DoctorQ September 2015

September 2015 . vol 96

AMA Queensland Membership Magazine

Private health insurers pulling the strings Snowball recommendations given cold shoulder Health Ombudsman not meeting time limit Nurse endoscopy not the solution

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CONTENTS

this issue

private health insurers on the brink the contract stoush between calvary and medibank private has started a heated debate on private health insurers and their influence on good medicine.

14

28

16

24 REGULARS

36

business tools

4

From the Editor’s desk

6

40 mda national’s strategic alliance

President’s Report

8

43 a home loan that keeps working for you

CEO’s Report

44 is it better to buy insurance directly or use a broker?

28 ama queensland foundation news 32 Member News

Features

14 private health insurers pulling the strings 20 health vision: reprioritising care 24 health ombudsman not meeting time limit 26 nurse endoscopy not the solution

Current issues

10 snowball recommendations given cold shoulder 12 restoring fairness for doctors 16 ama queensland council update 18 agony aunt: reporting family violence 22 Moca 4 update 30 media campaign shows benefits of regular gp visit

46 how to leverage digital trends for your private practice 47 asset allocation decisions continue to drive investment performance 48 managing cash flow 50 what is intellectual property?

52 transitioning to private practice

Life

55 movies 56 wine 57 Travel 59 restaurant review 60 all about you 61 ocker doctor 62 In print

33 resilience on the run pilot

people & events 34 Calendar

36 speaker update: justice david boddice 38 local medical association round up 54 finding my balance:the queensland medical orchestra DoctorQ September 2015

3

editor’s desk

from the editor’s desk Board of Directors

Michelle Ford Russ Doctor Q Editor There’s certainly some meaty issues to digest at the moment! The private health insurance stoush between Calvary and Medibank Private has been a stark reminder of the need to keep working hard to ensure decision making is kept between a doctor and their patient. Read our article on it on p14.

Doctors too, deserve the right to an uncompromised doctor-patient relationship. The Snowball Report delivered some promising recommendations, only to be given a ‘wait and see’ from The Australian Health Workforce Ministerial Council.

AMA Queensland will continue to advocate for better treatment of doctors’ health(p10).

Our Ethics and Medico-Legal Committee have hit on a particularly tragic current issue in family violence.

They outline the best steps for you to take if you suspect family violence is to blame for one of your patients.

A recent campaign showed the importance of a regular GP visit and we’ve been more than happy to join Queensland Health’s Drive to 95 campaign to increase vaccination rates to 95 per cent.

On a lighter note, we’ve included a restaurant review in our Lifestyle pages and we’d love to hear from you about your gastronomic adventures.

Michelle

Dr Chris Zappala President

Dr Kirsten Price Honorary Secretary

Dr Shaun Rudd Chair of Board and Council

Dr Dilip Dhupelia Appointed Director

Dr Bill Boyd Vice-President Dr Bav Manoharan Treasurer

Dr Richard Kidd Appointed Director Dr Sharmila Biswas Appointed Director

Council Dr Tom Arthur Greater Brisbane Area

Dr Sharon Kelly Specialist Craft Group

Dr Sharmila Biswas Far North Area

Dr Richard Kidd General Practitioner Craft Group

Dr Kimberley Bondeson Greater Brisbane Area Douglas Brown Medical Student Observer Dr Lisa Byrom Greater Brisbane Area Dr Sarah Coll Specialist Craft Group Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group Dr Jim Finn Full-time Salaried Medical Practitioner Craft Group Dr Malcolm Forbes Doctors in Training Representative

Professor Steve Kisely Greater Brisbane Area Dr Luke Lawton North Area Honor Magon Medical Student Group Representative Dr Bav Manoharan Gold Coast Area Dr John F. Murray Specialist Craft Group Dr Paul Neeskens General Practitioner Craft Group Dr Kirsten Price Greater Brisbane Area

Dr John Hall Downs and West Representative

Dr Anil Sharma International Medical Graduate Representative

Dr Wayne Herdy North Coast Area

Dr Josie Sundin Greater Brisbane Area

Dr Brad Horsburgh Greater Brisbane Area

Dr Harley Wilson Capricornia Representative

AMA Queensland Secretariat Jane Schmitt Chief Executive Officer Filomena Ferlan General Manager Corporate Services

Holly Bretherton General Manager Member Relations and Communications

Editor: Michelle Ford Russ Graphic Designer: Nathan Pitt Journalists: Rachael Finley

James Hodge Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice. Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.

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September 2015 DoctorQ

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5

PRESIDENT’S REPORT

dr Chris zappala President, AMA Queensland

One of the goals I have for the next (now) 10 months is to help diminish the boundaries between tribal disciplines within medicine – those traditional divisions/differences that have very effectively been used to divide and marginalise our profession in the past. I was going to list some examples, but let’s not dwell on our disappointments.

It’s long amazed me that GPs perpetually accuse the AMA of being specialist focus and specialists perceive our organisation as favouring GPs. Connected with this defensive tribalism is unfortunately a touch of selfishness. It worries me that I still get harangued in the hallway by a private practicing doctor (GP or specialist) who cannot understand why AMA Queensland was at all involved in the salaried doctor contract difficulties last year.

A well remunerated and managed public hospital system is absolutely required for RMO and registrar training to be effectively undertaken and for there to be balance in workforce and case-load between the public and private systems. This matters to us all. Role substitution in the current guise of nurse endoscopy (p26) and the threat posed by Medibank Private are other profession-wide issues (p14).

So why does the MBS rebate freeze matter?

As a consequence, when GPs bulk-bill they make proportionally (and progressively) less money and general practice becomes a more marginal enterprise. Please don’t even momentarily think the implications cease here or are limited to general practitioners.

The revenue implications obviously flow to all patient groups seeing all doctors, whether they are seeing a GP or specialist – patient gaps increase. Perhaps this has less effect in specialist practice where gaps are better accepted and not subject to the perversions created bypolemical Government rhetoric. However, in general practice there are low SES areas where an absence of bulk-billing may create a disincentive for patients to access basic and preventative care.

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September 2015 DoctorQ

What about our private practice specialists?

The private health insurance funds are becoming increasingly obstreperous and willing to limit clinical decision-making and delivery to contain costs regardless of the treating doctor’s wishes or what good evidence would suggest as optimal.

I intend to focus future discussions on the complex issue of private health insurance and how to improve the contribution of this sector to healthcare delivery and access for patients. For now, we must recognise that the funds have absorbed some of the growing gap between the frozen rebate and actual costs of healthcare. This could then contribute to inordinate increases in premiums and makes private health insurance less affordable – then private practice funding could shrink with a movement of patients back to the public system – where they’re still de-moralised and under-resourced from the enervating vitriol and loss of resources that have marred the last couple of years.

AMA is advocating strongly for us all on this issue and I encourage you to update yourself with progress on the federal website. Our role in Queensland is to echo the need for MBS rebates to be appropriately indexed.

Please don’t misunderstand me – I do not favour a model of healthcare that hinders doctors from setting their own fees and shackles them to conscripted bulk-billing.

The point here is in the enormity of the discussion for our profession as a whole.

Our role is to understand the issues, speak with each other and with the AMA and most importantly, never miss an opportunity to speak to our administrative overlords, speak to members of parliament, speak to health department bureaucrats, speak to College representatives, speak to Primary Healthcare Network representatives and speak to our patients about how important these issue are and why they matter to us all. Q

The private health insurance funds are becoming increasingly obstreperous and willing to limit clinical decision-making and delivery to contain costs regardless of the treating doctor’s wishes or what good evidence would suggest as optimal.

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2:482015 PM DoctorQ 23/10/14 September

7

ceo’S REPORT

JANE SCHMITT Chief Executive Officer, AMA Queensland

out and about around the State

On Friday 9 October, Health Minister Cameron Dick will join us in Townsville as guest speaker at our AMA Queensland breakfast. We are looking forward to the opportunity to hear from the Minister and visit our Townsville members. We still have plenty of free member places available and this is your opportunity to come along and have your say. Visit the AMA Queensland events calendar on www.amaq.com.au for more information.

In addition to our visit to Townsville, our team has been travelling throughout the State to present the AMA Queensland’s latest Private Practice Series. This series was held in 12 locations across the state, including regional centres, to explore the topic of building a sustainable medical practice. Our workplace relations staff also had the time to speak to many members and their staff about issues affecting them in their practice. If you missed this series or are wondering how you can further build your private practice, keep an eye out for part three of this series which will launch in November.

In the meantime, should you have questions, from staff employment to the need for bookkeeping services, our Workplace Relations and Business Support Services teams are ready to take your call.

MEDICAL OFFICERS CERTIFIED AGREEMENT 4 As I write this column, drafting of the in-principal MOCA 4 Agreement is being finalised. MOCA 4 is the agreement which will govern employment conditions for SMOs, RMOs and Medical Superintendent and Medical Officer with Private Practice (MSPP/ MOPP) for the next three years. The key changes are set out in this edition at page 22.

The Director-General will lead a two week consultation period whereby Queensland Health will consult with you on the proposed changes and put the Agreement out to ballot. Thank you to members who assisted our team at ASMOFQ by providing feedback about what you wanted to see in the new agreement for the next fortnight and by the time you are reading this, the agreement should be at postal ballot.

VMO Committee

The AMA Queensland VMO committee, chaired by Dr Sharon Kelly recently conducted a survey of VMOs to gauge their expectations for their future employment arrangements. The results showed a preference for the next agreement to be a collectively bargained certified agreement, with key issues including but not limited to, remuneration, flexible working hours, professional development leave, the right of private practice, clinical support time and the dispute resolution process. Talks will now begin to identify the timeline to achieve a new agreement for Queensland’s VMOs.

COAG Intern Review

A review is currently under way by the Council of Australian Governments into medical internship training. AMA has been 8

September 2015 DoctorQ

involved in the review process through member consultation, various submissions and ongoing advocacy on behalf of our junior doctor members.

Member feedback demonstrates support for the current internship model, and we firmly believe any changes need to be incremental and focused on improving supervision and assessment as well as a better use of community settings. Any changes must also be driven from comprehensive stakeholder feedback, which is why AMA has recommended a national survey of medical training. We will continue to monitor the developments, advocate on behalf of members and provide you with updates.

resilience on the run

Our Resilience on the Run program has been piloted at Rockhampton Hospital with the intention of providing junior doctors with the coping skills necessary to be resilient in stressful situations at any point in their life and our charitable arm, the AMA Queensland Foundation, has funded this pilot program. The feedback from the doctors who have attended has been overwhelmingly positive.

Our hope is that it won’t be a one off and will be taken up by each Queensland Health and Hospital service to genuinely support the wellbeing of their health staff.

Our thanks to the Resilience on the Run team: Drs Lisa Byrom, Malcolm Forbes, Margaret Kay, Bav Manoharan, Alex Markwell, Ira van der Steenstraten who have worked with AMA Queensland staff Holly Bretherton and James Hodge.

AMA Queensland in the Big Apple

September marks AMA Queensland’s Annual Conference. With the theme, A BIG Apple a Day keeps the doctor away – Strategies for a healthy and happy life, this conference brings us to New York City where delegates will explore topics including doctors’ health and wellbeing, mental health, obesity work/life balance and preventative health.

There is no shortage of innovative medical minds in New York and this year’s location will allow us to hear from some of the brightest in the field while giving delegates the opportunity to meet and learn from other members.

Immunisation drive

We are working with Queensland Health on a new campaign to boost immunisation rates to the 95 per cent required for herd immunity.

Queensland Health will be contacting families who have fallen behind on their immunisation schedule with options for getting up to date.

In addition to seeing their regular GP, the campaign will offer after hours services with the goal of ensuring access is not a barrier to any child being immunised. For this campaign to be successful, we will need GPs from around the State to open their clinics after hours or participate in special events.

If you are interested in being involved, please contact Rachael Finley, our media and communication advisor, on r.finley@amaq.com.au. Q

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www.svphb.org.au DoctorQ September 2015

9

CURRENT ISSUES

Snowball recommendations given cold shoulder It has been an extremely busy few months in the medico-legal sphere in relation to mandatory reporting. AMA Queensland has consistently maintained the position that Queensland must allow doctors to seek treatment without the risk of mandatory reporting.

Under the mandatory reporting regime a doctor is required to make a notification when they believe a practitioner has placed the public at risk of substantial harm, in their practice of the profession because they have an impairment.

While Queensland did include a limited amendment that provides that a treating practitioner is not required to make a notification if they believe the impairment does not place the public at substantial risk of harm and is not professional misconduct.

However, in practice, professional misconduct is a legal concept even experienced health lawyers can disagree on based on the individual and unique circumstances of the practitioner. Western Australia, in comparison, provides a blanket protection where a practitioner is treating a second practitioner. AMA Queensland advocated on this exact point in part II of their Health Vision.

Christine Clements, on 27 July 2015, handed down her findings into the inquest into the death of Katie Lee Howman. It involves the tragic death of a nurse at Toowoomba Hospital who fatally overdosed on fentanyl in 2013.

She had previously survived an accidental fentanyl overdose in 2010 that caused monitoring conditions to be placed on her

by AHPRA. She also sought treatment from a psychiatrist. At inquest the psychiatrist indicated there were several clinical signs and

incidents that Ms Howman had hidden from him and, if they’d been fully disclosed, would have raised several concerns.

However, he postulated that as a result of the reporting regime health practitioners are afraid to raise these incidents for fear of further conditions being placed on their practice. The coroner found the psychiatrist to be a highly credible witness and made the following recommendation, consistent with his evidence, that: ... a more limited requirement to report to AHPRA would meet both the public safety requirement for AHPRA while providing the most therapeutic environment for the health practitioner to receive treatment... a treating doctor report to AHPRA the following: i. That the person was being treated, ii. Was compliant with treatment and iii. When it is possible the person might be able to gradually return to work iv. Given their condition It was also recommended consideration be given to expanding and continuing education around the issue by relevant stakeholders.

The Australian Health Workforce Ministerial Council (AHWMC) recently released the independent review into the National Registration and Accreditation Scheme for the Health Professions. The independent reviewer, Kim Snowball, made 33 significant recommendations, including:

“The Health Practitioner Regulation national Law 2009 (the National Law) be amended to reflect the same mandatory notification exemptions for treating practitioners established in the Western Australian law.”

This is a significant recommendation given Kim Snowball’s status as an independent reviewer at the end of an extensive, national, consultation process.

Disappointingly, AHWMC has declined to accept this recommendation as they believe the data is inconclusive and they await further information. Given the uniqueness and complexity of the legislation it is difficult to comprehend what research they are awaiting.

AMA Queensland will continue to advocate for the introduction of the WA exemption in Queensland as we believe doctors are entitled to a doctor-patient relationship of their own. Given the increased funding and importance placed upon awareness and identification of doctors’ health issues it remains contradictory that AHPRA has focused so heavily on identification, triage and case management while effectively limiting practitioners utilising health services as regular patients. Q

In practice, professional misconduct is a legal concept even experienced health lawyers can disagree on based on the individual and unique circumstances of the practitioner.

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September 2015 DoctorQ

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DoctorQ September 2015

11

CURRENT ISSUES

ASMOFQ - Restoring fairness for doctors

ON 4 JUNE 2015, THE INDUSTRIAL RELATIONS (RESTORING FAIRNESS) AND OTHER LEGISLATION AMENDMENT BILL 2015 WAS PASSED AS PART OF THE GOVERNMENTS ELECTION COMMITMENT TO REVERSE A NUMBER OF CHANGES TO THE INDUSTRIAL RELATIONS ACT (IR ACT) MADE IN 2012 AND 2013 FOR GOVERNMENT EMPLOYEES.

Following the passing of the bill, ASMOFQ and AMA Queensland have been working diligently with Queensland Health in an effort to ensure the restoration of fair and equitable working conditions to Queensland doctors. Some of the changes that you will see over the coming months will be the:

Stronger management of doctors’ fatigue including strategy to ensure doctors get home from work safe if fatigued

1. Establishment of a safety net for all doctors in Queensland through the development of the underpinning Industrial Instrument which is to be drafted and certified through the Award Modernisation’s process

Equity in relation to the Motor Vehicle Allowance entitlement for full time and part time SMOs

2. Re-establishing the independence of the Queensland Industrial Relations Commission (the Commission) and ensuring the Commission is a layperson’s tribunal where employees and unions operate on a level playing field; 3. Restoring previous right of entry provisions so industrial organisations have the ability to access members so as to enhance and protect their industrial interests; 4. Returning a dispute resolution procedure that provides for consultation at the workplace and involvement of individual; 5. Facilitating fair and just employment conditions for employees through collective bargaining which will see the Medical Officers Certified Agreement, known as MOCA 4 be renegotiatedand apply to all doctors in Queensland.

You will be pleased to know that a number of these initiatives have already commenced and are in the final stages of being implemented to ensure the restoration of fairness is achieved. Over the past few months ASMOFQ has been negotiating the MOCA 4 with Queensland Health. The outcome s that have been achieved for you include; A 2.5 per cent wage increase each year for three years, back paid from 1 July 2015 Genuine consultation and collaboration with the Department of Health and the Minister to ensure the delivery of high-quality and efficient patient services.

No SMO being forced to work an extended hours roster that is currently not in place

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September 2015 DoctorQ

In addition to indexation to PDA for doctors in training all RMOs, other than interns or those RMOs in receipt of the Vocational Training Subsidy will be entitled to a payment $1500 per annum

retain the existing multipliers with the exception that the penalty payment for work performed on a public holiday which will be increased from 100 per cent to 116 per cent provide for the payment of shift penalties, on-call, recall and overtime entitlements as worked (ie by exception).

Annual progress for full time and part time medical officers within levels or between classifications(acknowledging at times certain criteria must be met) ASMOFQ will continuing to fight and lobby the government for some of the provisions that were not achieved as part of the EBA process including a higher Professional Development Allowance for RMOs and changes to the on-call and recall requirements.

Following a two week period of consultation, it is anticipated that Queensland Health will seek to hold a ballot, anticipated in October this year. If successful, MOCA 4 will be in operation late November with your first full MOCA 4 pay being made just to you just prior to Christmas.

It is important to reflect and remember the achievements made over the past 18 months.The vital work undertaken by ASOFQ is only possible with the support of members. A strong membership base is critical to ensuring we are representing Medical Officers effectively, andHospital and Health Services (HHSs) work in collaboration with doctors to enhance the employment relationships and subsequent patient care As you read this, we are only weeks away from see the extinguishing of contracts, and long awaited restoration of fairness for Queensland doctors in the workplace. Q

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DoctorQ September 2015

13

Feature story

Private health insurers pulling the strings

A contract fallout between Calvary Health Care and Medibank Private has started a heated debate on the role of private health insurers in medicine and created a pivotal decision point for Australia.

Medibank is insisting that its contract with the hospitals contain a ‘safety and quality’ clause which means it will not pay the hospital costs for any episodes where any one of 165 events occur. This list of events, that Medibank has determined as ‘highly preventable’, was derived from a list of high priority hospital complications for routine review by hospitals, that is still in development and yet to be validated by the Australian Commission on Safety and Quality in Health Care, and that is not fit for financial incentives or disincentives.

These “adverse events” are highly contentious and show a lack of understanding about the difference between medical error and a known complication that can happen even in the best of hands. Some of these events include maternal death due to childbirth and falls in care. In addition to this, Medibank is also insisting on a clause for non-payment for re-admissions within 28 days.

This is the latest in a steady history of dubious behaviour by Medibank, who – Pays the lowest fees in its known gap schedule Heavily promotes poor quality policies with multiple and increasing exclusions that leave patients (often without knowledge) of lacking cover Refuses to index known gap schedules since the introduction of the freeze Actively seeks to downgrade policies 14

September 2015 DoctorQ

of members, even via ‘cold calling’ and persuading patients to switch to inferior policies.

Medibank is not alone in this – although they are leading the health insurer charge. In comments to The Australian in July, Dwayne Crombie, Bupa’s Managing Director of Private Health Insurance, said it supported Medibank Private in wanting to get better value for customers. “We get the impression that private hospitals and doctors are living in a world of their own, thinking the golden goose will never stop laying the eggs,” Mr Crombie said.

NIB is not free of nefarious acts either. They have downgraded policies through email notifications leaving patients to discover a lack of coverage only at the time when they actually need it. NIB has also moved to create a website detailing doctor fees, including outof-pocket expenses for the 10 most commonly performed procedures for that doctor. To appreciate the extent of the threat, consider the top five health insurers: Health Insurance Fund

Marketshare

Medibank Private

29.1%

BUPA

26.7%

HCF

10.8%

NIB

7.7%

HBF

7.4%

At the time of printing, Calvary Hospital and Medibank Private had reached an agreement, with neither party disclosing any information about which elements of the agreement had been compromised. It is unclear what will happen to patients currently being treated in a Calvary Hospital.

Re-admission is a significant issue also. All patients re-admitted within seven days of discharge, where Medibank decides the readmission is related, will not cover costs associated with the readmission. There is no ability to dispute Medibank’s decision and there are no exclusions. Examples include cancer patients admitted with nausea/ infections and patients with breast lumps found to be malignant who are re-admitted for wider excision.

The outcome of these changes are that more complex patients will be difficult to treat in the private sector and move to the public system. The community rating system of health insurance is undermined and health insurance becomes less appealing overall – so people leave. Hospitals also become responsible for ensuring patients discharged adhere to treatment protocols to prevent readmission (e.g. finishing antibiotic courses or clexane for DVT prophylaxis) without a true ability to monitor or supervise this.

AMA has mounted a campaign against the insurer and President Dr Brian Owler condemned Medibank’s interference in

Feature story

Medibank Private has grouped 165 adverse events which it will not pay hospital costs for: Pressure injury (ulcers) Falls resulting in fracture and intracranial injury Surgical complications Venous thromboembolism Healthcare associated infection: urinary tract infection from a catheter surgical site infection prosthesis associated infection

These “adverse events” are highly contentious and show a lack of understanding about the difference between medical error and a known complication that can happen even in the best of hands.

quality care for patients. “It is not Medibank Private’s role to unilaterally decide what are preventable complications or set quality benchmarks.”

AMA Queensland President Dr Chris Zappala believes there should be greater regulation and oversight of the private health insurance industry to ensure transparency within the industry and preservation of true value in private health insurance products with honest (and limited) advertising and approaches to patients. “It’s essential that the ability of a doctor to decide on the best course of treatment for their patient is preserved. We’ve seen plenty of cases where the private health insurers have decided to cover an inferior treatment over another recommended by the doctor. That’s clearly a case of managing health care by stealth,” said Dr Zappala.

Dr Owler said the AMA will start educating the public about what health insurance products were about, and what people should provide, as patients need to realise they can change funds easily.

The government site www.privatehealth.gov. au shows a comparison between all health insurers and Dr Zappala said more money should be spent promoting this free service to patients to ensure they receive accurate

information about health insurance products without the fine print or deceptions of emotive industry marketing.

It is critical that Medibank Private withdraw the offending clauses from its hospital contracts before consumer confidence in the private sector is undermined to an extent where people drop their private insurance altogether and/or turn to the public hospital sector for treatment.

Information about the benefits paid by private health insurers for hospital costs is relevant to patients’ decisions about their treatment.

Many patients will find it challenging to properly assess the implications of changing their private health insurer. If patients ask you about changing their private health insurer, you should advise them to ask prospective insurers: How long do I have to wait before benefits can be paid?

If I go to hospital will I have to pay an excess or make any co-payments?

Are there any treatments I won’t get full hospital benefits for?

Does this fund have agreements with private hospitals I might need to attend?

The AMA document Guide for Patients on how the Health Care System Funds Medical Care might assist your patients to better understand how their healthcare is financed, and explains the contracting arrangements between hospitals and insurers.

The AMA has been very active in arguing for a reversal of any change that imposes managed care restrictions on doctors and patients and leaves patients with inferior private health insurance products. As with all issues that have such a big impact on the health care of our patients, advocacy and action must come from the grass roots to bring about change.

AMA encourages you to write to the Minister for Health at Minister.Ley@health.gov.au and to your local member about the impacts for your patients. We urge you to encourage your patients to do the same. Q DoctorQ September 2015

15

CURRENT ISSUES

AMA Queensland Council update

The following members now serve on the AMA Queensland Council, in addition to the those listed in the last edition of Doctor Q. Your councillors are your represented officials at AMA Queensland and can hear and address your concerns about medicine in Queensland.

Dr John F. Murray

Dr John Hall

MBBS FFARACS

MBBS BSc (Hons) FRACGP FACRRM DRANZCOG (Adv) GradDipRural ACSCM

Specialist Craft Group

Downs and West Area Representative

Specialty: Salaried Anaesthetist

Specialty: Rural Procedural Medicine and General Practice

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

Councillor

Councillor

“As a representative of rural and regionalQueensland, I hope to help advise the Council on issues affecting the health of rural Queenslanders and their health care teams. I intend to highlight important issues including; the strengthening of the rural healthcare workforce, access to essential healthcare for the bush, including quality primary care, emergency services, inpatient care and maternity services, and strengthening access to outreach specialty services.”

Honor Magon Medical Student Group Representative

Douglas Brown

Specialty: Student

Councillor

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September 2015 DoctorQ

“Currently in my second year of a Bachelor of Medicine, Bachelor of Surgery at the University of Queensland, I feel that there is so much more to a medical degree than the classroom can offer. I have active interests in the rights of medical students, and the support that institutions such as AMA Queensland can offer us. I currently play an active role in the Australian Medical Students Association (AMSA), being part of the 2016 Townsville Convention Team. It is my pleasure to represent the thousands of medical students located all throughout Queensland, and look forward to maintaining the great relationship between AMA and medical students.”

Medical Student Observer Specialty: Student

Councillor

“As the medical student observer, I hope to work with our fellow Councillors to ensure any issues or concerns experienced by our medical students across Queensland, are represented adequately, fairly and equally in the AMA Queensland Council. AMA is truly a fantastic organisation in representing not only its medical practitioner members, but also its medical student members as well. It is due to these factors, through my role, I hope to continue building greater involvement and participation between the medical students and the AMA Queensland community as a whole.”

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DoctorQ September 2015

17

CURRENT ISSUES

reporting family violence

ama queensland’s ethics and medico legal committee outline the ways to help if you discover a patient is being subjected to family violence.

Dear Agony Aunt,

Hello Dr Conflicted,

I’m a GP in South Brisbane. In the past month I’ve had a young couple start to attend my practice with their eight year old son. I’ve started to have concerns that the child may be experiencing abuse at home. While there are no physical signs of abuse there are several worrying psychological and behavioural indicators. I’ve noticed that his language development is significantly behind where it should be for a child of his age. I’ve also observed that he is afraid to leave his mother and has clear problems with restlessness and concentration. What should I do to discharge my ethical and legal obligations Agony Aunt?

AMA, in conjunction with the Law Council of Australia, has recently released a resource for medical practitioners on how to support patients experiencing family violence. I’ve summarised the steps for you below but the full document is available at: https://ama.com.au/article/ama-family-violence-resource

Kind regards, Dr Conflicted

Recognise the indicators associated with victims of family violence: This can include physical symptoms, such as difficulty eating or sleeping or physical complaints. It can also include psychological symptoms such as difficulty adjusting to change or transience. All the symptoms that you describe would fall into indicators worth noting.

Asking the patient: It is important to realise that people who have been abused want to be asked about domestic violence and are more likely to disclose if asked. If you have concerns that your patient is experiencing family violence, you should speak with her or him alone, separate from the partner or other family members. Based on the situation, it may be better to ask broad, direct, or specific questions in response to particular clinical indicators.

Responding to a disclosure: One of the most important steps is the response to a disclosure of family violence. This immediate response can make a huge difference in how the patient reacts and responds. The key messages are to listen, communicate belief, validate the decision to disclose, emphasise the unacceptability of violence, and be clear that the patient is not to blame. Do not ask why the patient hasn’t left, what could they have done to avoid the situation or why they are experiencing violence.

Initial safety planning: Speak to the patient alone. Assist your patient to evaluate their immediate and future safety, and that of children. This involves seeking relevant facts about a patient’s particular situation, asking about their own perception of risk, and using professional judgement. You should check for immediate concerns. If immediate safety is not an issue check their future safety (including an emergency telephone number), check whether they need a referral to a family violence service for help and document any initial plans for reference.

Risk assessment is an ongoing process that may need ongoing discussion and refinement.

Continuing care: It’s important to provide ongoing support to the patient and children through the doctor patient relationship. This can include ongoing monitoring and familiarity with appropriate referral services and their processes.

Mandatory reporting of domestic violence: You should ensure that you are familiar with the mandatory reporting obligations to domestic violence that apply to doctors in Queensland. In relation to children, sexual, and psychological/ emotional abuse must be reported to the authorities. Neglect must be also reported. However, there is no mandatory requirement to report exposure to domestic violence in children. The obligation arises where the doctor becomes aware, or reasonably suspects, a significant detrimental effect on the child’s physical, psychological or emotional wellbeing in the past, present or future.

This can be an incredibly complicated situation for a general practitioner to get involved in and we would strongly advise that all members make themselves aware of the AMA resources. If you have further queries we would advise that you contact your MDO’s medico-legal advisory service for further advice and support.

Agony Aunt Q

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September 2015 DoctorQ

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health vision

20

July / August 2015 DoctorQ

health vision

AMA Queensland’s Health Vision: Reprioritising care in response to need

AMA Queensland is pleased to launch Part Three of its Health Vision, the third of five documents that will guide the organisation’s advocacy and policy efforts over the next five years.

AMA Queensland knows our state is facing an epidemic of lifestyle-related chronic disease.

We know these diseases are largely affecting our most disadvantaged citizens, including the unemployed, Aboriginal and Torres Strait Islanders and refugees. Areas where generational disadvantage has become entrenched suffer high rates of type two diabetes, heart disease, stroke and chronic lung disease.

Our doctors and clinicians are doing amazing work in regard to managing this deficiency, but clearly more needs to be done. AMA Queensland believes that in Queensland we must reprioritise our health care funding so our health system is refocused on patients’ needs and at the same time strive for greater equity and sustainability.

AMA Queensland recently launched the third part of its Health Vision, which focuses on how we can reprioritise the health system from being largely one based on making patients healthier when they get sick, to one that aims to try and prevent people from getting sick in the first place.

To achieve this goal, AMA Queensland will advocate for the Queensland Government to invest in a trial of a Health Hub which would demonstrate the clear advantages of reprioritising our health system into a patient-centred, coordinated care model.

Health Hubs are based on the patientcentred medical home (PCMH) model and are designed to better coordinate the care of patients in the community; to improve the quality of healthcare in Queensland and to reduce future potential costs by reducing demand on hospital services. The medical home has been used extensively overseas,

dating back to 1967, and trials of a PCMH are now underway in Western Australia and Victoria. This provides us with a growing body of evidence demonstrating the effectiveness and efficiency of the model.

In a PCMH, patients and their families have a continuing relationship with a particular General Practitioner (GP), who is supported by a practice team and clinical services within the area. The medical home coordinates the patients’ care and acts as a gateway to the wider health system.

Some would argue general practices in Australia are already doing all of this, which is absolutely true. Many Queenslanders are already receiving high quality care through their GP and other providers. As the Australian Centre for the Medical Home explains, in Australia, all medical homes are general practices but not all general practices are medical homes. Making Health Hubs a reality in Queensland empowers our general practitioners to deliver an even greater service to their patients. And it gives patients a greater understanding of their own health care needs, leading to greater health literacy, better health outcomes and lower instances of chronic disease.

A PCMH would support reprioritisation in our health system, strengthening it into patient-centred, coordinated care model. A trial of such a model would ideally fall under the auspices of a whole-of-government public health plan which we advocated for in Health Vision Part One: Public Health and Generational Disadvantage.

Once a whole-of-government public health plan and medical home has been established in Queensland, it opens up the possibility of

further reforms, such as expanding outpatient ambulatory care and the GP Liaison Program. AMA Queensland believes these recommendations could, if implemented, lead to Queensland having the lowest rate of potentially preventable admissions in Australia by 2020.

Overcoming the challenges facing our health system will be difficult. It will take time. The fundamental challenge our health system faces is to ensure we continue to maintain our high standard of care while making the system more equitable and accessible. AMA Queensland believes implementing the ideas outlined in Health Vision Part 3 will drive significant progress towards improving healthcare access and patient outcomes by 2020. Q

We can reprioritise the health system from being largely one based on making patients healthier when they get sick, to one that aims to try and prevent people from getting sick in the first place.

DoctorQ July / August 2015

21

CURRENT ISSUES

MOCA 4 update

Over the past few months, AMA Queensland’s COUNCIL OF DOCTORS IN TRAINING (CDT) had been collaborating closely with our union ASMOFQ and meeting with Queensland Health to negotiate for improved working conditions in the Medical Officers Certified Agreement 4, (MOCA 4) specifically relevant to doctors in training. As CDT’s Dr Matthew Cheng reports, the outcome was largely positive.

Dr Matthew ChEng Council of Doctors in Training

An important issue for doctors in training, which was prioritised in negotiations, was establishing a Professional Development Allowance (PDA) for non-vocational trainees, and increasing existing allowances for vocational trainees.

We recognise that doctors in training have spent increasing amounts on courses, conferences and examinations, often with minimal or no reimbursement. Ultimately, PDA is essential to training doctors, which has direct implications on patient health.

We have successfully negotiated for nonvocational trainees a PDA of $1,500 per annum. This is a huge step forward as this will see non-vocational trainees receive PDA for the first time.

We have also successfully negotiated an increase in PDA for all vocational trainees who will now receive $2,500 per annum, instead of $2,000.

However one of the most significant achievement was securing indexation of PDA for RMOs. This means that for certification of MOCA 4, this allowance will increase every year for current and future RMOS. During the life of MOCA 4, PDA for RMOs will increase 2.5 per cent year for the following two years.

Whilst this may seem to be a modest increase, it certainly is a positive step in recognising the importance of professional development and provides a base for further MOCA negotiations in three years.

Additionally, we recognise that access to Professional Development Leave (PDL) is as important as PDA because without leave, any allowance cannot be utilised. As such, the MOCA 4 will declare that any PDL cannot be unreasonably withheld and the MOCA 4 Oversight Committee will monitor access.

The draft agreement will also have the following benefits: Wages will be increased by 2.5 per cent per year for three years with the first increase being backdated to 1 July 2015.

A maximum of seven consecutive night shifts can be worked, followed by a mandatory 96 hours off duty.

Great accountability and management strategies such as taxi vouchers to ensure a medical officer gets home safely when fatigued.

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September 2015 DoctorQ

A MOCA implementation group will be formed addressing issues such as portability of leave between Hospital and Health Services and remuneration for telephone advice.

Currently MOCA 4 is out for consultation, which we expect will be put to a ballot by early October 2015. This will be your opportunity to vote in favour or against the agreement. The outcome will be determined by 51 per cent of those doctors who voted.

Whilst not all of the items in our log of claims were accepted, the outcome is largely positive and genuine strides have been made to improve the working environment for doctors in training. The Council of Doctors in Training is committed to working together with ASMOFQ to prioritise the issues affecting doctors in training. Collectively we represent a strong voting bloc and for the next negotiations we will be pushing hard for greater PDA. On a final note, the CDT is working in close collaboration with the Doctors Health Advisory Service (DHAS) addressing the well publicised issues of health and wellbeing on junior doctors and medical students. A new Queensland website is now available – dhasq.org.au which I encourage all to view.

We welcome all feedback especially regarding any issues or concerns on the MOCA negotiations. Feel free to contact us by email cdt@gmail.com. Q

We recognise that doctors in training have spent increasing amounts on courses, conferences and examinations, often with minimal or no reimbursement.

Phone 07 3834 4285

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StAMPS brings together a team of experts in the field of pain medicine, dependency, psychology, rehabilitation medicine, occupational therapy and physiotherapy.

Dr. Jason Ray

MBBS (Qld), FANZCA , FFPMANZCA

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MBBS, FRACGP, FAFRM, FFPMANZCA

Dr. Jayne Berryman

BSc, MBBS (Qld), FANZCA, FFPMANZCA

Dr. Christian A.C. Rowan

MBBS (Qld), MDiplTrade (Mon), FRACGP, FARGP, FACRRM, FRACMA, FAChAM (RACP)

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2. Refer by fax to 07 3834 4291 4. Post referral to StAMPS St Andrew’s War Memorial Hospital 457 Wickham Tce Spring Hill Q 4001

P 07 3834 4285 F 07 3834 4291 E enquiries@standrewspainservice.com.au W www.standrewspainservice.com.au

DoctorQ September 2015

23

Feature story

Health Ombudsman not meeting time limit

The Office of the Health Ombudsman (OHO) has the simple slogan ‘Listen, Respond, Resolve.’ While it is clear that OHO has the capacity to listen, as evidenced by its 3,448 complaints,1 significant concerns remain about its ability to respond and resolve and the effect that this can have on the health of medical practitioners.

The Health Ombudsman Act 2013 (QLD) provides that the Health Ombudsman must complete an assessment of a complaint within 30 days of deciding to carry out the assessment.2 The Health Ombudsman may extend the period for assessing the complaint to 60 days if the case is large or complex, or there is a delay in receiving submissions or information.3 In our original submission on the Health Ombudsman Bill 2013 (QLD), AMA Queensland was supportive of the introduction of strict timeframes so as to ensure the complaint doesn’t hang over the medical practitioner for an unreasonable amount of time while ensuring the matters are ventilated in an expedient manner.

OHO commenced 2,446 assessments in the 2014-15 financial year.4 Within this same period it completed the sum total of 1,886 assessments. 1,030 (54.61 per cent) were completed within 30 days. 379 (20.09 per cent) were completed within 60 days. Of those 379; 114 matters were eligible for, and received, an extension, while 265 matters ran past the 30 day period. 477 (25.30 per cent) of assessments took greater than 60 days.

In total, 742 (39.34 per cent) of assessments ran over the legislatively mandated period for completing assessments. While AMA Queensland appreciates the considerable workload that OHO has been placed under,

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September 2015 DoctorQ

we believe that, from a doctors’ health perspective, there is an absolute necessity to complete the assessment process promptly.

A survey by Charles et al found that while undergoing litigation:5 96 per cent of medical practitioners acknowledged an emotional reaction for at least a limited period of time, 39 per cent experienced depression, including symptoms such as depressed mood, insomnia, loss of appetite and loss of energy, 20 per cent experience danger, accompanied by feelings such as frustration, inability to concentrate, irritability and insomnia, 16 per cent described the onset or exacerbation of a previously diagnoses physical illness, 2 per cent of medical practitioners engaged in excessive alcohol consumption, and two per cent experienced feelings of suicidal ideation.

These results are supported by a further survey by Bark et al. who noted that medical practitioners felt distressed (79 per cent), angry (70 per cent) and attacked (68 per cent) while undergoing medical litigation.6 A further 40 per cent felt that it had affected their life.7 The most recent research, by Bourne et al,8 echoes these findings. They found, in a cross-sectional study of 7,926 doctors, that 16.9 per cent of doctors with current/ recent complaints reported moderate/severe depression compared to doctors with no complaints (9.5 per cent). 15 per cent reported

moderate/severe anxiety compared to doctors with no complaints (7.3 per cent).

AMA Queensland has consistently argued that long, drawn out assessment processes as a result of inadequate resourcing or expertise is both unfair and unacceptable.

Such a process places additional strain on the medical practitioner and simply delays an appropriate conciliation process for the complainee.

In our submission to the Health Ombudsman Bill 2013 (QLD), AMA Queensland insisted any medical regulator must encapsulate the following principles: 1. Protect the public and uphold professional standards: AMA Queensland’s primary concern was the protection of the public and the maintenance of high professional standards among the medical profession.

2. Medical practitioner leadership in health regulation is essential: The expertise and experience of senior medical practitioners is essential in order to appropriately assess the conduct and performance of medical practitioners using a solid evidence-base and benchmarking. Medical leadership must be supported by strong oversight, community involvement and transparent decision-making.

Feature story

3. A transparent and fair system: AMA Queensland supported the introduction of a system that is fair and upholds the principles of natural justice for all stakeholders; shows a commitment to independence and impartiality, and is transparent and accountable to the community. A fair system must identify the source of the complaint, whether it is the individual practitioner or the system within which the practitioner operates. A fair system must not expose practitioners to obviously vexatious or spurious complaints.

Vexatious complaints undermine the system, use up valuable resources and must be discouraged. Early assessment and triage should confirm the authenticity of the complaint, and identify apparent vexatious or inappropriate complaints.

4. Complaints should be dealt with as quickly and as locally as possible: Any health complaints system must ensure that investigations and decisions of complaints are finalised as quickly as possible.

Any health complaints system must be adequately resourced in order to complete investigations and decisions in a thorough, fair and timely manner. Local resolution of complaints, where appropriate, will assist by ensuring system issues are addressed in a timely manner. Any health practitioner

regulating officer or body must be in a position to fearlessly address systematic issues including, but extending beyond, complaints about individual practitioners.

5. A national system: AMA Queensland has consistently supported a national registration scheme to register practitioners nationally. This has improved transparency for patients and flexibility for medical practitioners working across multiple jurisdictions.

AMA Queensland still has significant concerns that principle four is not being met. We believe that the recent change of government in Queensland provides an opportunity for the OHO to be refreshed and improved upon, with the ultimate aim of ensuring that Queensland has a health regulator which is procedurally fair, efficient and effective. AMA Queensland will continue to advocate on this, and other points, to ensure that the voice of the profession is heard. Q 1 P6 http://www.oho.qld.gov.au/wp-content/ uploads/2015/08/OHO-annual-performancereport-2014-15.pdf 2 S49(1) Health Ombudsman Act 2013 (Qld)

From a doctors’ health perspective, there is an absolute necessity to complete the assessment process promptly.

3 S49(2) Health Ombudsman Act 2013 (Qld) 4 P11 http://www.oho.qld.gov.au/wp-content/ uploads/2015/08/OHO-annual-performancereport-2014-15.pdf 5 http://mdanational.com.au/~/media/Files/MDANCorp/Medico-Legal/MDANmanagingstresspdf.pdf ; Charles SC, Wilbert JR, Kennedy EC. Physicians’ self reports of reactions to malpractice litigation. Am J Psychiatry 1984: 141: 563-565 6 Bark P, Vincent C, Oliveri L, Jones A. Impact of litigation on senior clinicians: implications for risk management.

Quality in health Care 1997; 6:7-13 7 ibid 8 Bourne et al, The Impact of Complaints Procedures on the Welfare, Health and Clinical Practise of 7926 doctors in the UK: a cross-sectional survey

DoctorQ September 2015

25

Feature story

Nurse Endoscopy: not the solution

After two Australian trials of the nurse endoscopy model in Victoria and at Logan Hospital in Queensland, the model is now being rolled out around the state. President Dr Chris Zappala says doctors are right to be concerned about a model that may not necessarily be cheaper or more effective.

There is a regular appearance of ideas designed to improve access to cost-effective healthcare that have a beguiling superficial appearance, but lack substance or a credible evidence-base following deeper, thoughtful scrutiny free of political expediency.

Although the AMA’s concerns in relation to role substitution in its various guises, such as nurse endoscopy, are quickly attacked as being selfish and paranoid, our concerns also quite often are borne out to be reasonable and true. Such criticisms shouldn’t dissuade us from firmly declaring our reasonable views or shrink from stating that doctors are better at doing some things within healthcare – just as each profession has its professional niche and strengths.

The dilemma we face as a profession and as a state is that endoscopy services are woefully

It’s time for us to be clear on what we expect of Queensland Health to improve the endoscopy access dilemma

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September 2015 DoctorQ

inadequate for the growing demand created by our population demographics, the bowel cancer screening program and well-informed GPs and patients.

Nurse endoscopy does not provide the answer to this problem. At best this model of care, particularly the version being aggressively pursued by Queensland Health, is a premature, partial solution that does not build enduring, self-replicating capacity within the system in regional and metropolitan areas.

Recently published evidence confirms the overall cost of nurse endoscopists exceeds medical endoscopists. Furthermore, any diversion of resources away from medical endoscopists who can train more medical endoscopists does not build enduring capacity.

The problems with the nurse endoscopy model include – Inability of non-medical endoscopists to manage all procedure-related complications Inability of non-medical endoscopists to undertake emergency procedures eg acute gastrointestinal haemorrhage High re-procedure rates Longer procedure times Unclear supervision policies and responsibilities for medical endoscopists under whose auspices non-medical endoscopists are trained and work ie inability for nurse endoscopists to work independently with dubious accreditation standards Reduction in training opportunity for physician and surgical registrars – both in terms of the number of procedures

Feature story available and access to routine work to build competence and capacity towards complex or emergency procedure proficiency.

To point to slightly precarious models of care in the USA and UK and use them as shining examples of what can be achieved is fraught – as we’ve learnt on numerous occasions in the past, such as the Staffordshire Hospital system deficiencies. The Australian system and expectations are unique and our solution must be crafted to optimise a net gain for our system and healthcare outcomes. The nurse endoscopy model does not achieve this – and worse it is more expensive due to reprocedure rates and subsequent requirement for consultations with specialists/GPs etc. It’s time for us to be clear on what we expect of Queensland Health to improve the endoscopy access dilemma.

AMA Queensland has raised these concerns with the Minister and Director General and offered a solution (see below). DirectorGeneral Michael Walsh, in reply, indicated the trial of nurse endoscopists at Logan Hospital had been “successful” and Queensland Health has “commenced a program to educate and train nurse endoscopists in line with international practice in expanding endoscopy services”.

AMA Queensland is seeking to work with the Queensland Government to create a sustainable, cost-effective model to increase access to endoscopy services for all Queenslanders that builds true capacity in the public healthcare system encompassing regional areas. The proposed actions are as follows – 1. Abandon resourcing of nurse endoscopy training and service provision.

2. Return this (significant) investment to currently idle and/or under-utilised endoscopy suites to immediately increase capacity, using medical endoscopists.

3. Investment in an increased number of gastroenterologists (and colorectal/ general surgeons) and gastroenterology (and surgical) registrars, in approved College training positions.

4. Collaboratively work with the College and professional societies to appropriately increase registrar/fellow training positions across the state.

5. Provision of a training pathway for procedural rural general practitioners to obtain accreditation through existing, internationally accepted GESA standards as endoscopists, to undertake independent practice in appropriate regional facilities.

Such individuals would have links to

large tertiary hospital gastroenterology departments for collegiate support and cross-referral.

I realise some among us might be partial to the notion that nurse endoscopists will allow full utilisation of endoscopy suites. This only holds true because historic funding has specifically (and tellingly) excluded recruitment of more gastroenterologists and fellows.

The Gastroenterology Society of Australia notes that there is not a shortage of endoscopists in this country and the workforce is predicted to grow steadily at least for the next decade. This could be predicted from the huge growth in medical student numbers and junior doctors within the system.

Let’s train and employ these doctors who will function independently, cost less to Queensland and train further generations of doctors before we settle for nurse endoscopists as a seductive ‘quick-fix’ solution. If we proceed too far with this expensive non-medical endoscopy model, we’ll find ourselves only helping those few patients living near large teaching hospitals, who’ve no complications or acute care requirements and can be scoped between nine and five without need for ongoing medical/ surgical management and planning. Q

DoctorQ September 2015

27

FOUNDATION

THANK YOU FOR ALL YOU DO FOR AMA QUEENSLAND FOUNDATION A huge thank you from the AMA Queensland Foundation to all our donors who gave generously to our recent end-of-year financial campaign. Together your support has raised $39,045 for our general fund which will help deliver vital services outside those catered for by the public health system such as: improved or emergency medical services, especially in rural and remote areas medical and specialised equipment for those whose needs don’t fit into the neat boxes of other health-specific charities scholarships to medical students enrolled at James Cook University, who have demonstrated commitment to working in rural medicine improved medical education vital medical research We also thank those supporters who completed our recent survey. We will use this information to plan for the future and provide you with feedback and updates.

Thank you once again – your continued support is an investment that will bear dividends for years to come. Q

A LIFETIME OF CARING A gift in your Will (bequest) can ensure we are there to lend a hand and potentially help us overcome the most challenging medical problems of tomorrow.

For more information on making a bequest to the AMA Queensland Foundation please visit www.amaqfoundation.com.au or contact the Foundation Office on (07)3872 2204.

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September 2015 DoctorQ

FOUNDATION Doctors doing good

Do you have a project which needs financial assistance?

Contact Fran Hawkes, Foundation Coordinator: Phone: (07) 3872 2204 Email: f.hawkes@amaq.com.au Website: www.amaqfoundation.com.au

YOU CAN HELP BRIDGE THE GAP In the words of Winston S Churchill, “We make a living by what we get. We make a life by what we give.”

You too can help “make a life” by donating to our regular giving campaign.

Members who currently pay monthly or quarterly will have recently received an email regarding making a donation to the Foundation.

The AMA Queensland Foundation (the charitable arm of AMA Queensland) is about supporting you and your medical colleagues who are filling in the gaps, delivering and championing vital services and projects outside of those catered for by the health system for Queenslanders in need.

For little more than a cup of coffee, you can help us deliver vital services and help bridge this gap. Small regular donations from a large number of members add up.

“You’re not going to change the world.

But you can make someone’s life better” The 2015 AMA Queensland Foundation Medical Scholarship recipient is Jessica Roberts, a second year Bachelor of Medicine/Bachelor Surgery student at James Cook University.

Jessica was drawn to a career in medicine through her desire to directly help and care for people. She was recently asked which area of medicine she was interested in pursuing, to which she responded: “I am greatly considering the rural generalist pathway. ... from what I have heard from rural generalists their careers are unique, challenging and very much rewarding. One of the most inspiring quotes that has encouraged me into rural medicine is from a rural health nurse of Palm Island. She said the best way to describe rural medicine is “You’re not going to change the world.

But you can make someone’s life better.” I feel that this very much puts into perspective that in rural medicine, you will not have a huge population effect, but you will have a very large affect on individual people i.e. the communities..... I feel that is something I very much wish to pursue and be a part of.”

Jessica recently completed voluntary hospital experience in Africa which she says “was not only an unforgettable experience but it also embedded my desire to work in rural environments.”

Jessica at one of the local orphanages playing soccer with the children.

Jessica on her voluntary mission at a hospital in Tanzania, Africa. “This was the first baby I have helped to deliver and was a very special moment for me.”

Choosing to donate regularly is just one way you can help the Foundation carry on its vital work. Regular giving is our lifeblood and allows us to budget, confidently plan ahead and commit with confidence to supporting various projects.

Your regular gift can make a difference. We do hope you can support us by including a donation to the AMA Queensland Foundation.

Donations over $2 are tax deductible and can be made via our website www. amaqfoundation.com.au/donation/ or by phone on (07) 3872 2204. Please help us fulfil our charter of doctors doing good.

DoctorQ September 2015

29

CURRENT ISSUES

PRESCRIPTIONS

HEALTH CHECKS

KIDS HEALTH

FAMILY PLANNING

DIET + LIFESTYLE ADVICE

YOUR GP

Switch on to better health for life

VACCINATION

CHRONIC DISEASE CARE

MENTAL HEALTH

Ask your GP to show you the way

Media campaign shows benefits of regular GP visit

In a new partnership with Brisbane North PHN (formerly Medicare Local), AMA Queensland kicked off a public campaign during Family Doctor Week aiming to make Queenslanders more aware of the health and economic benefits of a regular visit to their GP. AMA Queensland has worked hard to get the message out that a patient’s annual visit to the doctor could save Queensland’s health budget almost $630 million.

Although they come from different backgrounds and face different challenges, what they have in common is a passion for general practice and the health of their patients.

Crunching the numbers shows that more than 130,000 hospital visits a year could be avoided if Queenslanders sought regular care and advice from their GPs. These include admissions for chronic illnesses such as diabetes and heart disease, and even for some acute conditions.

Deception Bay GP Deborah Sambo spoke to the Redcliffe and Bayside Herald about the benefits of treating a whole family.

AMA Queensland President Chris Zappala urged the state government to invest more into prevention and early intervention.

“The average cost of a hospital visit is close to $5,000 ,”1 Dr Zappala explained. “So cutting the number of people admitted to hospital would have a huge impact on the budget bottom line.”

In its initial phase, the campaign has enlisted a number of GP ambassadors across the state to be the faces and voices of a media campaign in their local areas. There are some great personalities among them who will no doubt contribute to broadening the public perception of GPs and their role in the community.

30

September 2015 DoctorQ

“A family doctor is like your medical home, or medical library,” she said.

“You get better coordinated care by a family GP who knows your medical history and understands the medical journey you have been through.”

Milton GP Beres Wenck told the Westside News about the importance of consistent care and her 40 year passion for the job.

“I love that you never know what will come through the door,” she said.

Brisbane North PHN CEO Abbe Anderson said they were happy to support the campaign as GPs had an important role to play in keeping people well.

“Doctors know the health system inside-out and will help navigate through the myriad treatments and therapies on offer – from

vaccinations and weight loss to counselling and everything in between,” she said.

Brisbane GP Dr Matt Young, whose practice is based in the western suburb of Inala, said one of the best things about his work was getting to know his patients.

“Inala is very multicultural, so I love being able to talk to my patients about where they’re from. It helps me relate to them on a deeper level than just being their doctor,” he said.

“Everyone needs a GP they can talk to.”

You may have already seen GP articles in your local newspapers and can expect to see more popping up over the coming weeks. We have also produced a range of print and radio Community Service Announcements (CSAs) and are seeking media support in encouraging Queenslanders to check in with their GP and ‘switch on to better health for life’. Q 1 Australian Institute of Health and Welfare 2015, Admitted patient care 2013-2014: Australian hospital statistics.

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DoctorQ September 2015

31

MEMBER NEWS

Congratulations to the following doctors who are now elected members of AMA Queensland. may 2015 doctors in training Dr Nicole Lehmann Dr Gursimran Kaur Dr Veeranjit Singh Dr Chiedza Chimbare Dr Stuart Bailey Dr Maria Vartanyan Dr Stefanie Tran Dr Kendra Hopper Dr Mostafa Vahabi Dr Courtney Ashford Dr Sally Street Dr Kathleen Shaw Dr Yen-Yu Chen Dr Geeth Weerasooriya Dr Kiran Sheikh Dr Hatem Elfieshawy

General Practitioners Dr Janaka Sudheera Edirisinghe Dr Sonya Stemper Dr Kannan Natarajan Dr Peter Hawes Dr Edi Sottile Dr Melita Cullen Dr Michael Chen Dr Eduardo Rodriguez Dr Mehdi Rafiei Samani Dr Takavada Mapfumo

specialists Dr Heydon Kufakwame Dr Vesna Markovic Dr John Meulet Dr Asha Sadasivan Dr Hanlon Sia Dr David Kitchen Dr Karyn Lun

part-time Practitioners Dr Dinithi Samaratunga Dr Sonali De Sylva Dr Sepalika Jayamaha Dr Miriam Vassallo Dr Phoebe Donaldson Dr David Copeland Dr Alicia Kohn Dr Naomi Tracey Dr Matthew Hope Dr Elavarasi Ranjithan

SALARIED Dr Bernard Carty

june 2015 doctors in training Dr Stephanie Collins Dr Andrew May Dr Alexandra Douglas Dr Robert Yeh Dr Mayur Raniga Dr Chad Wong Dr Lawrence Ma Dr Tahlee Minto Dr Lauren Penney Dr Catriona Duncan Dr Adam Macfarlane Dr Carly Talbot Dr Yusuf Eqbal Dr Eric Douglas Dr Paul Mousa Dr Richa Dua Dr Kishen Narayanasamy

General Practitioners Dr Julie Hall Dr Clemente Brazil Dr Harpreet Kaur Dr Barrie Lennon Dr Bahram Adeli Koodehi Dr Kuinileti Chang Wai Dr Caetlin Jopson Dr Katrina McLean

32

Dr John Tran Dr Ryan Dougherty Dr Kandula Gupta Dr Siddhartha Sarmah Dr Sivaprakash Appanna Dr Seyed Majid Mousavifard

specialists Dr Derrick Brown Dr Amen Hassan Dr Katherine Smallcombe Dr Assad Bangash Dr Manoj George Dr Andrew Cameron Dr Kee Ong Dr Rahul Dua

Part-time Practitioners Dr Kerry Buchanan Dr Robina McCann Dr Karen Wright Dr Kah Chan Dr Krishanthini Kanagasabai

Salaried Prof Jeffrey Lipman Dr David Sharp Dr Vipul Vyas Dr Peter Gillies A/Prof Jon Hodge

july 2015 doctors in training Dr Cuong Ngo Dr Joseph Burke Dr Rashmi Mohan Dr Matthew Noussair Dr Bianca Westall Dr Portia D’Anverrs Dr Liat Barrett Dr Katherine Lewis Dr Sunayana Moriarty Dr Ian Condon Dr Stephen Fung Dr Jane-Marie Natoli Dr Yasmin Esat Dr Margaret Swenson Dr Sarah Galloway

General Practitioners Dr Thomas D Doolan Dr Jacqueline Crisostomo Dr Sajit Thomas Dr Chandra Jinabhai Dr Matthew Tatkovic Dr Jack Lai Dr Sean Scanlan Dr Deborah Sambo Dr Nelum Dharmapriya Dr Magdalena Brits Dr Ma.Teresa Laminero Dr Julius Ceasar Soriano Dr Suresh Kesavan Dr Michelle Kwan

specialists Dr Matthys Campher Dr Robyn Aldridge Dr Evan Willingham

part-time Practitioners Dr Juliet Tucker Dr Amanda Casperson Dr Don C.J.S Dematagoda Dr Natasha Laurens

SALARIED Dr Suranga Weerasooriya Mudiyanselage Dr Sue Williams Dr Archana Dwivedee Dr Sutrisno Gunawan Dr Bruce Goodwin

September July / August 2015 2015DoctorQ DoctorQ

A pulse check on my life and income protection insurance

Holly Bretherton, AMA Queensland’s General Manager – Member Relations, recently underwent a check on her life and income protection insurances with Experien’s Craig Wright.

Reviewing my personal insurances has been on the to-do list for quite a while.

Since the purchase of my first home, I had not really reviewed the level of life and income protection cover I had in place. I had added on some additional insurance at one point that I thought I may have needed, but had no real point of reference to determine whether it was sufficient, cost effective cover compared to what is now out there in the market.

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The team at Experien also coordinated the issuing of cancellation letters to my existing insurers and ensured the whole process was quick, easy and painless.

There was no need for a medical or further follow up appointments which meant less time out of my day.

So with my premiums rising, I booked an appointment with Craig to conduct a free audit of my insurance. Craig reviewed my existing cover and specific needs and within a couple of days proposed a comprehensive life, trauma, TPD and income protection solution that far exceeded the levels of cover I had in place, for very little extra premium.

One old policy I was holding for income protection was very basic in its features, and only covered me for a period of three months, rather than to age 65 (which I was unaware of until Craig reviewed the fine print). My existing trauma insurance was also more limited in the range of conditions it covered and Craig proposed a solution that increased the range of conditions covered, including lifting an exclusion that was previously in place on my existing insurance policy.

As Experien are insurance brokers, I felt confident that a range of solutions would be considered to best suit my needs and budget. I also felt reassured that the final product recommended had won Canstar awards for outstanding value and my policy is underwritten by one of the top 12 reinsurers.

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I was really impressed with the service provided by Craig, and he went the extra mile to ensure an old exclusion was lifted.

If you would like to review your insurance needs give Craig a call on 0488 273 399 or email craig.wright@experien.com.au Q Holly Bretherton reviewed this member product at her own time and expense and the cover she has secured is specific to her own needs and budget.

This article does not constitute financial or insurance advice. AMA Queensland recommends that you consult with your own financial or insurance adviser to best determine your insurance needs.

CURRENT ISSUES

resilience on the run pilot

with ama queensland’s resilience on the run pilot underway, doctor q had a chat to the principal investigator for the resilience on the run pilot, dr lisa byrom.

Dr lisa byrom

Council of Doctors in Training

Resilience on the Run is clearly an exciting step in improving the health of Queensland’s doctors. What was the inspiration for the program?

I was completing my JHO year when the Beyond Blue Survey was published. The report of significantly increased psychological distress in doctors brought this issue back into the spotlight.

Doctors in training are faced with a variety of stressors including working long hours, shift work, preparing for college exams, attending conferences, and applying for jobs.

This was also during the midst of the Queensland Health SMO contract crisis with growing concern amongst the junior doctors that they would not only lose their mentors but also future job security.

During this time I was involved in the AMA Queensland Council of Doctors (CDT) in Training advocating for working conditions and access to professional development opportunities, such as organising the first Junior Doctors Conference.

CDT believes it is important to advocate for the health and wellbeing of doctors. Particularly providing support during times of uncertainty such as transitioning from medical school to intern year and from prevocational to vocational years. This was where we thought we should aim our intervention, during the intern year.

When did work on the program begin?

What has been involved in getting it to where it is today?

We are very excited to see Rockhampton Base Hospital pilot the program and Cairns Hospital is our control site.

Initial discussions were held within the AMA Queensland Council of Doctors in Training after the publication of the Beyond Blue findings. An environmental scan and literature review was conducted to identify the current resilience programs in Australia and internationally.

Surprisingly, despite the high level of psychological stress documented from medical students to consultants, there have been few interventions implemented to address this issue.

A working group was then established to develop an educational program focussing on mental health and wellbeing of the junior doctor. With a focus on mindfulness, many programs centred on the theoretical concept with didactic learning styles.

We wanted to develop a program that taught practical mindfulness, which could be applied to common scenarios faced by the junior doctor. These include being faced with the death of a patient, receiving poor assessment from a supervisor, and bullying in the workplace. We named it Resilience on the Run to reflect that the practical skills taught during these sessions can be readily applied to our day-to-day practice.

We also wanted to evaluate the program to ensure it was effectively addressing stress and workplace pressure on doctors and the potential mental health consequences.

We are very excited to see Rockhampton Base Hospital pilot the program and Cairns Hospital is our control site. This evaluation has received ethics approval.

With the development of a new program, funding is required to ensure its successful implementation. Resilience on the Run would not have been developed and initiated without the generous support of the AMA Queensland Foundation.

Do you have any tips on how junior doctors can get involved in research?

The most important piece of advice is to ensure you do research in an area that you are interested in.

Research projects, even case reports, can often take a long time to write and get published, so you need to enjoy learning about the area.

Secondly, a mentor that understands your interests and aims is invaluable. To help you identify areas of interest and meet appropriate mentors I would encourage you to attend research seminars in translational settings.

This includes the seminars held at the UQ Centre of Clinical Research and the Translational Research Institute.

You can find relevant mentors and potential supervisors on the research institutes websites along with details of research higher degree topics.

AMA Queensland runs professional development events such as the Junior Doctor Conference and Research Evening designed to assist you in starting medical research. Q

DoctorQ September 2015

33

events calendar

9 October

Inaugural Health Minister’s Breakfast Townsville Townsville Mercure Hotel Meet Queensland Health Minister Cameron Dick in Townsville, where he will outline key priorities for Queensland Health. A question and answer session will follow, with a chance to raise local issues. The breakfast is presented by MDA National, and AMA Queensland’s President and CEO will also attend.

what’s on

September October

31 October Medico Legal Conference

Intern events

AMA Queensland’s membership team is gearing up to host events to help interns gain some valuable inside information to get through their internship.

Presented by junior doctors and industry experts, the workshop will ease the transition from student to medical practitioner.

The intern lunches are planned for the Princess Alexandra, Mater, Nambour, Royal Brisbane and Women’s, Ipswich, Greenslopes and Toowoomba Hospitals.

From doctor shopping and mental health reform to mandatory disclosure and defensive medicine, the AMA Queensland Medico-Legal Conference aims to arm you with information on the intersecting worlds of law and medicine to protect you and your patients.

26 November

Brisbane Convention and Exhibition Centre

Mayne Medical School

FREE Professor Paul Glasziou, a Professor of Evidence-Based Medicine at Bond University, will present the historic Bancroft Oration with a presentation titled What medical research should we believe and use?

September 2015 DoctorQ

Saturday 31 October 2015, law society house, Brisbane CBD

Law Society House

12 November

69th Bancroft Oration

34

Third annual

To view the full events calendar

Resume Writing for junior doctors By popular demand, AMA Queensland will host a resume writing workshop to attract your ideal role. A stand-out resume and LinkedIn profile is essential in today’s job market, and this seminar will show you what you need to do today to support your career tomorrow and beyond.

The workshop will also be available via webinar.

Or to register for an event, visit amaq.com.au or contact the AMA Queensland Membership team on (07) 3872 2222 or email registrations@amaq.com.au

69th Bancroft Oration What medical research should we believe and use?

Thursday 12 November 6.30pm for 7pm Sky Room, Sky Level, Brisbane Convention & Exhibition Centre, Grey Street, South Brisbane FREE for members and non-members.

Limited places available Live webinar attendance is also available for regional and rural practitioners.

Proudly sponsored by

Register via registration@amaq.com.au DoctorQ September 2015

35

People & EVENTS

join your lma

Local Medical Association round up

Stay connected with colleagues and up to date with the latest health news and issues affecting your local area. Don’t stand on the sidelines —join your Local Medical Association today and make a difference.

Sunshine Coast Contact: Jo Bourke Phone: (07) 5479 3979

Toowoomba and Darling Downs Email: info@tddlma.org.au Web: www.tddlma.org.au

Meeting dates: 24 September Speakers: From Nambour General Hospital Topic: Research Now and for the Future Venue: Maroochydore Surf Club

Meeting dates: 9 October, Inbound (restaurant)

22 October Speakers: SCUPH doctors Topic: Cardiology (tbc) Venue: Maroochydore Surf Club Sponsor: Ramsay Cairns Contact: Dr Sharmila Biswas Phone: (07) 4036 4333 mackay Contact: Dr Bill Boyd Phone: (07) 3872 2260 Meeting dates: 12 October Central Queensland Contact: Dr Harley Wilson Phone: 0419 277 611 Email: harleywilsonOO@gmail.com

Bundaberg Contact: Dr Daud Yunus Phone: (07) 4152 2888 Email: daud.yunus@gmail.com Brisbane Northside Contact: Dr Graham McNally Phone: (07) 3265 3111 Web: www.northsidelma.com Meeting dates: 13 October 10 November Redcliffe and District Contact: Margaret McPherson Phone: (07) 3121 4043 Web: www.rdma.org.au

Gold Coast Phone: 0419 780 505 Email: info@gcma.org.au Web: www.gcma.org.au Meeting dates: 25 September, 6.30 PM - 9 PM Venue: Gold Coast Surgical Hospital, Varsity Lakes fraser Coast Contact: Drs Thomas Dunn and Paul Neeskens Email: tomdunn@bigpond.com.au ipswich and west moreton Contact: Dr Thomas McEniery Phone: (07) 3281 1177 Meeting dates: 22 October Speakers: Jennifer Howard MP for Ipswich Social function

Meeting dates: 28 October

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

36

September July / August 2015 2015DoctorQ DoctorQ

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DoctorQ September 2015

37

People & EVENTS

Speaker update: justice david boddice

ama queensland’s medico legal Committee is pleased to welcome justice david boddice to our medico legal conference on 31 october. We had the chance for a quick q&a with his honour.

Q: What are the greatest challenges, in your perspective, facing the Mental Health sector in Queensland?

A: The major challenges are the identification, at the earliest possible opportunity, of the existence of mental illness, and the provision of adequate resources for its prompt treatment. Mental illness creates vulnerabilities; without early identification and treatment, people with mental illness can suffer harm, either at their own hands or at the hands of others, or may place members of their own family, friends or the wider community at risk.

The major challenges are the identification, at the earliest possible opportunity, of the existence of mental illness, and the provision of adequate resources for its prompt treatment.

Q: What does the standard day as President of the Mental Health Court entail?

A: The President of the Mental Health Court is a Judge of the Supreme Court of Queensland. That Judge sits in the other jurisdictions of that Court for the majority of the year as, on average, the Mental Health Court sits 10 to 12 weeks each year. The Court determines the issue of soundness of mind and/or fitness for trial in respect of criminal charges referred to the Court. The Court also hears appeals from decisions of the Mental Health Review Tribunal. The Judge is assisted by two psychiatrists. In any given week,the Court would hear and determine an average of 30 references or appeals.

Q: The legal profession has been dealing with problems related to the mental, and physical, health of lawyers. Given your unique position on the Judiciary would you have any advice on how professionals, both individually and collectively, can address these issues?

A: Every day, lawyers give advice or represent their clients in relation to criminal charges or civil litigation. By their nature, court proceedings are stressful. Lawyers, as professionals, must place their duty to the client above their own personal considerations. That means lawyers often do not recognise that the stress associated with litigation is taking a personal toll. It is important for all individual lawyers to be mindful of this possibility. It is important to talk to others about those stressors. It is equally important for lawyers to be observant of the impact of such stressors on their fellow professionals and to offer guidance and assistance in those times of stress.

Medico-Legal Conference keynotes include: The changing landscape of mental health reform in Queensland, The Honourable Justice Boddice, President, Mental Health Court, Supreme Court of Queensland Medico-legal Case Digest, Jennifer Rosengren, Barrister, Bar Association of Queensland The prescription opioid epidemic: a review of coronial findings and recommendations, Magistrate James McDougall, Southern Coroner, Office of the State Coroner Full program available at www.amaq.com.au 38

September 2015 DoctorQ

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DoctorQ September 2015

39

professional services

MDA National and AMA Queensland Launch Strategic Alliance

MDA National has established a strategic alliance with AMA Queensland to enhance and optimise education, advocacy and support for Queensland’s medical professionals.

MDA National President Dr Rod Moore, said the alliance is a natural extension of the long-term working relationship between the two organisations, and will deliver additional value to members of both organisations and the local profession via:

greater access to education and promotion of doctors’ health and

wellbeing additional fundraising and support for the local medical community through alignment of the AMA Queensland Foundation and MDA National’s Corporate Social Responsibility Program complimentary professional medical indemnity for eligible post graduate doctors*

professional indemnity premium reductions for eligible doctors in specialist training* collaborative events and activities of interest.

AMA Queensland President Dr Chris Zappala, said the alliance formalises MDA National’s position as the AMA Queensland’s preferred indemnity provider.

“We are delighted to be working with a like-minded membership organisation, and are confident our collective members will value the enhanced opportunities that the relationship provides,” Dr Zappala said. Q

*Subject to the Terms and Conditions of MDA National’s Professional Indemnity Insurance Policy and Underwriting approval MDANDIP200_90-YEAR_RECOMMIT_180(W)X130(H)5(BL)MM_F.indd 1

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September 2015 DoctorQ

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Supporting Queensland’s medical profession together MDA National and the AMA Queensland share a strategic alliance to support our collective Members and our local medical profession via:  promotion of doctors’ health and wellbeing  education, events and collaborative initiatives  fundraising for our local medical community through the AMA Queensland Foundation and MDA National’s Corporate Social Responsibility Program  complimentary medical indemnity for post graduate doctors*  50% premium reduction for eligible doctors in specialist training off the total cost of MDA National’s medical indemnity.*

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*Premium reductions are applicable for MDA National’s eligible “post graduate” and “doctor in specialist training” categories, where you are a member of both MDA National and the AMA Queensland. For more detail visit the Industry Alliance page at mdanational.com.au. These reductions cannot be claimed in conjunction with any other offer.

Subject to the terms and conditions of the Professional Indemnity Insurance Policy and underwriting approval.

The MDA National Group is made up of MDA National Limited (MDA National) ABN 67 055 801 771 and MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073. Insurance products are underwritten by MDA National Insurance. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your personal circumstances and read the Product Disclosure Statement and Policy Wording and Supplementary PDS and Endorsement to the Policy Wording available at mdanational.com.au. DIP199 DoctorQ September 2015

41

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42 September 2015 BENEVOLENT OF QUEENSLAND

DoctorQ

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professional services

A home loan that keeps working for you

BOQ Specialist’s Jeff Miller explains how boq specialist is uniquely tailored to doctors at all career stages.

After a decade of education and training, most medical professionals and specialists only enter full time paying roles in their early 30s – significantly delaying the purchase of their first home or investment. Couple this with the requirement by many traditional banks of two years’ worth of earning statements and owning your own home could seem a long way off.

With a 25-year track record working with medical professionals, BOQ Specialist understands the financial needs of doctors at all career stages. We are an expert partner banking on the professions we service: with our tailored offer not determined by net wealth but on an understanding of our clients’ professional qualifications and what that means. BOQ Specialist understands that doctors are not like mainstream clients. We also know doctors can potentially substantially increase their income once full-time work commences – which means what you’re looking for in a home could change quickly too.

It’s not just a mortgage, but a long-term plan Given our understanding of the medical profession, BOQ Specialist can help clients purchase a property as part of a longer term plan as opposed to a single transaction. For example, an inner-city apartment may not be the home you imagine raising your family in but could become an investment when you upgrade and buy something bigger – helping you build a portfolio of properties as part of a broader investment plan. If this is the case, structuring your first mortgage correctly is very important. An offset home loan with an attached offset transactional account, could allow you to save a deposit for your second property. This would ensure your original credit line remains fully in place to take advantage of other investment opportunities.

We also appreciate doctors are time-poor and that efficiency comes from working with the same relationship manager. While some other banks may see lending officers as generalists, our financiers are specialists who deeply understand the needs and circumstances of specific professional clients.

We are committed to long-term partnerships, allowing doctors, regardless of age or career stage, to manage their finances in one place. Our financial specialists visit clients directly to make it easier – often after hours to fit in with a client’s busy work schedule.

Jeff Miller BOQ Specialist (07) 3018 8100 jeff.miller@boqspecialist.com.au

Now is the time to think about finances No matter what stage you are at in building your property portfolio, our financial specialists will ensure financing is structured in the most beneficial way to give you flexibility as your medical career and assets mature – all done with a long-term view to support and help you build your practice (if you have one) at the same time.

Our banking package efficiently brings together a full suite of services. The package combines a home loan where doctors can borrow up to 90 per cent without paying Lenders Mortgage Insurance, as well as hold a credit card and everyday bank account, including optional extras, for a single annual fee. Q

Disclaimer: 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”). Terms and conditions, fees and charges and lending and eligibility criteria apply. Any information is of a general nature only.

We have not taken into account your objectives, financial situation, or needs when preparing it.

Before acting on this information you should consider if it is appropriate for your situation. You should obtain and consider the terms and conditions and if relevant, the Product Disclosure Statement (PDS) from www.boqspecialist.com.au before making any decision about whether to acquire the deposit products. We reserve the right to cease offering these products at any time without notice.

The information contained in this article (Information) 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. We recommend that you obtain independent financial and tax advice before making any decisions.

DoctorQ DoctorQJuly September / August 2015

43

professional services

Craig Wright 0488 273 399 craig.wright@experien.com.au for a free no obligation review.

Craig Wright is a life and income protection insurance specialist for Experien Insurance Services, based in Brisbane. They are the preferred life insurance partner of AMA Queensland. He focuses on the medical industry and understands the unique needs of doctors. This has helped him to negotiate enhanced products for our sector from insurers.

Is it better to buy insurance directly or use a broker?

In this edition of Doctor Q, Experien’s Craig Wright explains how using a broker has many benefits and debunks the myth that going through a broker can be more expensive when it comes to life insurance.

Is using an insurance broker more expensive than going direct?

Research shows that life insurance premiums on policies offered through brokers are commonly cheaper than policies offered to the public by direct insurance companies. This is partly because the health checks that the adviser arranges for the insurers can allow them to offer lower prices.

Sometimes direct insurers will not even offer cover if there is an existing health condition but advisers can overcome this in negotiations with insurers.

As a national brokerage firm, we utilise over 10 different insurance providers and have access to exclusive offers – so using our knowledge of the market, we run comparative quotes against direct insurance companies and often come up cheaper by 50-100 per cent, and with better quality benefits.

The devil is in the detail Getting your insurance over the counter or “direct” can sometimes appear to be a fast and simple solution. However, you may not be aware of all the product details, know what’s best for your needs or have missed a fundamental exclusion of the policy.

Understanding the fine print can be a complex and time consuming process.

Disclaimer: This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and also obtain independent professional advice before acting on the information contained inthis publication.

Life Insurance services are provided by Experien Insurance Services Pty Ltd (ABN 99 128678 937).

Experien Insurance Services Pty Ltd ABN 99 128 678 937 is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367.

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Advisers are educated in knowing what details are included or excluded within a given policy. We have spent time studying the product terms in detail so we can be confident in recommending and providing you with the most appropriate cover options available.

Insurance check-ups As we get older and our lives change, so do our insurance needs. Different stages of life and different family situations require changes to your insurance.

That means when any major life event occurs – getting married, getting divorced, starting a family or building a business – it may be time to review your coverage levels and your beneficiaries.

Make sure you don’t get stuck on an old policy that becomes out of date. It is also important to check your level of coverage and to make sure that it is still adequate. Being underinsured could leave your family vulnerable should anything happen to you.

What happens at claim time?

The value of insurance is never felt more than at claim time. This is also when dealing with an insurance adviser (as opposed to dealing direct with an insurer) is so valuable. Advisers help with such things as, arranging claim forms and delivering it to a client’s house, arranging a death benefit payment for the grieving family or assisting with many other complex aspects such as arranging probate. It is essential that the manager of your insurance has a strong relationship with the insurers, and are able to ensure your claim is managed in an efficient manner. Q

Did you know 83% of Australian’s say they have insurance for their car?

Yet only 31% have income protection.

For the equivalent of an average annual car insurance premium you can insure your cumulative loss of income to age 70 (in excess of $2,000,000).* Experien is the preferred life insurance provider to the AMA Queensland and one of the few national brokers that specialise in the medical sector.

Speak to Craig or Justin for a complimentary consultation or review.

P 1300 796 577

Life Insurance services are provided by Experien Insurance Services Pty Ltd ABN 99 128 678 937. Experien Insurance Services Pty Ltd is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367. General Insurance services are provided by Experien General Insurance Services Pty Ltd trading as Experien Insurance Services ABN 77 151 269 279 AFS Licence No. 430190. This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and obtain independent professional advice before acting on the information contained in this publication. *Based on an average annual car premium of $900.00. Comparison based exclusively on Male, non smoker, age 28, $5,500 monthly benefit and accurate as of 02/02/2015. Statistical source: lifewise.org.au

E info@experien.com.au

professional services

HOW TO LEVERAGE DIGITAL TRENDS FOR YOUR PRIVATE PRACTICE Vividus Marketing Director Jason Borody’s presentation at the recent AMA Queensland Annual Private Practice Conference sparked numerous delegate questions and conversation about the most effective ways to engage digital marketing. Here are some highlights.

Jason Borody Director (07) 3283 2233 Jason@vividus.com.au

Vividus specialises in healthcare marketing for hospitals, medical centres, GP and specialist practices, and healthcare businesses.

Google, Twitter, Facebook, Pinterest, Yahoo.com, Bing…and now, mobile marketing. The digital healthcare market is surging with activity, and the list just seems to keep growing. It’s no wonder so many practice managers and medical professionals are confused and even overwhelmed about where and how to focus their marketing.

Direct mail Direct mail (electronic and traditional) is still one of the most trusted forms of media for reaching new patients or referrers, and for following up with existing ones. And new technologies are constantly making it easier and cheaper to reach your audience.

Even professional marketing firms are having a hard time integrating marketing strategies across all the available communication channels. What’s the answer? Surprisingly, even with the array of options available today, you can make a big impact by focusing on implementing a small number of activities well.

Email marketing is currently growing at 20 per cent year-on-year, and studies show that email is 40 times more effective at acquiring new customers than Facebook or Twitter. Every day, millions of businesses—from sole traders to multinationals— send email to their clients, subscribers, suppliers and partners. Email marketing provides the highest return on investment of any form of marketing: for every dollar invested, the average return is $44.25 - or 4,400 per cent.

Here are a few of the more dependable and effective marketing channels for growing a thriving practice.

Content and inbound marketing Patient engagement and education remains a primary challenge in helping people to not only manage their own health, but to convince them to undergo life changing transformations. But how do you do that? Through continual support and education programs – which is most efficiently delivered digitally.

Content marketing is a strategic marketing approach focused on communicating with your existing and potential customers without selling.

The key to successful content marketing is valuable, relevant, and consistent information, designed to engage clearly defined and segmented audiences.

Sharing content that is useful and educational to your patients and referral sources will help develop trust and they will consider you to be an authority on the topics. The more helpful your content is, the higher the chances that they will return for more.

Interaction builds relationships; relationships are memorable, improve likability, and build trust in you and your practice brand.

Content marketing also forms the backbone of your search engine optimisation (SEO) activity to ensure you are easily found on Google, social media, direct mail, and reputation management marketing.

While the benefits are significant, the challenge is finding the time to produce consistently high quality content for your various audiences. A medical marketing agency will be able to help by implementing more efficient processes as well as researching and ‘ghost-writing’ content on your behalf.

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Try direct mail for the next 90 days. Measure your response rates and track the profits which come from using this trusted form of media.

Here are a few tips for using direct mail: 1. Segment your lists and only mail people who match your ideal prospect. A smaller targeted list is better than a large general list.

2. Use multi-step campaigns instead of just sending one communication. The more touch points you make, the more likely people are to respond.

3. Give your reader two response options instead of just inviting them to call a phone number.

Some people might be ready to download a brochure online and do some research before talking to someone.

Google+ Does your practice have a Google+ (G+) Page? I can almost assure you that you do, given Sensis’ (Yellow Pages) business listings integration with Google. However, many practices don’t realise they have this digital asset and do not optimise or use their page effectively. Unfortunately if you have not reviewed your G+ Page there is a high chance that your listing details may be incorrect.

G+ is growing rapidly in usage and influence, it has outpaced Twitter to become the second biggest social network behind Facebook with 300 million active G+ users and 540 million users engaging with some form of Google product monthly.

A practice’s G+ page is a major contributing factor to your search rankings. Start by updating your practice’s profile, posting original content, then networking through circles as soon as possible.

This is one area of digital marketing that is free, and relatively easy for a practice to self-manage. Q

professional services

Asset allocation decisions continue to drive investment performance

A portfolio comprising just Australian shares would have delivered a return of -3.16 per cent for the year while a portfolio comprising 50/50 international and Australian shares would have delivered 19.95 per cent for the same period.

The S&P/ASX200 Index returned just 1.18 per cent, or 5.68 per cent including dividends, for the year to July 31. However, while the Australian share market struggled to stay positive for the 12 months, other asset classes performed strongly with international shares surging 30.92 per cent, listed property up over 21.0 per cent and government bonds delivering 16.83 per cent over the same period1 (refer table below).

Over the medium term, asset class performance is typically driven by cyclical factors such as corporate earnings, interest rates and inflation.

The business cycle, which encompasses the cyclical fluctuations in an economy, can therefore be critical in determining the relative performance of various asset classes.

The performance of economically sensitive assets such as shares tends to be the strongest when growth is accelerating during the early part of economic recovery and then moderates as economic growth slows. By contrast, defensive assets such as government bonds generally deliver their highest returns during periods of weak or negative economic performance.

So, there is potential to enhance portfolio performance by tilting exposure to the major asset classes based on the changes in the business cycle. That is, by increasing portfolio weightings to the asset classes that tend to

outperform during a particular phase of the business cycle.

To their detriment, investors can become too fixated on stock selection alone without considering whether they should be investing in an asset class more likely to outperform in the current stage of the business cycle.

For example, in the year to 31 August 2015 a portfolio comprising just Australian shares would have delivered a return of -3.16 per cent including dividends, while a portfolio comprising 50 per cent Australian shares, and 50 per cent international shares would have increased performance to +19.95 per cent for the year. 1.

Ross Noye Macquarie Private Wealth (07) 3233 5805 0438 779 955 ross.noye@macquarie.com Ross Noye is a stockbroker and financial advisor at Macquarie who specialises in investment and retirement planning.

A more diversified portfolio comprising 40 per cent Australian shares, 30 per cent international shares, 20 per cent listed property, five per cent fixed interest and five per cent cash would have delivered investors 12.88 per cent more than the single asset class approach for the year. For a $1 million portfolio that’s an increase in portfolio value of $128,800 for the same period.

The importance of the asset allocation decision becomes even more compelling if the investor was to continue with the single asset class approach by switching to international shares alone, which outperformed Australian property by 8.92 per cent for the year and outperformed Australian shares by 26.27 per cent. Q

Macquarie Wealth Management Research 31-Jul-15

1 mth %

3 mth %

1 yr %

3 yrs %pa

Australian shares S&P/ASX 200 Accumulation

-7.79

-8.84

-3.16

11.25

8.16

S&P/ASX 200

-8.64

-9.87

-7.45

6.45

3.41

All Industrials Accumulation

-7.89

-7.20

2.76

15.73

13.04

All Resources Accumulation

-7.24

All Industrials

-8.72

-8.27

-1.83

10.45

7.45

All Resources

-8.15

-17.89

-30.21

-8.92

-9.92

S&P/ASX 20 Accumulation

-8.99

-9.17

-5.37

11.33

8.81

-17.08

-27.10

-5.74

31-Jul-15

5 yrs %pa

-7.23

1 mth %

3 mth %

1 yr %

3 yrs %pa

5 yrs %pa

Dow Jones

-6.57

-8.23

-3.34

8.08

10.54

S&P 500

-6.26

-6.42

-1.56

11.93

13.45

Toronto Comp

-4.21

-7.69

-11.31

5.07

3.07

Nikkei

-8.23

-8.13

22.47

28.80

16.44

Dax

-9.28

-10.11

8.33

13.75

11.61

Regional Markets (local currency returns)

FTSE 100

-6.70

-10.54

-8.38

3.04

3.64

Hang Seng

-12.04

-20.98

-12.41

3.61

1.08

NZSE 50

-4.67

-4.07

3.07

10.38

7.95

-4.09

-2.83

14.19

16.81

13.53

S&P/ASX 50 Accumulation

-8.35

-8.77

-3.68

11.48

8.76

Property

S&P/ASX 100 Accumulation

-7.93

-8.65

-2.67

11.89

8.70

S&P/ASX 200 Property Trust Cash and bonds

International shares MSCI World Indexed Hedge in $A

1.00

6.29

5.15

6.39

-7.14

1.96

14.28

12.75

Bloomberg Composite Bond All Maturities

0.64

-6.88

MSCI World Index $A (unhedged)

0.35

5.49

5.94

6.63

-0.59

23.44

23.11

13.73

Citigroup World Govt Bond Index Helped

-0.01

-4.27

MSCI Emerging Markets $A (unhedged)

8.69

21.76

10.33

4.79

-12.36

-1.27

7.82

1.07

Citigroup World Govt Bond Index

4.07

-6.73

Bloomberg Bank Bill Index

0.18

0.54

2.51

2.78

3.55

1 Iress; Macquarie Wealth Management Research; 2 Macquarie Research, Macquarie Wealth Management Research, IRESS 3 Macquarie Wealth Management Research

important information: This information has been prepared by Macquarie Equities Limited ABN 41 002 574 923 (“MEL”) participant of Australian Securities Exchange Group, Australian financial services licence No. 237504, No 1, Shelley St, Sydney NSW 2000, and does not take into account your objectives, financial situation or needs. Before acting on this information, you should consider whether it is appropriate to your situation. We recommend that you obtain financial, legal and taxation advice before making any financial investment decision. Members of the Macquarie Group or their associates, officers or employees (“Macquarie”) may have interests in the financial products referred to in this advice by acting in various roles including as investment banker, underwriter or dealer, holder of principal positions, broker, lender or adviser.

DoctorQ DoctorQJuly September / August 2015

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professional services

Managing cash flow An ever present issue with medical practices, like all small businesses, is cash flow management. Paul Copeland from William Buck explains how medical practices can now access powerful, low cost tools such as the accounting software, Xero, to help start addressing the issues of cash flow management.

Paul Copeland William Buck (07) 3229 5100 paul.copeland@williambuck.com

Paul Copeland is Business Advisory Director at William Buck Chartered Accountants and Advisors.

In a typical business, cash flow management usually revolves around ensuring there is enough cash in the bank to pay the bills for the coming month. In a medical practice, while this is also an issue, unpaid debtors and private health insurance claims as well as potential misallocations of funds, should also be looked at more closely.

Medical practices can now leverage the power of technology to take the financial control on their businesses to the next level. The crucial ingredient in this recipe is the integration of practice management software with the practice’s accounting software.

Modern accounting software, such as Xero, automatically imports detailed bank account transactions that can simplify the bookkeeping process for revenue. However, the bank transactions themselves do not allow reconciliation with the ‘source of truth’ – which for most medical practices, is the revenue recorded in the Practice Management System (PMS).

Prudent financial management of these practices, along with the development of strong internal controls, is an essential component for maintaining profitability and safeguarding assets.

DISCLAIMER: This article has been prepared

by Paul Copeland of William Buck. The article is intended to be general in nature and should not be relied upon by any person without seeking advice concerning their own circumstances.

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Most medical practices account for revenue based on cash deposits to their bank. Some will provide a debtors balance of fees owing at the end of a period but this would be rare. The problem with this approach is that there is usually no timely reconciliation of the practice’s revenue as shown in the PMS with deposits to the bank undertaken by an independent party.

Specifically, the practice’s external accountant would not usually have sufficient information to be able to undertake this important internal control procedure.

The open-integration policies of accounting systems like Xero can allow the automated recording of PMS revenue and payments in the accounting system.

The two primary benefits of this are: 1. True accrual accounting of revenue in real time, which when matched appropriately with expenses, can give a powerful presentation of practice probability; and

2. The ability to readily and electronically reconcile PMS payments/receipts with the bank account transactions, dramatically increasing financial controls.

William Buck is currently working with Surgical Partners and practice software providers to understand these issues to the point of providing a receipt-level integration solution that connects to the PMS ‘source of truth’. Surgical Partners’ Integration Hub allows medical practices to integrate their PMS with Xero, thereby facilitating the easy, electronic reconciliation in Xero of individual bank deposits with individual receipts integrated from the PMS. There are several benefits of receipt-level accounting integration: 1. Accrual accounting, by law, is a requirement for businesses with a turnover of over $2million or more.

2. When used with other fraud prevention measures, the process of a daily bank reconciliation can reduce incidence of fraud.

3. The data within Xero should be able to be further reviewed and analysed in ways currently not easily available.

As the trend for larger medical practices continues, the prudent financial management of these practices along with the development of strong internal controls is an essential component for maintaining profitability and safeguarding assets.

With improvements in software technology and integration, medical practices can now take advantage of the efficiencies and financial control that other small business industries have been enjoying for years. Q

ARE YOU THINKING

OF SELLING YOUR

MEDICAL PRACTICE? WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK CAN HELP YOU SELL YOUR PRACTICE AND MAKE THE MOST OF YOUR FINANCIAL FUTURE. We understand that the sale of your practice is crucial to your retirement and can help you plan and prepare to achieve the best possible outcome.

William Buck is experienced in managing the sale process for medical practices, and can assist with the following: — Valuing your practice — Negotiations and the purchase process — Due diligence — Prepare your financial data ready for sale — Structuring the sale and maximising tax outcomes — Benchmarking your practice against industry profit trends CONTACT PAUL COPELAND FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION Phone: + 61 (7) 3229 5100 Email: Paul.Copeland@williambuck.com

DoctorQ September 2015

49

professional services

WHAT IS INTELLECTUAL PROPERTY?

Robin Lonergan, Partner at TressCox Lawyers explains what intellectual property is and how to protect it.

Robin Lonergan Partner (07) 3004 3530 Robin_Lonergan@tresscox.com.au Robin has 30 years’ experience advising on all aspects of contract and corporate law. He specialises in advising of companies, joint ventures and commercialisation of Intellectual Property.

Intellectual property is the non-tangible property which often adds real value to business. It includes the goodwill of the business, the way that the business operates from a management system point of view and it can include new technologies or methodologies. Some common intellectual property includes: a) the business name of the enterprise; b) trademarks which can be registered; c) patient details and records (which are owned by the doctor or the practice though the patient may require a copy); d) inventions of new products; e) invention of new business methodologies; and f) the confidential information of the business which is very broad and can include the names of patients but also names of reliable suppliers which can be protected contractually.

Protecting intellectual property Rights in intellectual property will be lost if the information ceases to be confidential – if it enters the public domain. An invention or information can enter the public domain by having been published on a website or if it is allowed to be seen by the general public. It is therefore very important to ensure information is kept in a confidential way and that employees (or anyone else having access to the information) are aware of their obligations to maintain the confidentiality of that confidential information.

The registration of a company does not necessarily provide protection that that name will not be used by anyone else.

If there is a breach of the confidentiality, it is important that the owner acts quickly as usually the best way to prevent a breach of confidentiality and to maintain the intellectual property is to seek an injunction from a Court to stop the breach continuing. Courts will only grant an injunction where there is strong evidence relating to the breach of confidentiality and evidence about how the information is being used improperly and the potential loss to the owner.

In general, employees owe an obligation of good faith to the employer and any inventions improvements made by an employee during the course of his or her employment will be owned by the employer. Some organisations, such as universities, may have agreements in place so that a particular researcher or group of researchers will be entitled to share in the commercialisation of inventions they have made even if it is during the course of their employment.

An employee may develop an invention in his or her own time. Usually, such an invention would be owned by the employee however if the employee

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September July / August 2015 2015DoctorQ DoctorQ

has used the employer’s confidential information to develop that invention, it is likely that it will be considered to be a development in the course of employment.

Registration The registration of business name is easily managed through the ASIC website and registration is now throughout Australia. The registration of a company does not necessarily provide protection that that name will not be used by anyone else.

This is because the Corporations Law has been developed on the basis of the Australian Company Number (ACN) being the identifier for a company rather than its name.

To provide the best protection for a name, it is better to consider registration of a trademark incorporating that name. Trademarks are registered in various categories and it may include a logo or a particular group of words though a trademark cannot protect the name of a locality or generic words such as medical practice.

The categories of registration mean the name could be used in a completely different industry for example if the word was registered by you for purposes of health services, someone else may be able to register the same word in relation to mining equipment as there would be no confusion by a member of the public in dealing with a business with that name because of the completely different nature of the operations.

Patents are registered by patent attorneys, not lawyers. Generally patent attorneys are people who have a science or engineering degree as well as a law degree. The patent protects the specific item or process and documents that item or process in a diagrammatic way. In Australia, a patent is registered by IP Australia and is a right that is granted for any device, substance, method or process that is new, innovative and useful. A standard patent lasts for up to 20 years, pharmaceutical patents can last to 25 years and an innovation patent lasts up to eight years. The innovation patent is designed to protect inventions that do not meet the inventive threshold required for standard patent. It is relatively quick and inexpensive way to protect a new device, substance, method or process. It is particularly useful where the invention may have a short market life and be superseded by newer inventions, particularly computer based inventions.

We are able to assist you with putting in place the agreements and registrations needed to protect the intellectual property associated with your practice. Q

, Partner

Simon Harrison, Partner Phone 07 3004 3535 Mobile 0449 533 315 Simon_Harrison@tresscox.com.au

, Partner

, Partner

, Partner

, Partner

, Partner

We can help you with: Purchase and sale of medical practices Medical indemnity claims IR & Workplace Safety Registration issues Business structuring and contracts Corporatisation

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

DoctorQ September 2015

51

professional services

Transitioning to private practice

THERE ARE MANY RISKS IN RUNNING A PRIVATE MEDICAL PRACTICE. CHRIS MARIANI FROM AMA QUEENSLAND INSURANCE SOLUTIONS TALKS ABOUT SOME COMMON RISKS IN A PRIVATE PRACTICE AND THE INSURANCES THAT SHOULD BE CONSIDERED.

Chris Mariani AMA Queensland Insurance Solutions 1300 883 059 chris.mariani@amaqis.com.au Chris Mariani is a medical indemnity specialist at AMA Queensland Insurance Solutions.

AMA Queensland Insurance Solutions recently ran a session at the AMA Queensland Annual Starting and Working in Private Practice Conference (a key event every practitioner should attend if they are considering moving into private practice). We focused on common risks a private practice is exposed to, how to effectively insure these risks and practical strategies a practice can put in place from a risk management perspective. Many of the other sessions at the conference had a risk management element – from setting up appropriate business structures, IT systems, privacy obligations and many more.

Our session focused on implementing a ‘risk register’ to identify and manage a practice’s key risks. We usually find it helpful to group risks into key areas and the following table represents some of the common risks found in a medical practice.

Risk Group

Risk Example

Medical/clinical

A patient bringing a civil claim against a doctor alleging medical negligence in their treatment of the patient.

A patient brings a civil claim against the practice entity and/or employed staff, alleging failure of practice processes leading to a clinical error (eg breach of privacy, test results not being followed up, etc).

Rooms

Fire, storm, water damage, theft or some other physical event resulting in loss or damage to practice contents, fitout, equipment.

Lost revenue following a physical event (eg do your rooms need their own ‘income protection’?).

Patient and visitor slips and trips.

Breakdown of key equipment (including the potential lost revenue)

Management/employment

IT systems

Loss of revenue, data and costs following electronic breakdown, physical loss of hardware or a cyber-attack.

Responsibilities as a director Employment liability (eg unfair dismissal, harassment etc) Employee theft Statutory fines (eg workplace health and safety fines, privacy fines) Workers compensation (injury to workers)

Once a practice has identified its key risks, it can then decide on an appropriate risk treatment strategy. For many of the above risks, a key part of this treatment is purchasing the right insurance protection. This is usually done with the following key insurance policies: 1 Medical Indemnity (practitioner) 2 Medical Indemnity (practice entity and staff) 3 Business Package (cover for the rooms) 4 Management Liability 5 Workers Compensation 6 Cyber risks The cost of the above insurances depend on various factors such as medical speciality, revenue, staff numbers, wages paid, insured values and the quality of the construction and security of the building. Q DISCLAIMER: AMA Queensland Insurance Solutions is a trading name of KSLR Pty Ltd, a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, AFSL 240549.

Corporate Authorised Representative No: 366807.

The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

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September July / August 2015 2015DoctorQ DoctorQ

ONE LESS THING ON YOUR TO-DO LIST Have all your insurance needs covered through AMA Queensland Insurance Solutions

Free insurance health check

www.amaqis.com.au

We know doctors have a busy schedule, and while it may be easy to renew your insurance each year without proper revision, changes may have occurred for which you may not be fully covered and premiums need competitive comparison.

For peace of mind and an insurance healthy practice, contact AMA Queensland Insurance Solutions on 1300 883 059.

DoctorQ September 2015

53

People & EVENTS

Finding my balance in the Queensland Medical Orchestra

Dr Lily Vrtik, a Plastic and Reconstructive Surgeon tells Doctor Q how the Queensland Medical Orchestra restored some balance to her busy life.

Dr Lily VRtik

Queensland Medical Orchestra

back. Like so many others on this similar path, I made sacrifices - one of which was giving up music, something that I have had since I was six years old.

I ploughed my way through medical school with four part-time jobs, and then did the obligatory overtime as a junior doctor to get onto a surgical training program. After that, setting up private practice and running between public hospitals consumed my socalled ‘spare-time’. There weren’t enough hours in the day for my work - let alone for myself. People often asked about my hobbies - and my answer would always be eating, sleeping and remembering to breathe.

For me, apart from going to the occasional concert, and tinkling on the piano at home once a month (if that), music really wasn’t part of my life.

Then I decided to join Queensland Medical Orchestra.

54

As anyone who has treaded the path of medicine will tell you - medicine is a way of life. As all of us try to find the balance between work and living, we ultimately find ourselves juggling between our responsibilities to patients and our desires to spend more time on our families and ourselves. Some manage to fit their work around their personal lives, whilst others devote their life to their work.

One way or another, everyone is continually trying to reach that personal ‘perfect balance’.

It was March 2012, and after another gruelling seven day 80 hour week, I decided that it was time I put time aside for myself. At the time, QMO was recruiting players for their next concert. My love for making music had always been very personal to me, so joining an orchestra was naturally ‘doing something for me’. I was pretty nervous on the first day- I didn’t know anyone, I hadn’t read music for years, and the last time I touched my flute was before Medical School!

Everyone has a fork in their life - the moment when they had to make a decision and chose a certain path - mine was between medicine and music. I chose medicine because I wanted to help people; unfortunately, I found that my music was only helping little kids who did not want to practice before they came to their piano lessons. So, since I started my life on the path of medicine, I have not looked

I could not believe the buzz I got during that first rehearsal. It didn’t matter that I finished a bar earlier than everyone else and that I was playing in a different key to everyone else around me, I was making music.

September 2015 DoctorQ

Each rehearsal was better than last, because each time the music we made sounded better.

The buzz never went away. The concert itself

was both exciting and nerve-racking for me - not having performed in public for over 10 years. We made a magnificent sound in the Old Museum - as the audience at the sold-out concert will tell you. And I even finished the last note at the same time as everyone else!

It was then I realised that in the last 15 years of immersing myself in medicine, I had forgotten how much I loved making music.

So for all of you out there who have forgotten how much you loved doing something before medicine took over your life, maybe it’s time you do something for yourself.

For all the music lovers in medicine, come and join us at Queensland Medical Orchestra and Choir, as players or singers, support or audience. Contact us on qmo@uqms.org for more information.

This article originally appeared in North West Private’s Medical Matters magazine. Q

It was then I realised that in the last 15 years of immersing myself in medicine, I had forgotten how much I loved making music.

lifestyle

Roger waters the wall From the creator of the classic Pink Floyd album, the groundbreaking tour seen by over 4 million fans worldwide, comes to cinema screens and includes an exclusive in conversation with Roger Waters. For one night only be a part of this immersive concert experience: a road movie of Waters reckoning with the past, and a stirring antiwar film. It is truly a breath taking cinematic experience.

Aida

met Opera

macbeth

The Beaux Strategem

cinema

National Theatre Live

3 October 10.30am, 4 October 1pm

Starting 1 October

Verdi’s iconic opera set in ancient Egypt stars powerhouse Ukrainian soprano Liudmyla Monastyrska, who makes her Met debut in the title role of an enslaved Ethiopian princess. Olga Borodina, one of the world’s best-known interpreters of the role, sings Aida’s royal rival, Amneris, and Roberto Alagna is the hero Radamès, who must choose between his love for Aida and his duty to his country. Fabio Luisi conducts his first Met performances of the opera, which also stars George Gagnidze as the Ethiopian king, Amonasro. Sonja Frisell’s spectacular staging uses the full theatrical capabilities of the Met stage to immerse the audience in the grandeur of ancient Egypt.

The story of a fearless warrior and inspiring leader brought low by ambition and desire. A thrilling interpretation of the dramatic realities of the times and a truthful reimagining of what wartime must have really been like for one of Shakespeare’s most famous and compelling characters, a story of all-consuming passion and ambition set in war-torn 11th Century Scotland. Starring Michael Fassbender, Marion Cotillard and Elizabeth Debicki.

10 and 11 October 1pm, 12 and 14 October 6pm Simon Godwin (Man and Superman) directs George Farquhar’s wild comedy of love and cash. The ‘Beaux’: Mr Aimwell and Mr Archer, two charming, dissolute young men who have blown their fortunes in giddy London. Shamed and debtridden, they flee to provincial Lichfield. Their ‘Stratagem’: to marry for money.

17 Sept Everest

COMING FILMS

1 Oct Macbeth The Intern

Blinky Bill

*films releasing at Dendy

Oddball

Portside are subject to change –

24 Sept Sicario Pan

check the website for up to date releases

30 Sept The Martian

WIN MOVIE TICKETS FOR TWO Name:

Member No:

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

Phone:

FAX TO (07) 3856 4727 or email competitions@amaq.com.au by 30 September DoctorQ September 2015

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lifestyle

A Slice of France in Pemberton

Our wine guru Phil Manser has discovered a whole new region perfectly suited to premium wine production and finds a fairly unique French inspired winery at its heart.

I must admit I’d heard of Pemberton the wine region but didn’t know much more about it until I was able to sample the wines of Picardy, a family owned boutique winery in the perfect site for the production of premium quality cool climate wines. For those of us keen to experience old world wine making in Oz, Picardy sits comfortably in an elite club of French inspired wineries.

In the Australian context Pemberton is one of our newest wine regions first planted under vine in 1977 with commercial plantings following in the 1980s. As with Margaret River the local conditions lend themselves perfectly to premium wine production, a combination of relatively high altitude and proximity to the Southern Ocean make for a long, sustained even ripening season. Add the prevalence of loamy, gravely soils and you’re looking at prefect conditions for the production of pinot noir and chardonnay.

The fruit is pristine in varietal terms, citrus, melon with a minerally hint to boot but what happens in the winery is what really sets this apart. The fruit starts its fermentation in tank using two different yeast strains and finishes the process in French oak barriques.

Whilst in oak it undergoes malolactic fermentation and is lees stirred once a week. After 10 months in oak the wine is lightly filtered at bottling.

The result? In balance all of this in combination makes a wine of complexity and depth and that’s what you have here. A wine that wouldn’t look out of place rubbing shoulders with Mount Mary, Leeuwin et al.

I’m a fan and you will be too. To access AMA Queensland member pricing on this gem and others in the Picardy stable contact Phil at phil.manser@winedirect.com.au or phone 1800 649 463 for a chat. Q

Picardy was established in 1993 by the Pannell family with the goal of harnessing these local conditions to produce wines of quality and excellence. Picardy’s wines are inspired by time spent in Burgundy where tried and trusted techniques have been used for centuries to make outstanding pinot noir and chardonnay. This experience and specific clones imported from Burgundy make their wines a must for Francophiles.

This is a real eye opener for the ABC crowd (Anything But Chardonnay) as this is nothing like the chardy served up under commercial labels.

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September 2015 DoctorQ

Top of my list is the 2012 Chardonnay, an amazing wine brimming with delicate flavour and complexity that becomes more apparent as the wine creeps closer to room temperature. This is a real eye opener for the ABC crowd (Anything But Chardonnay) as this is nothing like the chardy served up under commercial labels.

2012 Picardy Chardonnay

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

lifestyle

The perfect skiing holiday

Whistler, Canada

Sitting at work on Monday afternoon and dreaming of a powdery white snow field? Maybe it’s just us then. AMA queensland Travel highlights the best places around the world to hit the snow.

A clear blue sky with the sun glistening on the pine trees, standing at the top of the mountain about to start your first run of the day on a perfectly groomed trail or do you go for the fresh powder? Such decisions… the perfect ski holiday can be a dream come true, providing you with memories that last a lifetime.

Snow skiing and snowboarding at Niseko or Hokkaido in Japan offers the avid skier great opportunities and an amazing powder experience. Skiers and boarders are able to combine great snow with the unique culture of the country. With its close proximity and similar time zone, Japan is a popular destination for Australians.

A skiing holiday is ideal for everyone - families of all ages, singles, couples, groups of friends.

The choice of destinations and experiences are as varied as the ski runs. It is time to be planning your Christmas break if you haven’t already and the Northern hemisphere ski season is perfect to consider.

Europe offers the adventurous skier a wide variety of snow skiing and snowboarding opportunities. You may wish to ski the alps of Austria or experience the extreme valleys of France for stunning snowboarding and varying styles of ski resort accommodation.

The Christmas Markets that run in December are a sight to behold, offering seasonal gifts and mouth-watering treats with lights and entertainment to showcase these winter wonderlands.

Canada offers fabulous resorts from Whistler and Lake Louise to Big White and Sun Peaks. Whistler is considered one of the best mountain resorts in the world that offers perfectly groomed cruising runs to amazing mogul fields. Or would you prefer to ski down a mountain with the stunning Lake Louise as your background? QANTAS offers direct Australia to Vancouver flights during the ski season to enable easy access.

In America your choices vary from Vail and Aspen in Colorado to Lake Tahoe in California.

You may like to consider one of the lesser known resorts such as Copper Mountain in Colorado with its 140 trails, 23 lifts and 2,465 acres of skiable terrain, only 145kms from Denver. Combine the skiing with a stop in Vegas or Disneyland with the kids and the US has it all.

Most of the resorts also offer a variety of activities other than skiing – snowmobiling, winter wildlife tours, dog sledding, snow shoeing, ice skating and shopping! You could also opt for the ultimate sea and ski experience - combine a skiing holiday with a cruise.

Getting your skis or board on the snow is getting even easier with the introduction of more direct flights from Brisbane to Los Angeles, Tokyo, Vancouver and Europe.

So whether you want to ski, snowboard, cross country, après or just SKI (spend kids inheritance) AMA Queensland Travel can get you on those slopes. Q

Hokkaido, Japan

Italian Alps, Italy

Cooper Mountain, America

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HELP is only a call away

An independent, confidential and colleague-to-colleague advisory service for doctors, dentists and the students of these professions.

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September 2015 DoctorQ

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lifestyle

restaurant Review Around the AMA Queensland office Moo Moos is synonymous with high-quality steak. It was with much excitement that I finally had the chance to spend an evening at their Brisbane restaurant nestled into the Port Office Hotel. My partner was a willing participant, and excuse, to sample this vaunted establishment.

From the moment you walk into Moo Moos, past the statue of the enraged bull, there’s little doubt that you’re entering a shrine to beef. Any thoughts that this would be anything but are firmly displaced by the time you walk past the glass cabinets stuffed with cuts of meat and the serving window to the chefs. This place is unapologetically carnivorous.

Decor: The restaurant does an admirable job of combining the heritage charms of the building with the genteel, soft industrial interior. The tables, especially in the centre of the restaurant, are awfully close together and sometimes feel like you’re sharing a meal with the couple next to you. Most nights this wouldn’t be a problem but we were provided, thanks to the polite yet overly friendly lady on the table next to us, a running commentary on our meal choices. While some restaurants are designed to celebrate and enhance this sense of culinary community Moo Moos plush decor and clubhouse vibe makes it feel more like an intrusion.

Food: There’s a well known phenomenon in consumer psychology called analysis paralysis. After reading the menu at Moo Moos I believe it should be renamed after the menu. Prior to my dining experience I didn’t actually realise there were that many cuts of beef, in differing sizes, ages, breeds, geographic locations and feed to choose from. After a surprisingly stressful period of selection we finally decided on the breads for entree and the Cheese Steak 700g BBQ Wagyu Brisket, with sides of fries with truffle salt and parmesan, wagyu fat fried Nicola potatoes and tempura onion rings. It’s hard to fault the food; the sides were appropriately cooked and interesting in their own way. The salty tastiness of the fries, the delicious crust on the potatoes and the crunch of the onion rings all provided a delicious side to the main course of the brisket. The brisket was carved at the table with an appropriate sense of theatre to make it feel like more than a $79 piece of barbeque beef. Our one regret is that we were too full to try dessert.

Staff: Put simply, the wait staff at Moo Moos were exceptional. They were perfectly attentive, but not so as to become overbearing. They explained menu item without condescension and didn’t feel the need to reduce the level of service to customers who weren’t entertaining on the corporate credit card like many other fine dining establishments.

Overall: On balance, if you were to make a checklist on how to establish a premier steakhouse then Moo Moos would tick all the boxes. However, like the use of criteria based discharge forms in emergency rooms, there was some intangible element missing. Whether this was the night that I ate dinner there, or whether I simply chose the wrong menu item, it felt as if there was some piece of the puzzle missing that would elevate this from a great experience to an exceptional one. I hope that upon my return, and there will be a return, these pieces will fall into place. Q DoctorQ DoctorQJuly September / August 2015

59

People & EVENTS

All about you Go back to school for The Smith Family

past,

The Smith Family is hoping to send you back to school to help disadvantaged Aussie kids transform their lives through education. Pick a date in September, dress up in your old school uniform, organise a little lunch or play some school yard games, organise some donations and take part in Back2School Day 2015. Register now at back2schoolday. com.au and organise an event at your workplace. Sounds like a great excuse for fairy bread.

re

Simon Bryant’s Vegies Simon Bryant’s long-awaited debut cookbook is a vibrant, inspiring collection of vegie recipes that will appeal to vegetarians and meat-eaters alike.

APP SNAP - Menulog Menulog offers a wide variety of restaurants where you can order takeaway online for delivery to your home. Menulog partners with more than 55,000 restaurants in Australia that offer 67 types of cuisine so chances are you’ll find something you like. You can order an all day breakfast of eggs or a dinner of Kangaroo Medallions, pizza or pasta. For the health conscious, delicious Garden Salad, Caesar Salad or salad with feta cheese or Asian spiced duck are also on the menu.

Let Simon guide you through the changing seasons, as he shares tales from his vegie patch and brilliant tips for selecting the finest produce. Discover new ways to enjoy your favourite vegies and learn simple cooking techniques to make them really shine.

te:

Time:

Simon Bryant’s Veggies by Simon Bryant with photography by Alan Benson, published by Lantern, RRP $39.99.

ation:

ntact:

ation at back2schoolday.com.au

ds in need transform their lives through education

Simon’s recipes sing with flavour. Comforting dishes such as Sweet potato, peanut and mandarin curry and Beetroot ravioli with roast garlic and lemon-zested chevre and walnuts will warm and nourish during the colder months, while the light, fresh flavours of Lavender and orange broccoli with cous cous and Sugar snaps and capsicum with burnt chilli sambal and basil are perfect for spring and summer.

Vegies effortlessly dispels the myth that vegetarian cooking can’t be daring, original and delicious.

Carrot Farro Coriander Mint and Orange Soup Serves 4

3 tablespoons cracked farro, soaked overnight in cold water Salt flakes and cracked black pepper 100 ml extra virgin olive oil, plus a splash for drizzling 1 onion, diced 4 cloves garlic, crushed 1 tablespoon ground coriander 1 teaspoon ground cumin 1 cinnamon stick 1 kg carrots, diced 4 tablespoons dry white wine or sparkling white wine Finely grated zest and juice of 1 orange 1 handful each mint and coriander leaves, chopped Photo credit: Alan Benson

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September 2015 DoctorQ

1/2 cup (140 g) Greek-style yoghurt

1. Drain the farro, discarding the soaking water. Place it in a heavybased saucepan with 3/4 cup (180 ml) of cold water and 1 teaspoon of salt and bring to a gentle simmer. Cook the farro for 20 minutes until it’s tender to the bite, then drain and set aside.

2. Meanwhile, heat the olive oil in a large heavy-based saucepan over medium heat and sweat the onion until it’s soft and translucent.

Add the garlic, coriander, cumin and cinnamon and saute for 5 minutes, then add the carrots and 3 teaspoons of salt and saute for a further 5–8 minutes until the carrot is coated with the spices and slightly coloured. Deglaze the pan with the wine. Add 800 ml of water and simmer over low heat for about 10 minutes until the carrot is tender.

3. Remove the pan from the heat and discard the cinnamon. Carefully blend the diced carrots to a smooth consistency using a stick blender. Stir in the orange juice, then check the seasoning, adding more salt to taste.

4. Fold the orange zest and chopped herbs through the yoghurt and add a pinch of salt. Place a large spoonful of farro into four warmed soup bowls and ladle the carrot and orange soup over the top. Garnish with a dollop of the herb yoghurt. Finish with an extra splash of olive oil and a good twist of black pepper.

lifestyle

Ocker doctor

All the world’s a stage

Just as Shakespeare eloquently described Seven Ages of Man in As You Like It, our Ocker Doctor considers the possibility that there might just be Seven Ages of Medicine.

Shakespeare’s first age is the infant “puking in the nurse’s arms” and I reckon this nicely equates to me as a medical student. Entirely dependent, no internal locus of control and with no way of knowing my own way in medical life without the dedicated help of my seniors.

Or maybe the “puking” is a not so subtle reference to a few Saturday nights that were dedicated to guzzling down some Dutch courage at the odd Med School keg.

“Then the whining school boy with … shining morning face creeping like a snail unwillingly to school”. I remember creeping like a snail to the Royal Brisbane in my Intern year. The smile was there thanks to the relief of not having exams hanging over my head and I was cashed up (I graduated in an era pre HECS).

I had a medical degree that no one could take from me. Life was pretty good, but the dread of living entirely out of my depth for a year was omnipresent.

“And then the lover, sighing like a furnace”. Medicine was a delightful mistress when I was a Resident. I was starting to get a handle on what the medical game was all about. I could diagnose a few diseases (six I think) and even treat a few (three) of them. Most of my patients were surviving (some because of me and some in spite me) and I was starting to really fall in love with Medicine.

I wasn’t quite sighing like a furnace but there were certainly embers of love simmering for my Medical mistress.

Shakespeare’s fourth age is the time of the devoted soldier“jealous in honour, sudden, and quick in quarrel…even in the cannon’s mouth”. Every Registrar I ever rang at Royal Brisbane seemed to be quick to quarrel

with me. They always wanted one extra blood test that I hadn’t requested and of course there were always a few questions that I had negligently omitted from my history taking. When I was a GP registrar, I didn’t have any Residents with whom to quarrel and so I felt a bit gipped.

Instead, as a devoted soldier of Medicine I made myself combat ready by heading to meetings and conferences, study groups and exam courses. I waged war against my ignorance and became a lot more comfortable in my role as a GP. The wise judge of Will’s fifth age was “full of wise saws (saws are proverbs for those whose Old English is as shoddy as mine), and modern instances”. For me this is the Consultant. The one who has climbed the highest pinnacles of academic knowledge and clinical experience. The one to whom all eyes turn when crises arise and who has all the answers to every question. The one who strides into the ward or the consulting room and with his confident demeanour sets all at ease. They are the doctors that every young practitioner aspires to be and that every patient wants to see. They are the essence of our profession.

But tragically, for the wise judge, while disease and the woes of every patient’s world are triumphantly and readily despatched, the insidious rigours of time cannot be defeated by any mortal man.

The robust figure, dressed in the immaculate suit fades into a figure “lean and slipper’d pantaloons, with spectacles on nose.” “His big manly voice, turning again towards childish treble”. He contemplates retirement, puts his slipper’d feet up and focuses on the relaxing facets of his life.

He generously and benevolently hands the baton of medicine over to a new generation to advance

technology and research, to find new ways and to continue the exponential explosion of medical knowledge. The “wise man” of medicine may even find himself relying on the younger generation that he once taught and inspired with his vast clinical acumen.

While he may shrink in his physical demeanour, he still satisfies his medical thirst with some part time work. He does some surgical assisting for his former registrar or does some mentoring of medical students and still does a few sessions to treat his equally ageing patients with the sort of altruistic care they have savoured for several decades.

The seventh and final age is a “second childishness and mere oblivion”. Perhaps this is retirement. Perhaps the doctor becomes the patient. The doctor’s grand career, with its immense

volume of altruistic help and care, becomes happy memories. He rattles off nostalgic, sentimental yarns about the glories of his medical youth, “sans teeth, sands eyes, sans taste, sans everything”, to any student or relative that will listen. And what a marvellous treasure chest of knowledge, experience and stories these grand old men of medicine possess. They have seen it all and cured it all.

It certainly says something about Shakespeare. What an amazing man to still be so incredibly relevant 300 years after his death. A true visionary and a remarkably insightful student of our species. He would have made a great doctor. Q

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lifestyle

In Print

Own the ABG Dr Luke Lawton Simple. Clear. Structured. Whether you are sitting your med school finals, boards, or college fellowship exams, the methods detailed in OWN the ABG make the interpretation of any blood gas question a straightforward exercise. For those who take the time to work through this book the reward will be an understanding that applies in the examination hall, the rests room, and by the patient’s bedside at 2am. Inside you will find 30 worked blood gas problems illustrating the four step method used to OWN the ABG, as well as comments referenced to the literature explaining the major themes of each question. There are a further 30 extended match questions designed to test your understanding, followed by explanatory notes on the major concepts in blood gas chemistry. All the questions and answers are detailed in both mmHg and kPa so that international clinicians can all learn to interpret the arterial blood gas.

Doctor Q has a copy of Own the ABG to give away.

Simply fill out your details in block letters on the form and fax it to (07) 3856 4727 or email editor@amaq.com.au.

Entries close 1 October

Own the ABG is available from Amazon for $38.39.

Entries close 1 October. Q

win this book!

Name: Postal Address:

check for your name!

competition winners

Telephone: Member No:

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September 2015 DoctorQ

Dendy WINNERS

QPAC winners

Book WINNER

Double pass winners

Dr Julia Mcleod won a double pass to Expressions Dance Company’s 7 Deadly Sins, thanks to the Queensland Performing Arts Centre.

Dr Peter Duff won a copy of Murtagh’s General Practice, sixth edition, thanks to McGraw-Hill.

1. Dr David A Clark 2. Dr Marjorie Busby 3. Dr Allan Tham 4. Dr Alison McColl 5. Dr Sue Colen 6. Dr Su Mien Yeoh 7. Dr Emily Mackenzie 8. Dr Julia McLeod 9. Dr Tim Briggs 10. Dr Chanelle Simpson

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We require specialists and VR GPs interested in establishing a private practice in a friendly research-based community clinic, for a service fee of 35% of gross receipts.

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DoctorQ September 2015

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