub: https://www.tga.gov.au/codeine-info-hub • NPS Medicinewise: https://www.nps.org.au/ • Scriptwise: http://www.scriptwise.org.au/codeine
HELPFUL WEBSITES FOR PATIENTS: • http://www.painaustralia.org.au/getting-help/ right-care/self-managing-chronic-pain • http://www.painaustralia.org.au/ References *Roxburgh, A., et. al. (2015). Trends and characteristics of accidental and intentional codeine overdose deaths in Australia, Med J Aust; 203 (7): 299 Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW
New Council members Dr Sam Kim MBBS FRACP MPH MBA MMED (SLEEP)
Greater Brisbane Area Representative, Thoracic and Sleep Physician Dr Kim is a consultant physician in private practice with broad multidisciplinary experience in respiratory and sleep medicine, public health, research, management, medical ethics and complementary medicine. He is an active member of different professional societies including AMA Queensland. Dr Kim qualified in 2003 as a Fellow of the Royal Australasian College of Physicians and is dedicated to early diagnosis and prevention, pulmonary rehabilitation and palliative care of advanced lung diseases in Brisbane CBD and the Northern NSW. He is actively involved in medical education as a Senior Lecturer at the University of Queensland and currently training in law relevant to health care and public health reform.
Haydn Dodds
B M E D S C M D C A N D I D AT E
Medical Student Group Representative Student, Bond University Haydn is currently enrolled in the Doctor of Medicine program at Bond University. He is formerly the President of the Medical Students’ Society of Bond University (MSSBU) and has also advocated for his peers as the local councillor to the Australian Medical Students’ Association (AMSA). Haydn has also authored policy for AMSA and is a John Flynn Scholar. He currently sits on AMA Queensland’s Council of Doctors in Training executive as the medical student representative.
Dr Stephen Withers
MBBS MMEDSC FRACP AFRACMA
Dr Siva Senthuran
MBBS BSC FRCA FANZCA FCICM
Full-time Salaried Medical Practitioner, Intensive Care Specialist Dr Senthuran is Senior Staff Specialist and Deputy Director of Intensive Care at Townsville Hospital. Trained in London, Dr Senthuran worked in hospitals in Norwich and Cambridge before working as a senior registrar in intensive care in Brisbane. He took up his current role as Senior Staff Intensivist in 2012.
40 Doctor Q Summer
Gold Coast Area Representative, Paediatrician and Clinical Geneticist A University of Queensland graduate, Dr Withers served his junior years at the Royal Brisbane Hospital and spent four months as a paediatric registrar covering Mornington Island, Doomadgee, Dajarra and Cloncurry. Dr Withers completed a fellowship in clinical and metabolic genetics in Toronto, Canada. Dr Withers has been in private practice at Clinical Genetics Service and Gold Coast Paediatrics since 2006. He sits on AMA Queensland’s Visiting Medical Officer committee and has been President of the Gold Coast Medical Association since 2015.
Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 to inspect or discuss further. An opportunity to practice in Upper Mount Gravatt, is available now. The Centre for Minimally Invasive Neurosurgery and Spine Surgery (CMINS) is located at Level 3, 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis. Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design. Other features include:
On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices.
Other nearby specialities include: Neurosurgery An opportunity to practice in Upper Mount Gravatt, is available Neurology Ophthalmology now. The Centre for Minimally Invasive Neurosurgery and Spine Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 or discuss Surgery (CMINS) is located atto inspect Level 3, further. 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis.
Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design.
Other features include: On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices. Other nearby specialities include: Neurosurgery Neurology Ophthalmology
Doctor Q Summer 41
Dr Chris Maguire, Junior House Officer, Logan Hospital; and Chair, AMA Queensland Council of Doctors in Training
Why leadership is so important When discussing the mental health of doctors, recognising the importance and impact of effective leadership is essential. Like the military, medicine is hierarchical. As such, a doctor has two choices in their working conduct: they can lead, or they can remain indifferent to that responsibility. If your choice is indifference, then you have already failed your colleagues and patients before any clinical assessment has commenced. By contrast, if your choice is to lead, then you are obliged to ask the question, ‘am I a good leader?’ Furthermore, ‘how do I define my success in leadership?’ This question is necessarily perennial and role dependent.
42 Doctor Q Summer
A consultant has a strategic role in patient care. Providing deep experience and a long-term view to the outcome required. A registrar, by contrast, provides senior tactical direction on a day-to-day basis. They set the tasks at hand, and lead junior staff in achieving them. A resident, meanwhile, is the enactor of that plan, however, also needs to be tactically agile enough to achieve the ‘commander’s intent’ in the most efficient and safe way regardless of the circumstances.
those you are leading. Fundamental to all of that is personal example. Major Richard ‘Dick’ Winters, of the 506th Parachute Infantry Regiment in World War II, makes special note of this in his book Beyond Band of Brothers, “How do you get the respect of the men? By living with them, being a part of it, being able to understand what they are going through and not to separate yourself from them.” The Australian Army distils this into four values that are engraved on stone signs that adorn the entrance to basic training at Kapooka: courage, initiative, respect, teamwork. These tenants are not unique to battle - they are universal.
In this context, the question of effective leadership is complex and has a direct impact on patient care. Poor strategic planning and involvement from consultants, leaves registrars directionless. Poor tactical direction from registrars handicaps good residents from achieving their boss’s intent. Poor base level leadership from residents creates animosity, confusion, and frustration among nursing staff and colleagues. All of this has an impact on the patient’s experience. It also has a tremendous impact on the morale of those we work with, and supervise.
They are also tenants that doctors need to reflect on. Am I calm, respectful, direct, and purposeful in my activities? Do I pay adequate regard to the state of those I’m working with and seek to relieve them, or use my resources to make their lives easier were possible? Do I make a point of only asking for an extreme effort from my subordinates when it is truly justified, and then do I make myself a part of that effort? Am I developing the potential of those I lead and empowering them to do the same? In short, am I someone that my subordinates want to follow, or someone they have to follow?
Despite this fundamental truth, medical school and professional development rarely, if ever, focuses on the important job of training doctors to be good leaders. I have always found this shocking since the tragedy, fatigue, and stress of a hospital has always reminded me of military experiences.
These are basic questions that all levels of medicine demand we ask ourselves. They are also only a start.
From base principles, leadership must be derived from integrity, professionalism, effective communication, and a deep care for
It is a myth that leadership is inherent in some people and not in others. It is a learned skill that like any, needs to be developed over time. It is our responsibility as doctors to always seek to master this skill. Our patients and colleagues depend on it.
QDHP is here for you For nearly 30 years, Doctors’ Health Advisory Service Queensland (DHASQ) has helped care for doctors. Last year, DHASQ launched its service arm – Queensland Doctors’ Health Programme (QDHP). QDHP has been delivering the helpline and providing support for doctors and medical students across Queensland who have been experiencing distress or health issues. We are very grateful for the wonderful group of volunteer GPs who support our service, providing valuable care for those who call. Our social worker, Hester Van der Elst, provides advice and assists those navigating the complex problems. We provide support for a breadth of issues: mental and physical health, workplace concerns and career quandaries. We focus on connecting doctors and medical students to the health system - to find the compassionate care they require.
W H AT H A P P E N S W H E N I RING? We aim to provide a confidential and independent service for all our callers. When you ring, your call goes directly to our personalised paging service. You will be asked to leave your name and number. The person on call will ring you back within a couple of hours. During the day, Hester will often make the first call to touch base, with further options for more complex advice. A panel of specialists provides support for our GPs taking the calls. We always encourage our callers to have their own GP, but we understand that many doctors have found this difficult. We don’t provide clinical care, but we will help to link you to the care you need and to other relevant support services.
W H AT E L S E D O E S THE QUEENSLAND D O C T O R S ’ H E A LT H PROGRAMME DO? QDHP also provides education to help doctors improve their health and wellbeing. Importantly, we provide training so that doctors can better care for their doctor-patients. We are extending our educational services into regional and rural areas with presentations across Darling Downs, West Moreton and Gold Coast. We work with organisations such as the Primary Health Networks to assist doctors in remote areas to receive independent support for their wellbeing. We deliver education in many settings, including grand rounds, covering many of the specialties.
Help is only a call away
Ph: 07 3833 4352
For doctors and medical students only
Dr Margaret Kay - Medical Director, Qld Doctors’ Health Programme QDHP advocates strongly for doctors’ health. We supported the introduction of Resilience on the Run in Queensland hospitals providing junior doctors with an excellent opportunity to build resilience and skills to integrate their personal health strategies with their busy work. QDHP worked closely with AMA Queensland and Queensland Health at the recent Suicide Prevention Forum – Doctors’ Wellbeing in August, which provided input into the National Forum in Sydney in September 2017. As part of the Australasian Doctors’ Health Network, QDHP supports the biannual Doctors’ Health Conference. QDHP has also supported your initiatives in your workplaces, providing advice and input to enable your ideas come to fruition. Our expertise has helped to inform new initiatives and research. Our work with Metro South Health supported their Health and Wellbeing Survey1 which has since led to a number of interventions to support the health of their staff including the development of their App – Vigeo.2
FOLLOW US @DocHealthQLD 1. Kay M, O’Dwyer S, Cooke G, Fergusson L. My Health: A Doctors’ Wellbeing Survey 2016. Brisbane: Medical Employment and Workforce Planning Unit, Metro South Hospital and Health Service, 2016. https://metrosouth.health. qld.gov.au/research/my-health-report
2. Vigeo is available at: https://play.google.com/store/apps/details?id=dh. greenacorn.com.au.doctorshealth&hl=en https://itunes.apple.com/au/app/vigeo/id1173368701?mt=8
Doctor Q Summer 43
Different approach needed to close the gap While progress is being made thanks to some great services across Queensland, the statistics remain concerning. Earlier this year the Senate partnered with four of the state’s peak health bodies* to host a unique forum with the potential to deliver outcomes that could genuinely make a difference to the health and wellbeing of Aboriginal and Torres Strait Islander children.
If we are to improve the health of Aboriginal and Torres Strait Islander peoples and close the gap we need to do things differently, writes the Chair of the Queensland Clinical Senate, Dr David Rosengren. The health of Aboriginal and Torres Strait Islander peoples is one of the greatest health challenges in Australia today. I’m sure no one reading this needs to be reminded of the average 10-year life expectancy gap between Aboriginal and Torres Strait Islander and non-Indigenous Queenslanders. Or the fact that around 15 per cent of pregnant Aboriginal and Torres Strait Islander women attend fewer than the recommended five antenatal visits. And that 1.8 times as many babies born to Aboriginal and Torres Strait Islander mums are born of low birth weight compared to non-Indigenous mums. 44 Doctor Q Summer
The August 2017 meeting, Growing deadly families, gave Aboriginal and Torres Strait Islander women, elders and health workers the opportunity to share their experiences of using the health system and their thoughts on how we could do better. Their input was invaluable. We were challenged to do things differently and to stop doing things that aren’t working. And we were asked to continue to listen and work in partnership with the community and for organisations to also work in partnership. We heard that while improving Aboriginal and Torres Strait Islander peoples’ health and wellbeing is everyone’s business, enabling local communities to take charge of their healthcare is key to closing the gap. The critical role of Aboriginal Community Controlled Health Services (ACCHSs) in delivering holistic and culturally appropriate health care to their communities also became very apparent.
Recommendations from the forum focus on the importance of partnerships between local communities, ACCHSs, primary health networks, hospital and health services and other key local stakeholders to identify goals, design, implement and evaluate integrated services that empower patients. We have challenged organisations to build a workforce that reflects the community and its needs by increasing the number of Aboriginal and Torres Strait Islander people employed across all professional streams and nurturing and developing their leadership skills. And we are asking health system leaders to be innovative and active in developing and implementing strategies to embed cultural competence and cultural safety in their organisations. At an individual level, we have to build a comfort and confidence in providing care to our Aboriginal and Torres Strait Islander patients and their families and I believe this will go a long way in breaking down the barriers to care. To read the meeting report and full list of recommendations visit: www.health.qld.gov.au/clinical-practice/ engagement/clinical-senate/meetingspublications/previous-archive. *The Growing Deadly Families forum was a partnership between the Queensland Clinical Senate, the Queensland Aboriginal and Islander Health Council, Queensland Health, Health Consumers Queensland and the Institute for Urban Indigenous Health.
T H E H E A LT H O F A B O R I G I N A L A N D T O R R E S S T R A I T I S L A N D E R P E O P L E S I S O N E O F T H E G R E AT E S T H E A LT H C H A L L E N G E S I N A U S T R A L I A T O D A Y.
Doctor Q Summer 45
Events Calendar W O R K P L A C E R E L AT I O N S WEBINAR Date: Friday 1 December
MOCA 5 WEBINARS Doctors in Training Webinar: Senior Medical Officer Webinar:
Thursday 30 November Wednesday 13 December
The final WR webinar in our series will look at employee misuse of social media in the workplace. The first two webinars, covering personal, carer’s and compassionate leave and managing underperformance are also now available for purchase.
Meet with a panel of AMA Queensland Council and ASMOFQ representatives to understand what the MOCA is, what we are pushing for to support our members, and how you can have your say on what matters most to you.
TOWNSVILLE MINISTER’S BREAKFAST Date: Thursday 7 December Join local colleagues for the bi-annual keynote address by Health Minister Cameron Dick, Minister for Health and Ambulance Services. Following the Minister’s address, our diverse panel will discuss topical local issues for general and specialist private practitioners, salaried doctors and doctors in training.
P R I VAT E P R A C T I C E SERIES TWO Date: Until 8 December
2018 Events
Our travelling roadshow will update those in general and specialist private practice on the major changes to the modern awards and privacy framework.
22 March Doctors in Training Seminar: Thrive in your junior doctor years
Visit www.amaq.com.au for more information or to register for our upcoming events.
7 - 8 September Private Practice and Medico-Legal Conference
April - May Workplace Relations Training
October - November Workplace Relations Training Series
23 - 24 June Junior Doctor Conference
9 November Dinner for the Profession
23 August Women in Medicine Breakfast
6 December Minister’s Breakfast Cairns
46 Doctor Q Summer
DAT E
Thursday 22 March
R EG IS TR AT I O N T I ME 6pm - 6.30pm
EV EN T TI ME 6.30pm - 10pm
N ET WO R K I N G
Canapes & drinks Upon arrival 6.30pm and 8.30pm - 10pm
V EN U E
To be confirmed
THRIVE IN YOUR JUNIOR DOCTOR YEARS
REGIS
Events C
Thrive
TR
alen AT da r a ION tw Avail ww able via the .am aq.co m.au
Qu MA F R E E f o r A bers em $55 for non-m
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With the spotlight firmly on the importance of junior doctor mental health, our panel of senior and junior doctors will discuss a range of topics crucial in keeping yourself happy, healthy and motivated during your junior doctor years. Our panel will step through: Navigating hospital politics safely; Strategies for working in, building and fostering healthy junior doctor teams; Tips for developing assertive communication and handling conflict;
How to build your leadership skills on the job, and ideas on leading at any level; Self-care ‘on the run’ for busy junior doctors, and hacks for keeping yourself healthy; and Avenues for support and assistance at your hospital and through AMA Queensland and other external services.
JU N IO R D OCT ORS
SEN IO R DOC TORS
Dr Rhys Thomas, Principal House Officer, Royal Brisbane and Women’s Hospital; and AMA Queensland Council of Doctors in Training Member
Dr Una Harrington, Emergency Physician, QEII Hospital
Dr Ekta Paw, Principal House Officer – General Surgery, Townsville Hospital; and Rural and Remote Representative, AMA Queensland Council of Doctors in Training
Dr Shahina Braganza, Emergency Physician, A/Director of Clinical Training, Gold Coast University Hospital
John Cosgrove, Senior Industrial Advocate, AMA Queensland
Prof Leonie Callaway, Head - Royal Brisbane Clinical School, and Senior Specialist in Obstetric and Internal Medicine at the Royal Brisbane and Women’s Hospital
1.5 hours of CPD can be claimed for Doctors in Training in year 2, 3 and 4 plus towards their 50 hours CPD activity requirement as mandated by the Medical Board of Australia.
C H AIR Dr Kat Gridley, Advanced Emergency Trainee, Lady Cilento Children’s Hospital; and Deputy Chair, AMA Queensland Council of Doctors in Training; and Secretary, Doctors’ Health Advisory Service Queensland
Renew your membership for 2018 BPAY
Biller code: 134585 Please refer to your individual letter for BPAY details.
online to ONLINE Jump www.ama.com.au/join_renew and have your login and password ready.
PHONE Phone our Membership Team on
(07) 3872 2222 or 1800 626 637 (outside Brisbane) and have your credit card handy.
A hard-copy 2018 membership renewal invoice has been posted to your preferred mail address. Return your renewal tax invoice with payment to PO Box 123, Red Hill QLD 4059.
A M A Q u ee n sl a n d h el pe d o u r m em b er s w it h 5 ,3 4 5 w o r k pl a ce r el at io n s q u er ie s.
w e ’v e g o t yo u r ba c k .
AMA Queensland is leading the fight for your professional interests and better public health. This year, with your support, we’ve gone from strength to strength with major wins for doctors and the health system. AMA membership gives you influence over health policy, as well as unmatched resources to support you at every step of your career including trusted advice from our in-house experts and workplace services, accredited training and professional development, events and networking. We are your voice and your champion. For those in the public system, membership of AMA Queensland also grants you automatic representation by our union partner, the Australian Salaried Medical Officers’ Federation of Queensland (ASMOFQ). With the bitter 2014 contract dispute still fresh in our minds, we are now preparing for a Medical Officers’ Certified Agreement 5 (MOCA 5) battle. When it comes to achieving the best possible pay and conditions, our strength is your strength, so it is a crucial time to renew your support and strengthen our bargaining power. Our in-house Industrial Relations Team has assisted Salaried Medical Officer and Doctor in Training members with over 3,381 queries this year, relating to bullying and harassment, appropriate rostering and payment of overtime and review of contracts. For members in the private system, we provided unrivalled workplace relations support and trusted advice on every aspect of running your private practice, with close to 2,000 member queries answered. Did you know we have a dedicated team who can provide a free in-house practice audit, as well as advice on compliance with relevant legislation? With each and every member we can do more. Your tax-deductible membership supports our advocacy for a world-class health system and medical workplaces.
renew
your membership by 1 December
2016 -17 advocacy highlights for you Helped members with 5,345 workplace relations queries from public and private practice. Compelled the Federal Government to phase out the Medicare rebate freeze. Conducted a national Safe Hours Audit to highlight the need to improve rostering arrangements. Drove Queensland Government to change the Health Ombudsman Bill for the betterment of the complaints system. Secured Queensland Health funding to provide AMA Queensland’s proven Resilience on the Run program at all intern hospitals over the next three years. Pushed for a Queensland trial of non-dispensing pharmacists within general practices.
Secured Council of Australian Governments Health Council review of mandatory reporting laws to support improved mental health for doctors. Produced the second benchmarked AMA Queensland Resident Hospital Health Check Survey identifying the pros and cons of working at each hospital, and supported hospitals to make improvements in problem areas. Released the AMA/ASMOF National Guide on Rights of Private Practice in Public Hospitals and the AMA Public Hospital Report Card showing that without better funding, public hospitals will never meet performance targets. Ensured that a medical professional was appointed as the chair of the Queensland Medical Board and that on the National Board, a medical professional was also sought as chair.
Promoted doctors in medical leadership roles, which means your role as a doctor is not eroded through task substitution. Supported our Doctor in Training members with trusted interview skills advice and resume review assistance through the AMA Careers Advisory service. Lobbied for reforms to Queensland’s maternity services to reverse the trend to midwifery-led practice. Delivered the AMA Private Health Insurance Report Card highlighting policy deficiencies and arguing for regulatory oversight of the industry and better premiums for the public. Began the MOCA 5 campaign in partnership with ASMOFQ for improved pay, conditions and professional development leave.
WITHOUT AMA QUEENSLAND
MAY
2014 march Successfully campaigned to scrap $7 GP co-payment.
june Ran the first annual Junior Doctor Conference and subsidised prices to support junior doctor professional development.
WHO WOULD HAVE ACHIEVED THESE CRUCIAL MILESTONES THAT HELP YOU ON THE JOB?
Negotiated a successful end to a bitter salaried doctor contracts dispute.
Delivered the first annual Queensland Resident Hospital Health Check gauging how doctors in training fare with access to professional development leave, rostering, overtime and bullying and harassment.
may
Queensland Government adopted our recommendation to create whole of government public health plan.
AUGUST Partnered with Queensland Government to launch the GP-focussed vaccination drive.
2015
At our urging, government agreed to an online referral tracking system for GPs and patients.
MAY
LATE 2016 DECEMBER
Queensland Government agreed to fund the AMA Queensland Resilience on the Run wellbeing program at all intern hospitals over the next three years. The Council of Australian Governments (COAG) agreed to a review of mandatory reporting laws, with commitment at COAG for national review of these laws.
Together with our partner union ASMOFQ, working diligently to negotiate the best pay, terms and conditions in the Medical Officers Certified Agreement 5 (MOCA 5) to support Salaried Medical Officers and Doctors in Training.
2017/2018
Successfully lobbied for a medical professional as new chair of the Queensland Medical Board. Lobbied Federal Government to phase out Medicare rebate freeze.
Queensland Government adopted AMA Queensland’s recommendation to subsidise bariatric surgery.
2016 may
june
2017
AUGUST
Queensland Government began reform of the Office of the Health Ombudsman following our discussion paper arguing for a fairer, more expedient complaints management system.
AMA AMEX PRIZE
BAROSSA VALLEY TRAVEL PRIZE
LEXUS EXPERIENCE PRIZE
ONE OF FOUR $500 COLES MYER VOUCHERS
What would you do with $1,000?
The Barossa Valley showcases an array of high-profile wineries offering tours and cellar-door tastings. Renew your AMA Queensland membership by 1 December 2017 by annual payment to win a two-night mini break in the Barossa, including return flights, accommodation, breakfasts, a three-course dinner, and a balloon adventure for two. Soak up all this premiere wineproducing region has to offer.
Renew your AMA Queensland membership by 1 December 2017 by annual payment to go in the draw to win an exclusive Lexus experience package, proudly offered by our corporate partner, Lexus of Brisbane Group.
All members who renew their AMA Queensland membership by annual payment, or switch from monthly to annual payment, by 29 December 2017 go in the draw to win one of four $500 Coles Myer vouchers.
Prepare yourself for a captivating driving experience while you enjoy both the luxury and driving performance of a Lexus. The Lexus experience package consists of a Lexus for the weekend and an exclusive Lexus gift hamper comprising a selection of Crabtree & Evelyn products, Veuve Clicquot, and the finest quality chocolates for you to enjoy at your leisure.
Courtesy of AMA Queensland
– win one of three $1,000 credits
Renew your AMA Queensland membership by 1 December 2017 with your AMA American Express Credit Card for your chance to win one of three $1,000 credits. Courtesy of American Express
Courtesy of World Orbit Travel
Renewal Prizes
Courtesy of Lexus of Brisbane Group
For full conditions terms and visit:
q.co www.ama
enew m.au/page/r
als
New members J U LY Interns Dr Samantha Carmichael Dr Nathan El-Atem Dr Megan Grigg Dr Dominique Stower Doctors in training Dr Kristen Haakons Dr Fleur Muirhead Dr Nicola Campbell Dr Karina Borisova Dr Wen Jye Wong Dr Peter Neeskens Dr Ian Kennedy Dr Anna Lowe Dr Daniel Chivanga Dr The Lan Bui General Practitioners Dr Ajay Bhalla Dr Sarah McLay Dr Venkatesh Nagarajan Dr Dion Dewar Private Specialists Dr Suzanne Ma Dr Ali Kalhor Salaried Medical Officers Dr Danielle Howe Dr Verangi (Chathu) Herath Dr Bilesha Jayawardena Dr Dora Ng Dr Matthew Neal Dr Dominic Ormston Dr Suren Putter-Lareman Dr Robert Adam Part-Time Practitioners Dr Mary-Ellen O’Hare Dr William Pitt Dr Nicole Gastaldin Dr Casey Steele Dr Chee Tee
50 Doctor Q Summer
S EP TE M B E R AUGUST Interns Dr Alicia Palmer
Interns Dr Zoe Wright Dr Stacey Ler
Doctors in training Dr Lucy Hempenstall Dr Sai Navya Purchuri Dr Anna Windress Dr Grace Kirkby-Strachan Dr Sabina Eliseeva Dr Nicholas Starkey Dr Rohit Gupta Dr Deborah Farrell
Doctors in training Dr Esther B Jenkins Dr Stephanie Rea Dr Sebastien Stephens Dr Garth Kline Dr Thomas Cooney Dr Lawrence Ma Dr Cheng-Liang Chou Dr Shreya Armstrong Dr Anna Shirley
General Practitioners Dr Alfred Ngini Dr Christine Stathakis Dr Kevin Hsieh Dr Nilmini Gunawardana
General Practitioners Dr Ebele Chiemeke Dr Zyed Hamad Dr Daryoush Solgi Dr Nadira Anis
Private Specialists Dr Terri Hall Dr Mitchell Kim Dr Joe Alemkunnapuzha Varghese
Private Specialists Dr Greg Sterling Dr Oybek Rustamov Dr Ruth Young Dr Sarike Bhadange Dr Emma Taylor
Salaried Medical Officers Dr Paul White Dr Monica Trujillo Dr Tom Moloney Dr Prabhakara Palla Dr Annette Waterson Dr Solokara Karunarathne Dr Deepak Jain Dr Archana Dwivedee Dr Ramya Krishnan Dr Sandhya Menon Part-Time Practitioners Dr Margaret Davison Dr Harsha Ananthram Dr Rashmi Dixit
Salaried Medical Officers Dr Maria Taylan Dr Morgan Davidson Dr Digant Roy Dr Christopher Tang Dr Sabine Woerwag-Mehta Dr Mark Edwards Dr Hitesh Nischal Part-Time Practitioners Dr Jane Waugh
Local Medical Association round up Redcliffe District Local Medical Association (RDLMA)
Ipswich & West Moreton Medical Association (IWMMA)
Gold Coast Medical Association (GCMA)
Contact:
Contact:
Contact:
Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3284 9777 Meetings: 1 December - networking function
Sunshine Coast Local Medical Association (SCLMA) Contact: Jo Bourke, Secretariat Web: www.sclma.com.au Email: jobo@squirrel.com.au Phone: (07) 5479 3979 Meeting: 30 November
Bundaberg Local Medical Association (BLMA) Contact: Dr Daud Yunus Email: daud.yunus@gmail.com Phone: (07) 4152 2888
Mackay Local Medical Association (MLMA) Contact: Phone:
Dr Bill Boyd 0419 676 660
Phone:
Dr David Morgan, President; Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer (07) 3281 1177
Brisbane Northside Local Medical Association (NLMA) Contact:
Dr Robert (Bob) Brown, President Web: www.northsidelma.com Phone: (07) 3265 3111 Meetings: 12 December
Toowoomba and Darling Downs Local Medical Association (TDDLMA) Contact:
Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939 Wilsonton Medical Centre (Dr Peter Hopson) Meetings: First Tuesday of each month, 7pm at St Andrew’s Hospital, 280 North Street, Toowoomba
CAN’T FIND YOUR LOCAL AREA?
Chantell Badenhorst, Secretariat Manager Web: www.gcma.org.au Email: info@gcma.org.au Phone: 0419 780 505 Meetings: 17 November – social
Fraser Coast Local Medical Association (FCLMA) Contact: Dr Nicholas Yim, Secretary Email: drnnyim@gmail.com Phone: 0421 659 892
Cairns Local Medical Association (CLMA) Contact: Phone:
Dr Sharmila Biswas (07) 4036 4333
Central Queensland Local Medical Association (CQLMA) Contact: Phone:
Dr Michael Donohue 0419 715 658
If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au. Doctor Q Summer 51
A D AY I N T H E L I F E O F A
plastic and reconstructive surgeon Dr Michael Wagels is a plastic and reconstructive surgeon based at the Princess Alexandra Hospital in Brisbane and in a world first, recently led the team that transplanted a 3D-printed tibia into a patient’s leg. Dr Wagels is joining us to talk about the surgery at next year’s Junior Doctor Conference.
W H AT M A D E Y O U DECIDE ON PLASTIC AND RECONSTRUCTIVE SURGERY? I decided I wanted to be a plastic surgeon when I saw my first free flap. I was a medical student at the time, studying lower limb trauma with a special interest in cases that led to amputation. I was ensconced in an undergraduate research degree actively pursuing a career in orthopaedic surgery. During that time, I saw a patient with an exposed ankle fracture reconstructed with an auto transplant using latissimus dorsi muscle, which was performed by a plastic surgeon. It was a relatively new thing back then and it blew my mind. It was enough for me to realise what I really wanted to do. Of course, it took me away from orthopaedic surgery but it was fertile ground for growing into what I do now, both clinically and in terms of my research interests.
HOW H AVE YOU DONE T H I N G S D I F F E R E N T LY ? W H AT I S Y O U R APPROACH? I realise now that I often think about things differently and not necessarily in a good way. Some people find abstractedness frustrating. They usually want to put problems into boxes that 52 Doctor Q Summer
are familiar and this is a very safe way of doing things. I prefer to look for what is unique about any given problem and try to address that aspect specifically. It may not be the problem itself and is often the context; the social situation, co-morbid disease, a patient’s priorities – things that you can only work out by really getting to know your patient. This kind of approach is not to everyone’s liking and so you have to be measured about it. It benefits patients whose problem isn’t common or easy and it is important to be open and clear in your discussions with a patient. It is also important to know your limitations.
W H AT I S T H E M A I N ASPECT OF YOUR W O R K T H AT Y O U ENJOY? I enjoy problem solving; and not in a commercial ‘I am a concreter but I provide driveway solutions’ kind of way. Imagine something that is broken or has a missing part. The challenge is to replace whatever is broken or missing using whatever is sacrificable within the very thing that is already broken. It sounds silly but it is an important part of what plastic and reconstructive surgery is about. It commands an understanding of the problems faced by other specialties and close liaison with them, a solid foundation in the art of taking a history and performing an examination, creativity and an unwillingness to give up. The human body has an amazing array of spare parts and how and when to use them is fascinating. Of course, working out how to replace broken or missing parts when there is insufficient tissue available adds another dimension.
TELL US ABOUT YOUR PAT I E N T A N D T H E I R N E W L E G . W H AT H A S T H I S I N V O LV E D ? The patient came to the multidisciplinary clinic for complex lower limb problems at the Princess Alexandra Hospital in January. He had an infection in his right tibia affecting its entire length. Sadly, the patient had been in pain for the 12-18 months that it took to make a correct diagnosis. Standard treatment for this problem is an amputation. I had been working with a research group at the Queensland University of Technology for some years by then to address the problem of long segments of missing bone. We had been getting surprising results in sheep using absorbable 3D printed models laced with the animal’s own periosteum, the regenerative layer that helps heal fractures. We spoke frankly and honestly with the patient. He was very sensible and understood well the risks and potential complications that the experimental procedure we were proposing might entail. Of course, it was difficult to quantify most of the risks because the operation had never been done before. In situations like this, it is important to have the Hospital Executive team on board. At all times, they were very supportive and ensured that due process was followed. At the time of writing, the patient is well. He suffered no immediate complications and is resting at home with his family. It is too early to see any new bone on his recent scans but we think this could take up to two years and will continue to monitor him closely. I hope to be able to provide a further update at the 2018 Junior Doctor Conference in June.
Dis
cou nte de Ful arly l pr -bir o and gram dm doc em and ber tor will s u i rate bsid n tr be aini s ap rele i s ed ng ase ply d in (DIT stude Jan ) me nt m uar y 20 ber r ate 18 s
INTRODUCING OUR
5TH ANNIVERSARY
JDC INTERNATIONAL, NATIONAL AND LOCAL SPEAKER LINE UP... Dr Alessandro Demaio, Medical Officer, World Health Organisation, Geneva, Switzerland. Dr Dan Diamond MD, Founder and Director of the first state-affiliated medical disaster response team, mental health expert, United States of America. Dr Amandeep Hansra, Chief Executive Officer, Telstra Readycare, Sydney. Prof Barry Marshall, Nobel Laureate and Honorary Clinical Professor, Pathology and Laboratory Medicine, The University of Western Australia, Perth. Dr Amanda Smith, General Practitioner and co-owner/operator of Queensland Raceways, Willowbank. Dr Jeannette Young, Chief Health Officer and Deputy Director-General, Prevention Division, Queensland Health, Brisbane.
FOR MORE INFORMATION W W W. A M A Q . C O M . A U R E G I S T R AT I O N S @ A M A Q . C O M . A U (07) 3872 2222
PLUS MANY MORE TO BE ANNOUNCED...
The Deep South As much a way of life as it is a geographical area, the Deep South still holds that old world charm. Historically, it was differentiated as those states most dependent on plantations and slave societies during the pre–Civil War period. Today, we better know it for its hospitality. It is a melting pot of cultural influences from France, Spain and the Caribbean. The city of New Orleans will play host to the 2018 AMA Queensland Annual Conference, but that is just the starting point to discovering the Deep South. Pre- or post-conference, you can take the opportunity to explore.
MEMPHIS, TENNESSEE
Further up river is the famous home of Elvis Presley in Memphis, Tennessee. While there is plenty to see in Memphis, let’s face it, Graceland is the must see. Not only can you see the mansion but also his impressive car collection and his two custom aircrafts. After the White House, Graceland is the second most visited house in the USA.
N AT C H E Z
Not far from New Orleans, you will find Natchez, probably one of the best places to see antebellum architecture in the south. Antebellum translated straight from Latin means ante – pre and bellum – war. The pre-war architecture is very well preserved and you can’t open your eyes without seeing a piece of history. Lucky for us 21 September heralds the start of the fall pilgrimage in Natchez: over 24 stately antebellum houses are open for touring and with entertainment every evening, it is the perfect time to visit.
NASHVILLE
You don’t have to be into country music to appreciate the juggernaut that Nashville has become. The Country Music Hall of Fame and Museum holds over 2.5 million artefacts and has many interactive exhibits, including a Taylor Swift room. No visit to Nashville is complete without a visit to the Grand ole Opry, which will be celebrating its 93rd year in early October. You can expect some big name to be performing! We will be offering a post-conference tour that will include all of these places and more.
54 Doctor Q Summer
ail ation call or em For more inform d. lan ns ee Qu l Ros at AMA Trave 7200 5 F: (07) 5556 P: 1300 262 88 .com.au E: travel@amaq ldtravel.com.au www.amaq.wor
S T E A M B O AT S
Also on offer is the American Steam Boat Company unique river cruise experience. The largest steamboat ever built, the grand American Queen is a gracious and elegant triumph of American ingenuity. Although filled with today’s modern amenities, her rooms and accommodations display all the opulence of the American Victorian era. Glistening woodwork, fresh flowers and antiques adorn her interior spaces. Outside, lacy filigree evokes memories of the many stately riverboats that preceded her and so inspired her designers. This journey showcases the diversity and drama of the Lower Mississippi River. From Memphis to New Orleans (or vice versa), the river rolls slowly and expansively, smooth as a southern drawl. The bayous and woodlands along the shore create dramatic landscapes that are virtually unchanged since the days of the French fur traders. Gracious towns with palatial mansions and tree-lined streets abound. History is everywhere!
AMA Queensland’s Annual Conference
Sun 23 – Sat 29 September 2018 29.9511° N, 90.0715° W
Doctors, practice managers, registered nurses and other medical industry professionals from around Australia are invited to attend the Annual AMA Queensland Conference in New Orleans from 23-29 September 2018. The program will feature high-profile American and Australian speakers on a range of medical leadership and clinical topics in an exciting, and unique location. RACGP points will be on offer.
To find out more about the conference program or to register, please contact: Neil Mackintosh, Conference Organiser P: (07) 3872 2222 or E: n.mackintosh@amaq.com.au Download a conference brochure from the events calendar at www.amaq.com.au
When overseas travel turns bad “Following a conference in Europe, Joe met his family in Switzerland for a skiing holiday. Whilst skiing, Joe fell and fractured his femur, requiring emergency evacuation to hospital for treatment and surgery. The total costs totaled over $180,000 which included emergency air evacuation, medical expenses, additional accommodation costs for his family and the costs in changing their flight arrangements home.” Overseas medical and evacuation expenses can end up in the hundreds of thousands. Daily hospitalisation costs in Southeast Asia regularly exceed $800; the cost of medical evacuations from the United States can range anywhere from $75,000 up to extreme cases of $300,000. In one private US-based emergency room, a set of four stiches for a badly gashed chin came to $14,107. 2 What would happen if you, one of your colleagues or a family member became ill or injured while away from home? International travel can quickly turn frighteningly expensive. A corporate/business travel insurance policy is an extremely flexible and yet simple solution to ensure you have the peace of mind no matter where you are in the world. A comprehensive corporate travel insurance policy will cover all insured persons (who are generally defined as being directors, executives and employees of the policyholder) whilst travelling to a destination 100km beyond their listed base. A good policy should also include cover for pure leisure travel of directors and include
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their accompanying spouse/partner and dependent children. If a pre-existing medical condition makes it difficult to obtain travel insurance, corporate/business travel insurance policies don’t usually have clauses against existing medical conditions, as long as you have been certified ‘fit to fly’. Any good corporate/business insurance policy worth considering should include the following at a minimum:
unlimited overseas medical and evacuation expenses; reasonable luggage and personal effects limits (minimum of $10,000); ability to specify valuable items, such as expensive bikes; access to a 24-hour emergency assistance hotline; worldwide claims settlement for serious claims; a maximum age limit for an insured person of no less than 80 years (some policies will cover an insurer person to 100 years of age); cover for rental vehicle excesses to a minimum of $5,000 without the requirement to buy down your excess with the vehicle provider; unlimited loss of deposits and cancellation cover; and an automatic extension for associated private travel and directors and executives private travel.
The premium for an annual policy covering up to 12 overseas trips and 50 within Australia can start from as little as $1,000. To qualify for a corporate travel insurance policy, you will need to:
hold an ABN; ensure most of your travel is for white collar business; not participate in professional or paid sport; and meet the definition of an ‘insured person’ within the policy.
At the commencement of the policy, an ‘insured person’ is:
at least eighteen years old; an Australian resident; and in permanent full-time employment at the insured entity.
DISCLAIMER: Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product. 1 Name changed for privacy purposes 2 Man astounded by bill for four stitches at “most expensive hospital in America” http://pix11.com/2014/02/25/manastounded-by-bill-for-4-stitches-at-most-expensive-hospitalin-america/
One less thing on your to-do list Specialist risk and insurance solutions for medical practitioners and healthcare businesses. We can identify your key risks and protect you with the right insurance program, all managed by your own expert insurance adviser: • • • • • •
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Free insurance health check
Call us on 1300 883 059
or speak directly to one of our experts: Chris Mariani 0419 017 011 chris@mgrs.com.au
James Warwick 0402 042 116 james@mgrs.com.au
www.mgrs.com.au
Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687
Income splitting FA C T S V S F I C T I O N As medical professionals, you earn personal services income or PSI. PSI is income derived by an individual as the result of his or her personal work or exertion. These services may be carried out by the individual as a sole trader or sometimes through a trust, partnership or company structure. The tax treatment of income from personal exertion is dealt with under legislation called the Personal Services Income (PSI) attribution regime. The aim of this legislation is to effectively treat the individual responsible for deriving the income as a quasiemployee. This involves looking through any structure that may be in place, such as a medical company or trust, to attribute the income generated back to the individual who earned that income. For example, if Dr Chan is earning $400,000 in personal income from his work as a doctor after business expenses, this income must, under law, be included in Dr Chan’s personal income tax return in the year that it has been earned. He does not have the option to:
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leave significant amounts of income in a medical company to be taxed at the company tax rate; or split the income with other family members to reduce his tax. If Dr Chan were to alienate some of this income away from himself, this would be considered tax avoidance and when found by the Australian Tax Office (ATO) will incur substantial penalties. When considering PSI, it needs to be clear that the type of income covered is only personally generated income, it does not include income generated by a medical practice from service fees or income from investments which may be held in another structure, such as a trust. As a preferred tax agent for the ATO, William Buck recently met with ATO officials, including Directors and Deputy Commissioners and they have advised us that there will be a particular focus on this activity in the coming financial year. Here we explain some of the facts (and the fiction) of personal services income.
I CAN SPLIT INCOME I MAKE AS A DOCTOR BECAUSE I H AVE A C O M P A N Y O R T R U S T. False. The ATO will look through any structure that is in place to see how that income is derived. This is the whole point of the PSI legislation. If income is derived by the medical practitioner as a result of his or her personal work or exertion, this income is personal services income and must be attributed to the individual performing the work. It is sometimes mistakenly assumed that if you meet the requirements to be classified as what is called a Personal Services Business, you can split your income between yourself and your family members. This is not the case. Where personal exertion income is split inappropriately with associates, the ATO is likely to consider this tax avoidance and ignore any tax benefits obtained.
I W O R K AT A N U M B E R OF PRACTICES AND SO 80 PER CENT OF MY INCOME DOES NOT COME FROM THE ONE SOURCE, SO I CAN SPLIT MY INCOME. False. This income is still derived by the medical practitioner as a result of his or her personal work or exertion, this income remains income which has been generated from personal services and must be attributed to the individual performing the work.
THE INCOME I G E N E R AT E M E A N S I AM A PERSONAL SERVICES BUSINESS S O I PAY M Y S P O U S E A WAGE AND S U P E R A N N U AT I O N ?
J U L I E O ’ R E I L LY
Business Advisory Director, William Buck Accountants P: (07) 3229 5100 E: Julie.OReilly@ williambuck.com
True. Provided you are considered a personal services business (PSB). Provided your spouse or an associate provides services to you which is necessary for the generation of your income and you remunerate them at a market rate, these payments will be a tax deduction to you. If no work is performed, no payments can be made to them. You may choose to maximise any superannuation contributions on behalf of your spouse (working in your business) up to the concessional cap, even if the superannuation contribution exceeds the value of the work performed. The current concessional cap in relation to the 2018 financial year is $25,000. This position is supported by Tax Determination 2005/29 and Ryan’s case.
I USE A MEDICAL C O M PA N Y B E C A U S E I T PROVIDES ME WITH ASSET PROTECTION F R O M M Y PAT I E N T S False. Sometimes sole traders are encouraged to operate through a company to take advantage of the additional legal protection and limited liability offered under corporate structure.
In our experience, these protections are not all that valuable to a professional, such as a medical practitioner, where any failing is likely to be at a professional level. In these cases, the limitation of liability offered by a company will not offer any protection to the professional person. Accordingly, it is vital that a medical practitioner maintains an appropriate level of professional indemnity insurance, regardless of the trading structure they have in place. In relation to professional failings (such as medical malpractice) it will be largely irrelevant, from an asset protection perspective, if the medical practitioner is trading as a sole trader, or through a different entity such as a company.
SUMMARY
It never hurts to seek a second opinion. As an AMA Queensland member, William Buck provides you with a complimentary consultation to review your financial affairs and ensure you are compliant with tax legislation. This second opinion is at no risk to you and will give you peace of mind that you are doing the right thing and can stay off the ATO radar.
Doctor Q Summer 59
Patient referral spotlight W H AT S E R V I C E D O YOU OFFER YOUR PAT I E N T S ? Lung Foundation Australia is the national first point-of-call for patients, their families, carers, health professionals and the general community. We work across all areas of lung disease, with a particular focus on Chronic Obstructive Pulmonary Disease (COPD), lung cancer and rare lung diseases including Idiopathic Pulmonary Fibrosis (IPF), Pulmonary Arterial Hypertension (PAH), bronchiectasis and rare lung disease in children. We also work to empower those with lung disease to take the important steps they can to understand and manage their disease. We offer a range of support and services to help people to manage their lung condition and improve their lung health and wellbeing, including: 1800 freecall information and support centre; 1800 freecall lung cancer support nurse; patient education seminars; self-management and disease specific resources; support services including support groups; education and training including webinars and patient seminars; access to the latest research and clinical trials; and advocacy and awareness activities, including fundraising events.
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HOW DID YOUR O R G A N I S AT I O N BEGIN? Lung Foundation Australia is the only national charity dedicated to supporting anyone with a lung disease. We were established in 1990 by a group of thoracic physicians who identified the need for more research in respiratory medicine and recognised the impact of lung disease on our community. Our mission is to improve lung health and reduce the impact of lung disease for all Australians by: supporting those with lung disease, their families and carers; driving world-class research; promoting lung health and timely diagnosis of lung disease; providing clinical support and education; promoting equitable access to evidence-based care; and we rely on the generosity of the community through donations, membership, bequests, grants, and support from business and industry.
HOW CAN DOCTORS HELP YOU/WORK WITH YOU? Lung Foundation Australia works with primary and allied health professionals to support early detection and best-practice clinical management by delivering evidencebased resources and training. As Lung Foundation Australia is the national first point-ofcall for patients, their families, carers; health professionals are encouraged to refer their patients to Lung Foundation Australia’s for access to a range of support and services to help them to live well with their lung condition. Find out more via freecall 1800 654 301 or lungfoundation.com.au. Lung Foundation Australia also has a number of resources to support health professionals including: Guidelines Online training and education Information resources Conferences and events
Where to park cash from your business SPREADING THE REST OF YOUR FUNDS Owning your own practice is a major accomplishment. Once you’ve reached that milestone, it can be difficult to know how to consolidate all your finances to ensure any extra cash coming in is used to its best potential. To help you make the best decisions as to how and where to park cash from your business, here are some of the options available to business owners.
ARE BUSINESS TRANSACTION ACCOUNTS THE ANSWER? Before deciding what to do, it is important to identify what not to do when opting to park cash from your business. One of the flaws a lot of practice owners will fall into is putting all their excess cash into their business transaction account. Historically, business transaction accounts earn very little interest. While this will depend on who you bank with, often business owners use these accounts as they think they need the cash flow.
THE FIRST STEP IN MANAGING EXCESS CASH For most business owners, identifying your short-term cash flow requirements is an excellent starting point. Start with working out your needs for short-term cash flow as it should be kept as liquid as possible. Once you have identified your cash flow for the next month, the best way to keep this cash as liquid as possible is in an everyday transaction account.
The rest of your funds should then be spread among a range of other products available to you. This will allow you to plan and maximise your return. For cash that doesn’t need to be easily accessible, higher interest savings accounts provide excellent returns. There are some good financial products in the market that are geared towards getting the most out of your money. One example of this is our 32-day notice account, which provides higher interest than an everyday account. It functions like a savings account, but with the requirement that you give 32 days’ notice to pull your funds out.
TERM DEPOSITS AS AN OPTION In contrast to higher interest savings accounts, adding a portion of excess funds to a term deposit can also be beneficial for your business. Locking your funds in for a set period of time, whether 30 days, 90 days, or even five years can maximise returns. Once your term deposit matures, you get to make the call on what happens next, whether you roll it over and continue in a term deposit or pull the funds out. The process of setting up shorter term deposits but rolling the funds over is referred to as layering, and layering money is the best way to be able to maximise the business and individual returns for your savings.
SHEHAN RAJAKUMAR BOQ Specialist
www.boqspecialist.com.au
The credit provider is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 Australian credit licence no. 244616 (“BOQ Specialist”). Terms and conditions, fees and charges and lending and eligibility criteria apply. The information contained in this article is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided. BOQ Specialist is not offering financial, tax or legal advice. We recommend that you obtain independent financial and tax advice before making any decisions.
TO GET YOUR CASH FROM HUMMING TO SINGING Spreading some of your excess cash between your everyday transaction account and a notice account or term deposit is an efficient way of getting the most from your money. While it remains sufficiently available to cover any unexpected bills, making the most of these other accounts ensures your money continues to work for you— even when you’re not using it. Doctor Q Summer 61
Prescribing for self and family - what could go wrong? A recent decision in the NSW Tribunal1 found a doctor guilty of professional misconduct, reprimanded and ordered to undergo medical ethics education and mentoring by a psychiatrist because she treated her family members.
CASE HISTORY
The doctor provided prescriptions to her two adult children and husband. She also self-prescribed by issuing scripts in her husband’s name for medications which she consumed. The prescribing spanned five years. The doctor failed to maintain records of the prescriptions, or records of any kind. The doctor attributed her conduct to the chaos and stress that existed in her home life during the time of her misconduct, and a misplaced sense of duty as a mother to meet the needs of her family. She felt obligated to assist her children and her husband in whatever way she could under very stressful circumstances. One of her daughters had received treatment for a variety of addiction, mental health and other problems. Although the tribunal found that the prescriptions to family members were issued in quantities and frequencies that fell within normal parameters, it was considered improper for a doctor to treat and prescribe medicines to family members, other than within narrow limits such as emergency or necessity.
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DISCUSSION
The Medical Board of Australia’s Code of Conduct for Doctors in Australia states: Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. Difficulties may arise for both parties in traversing sensitive matters, or for the patient in making frank disclosures in relation to intimate matters such as private behaviour, giving rise to special risks. The doctor who treats a family member may be affected by subjective emotions and views which hamper his or her ability to undertake a full investigation and give the best and most appropriate treatment. The doctor may be influenced by a desire to please the family member, and not upset that person. Research suggests that it is common for doctors to be asked for medical advice by family members, and it may be useful to discuss the reasons why this is not advisable with your family. 2, 3
SUMMARY POINTS
It is not advisable to treat family members, or yourself. If you need to provide care to a family member in an emergency, hand over your care to another doctor as soon as possible, and document your treatment. Your Professional Indemnity Insurance Policy may exclude cover for claims arising from elective medical treatment provided by you to your immediate family. State and territory legislation regarding prescribing for self and family varies significantly. However, S8 self-prescription is not generally permitted. In Victoria, S4 or S8 self-prescribing is NOT allowed under any circumstances.
References 1.
Health Care Complaints Commission v BXD (No. 1) [2015] NSWCATOD 134 (7 December 2015).
2.
La Puma J, Stocking CB, La Voie D, Darling CA. When Physicians Treat Members of Their Own Families. Practices in a Community Hospital. N Engl J Med 1991;325(18):12904. Epub 1991/10/31.
3.
Evans RW, Lipton RB, Ritz KA. A Survey of Neurologists on Self-treatment and Treatment of Their Families. Headache 2007;47(1):58-64. Epub 2007/03/16.
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.
Business of medicine BILL HICKEY Partner TressCox Lawyers
P: (07) 3004 3523 E: Bill_Hickey @tresscox.com.au
Today’s doctors don’t just need medical skills, they need business skills as well. The business of medicine is an integral component to running a successful business and medical practice. However, the reality of economic pressures to reduce costs while increasing quality and patient care and services are often at odds with each other. Just as compassion and the ability to think fast on ones feet are elements of what makes a good doctor, good doctors today also need business skills to be able to identify and respond to risks and opportunities. TressCox Lawyers is able to assist doctors with the business of medicine in the following areas:
E M P L O Y M E N T, WORKPLACE AND H E A LT H A N D S A F E T Y
VANESSA JAMES-MCPHEE Senior Associate TressCox Lawyers
P: (07) 3004 3512 E: Vanessa_James-McPhee @tresscox.com.au
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It makes business sense to know more about the rules and regulations surrounding managing staff and independent contractor doctors. This business skill not only enables you to potentially minimise labour costs, risk and expenses, but with good leadership and mentoring, maximise output and tenure. The reality though, is that sometimes things arise that lead to a breakdown in the working relationship, leaving the practice exposed to the risk of a claim (such as unfair dismissal, discrimination, bullying) being made against it or you wanting to enforce ongoing contractual restraint provisions. In situations like this, it makes business sense to talk to us about how best to protect your business.
SETTING UP YOUR PRACTICE Looking to open your own medical practice? In between finding a location, crunching the numbers, branding and positioning your practice, choosing your practice management software you should seek advice about the corporate structure of your business. Taking time to get the foundations of your business in order, such as drafting of shareholder agreements, establishment of a trust or another corporate entity is fundamental to the business of medicine.
E S TAT E P L A N N I N G Have you considered how you will leave your estate so that what you have built up during your lifetime is protected for your family and your wishes are fulfilled after you pass away? A poorly implemented estate plan can cause unnecessary stress on your family members and excessive costs out of your estate. We can assist you to put in place an estate plan which ensures that your wishes are upheld, your assets have maximum protection against bankruptcy or potential claims made against your beneficiaries and your family receive their inheritance in the most tax effective manner. TressCox Lawyers is also here to help you with exiting your business and buying and leasing commercial premises.
Look no further...TressCox Lawyers can assist you At TressCox we make it our business to know about Health and Aged Care. We can help guide you through the increasingly complex operational, legislative and policy framework. We can provide you informed legal advice on litigious, disciplinary and commercial issues at all levels. With considered legal advice we can assist you to operate a commercially viable business that complies with the health services industry’s unique and ever changing regulatory environment.
We can help you with: Setting up your practice, including buying a business, business structuring, contracts and advice on restraint of trade clauses Running your practice, including IR & Workplace Safety, employment, service, and locum contracts; and corporate governance Group practice issues and bringing in additional owners including partnership, shareholder and buy-sell agreements
Vanessa James-McPhee, Senior Associate
Brisbane P. (07) 3004 3512 M. 0438 874 511 Vanessa_James-McPhee@tresscox.com.au
Bill Hickey, Partner
Brisbane P. (07) 3004 3523 M. 0421 756 502 Bill_Hickey@tresscox.com.au
www.tresscox.com.au
Paul de Silva, Special Counsel
Brisbane P. (07) 3004 3520 M. 0422 858 807 Paul_de_Silva@tresscox.com.au
Selling your practice including helping to get ready for sale, workout and earn-out arrangements Resolution of disputes about restraints, contracts (including building contracts and shareholder agreements) and debt collection Regulatory issues including investigations by the OHO, AHPRA and Medicare Australia Your personal matters including buying, selling and leasing property and Estate Planning.
Tony Mylne, Partner
Brisbane P. (07) 3004 3545 M. 0422 044 210 Tony_Mylne@tresscox.com.au
Katharine Philp, Partner
Brisbane P. (07) 3004 3536 M. 0409 586 785 Katharine_Philp@tresscox.com.au
Lynette Reynolds, Partner
Brisbane P. (07) 3004 3555 M. 0416 069 573 Lynette_Reynolds@tresscox.com.au
P. (07) 3004 3500 @TressCox
Doctor Q Summer 65 @TressCoxHealth
Dr Kat Gridley, Advanced Emergency Trainee, Lady Cilento Children’s Hospital; and Deputy Chair, AMA Queensland Council of Doctors in Training, Queensland Doctor’s Health Programme Located an hour’s drive from Brisbane in Grandchester, Homage Restaurant at Spicers Hidden Vale is a hidden gem within the beautiful countryside of the Great South East. Recipient of a chef’s hat in the 2017 Good Food Awards, this charming restaurant on a 12,000 hectare homestead property is the perfect way to sample the produce of the Lockyer Valley and its surrounds, and an opportunity to truly relax while immersed in the tranquillity of the clean country air.
Homage Restaurant,
SPICERS HIDDEN VALE
66 Doctor Q Summer
Homage is open for breakfast from 7.30am to 10am daily, and is a truly gourmet occasion. Feast on eggs benedict with wood smoked ham, scrambled eggs with roasted onion and tomato tart, local yogurt panna cotta or the toasted waffle with banana and bacon, before tackling one of the local trail bike routes, or booking yourself in for a massage facial or body wrap at Spa Anise for the ultimate indulgent escape. Lunch is available from midday daily and is a showcase of all things Australian, in a’la carte or two and three course style. First course includes a choice between vegemite slow roasted pumpkin with macadamia, pork with orchard fruit from Homage’s own farm or smoked trout with cabbage and nasturtium. The “last of the rabbit, first of the carrot” entrée is a standout here. A flavourful harmony of sweet and savoury, the perfectly tender rabbit is complimented by a sweet carrot puree and carrot ribbons underneath a roof of crispy pork crackling for a textural crunch. The adventurous foodies will be drawn to the thought of emu, served with cured yolk, emu apples and native pepper. The dish is served with a Wolsterchire cracker and arrives atop a piece of saltbush lit alight for maximum smoky flavour, and is a feast for the eyes as much as the palate.
ordinary. The pescetarian option is a Murray cod in macadamia milk with bush lemon; a beautiful balancing act between creaminess and acidity, with the added texture of charred baby cos and a lashing of pea oil. Dessert is a must, whether it’s local Brie served with lavosh and pickles, the passionfruit with roses or the goats fare with milk. The chocolate with beetroot comes served as just that – a chocolate sphere atop a chocolate mousse and soil, just begging to be cracked to release the river of beetroot sauce within. The lemon meringue while lacking the same element of theatre, more than makes up for it taste, served with lemon myrtle ice cream, this dish lingers on the mind just as long as the palate. Homage also offer a spectacular eight-course tasting menu for $110, or for something smaller, the Homestead menu showcases the flavours of wood fire cooking in the form of a brioche pork burger, charred beef flatbread, chacuterie board or the pasture fed chicken and warm vegetable salad. For the ultimate weekend escape that will make you forget all about ward rounds and clinic, look no further than their gourmet getaway for $639 per night, which includes
‘a HIDDEN GEM within the BEAUTIFUL COUNTRYSIDE of the Great South East.’ The second courses are just as stimulating. Wild shot venison with fermented garlic. 120-day grain-fed siroin, lamb with olive and white chocolate, and pasture raised hen with cauliflower and smoked cheddar are all sure to entice and intrigue. True Australian foodies need look further than the tantilisingly tender tail of kangaroo, served with poached pear, lillipilli berries and walnut crumble, which only serve to respect the inherent sweetness of the kangaroo meat, and proves that game in the hands of a talented chef can be far from
luxury overnight accommodation at Spicers Hidden Vale, a gourmet breakfast, a wine and cheese plate on arrival and the Homage tasting menu for two. Spicers Hidden Vale and Homage Restaurant in Grandchester are the ultimate destination for a special occasion or just a weekend escape with a difference. Make the drive and discover the beauty of the Queensland countryside for yourself!
Doctor Q Summer 67
Real wine ARE YOU FOR REAL? IS THE WINE YOU’RE BUYING FROM A REAL WINERY? The wine industry has gone through some dramatic change in recent years and the retail landscape has had the biggest shake up of all. Where once the local bottle shop or independent chain was where most of retail wine was sold we now see a market dominated by two major players through a series of aggressive acquisitions which has seen a dramatic reduction in independent wine retailers. Many commentators are reluctant to use the ‘D’ word but duopoly is very close to the mark.
W H AT D O E S I T M E A N T H O U G H ? For the consumer it’s a bonanza, big wine brands are discounted to a level where in many cases they are being sold at or near cost price to get you reaching for your wallet. So where is the margin recovered for these companies? The official term is ‘buyer own brands’, a concept born of collaboration between a retailer and existing winery, a relationship both parties were proud to support and acknowledge. A special bottling of a wine made for that
retailer bearing the winery’s name. Sadly, this concept has gone down a disturbing road where biblical volumes of bulk wine are being passed off as wine brands that actually exist from companies you’ve never heard of before, or worse, companies that haven’t existed for years. At $10 per bottle or less, consumers are prepared to take the punt and in many cases the margin made on these wines are bigger than a restaurant mark up. Yes, you’ll see an address on the label somewhere, it’s the law, but look up the address and in many cases, it either leads to the same refinery or a registered address nowhere in coo ee of a winery. Don’t get in your car to visit the cellar door… it’s not there. Never was. None of this supports the wine industry, the growers, the vineyard contractors, the rural towns that support these people. The ‘beveragitisation’ of the wine industry remains a big challenge for wine producers and legislators alike, the next five years will be a critical time in an industry that’s been under siege since ‘the wine glut’, prolonged by the global financial crisis and parity with the US dollar. As consumers of wine you can do your bit by buying what’s real. When you’re pondering your next wine purchase ask your wine merchant about the providence of your wine. In our case, we continue to champion wineries that do exist, that have a destination and or family owned vineyard. There’s enough variety and value out there without making it up.
PHIL MANSER Wine Direct
P: 1800 649 463 E: phil.manser@ winedirect.com.au
68 Doctor Q Summer
Life gems ‘ H E T O L D M E T H AT T H E KEY TO PROLONGING YOUR MEDICAL CAREER WHILE STILL M AINTAINING YOUR M E N T A L H E A LT H W A S T O H A V E V A R I E T Y. ’
Sometimes the best tips for life are gleaned in random moments. Throwaway lines from someone wise delivered as they pass you in a corridor that inspires and shapes your destiny. I suppose your mind must be primed and ready to see the pearl of genius for what it is. I have been lucky in life. I have benefitted from some life-changing lines and inspirations. The more wise people you mix with, the more you improve your chances of a flash of fortune. I remember passing an older GP in the hall in the emergency department at QEII hospital 25 years ago. I hadn’t seen him for a while and I enquired as to his latest adventure. He was always travelling to the most exotic places. He told he’d just arrived home after taking a cargo ship to the middle of the Pacific Ocean to Kiribati Island. He was excited because it marked the hundredth country he had visited. Imagine that I thought, to be that well-travelled. In that very moment something galvanised in my mind and I set myself to rack up my own century. Perhaps it is the cricketer in me. I wanted a ton too. I have immersed myself in travel ever since and I thank my old mate every time I arrive in a new destination. I dare to dream of joining the century club and I will be sure to raise my bat and salute my old mate from QEII and thank him for the inspiration. He has probably raised his own bat for a double century in the meantime.
Another pearl came as we strode off to the car park at shift’s end. He told me that the key to prolonging your medical career while still maintaining your mental health was to have variety. Variety in the type of work and variety in the venues. He worked as a GP for a few sessions each week, as well as slotting in for some emergency work at QEII. He had a blend of practice styles and there was a blend of social environments. He loved knocking around with the nurses and other doctors at the hospital setting, having a few laughs but also loved spending a bit of time in the sanctuary of his GP consulting room. He suggested some private assisting, emergency work, teaching and even some military work might be fun and keep me vital. I took his word and have tried all those options and have found them all to have appeal and fascination. The third gem he delivered to me in the tea room as we relaxed over a cuppa. We were talking about doctor burn out. It seemed topical because I was getting flogged 60 or 70 hours a week back then. His theory was that every doctor had a finite number of patients he could see over the course of a career, before insanity was inevitable. He suggested I had to learn to pace myself over a 40 or 50 year career. There was no point front loading my workload to the junior part of my working life. So I thought about his statement and streamlined it a bit
M AT T Y O U N G
General Practitioner, Inala Medical Centre to suit myself. I thought to keep my marbles in my head I needed to set limits for the working life. There had to be a certain maximum number of hours per week that had to be respected, and a certain maximum number of weeks per year that could not be exceeded. As I aged and became slightly more self-aware I also realised that these parameters were dynamic and could change depending on other life situations. When I had kids I realised that the maximum number of hours had to be reduced because sleep deprivation is a killer of happiness. I also realised that the reason that school kids and school teachers only ever work for ten weeks in a row before having a break was because they understood this rule better than anyone else. I could scoff at what I perceived to be their lax work ethic or I could learn from it. I doubt my old mate from QEII will ever know how much he impacted my life. He probably doesn’t even remember slinging these pearls of wisdom my way. And I wonder if maybe as doctors we sometimes have these influences over our patients with the odd ad lib, spontaneous line that transforms their lives. I certainly hope so.
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All about you GLITCH
PA D D L E B O A R D I N G A walking meeting could be a way of getting some incidental exercise during the day, as well as some fresh air and a unique perspective. Instead of sitting still in a meeting room, office or café, organise a walking meeting in advance. The Harvard Business Review suggests picking a nice route with a view or landmark on the way to make it more interesting, and says that a small group of less than three is best for walking meetings.
L O N E LY PLANET’S AT L A S O F ADVENTURE Don’t just walk on the wild side - hike, climb, cycle, surf and even parachute. Lonely Planet’s Atlas of Adventure is an encyclopedia for thrill-seekers and adrenaline junkies, featuring the best outdoor experiences, country-bycountry, across the world - making it the ultimate introduction to an exciting new world of adventure. This book is an alphabetically ordered romp around the globe, highlighting the best outdoor pursuits you can enjoy in each country: riding with |eagle hunters and packrafting in Mongolia, kloofing and paragliding in South Africa or surfing and volcano diving in El Salvador.
T H E S M I T H F A M I LY ’ S TOY AND BOOK APPEAL The Smith Family began in 1922 when five businessmen decided to deliver toys to orphans on Christmas Eve. This year, The Smith Family aims to deliver more than 45,000 new toys and 30,000 new books to children in need around Australia. You could help by donating or fundraising, purchasing gifts from The Smith Family’s online catalogue or hosting a gift collection at your practice or hospital.
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James Hayes (Patrick Brammall) is a small town policeman. He’s called to the local cemetery in the middle of the night, after six people have inexplicably risen from the dead in perfect health. With no memory of their identities, they are determined to discover who they are and what has happened to them. Along with local doctor Elishia McKellar (Genevieve O’Reilly), James struggles to keep the case hidden from his colleagues, his family, and the world. This great little Australian series surprised everyone with its first series in 2015, and its back for the second series on ABC.
UPCOMING FILMS* 23 November Goodbye Christopher Robin 30 November The Man Who Invented Christmas Wonder 14 December Star Wars: The Last Jedi 21 December The Florida Project 26 December The Greatest Showman 1 January 2018 Pitch Perfect 3 Three Billboards Outside Ebbing Missouri 25 January 2018 The Jungle Bunch *Please note upcoming films are subject to change
THE E X T E R M I N AT I N G ANGEL
P E T E R PA N
9 December
Captured live at the National Theatre, a recorded performance of JM Barrie’s much-loved tale screens in cinemas. When Peter Pan, leader of the Lost Boys, loses his shadow, headstrong Wendy helps him to reattach it. In return, she is invited to Neverland, where Tinker Bell the fairy, Tiger Lily and the vengeful Captain Hook await. A riot of magic, music and makebelieve ensues. A delight for children and adults alike, Sally Cookson (NT Live: Jane Eyre) directs this wondrously inventive production, a co-production with Bristol Old Vic theatre.
2 December, 1pm | 3 December, 1pm National Theatre Live
Met Opera The American premiere of Thomas Adès’s The Exterminating Angel, inspired by the classic Luis Buñuel film of the same name. The Met presents the American premiere of Thomas Adès’s The Exterminating Angel, inspired by the classic Luis Buñuel film of the same name. Hailed by the New York Times at its 2016 Salzburg Festival premiere as “inventive and audacious … a major event,” The Exterminating Angel is a surreal fantasy about a dinner party from which the guests can’t escape. Tom Cairns, who wrote the libretto, directs the new production, and Adès conducts his own adventurous new opera.
TOSCA 10 February , 1pm | 11 February, 1pm Met Opera Rivaling the splendor of Franco Zeffirelli’s Napoleonic-era sets and costumes, Sir David McVicar’s ravishing new production offers a splendid backdrop for extraordinary singing.
FOLLIES 17 February, 1pm | 18 February, 1pm National Theatre Live New York, 1971. There’s a party on the stage of the Weismann Theatre. Tomorrow the iconic building will be demolished. Thirty years after their final performance, the Follies girls gather to have a few drinks, sing a few songs and lie about themselves. Tracie Bennett, Janie Dee and Imelda Staunton play the magnificent Follies in this dazzling new production. Featuring a cast of 37 and an orchestra of 21, it’s directed by Dominic Cooke (The Comedy of Errors).
WIN
movie tickets for two! Name:
Telephone:
Member no:
Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 15 December Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au
Doctor Q Summer 71
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AMA Queensland Foundation scholarship recipients, Renee Preston (2016), Louis Jenkins (2014), and Stuart Woods (2012)
Imagine having to quit your medical career because of financial pressure. Some of our best and brightest medical students are faced with the heartbreak of abandoning their studies due to financial hardship. Through our scholarship program, we are helping students from all walks of life realise their dream of becoming a doctor—your contribution counts. Since 2004, the Foundation has helped 11 scholarship recipients graduate from medical school and successfully pursue career opportunities throughout Queensland. The Foundation currently supports seven medical students across various year levels – all of whom have demonstrated an interest in pursuing regional or rural work and improving health outcomes for people in those communities. As some of our recipients share their stories with you, you can appreciate the significant challenges they have faced that threatened to jeopardise their studies. The Foundation is extremely proud of being able to assist these students – our future colleagues – in their time of need. Receiving no government funding, our scholarship program relies solely on the contributions of members and corporate partners. This Christmas, we urge you to please donate generously so that we may continue supporting medical students well into 2018 and beyond. Donations can be made by calling (07) 3872 2222 or online at any time www.amaqfoundation.com.au/donate
Our corporate supporter Lexus of Brisbane has nominated the AMA Queensland Foundation as their charity of choice for two years in row. They recently raised almost $5,000 from their golf tournaments which will go towards the Foundation’s projects that support Queenslanders in need. Our sincere thanks to Lexus for their continued generous support.
! u o Y k n a Th
IF YOU BELIEVE JUST ONE PERSON CAN CHANGE THE WORLD, IMAGINE WHAT WE CAN ACHIEVE TOGETHER. For more information about the AMA Queensland Foundation or to make a donation visit www.amaqfoundation.com.au or call the Foundation office on (07) 3872 2222.
Meet Rozita, Jessica and Michael - three of our extraordinary scholarship recipients who might not be studying medicine today if not for your donation. “I was totally overjoyed to be awarded the AMA Queensland Foundation scholarship and it is still an inexplicable feeling to express. Four years ago when I had to f lee my country and seek safety in Australia, I felt terribly hopeless and had lost all my dreams of becoming a doctor. If it was not for the scholarship that I received from the AMA Queensland Foundation, I could never afford the tuition fees and I could not live my dream. I owe what I have achieved now to all of the beautiful people of Australia who do not know me, yet supported me. I know a mere ‘thank you’ will not suffice, but that is what I can say for now. May I become a doctor one day, then hopefully I can compensate fully. Hence, a thousand ‘thank yous’ to the AMA Queensland Foundation and its members.”
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“My father was required to move from Townsville to Western Australia for work. My parents were already supporting my five siblings… if I wanted to continue studying at JCU,I could not relocate with my family - instead I had to move out of the family home and support myself. Being awarded the AMA Queensland Foundation scholarship has allowed me to continue studying medicine in Townsville and follow my dream to become a doctor. I have wanted to study medicine since before I can remember. I could not imagine any other career than one that so directly involves helping others.”
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“Prior to studying medicine at JCU, I spent 10 years working on beef cattle production enterprises in rural Queensland. I absolutely loved the lifestyle, but I felt like I needed to do more to help people in these rural areas where we love to live. I have a young family and studying medicine whilst finding time to spend with them is not easy. The biggest challenge is spending weeks away from them at a time when I am on placement. Being awarded the AMA Queensland Foundation scholarship has allowed me to study medicine, without having to spend even more time away from my family working for adequate income - and for that, I am sincerely grateful.”
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DONATE ONLINE AT www.amaqfoundation.com.au
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Thank you for your support! Doctor Q Summer 73
INPRINT
Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, eighth edition
by Wolff, K; Johnson, RA; Saavedra, AP; and Roh, EK.
One of the bestselling dermatology books in the world, this quick-reference clinical guide has virtually defined the field for thousands of physicians, dermatology residents, and medical students for more than three decades. Spanning the entire spectrum of skin problems, Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Eighth Edition combines laser-precise colour images of skin lesions along with an overview of epidemiology and pathophysiology, and detailed information on diagnosis and treatment.
Win this book Fill out this form and email to competitions@amaq.com.au. Name:
The text includes more than 1,000 full-color photographs speed diagnosis of the dermatologic conditions most often encountered in primary care, with man images highlighting skin disease in different ethnic populations.
Telephone:
Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Eighth Edition retails for $146.99. Thanks to McGraw-Hill Education, we have a copy to give away.
Entries close 15 December
DENDY WINNERS Dr Fred Leditschke Dr Brian Wilson-Boyd Dr Paul Bryan Dr Alison Harris Dr Mary Smyth Dr Allan Tham Dr David Paterson 74 Doctor Q Summer
Dr David A Clark Dr Noel Saines Dr Julia McLeod
Member no:
BOOK WINNER Dr JiaHaur Tho won a copy of Current Medical Diagnosis and Treatment, thanks to McGraw-Hill Education.
Don’t forget to enter in this Doctor Q edition to win.
AT POINT LOOKOUT, NORTH STRADBROKE ISLAND Modern, 3 bedroom, 2 bathroom “Straddie Style” beach house available for weekends and holiday rental. Set in a quiet bushland setting, a short walk to beautiful Home & Cylinder beaches, the Point Lookout Hotel, cafes & shops. Enjoy surfing, beach walks, BBQs on the deck and island wildlife. Reasonable rates. For more information and bookings contact Mary on 0407136 346 or email straddiehouse@outlook.com.au
Invest in Toowoomba! Suite 9, 195 Hume Street For Lease or For Sale at $650,000.00 - Fully fitted out A grade 151m2* suite with car parks
Julie Stewart 0418 700 140 www.ljhooker.com.au/9A1G6F *Approx.
SESSIONAL SUITE AVAILABLE FOR RENT Attractive Paediatric Rooms have availability for sessions at the Taylor Medical Centre, 40 Annerley Road, Woolloongabba. The rooms are suitable for Paediatric Specialists and Allied Health. The rooms are currently occupied by Paediatric Surgeons, a Paediatric Gastroenterologist and Paediatric Endocrinologists.
We are walking distance to the Mater Children’s Private Hospital and Lady Cilento Children’s Hospital. Our rooms are spacious and child friendly. The Centre also has parking for patients and good access to public transport. Secretarial support could be negotiated.
Please contact Christine Lawson on 3846 3915 to discuss our availability
WORKPLACE RELATIONS MANUALS
UPDATED MANUALS Work Health & Safety Manual
8 COMING IN 201
Employer Manual Employee Policy & Procedure Manual Starting & Working in Private Practice For more information or to order please contact the Workplace Relations Team on (07) 3872 2222 or email workplacerelations@amaq.com.au.
Doctor Q Summer 75
House calls? That’s an idea we pinched from you If every minute of your day is spent caring for your patients, when and where are you going to take care of your finances? Easy. Simply name the place and we’ll come to you. It doesn’t have to be your house, it could be your office or surgery. Or even a local coffee shop. Rest assured, when you require the specialist financial services we’ve spent 25 years developing, we’re happy to go out of our way to help you.
Visit us at boqspecialist.com.au or call a local finance specialist on 1300 131 141
Equipment and fit-out finance / Credit cards / Home loans / Commercial property finance / Car finance / Practice purchase loans SMSF lending and deposits / Transactional banking and overdrafts / Savings and deposits / Foreign exchange The issuer and credit provider of these products and services is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence no. 244616 (“BOQ Specialist”).