Your generation: how has medicine changed?
do you want fries with that prescription? frustration grows as vmo agreement stalls FREE TO AMA QUEENSLAND MEMBERS
NOVEMBER 2011 . Vol 76
THIS ISSUE: Acute Primary Care Clinics
CONTENTS
In this issue Current issues 18 queensland Health payroll: dead on arrival 22 should australia treat tb patients from png? 24 do you want fries with your prescription?
Nation Builders (born 1920-1945)
26 ama nurse practitioners and collaborative arrangements
Baby Boomers (born 1946-1964)
28 acute primary care clinics 12 frustration grows as vmo agreement stalls
Generation X (born 1965–1979)
Generation Y (born 1980–1994)
FEATURE STORY 20 Talkin’ ‘bout your generation: how has medicine and our perception of it changed?
AROUND THE REGIONS
Life
30 foundation news
48 review, reset and restructure
32 Local medical association round up
50 the passion of spain
33 RDAQ update
51 the insider’s guide to wine travel: mclaren vale 56 Dendy cinemas
MEMBER NEWS
57 Culture
38 general member news
58 In Print
40 member profile: DR alex kippen
business tools
REGULARS
42 the importance of management liability insurance
4 FROM THE EDITOR’S DESK
44 things that make you go aArRgGhH!
6 PRESIDENT’S REPORT
46 purchasing your own medical suite: does it make financial dollars and sense?
8 CEO’S REPORT 10 in brief 12 AMA Queensland news
people & events 34 calendar 36 amaq annual conference 52 social photos
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editorial
Michelle Ford Russ Doctor Q Editor At AMA Queensland, our members range from brand new interns barely out of their cap and gown, to our much older members who have done it all, seen it all and are now enjoying a quiet retirement. Our Communications Officer Stephanie Shield interviewed two members from each generation: Nation Builders, Baby Boomers, Gen X and Y and came up with some surprising answers to questions about the health system, patient-doctor relationships and family/life balance. (She interviewed men in the interests of comparing apples with apples). While there may have been differing answers on some topics, it was not really surprising to find that no matter what age or generation, most doctors became doctors and enjoy medicine for exactly the same reasons: working with people and being able to help them when they need it most. Enjoy, Michelle Ford Russ In our last edition, we reported that President Dr Richard Kidd had been interviewed about meningococcal disease, incorrectly using meningococcal as a noun instead of an adjective. Thank you to Dr Geoff Meara for bringing this error to our attention.
The AMA Queensland office will officially close from midday Wednesday 21 December and will reopen on Tuesday 3 January 2012.
Obituaries AMA Queensland sadly wishes to advise the following members have recently passed away: Dr Cameron (Cam) BATTERSBY AM General Surgeon Formally of Wickham Terrace Late of Kangaroo Point Member for 65 years Dr Walter PERETZ General Practitioner Late of Nundah Member for 65 years Dr Jack Alexander STOLL General Practitioner Formally of New Farm Late of Highgate Hill Member for 63 years
Dr David Geoffrey BANNEY Specialist Neurologist Formerly of New Farm and Sunshine Coast Late of the RBWH Member for 23 years Dr Nicholas COMINOS Specialist Physiatrist Late of Fig Tree Pocket Member 48 years Dr Laurence Edwin Georgeson OAM General Practice Formerly of Rockhampton Member for 56 years
Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland andmay not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice. Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.
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Board of Directors Dr Richard Kidd President and General Practitioner Craft Group Dr Alex Markwell President-Elect Dr Sharon Kelly Chairperson Dr Larry Gahan Treasurer
Dr Sharmila Biswas Honorary Secretary Professor Philip Morris Elected Member Dr Kirsten Price Elected Member Dr Christian Rowan Elected Member
Branch Council Dr David Alcorn Greater Brisbane Area Dr Sharmila Biswas Far North Area Dr Kimberley Bondeson Greater Brisbane Area Dr John W Cox Downs and West Area Dr Larry Gahan General Practitioner Craft Group Dr Noel Hayman Greater Brisbane Area Dr Wayne Herdy North Coast Area Dr Sharon Kelly Specialist Craft Group Mr Bavahuna Manoharan Medical Student Group Dr Deborah Mills Part Time Medical Practitioner Craft Group Professor Philip Morris Gold Coast Area Dr Stephen Morrison Specialist Craft Group Dr John F. Murray Full Time Salaried Medical Practitioner Craft Group
Dr Carl O’Kane North Area Dr Gino Pecoraro Immediate Past President Dr Kirsten Price Greater Brisbane Area Mr Matthew Roberts Medical Student Observer Dr Christian Rowan Greater Brisbane Area Dr Shaun Rudd General Practitioner Craft Group Dr Anil Sharma Capricorn Area Dr Jonathon Shirley Greater Brisbane Area Dr Mason Stevenson General Practitioner Craft Group Dr Jen Williams Residents and Registrars Craft Group Dr Chris Zappala Greater Brisbane Area
AMA Queensland Secretariat Jane Schmitt Chief Executive Officer Filomena Ferlan General Manager Corporate Services Neil Mackintosh Manager - AMAQ Foundation
Karen Fitzgibbons General Manager Member Relations and Communications Andrew Turner Manager - Member Services
Editor: Michelle Ford Russ Journalist: Stephanie Shield Graphic Designer: Rebecca Nathan Advertising: Rebecca Byrnes Doctor Q is published by AMA Queensland Contact Phone: (07) 3872 2222 Postal Address: PO Box 123, Red Hill QLD 4059 Print Post Approved PP490927/00049 Email: editor@amaq.com.au
NEW PET/CT Centre for Northern Queensland Our new PET/CT Centre in Townsville will offer oncology patients in the North of Queensland the chance to be diagnosed and treated sooner, and closer to home. The new Townsville PET/CT Centre will open in late 2011. The Townsville and Brisbane PET/ CT Centres offer Queenslanders an unrivalled diagnostic service – just another way Queensland X-Ray is providing a clearer picture of your health.
For further information on PET/CT please visit www.qldxray.com.au or contact one of our PET/CT Centres. Brisbane PET/CT Centre Level 3, Mater Medical Centre 293 Vulture St, South Brisbane QLD 4101 Ph 07 3840 6222 Fax 07 3844 6203 Hours: 7.30am to 5.00pm Mon to Fri
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PRESIDENT’S REPORT obligations involved in claiming Medicare item numbers. We have called for an immediate moratorium on the roll out of these clinics across the state and for Queensland Health to cease MBS billing at all Acute Primary Care Clinics until these concerns are addressed. Dr Richard Kidd President AMA Queensland
A
s the end of the year looms closer there remain a number of key issues we will continue to push now and into the New Year.
Nurse Practitioner led clinics
Nurse Practitioners have an important role to play in our health system and the AMA has always argued that they must work in collaboration with doctors in safe supported teams. The Office of Chief Health Nurse Officer upholds this principle through the Queensland Nurse Practitioner Advisory Committee (QNPAC). The recent establishment of a Nurse Practitioner led clinic in Chermside is of great concern as it does not give the nurse practitioner the safety and support of sharing a problem at any time with the patient’s GP. The model threatens to fragment care. It will compete with existing General Practices (some of which will have Nurse Practitioners in their teams) without the safety and support of an experienced GP front and centre.
Acute Primary Care Clinics
AMA Queensland as a part of the GP Alliance group and on behalf of our Queensland Health employee members have been strenuously lobbying against the introduction of Acute Primary Care Clinics in Queensland Hospitals. We remain concerned that the MBS billing arrangements may not be legal. They have been set up outside of the section 19(2) exemption process and may be breaching business rules under the National Health Care Agreement. I am also deeply concerned that our members who are Queensland Health employees are being pressured or influenced to procure MBS provider numbers and have services bulk billed through these provider numbers. I believe that some of our members are going to be put in harm’s way. AMA Queensland will be producing a fact sheet to help our members appreciate the risks and
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Queensland Health employees’ bulk billing services will impact on the District of Workforce Shortage calculation as it is determined by the MBS utilisation versus the population. This will negatively impact on general practices being able to recruit using Area of Need incentives. The APCC blight threatens the survival of general practice in regional and rural Queensland. These Queensland Health funded bulk billing clinics compete with general practice and will ultimately be a terrible disservice to the people of Queensland. The time to gird your loins is now.
VMO Agreement
During an interview on ABC radio with Dr Ross Cartmill on 20 October 2011, the Minister for Health Geoff Wilson unexpectedly announced that the proposed VMO agreement was rejected by the State Government. The fact an agreement is yet to be formed after three years is both frustrating and appalling. We have negotiated fairly and in good faith and our primary motivation has always been to encourage and support VMOs to work in rural and regional Queensland with the sole aim of improving health care for Queenslanders. Despite this the government has responded by saying that the proposal does not deliver “real dollars” back to government and accordingly has rejected it, using tired rhetoric about money grabbing doctors. This is a disgraceful attempt to divert the focus away from working to achieve the best healthcare outcomes for all Queenslanders, the very people who the government is meant to represent. A VMO Forum was held on Wednesday 26 October 2011 and we requested from those in attendance to guide the VMO Committee as to what the next step should be. To read more details from the outcomes of the forum refer to page 12.
Future challenges
There remains a number of challenges for the medical profession over the next few months and into 2012, in particular the ongoing roll out of the National Health Reform agenda.
Local Health and Hospital Networks (LHHNs) will be established by 1 July 2012 and Medicare Locals continue to open throughout Queensland. AMA Queensland has been reinforcing the need for local clinicians to be involved and engaged in these two different types of organisations. LHHNs will be statutory bodies while Medicare Locals are companies limited by guarantee. There are opportunities for Medicare Locals to identify gaps and deficiencies in our health system and something that is screaming out to me is the lack of access to cancer treatment for rural patients. The Cancer Council Queensland estimate nine per cent of regional cancer-related deaths could be prevented if regional cancer survival rates were equal to the Queensland average. Approximately 37 per cent of people diagnosed with cancer in Queensland each year live outside a major population centre. Annually an estimate 60 per cent of these patients will be required to travel at least one hour to access radiation therapy for cancer treatment but the Travel and Accommodation allowance is woefully poor. We need to urgently address the tyranny of distance. Please write to your local member supporting Cancer Council Queensland’s call to greatly increase the travel allowance spent. As we all know, a state election is pending and it is up to us, the main independent voice for doctors to ensure health is high on the political agenda. Despite the $11billion investment in health the State Government committed in the 2011/2012 budget we know the system is desperately stressed and key areas are falling short in service delivery. Reports of Emergency Departments continue to be on bypass and are overcrowded, elective surgery waiting lists are out of control, Public Hospitals are operating above the safe occupancy rate of 85 per cent, a severe lack of access to radiation treatment especially for patients outside of the metro centres and rural areas do not have enough staff or support to meet the population demands. An election is the time to put our policies and suggestions forward. It is the time to put health on the agenda. It is the time for our Association to pull together and be the voice for medical professionals and our patients. I wish you all a happy and safe Christmas and look forward to working with you all in the New Year. Q
CEO’S REPORT AMA Queensland Annual Conference Success
AMA Queensland held their Annual Conference in Prague in September 2011 and the presentations were not only of an extremely high standard, but also entertaining, provoking well rounded discussion amongst attendees.
Jane Schmitt Chief Executive Officer AMA Queensland
Reflecting on the theme of the conference, innovations in healthcare, a number of key topics were covered including the good, the bad and the ugly of innovations in healthcare, personally controlled electronic health records - a practical understanding and an extremely enlightening presentation on England’s national program for IT – the world’s most expensive lesson in e-health design and delivery. The keynote speakers Professor Claire Jackson and Professor Trisha Greenhalgh involved the audience and provided extremely entertaining and interactive sessions. We continue to receive overwhelmingly positive feedback from those members who attended and I am looking forward to the next annual conference in 2012 in Madrid. After the conference I met with staff from the British Medical Association (BMA) and the British Medical Journal (BMJ) in London. These initial discussions will open up opportunities to share ideas and strengthen our relationship.
Suicide Watch - Prevention Campaign
In December, AMA Queensland will launch a media campaign to raise awareness of the leading cause of death for men and women under the age of 34 – suicide. Suicide Watch will remind the public that the medical profession, in particular general practitioners, can be a valuable support to people who are suffering from suicidal thoughts or suicidal behaviour. AMA Queensland GP members participated in a survey in October which asked various questions such as what is the main reason people with a mental health issue do not seek help? These results will be published during the media campaign. As part of the campaign a video clip has been developed to highlight that ‘there is an answer’ that can help end the suffering and that answer is to call your GP. A number of our members will be part of the video
clip and we thank them for participating in ensuring this message gets out to the public. I hope you will all support this campaign once it is launched in December.
Queensland Children’s Hospital
AMA Queensland has finalised its submission on The Health and Disabilities Committee inquiry into the public works of the Queensland Children’s Hospital (QCH) which was due 31 October 2011. While the QCH has caused great concern to some of our members, AMA Queensland is absolutely committed to finding the best outcomes for Queensland children. In the submission there are concerns raised about lack of transparency in the process around the planning and implementation of this project and whether the number of beds will meet the population demands. Our intention is to ensure that the objectives of building the QCH are met in their entirety. Our submission will be available once The Health and Disabilities Committee inquiry authorises its publication.
AMA Queensland recognises that our members are very busy and often time-poor people leading extremely busy and hectic lives. With this in mind we have developed a new member service called e-connect that allows members, wherever they are in Queensland, to organise an appointment with an AMA Queensland representative either by teleconference or via a video conference using Skype. This service is going to very useful, particular for members living in rural and regional areas to have easier access to support and advice from us but we are also encouraging members in the South East corner to utilise the service. To access simply log on to www.amaq.com.au/econnect As this is my last report for the year, I wish you a well deserved break over Christmas and a safe and enjoyable time with your family and friends. Q
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IN BRIEF
MEDICARE PATIENT REBATES REMAIN INADEQUATE The Government has again failed to increase Medicare Benefits Schedule (MBS) patient rebates sufficiently to reflect the real cost of providing high quality medical care to the Australian community. From 1 November, the MBS patient rebate for a standard GP consultation will increase by just 70 cents to $35.60. AMA President, Dr Steve Hambleton, said that proper and realistic indexation of Medicare patient rebates is urgently needed.
drunken immunity University of Adelaide researchers have found that immune cells in your brain may contribute to how you respond to alcohol. This immune response lies behind some of the well-known alcoholrelated behavioural changes, such as difficulty controlling the muscles involved in walking and talking. “Alcohol is consumed annually by two billion people world-wide with its abuse posing a significant health and social problem,” said lead researcher Dr Mark Hutchinson from the University’s School of Medical Sciences.
“Inadequate or no MBS indexation, along with threatened cuts to some MBS fees (Better Access mental health services) and the withdrawal of MBS funding for other services (for example, joint injections) mean that the Government is simply shifting costs to patients. The overall Medicare fee increase of just two per cent is inadequate when compared with the Labour Price Index of 3.94 per cent and CPI of 3.18 per cent. The AMA List of Medical Services and Fees reflects these more realistic indices. The AMA recommended fees this year have been indexed on average by 3.2 per cent. The new AMA recommended fee for a standard GP consultation will be $69, up $3 from $66 in 2010. Q
“Over 76 million people are diagnosed with an alcohol abuse disorder. “This work has significant implications for our understanding of the way alcohol affects us, as it is both an immunological and neuronal response. Such a shift in mindset has significant implications for identifying individuals who may have bad outcomes after consuming alcohol, and it could lead to a way of detecting people who are at greater risk of developing brain damage after long-term drinking.” Q
Women’s health worse in regional areas A new national report shows that women living in regional and remote areas experience poorer health than their city counterparts. The further women were from major cities, the more likely they were to suffer from obesity and the obesity-related conditions of diabetes and hypertension, said Professor Annette Dobson of The University of Queensland, director of the Australian Longitudinal Study on Women’s Health. The latest report from the study Rural, remote and regional differences in women’s health: Findings from the Australian Longitudinal Study on Women’s Health, examines differences in women’s health. It also examines women’s access to and use of health services according to where they live in Australia. Q
South Asians react differently to common drugs A University of Sydney PhD student has discovered the different diets and lifestyles of South Asians compared to Europeans could lead to the two groups requiring very different doses of medicines commonly used to treat illnesses such as depression and psychosis. Vidya Perera, a final year PhD student in the Faculty of Pharmacy, has found people from South Asia could need lower doses of these medicines because they are likely to have lower levels of CYP1A2, an enzyme that metabolises drugs. “Vegetables such as cabbages, cauliflower and broccoli are known to increase levels of CYP1A2, as was demonstrated in this study and previous studies in people of European background. The lower levels of CYP1A2 in South Asians, however, appears to be due to the common practice of cooking these vegetables in curries using ingredients such as cumin and tumeric, ingredients known to inhibit the enzyme, overriding the effect of the vegetables,” Mr Perera explained. Q
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AMA QuEENSLAND NEWS
Frustration grows as VMO agreement stalls
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VMO Committee Chair Dr Ross Cartmill.
fter three years of negotiations with Queensland Health, AMA Queensland VMO Committee Chair Dr Ross Cartmill hosted a forum on 26 October to explain and discuss recent negotiations and take comment about how to move forward. Premier Anna Bligh; Minister for Health Geoff Wilson; Queensland Health Director General Dr Tony O’Connell; Opposition Leader Campbell Newman and Shadow Health Minister Mark McArdle were invited to the forum, only Mark McArdle attended. Robust discussion took place about the length of time over which discussions have been held and why the process has been unable to achieve any resolution.
Shadow Health Minister Mark McArdle.
President Dr Richard Kidd addressed attendees.
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In June this year, the parties agreed to fundamental elements to be incorporated into an agreement, including back-pay, wage increases (in line with the government wages policy), fee for service in defined circumstances, incentives to attract VMOs into rural and remote areas and a number of productivity initiatives. Unfortunately, these long and hard negotiated terms were rejected by government’s Cabinet Budget Review Committee on Monday 17 October with no explanation as to why. A motion of confidence in Dr Ross Cartmill and the
Committee was passed unanimously. The VMO Committee will now give consideration to the concerns and comments raised by members at the forum and factor them into their negotiations with Queensland Health over the coming weeks. VMOs are not alone is being in a stalemate with the Queensland Government over employment terms, with a number of disputes now before the Queensland Industrial Relations Commission. This is a possible path to resolution for the VMOs and one which the Committee with fully consider. AMA Queensland would like to thank those members who attended and all our members for their ongoing support. We will continue to provide updates over the upcoming period. Q
The forum was well attended.
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AMA QuEENSLAND NEWS
new council member for North queensland
D
r Carl O’Kane has joined the AMA Queensland Branch Council as a representative for North Queensland, replacing Dr Sam Baker, who served on the council from 2006 - 2011.
Dr Carl O’Kane | North Area Specialty: Emergency Medicine Background: Dr O’Kane graduated from the University of NSW in 1993 and began his emergency training in Gosford after a couple of years spent locuming in the United Kingdom. He completed his Training in Townsville in North Queensland (his wife is from Bowen) and has been a Staff Specialist at The Townsville Hospital for the last eight years. Dr O’Kane has an avid interest in teaching and is the Director of Clinical training at Townsville Hospital. He has been a member of the Postgraduate Medical Education training oversight committee for Queensland and is an accreditation surveyor for the Postgraduate Medical Council of Queensland. His passion for junior doctor education was recognised in 2010 when he was awarded the Queensland Clinical Educator of the year. Intention: “It is an honour to serve as the AMA representative for North Queensland. Given the challenges facing public health care, I hope to assist members working in this sphere and develop new clinical opportunities between the public and private sectors.”
Regional Tour
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n August, AMA Queensland President Dr Richard Kidd visited Emerald, Rockhampton, Mackay, Stanthorpe, Warwick, Dalby and Toowoomba as part of the 2011 regional tour.
Overall the tour was a complete success with many opportunities for members to converse directly with Dr Kidd about their concerns. It also enabled AMA Queensland to get a true picture of the health system shortfalls in each area. The undeniable issue plaguing members in these areas was the lack of doctors and need for better support. A full snapshot of the tour can be found in the 22 September Online News edition.
Regional Tour Outcomes
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hile in Mackay AMA Queensland President Dr Richard Kidd raised concerns to the Minister for Health and Director General about doctors at Mackay Base Hospital being denied access to their library after the hours of 4pm.
Dr John Cox and President Dr Richard Kidd address the crowd at the Downs Club in Toowoomba.
We are pleased to report that Queensland Health has responded by enabling 24 hour access to text books and internet access in the medical staff association house. Junior Doctor concerns are similar around the State relating to overtime, on-call, rostering, professional development leave and annual leave. We are formulating a log of issues that we can lobby Government on now and will continue to do so throughout the MOCA 3 negotiations. We will detail these in Online News and on our website over the next few months. To inform AMA Queensland of your concerns surrounding these issues please email Workplace Relations Manager Andrew Turner on a.turner@amaq.com.au
Dr Michael Belonogoff , President Dr Richard Kidd and RDAQ President Dr Ewen McPhee.
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Dr Hillary Vincent from Emerald.
President Dr Richard Kidd and Executive Director Medical Services Dr Alan Sandford check out the construction of Rockhampton Hospital’s new oncology ward.
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DoctorQ NOVEMBER 2011
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AMA QuEENSLAND NEWS
Suicide Watch Campaign: See the Signs Phase two
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MA Queensland is set to launch a suicide prevention awareness campaign in December called Suicide Watch which marks phase two of the See the Signs campaign.
people struggling with suicidal behaviour.
Every day at least seven Australians die by suicide and 178 attempt suicide. General Practitioners can be a valuable support to
As part of this campaign AMA Queensland will launch a video clip using AMA
The campaign will be launched to the media and will include results from an AMA Queensland mental health survey of our GP members.
Queensland members to bring home the message that the medical fraternity are here to support people who are suffering and feel alone. Keep an eye out for this launch in December. The See the Signs Campaign has been generously supported by AMAQ Foundation.
AMA Queensland E-Connect
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new member service particularly for members in rural and regional Queensland has now been launched following a trial period in September.
AMA Queensland e-connect ensures all members, no matter where they reside, have access to support and advice from us. The service allows members to the opportunity to organise an appointment with an AMA Queensland representative either by teleconference or via a video conference using Skype. Appointments are available every Tuesday from 7am to 1pm and every Thursday from 12.15pm to 6.15pm. Appointments with President Dr Richard Kidd are only available on Tuesdays. Log on to www.amaq.com.au/econnect to organise a meeting.
School Education Program – nambour success
T
he latest School Education Program session held on 12 October in Nambour was a huge success and one of the most well attended events with more than 114 people in attendance. Held at the Nambour Christian College, teachers, students, and their parents heard from three presenters: Dr Mason Stevenson, Past AMA Queensland President and local Sunshine Coast GP; Megan Tremlett, a Consultant Pharmacist and Jo Wall, a Midwife.
The presenters provided an overview on how they decided on their current career,
Linda McNeil (Head of Senior School Secretary and Secretary to High School), Helen Potter (Principals PA), Brad Elliott (Head of Senior School).
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what they really enjoy, the challenges they face, and valuable anecdotes that have happened along the way which provided a very personal portrayal of the jobs they do. Feedback received after the event was extremely positive. “I really enjoyed how approachable the presenters were when I spoke with them after the presentation” “This was as good if not better than going to an open day at Uni” The School Education Program was introduced in August 2010 and provides students and parents with a comprehensive
Dr Mason Stevenson, Stephen, Janice and Joshua Simmonds
overview of the health profession, provides access to real life health professionals and their stories, and provides an insight to the fabulous range of careers available. While this was the first time a session was held at the Sunshine Coast AMA Queensland has presented sessions for a number of Schools at the Gold Coast, Ipswich, Toowoomba and Brisbane. If you are interested in being a part of the program or would like to nominate a School to host a session, contact AMA Queensland on (07) 3872 2222.
Allan Petts and Abbie Petts with Dr Mason Stevenson
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DoctorQ NOVEMBER 2011
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CURRENT ISSUES
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he autopsy from the Auditor General regarding the Queensland Health payroll implementation are illustrative of some of the organisational and cultural issues currently confronting the organisation. Some 18 months and some $210 million over budget, ongoing uncertainty permeates Queensland Health. Questions persist: will pay be accurate; will the work performed be accurately recorded; and how will we reconcile this at the end of the tax period? This is inexplicable and intolerable for an organisation the size of Queensland Health. Now, many highly paid, private-sector, techsavvy management consultants are being engaged to resuscitate. The implications of this are manifold both for the organisation and the individual: Queensland Health isn’t able to attract and retain employees as it loses its employer of choice status; and staff who are worried by the ongoing uncertainty, particularly about whether they’ll get enough pay to cover their bills, are likely to be anxious, distracted and unfocused. Some 18 months after the initial implementation, the result of this tumult has calcified in a lack of trust in management. This takes its toll on the individual in ways that aren’t immediately apparent: more evidence of the human consequences are becoming clear: unprecedentedly low staff morale; the exodus of staff who are fleeing to the private sector; workplace stressors causing inattention. According to the Auditor General, insufficient technological planning prior to implementation caused the systemic failure. The stakeholders were unprepared as the project scope had not been formally agreed upon. This miscommunication resulted in delays in implementation
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and increased costs. Further, the lack of a test phase prior to the go-live date failed to reveal any flaws which soon became evident. But ultimately, the costs blowout of $210 million (and counting) has resulted in a re-organisation of the budget, leaching off much needed funds to patch the hole. To be fair, the Auditor General said all agencies involved needed to be accountable; including Corp Tech and IBM. However, the number of agencies involved led to some ambiguity about roles and responsibilities, and authority of the various parties. There was no specific project management methodology applied throughout the life of the project and the project board went against the recommendation that they should undertake a full parallel pay run comparison between the old and new payroll systems. And finally, the Auditor General also noted the ill-defined project scope; inadequate risk assessment; poor alignment between people, process and technology and lack of user involvement and training and inconsistent communication. The result of this is that an organisation that is $600 million in the red, has to compromise on clinical care and patient outcomes. Ultimately, for an organisation with 80,000 employees, HR technologies cannot be used to fix inadequate or broken processes. From an organisational management perspective, if there are systemic problems then no amount of technological implementation will solve the underlying issues. Because, as all Queensland Health employees have just borne witness, any strong wind can shake the foundations to its core. Q
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MAP Funds Management Ltd Phone: (07) 3838 1234 Source: SelectingSuper Performance Tables: 31 August 2011. MAP Funds Management Ltd (ABN 85 011 061 831, AFSL No. 240753, APRA RSE Licence No L0000703) (‘MAP’) is the trustee of MAP Superannuation Plan (RSE No R1001587) and MAP Pooled Superannuation Trust (RSE No. R1001563) and responsible entity of the MAP Australian Equity Fund (ARSN 092 833 308). MAP Financial Planning Pty Ltd (ABN 91 090 411 537, AFSL No 239117) is a wholly owned subsidiary of MAP. This document may contain general advice which does not consider any particular person’s objectives, financial situation or needs. These matters should be considered together with the relevant Product Disclosure Statement (‘PDS’) and professional financial advice before making an investment decision. The PDS is available at www.mapfunds.com.au or by calling 1800 640 055. Information in this document is believed to be reliable and accurate but may be subject to change and MAP (including its directors, employees, agents or subsidiaries) disclaims all liability, however caused, by any party which relies on its contents. Past performance is not a reliable indicator of future performance. Investments have risk and MAP does not guarantee the repayment of capital or the investment performance of any of its products.
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DoctorQ NOVEMBER 2011
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feature story
At a time when AMA Queensland is meeting the next round of interns and hosting a 50-year morning tea, Media and Communications Officer Stephanie Shield had a chat to members from each of our generations to see how opinions really differ on key topics.
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fter interviewing two members, one general practitioner and one specialist from each of the four generations there were some interesting themes that surfaced. It also provided an insight into how the medical profession ultimately shares similar values regardless of age or specialty.
Doctor-patient relationship
All generations agreed the doctorpatient relationship had changed quite dramatically. “Working at a veteran’s hospital we see many elderly patients, who are used to the paternalistic model of medicine, and expect to be directed by the doctor. Younger patients are coming in with a wealth of information thanks to the likes of Google, which makes for much more of a collaborative approach,” Generation Y Specialist said. Generation X Specialist described the current doctor-patient relationship as “less paternalistic and therefore more balanced” compared to when he first starting practising. Because of this change he believed patients have a greater sense of autonomy which brings with it both positives and negatives. In relation to the doctor-patient relationship today, Baby Boomer GP enforced there has been a complete turnaround since he started practising and does not agree that it is a positive change.
“The doctor-patient relationship has been eroded by bureaucracy.”
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“What is happening all the time is the patient is deciding what they need rather than me as the doctor making the decision for them or with them.
“I no longer have the gatekeeper role. I am now more of a drafter. There has been a power shift from patient-centric care and it is being replaced by patient-demand care.” The concern surrounding expectations of patients was raised as one of the single biggest challenges doctors of today face as Generation X GP explains “patients are expecting more of you and expecting better outcomes.” From the perspective of the Nation Builder GP, technology advancements have played a part in changing the doctor-patient relationship in the general practice setting because of the minimised need to do house calls. “Before, if someone was sick in the night you had to go to their home and wait for them to get better. This meant you got to know how the patient exists in their home environment.”
Advances in medicine and technology
When discussing major changes to the medical profession over the last 50-70 years the development in technology and pathology, improvement in pharmaceuticals, introduction of computerisation and the idea of a paperless office were resounding themes.
“The move to a paperless practice was an improvement and a positive step forward for the medical profession,” said Generation X GP. Baby Boomer GP said “computerisation is the single biggest change within practices but I am still unsure whether it is positive or negative”. Nation Builders who are often referred to as digital aliens and who would be expected to ridicule computerisation acknowledged it as a great asset but did show a lack of trust that the technology would deliver all it promised. Generation Y Specialist notes that the patients being seen today have a different knowledge base because of the internet and Google!
“Patients are presenting with a lot of information already because they have access to a plethora of information online, ranging from medical databases to internet forums and everything in between. This is mostly positive, but of course it depends on where they get their information from.”
Nation Builders (born 1920-1945)
Baby Boomers (born 1946-1964)
Specialist Nation Builder weighed quite strongly into this debate reinforcing that the “advancement in technology meant we could start saving people we couldn’t save before.”
Family and Lifestyle
When discussions changed to family life and work life, both Generation X and Generation Y recognise that as a medical professional you can have more flexibility and list getting the balance right between work and family as a priority. Generation Y GP indicated that “lifestyle” played a major part in his decision to choose general practice as his career. Interestingly though it was the Baby Boomer GP who argued that a work/life balance is possible and that it comes down to choice. When asked whether any key family events had been missed as a result of work he noted that “I focus on time management and organising myself well so I do not miss out on key family events”. Generation X Specialist said regardless of generation in certain specialties and particularly in a rural setting you cannot always have a balance.
“In a rural setting where you are working as a solo doctor you don’t have a choice to not be on call”. Not surprisingly the Nation Builders recalled working 60 - 80 hours a week. One of the Baby Boomers admitted to working 100 hours at one point in his career but has now dropped back to 65 hours a week.
Generation X (born 1965–1979)
Generation X and Generation Y worked 35 – 60 hours a week on average. At a simple glance it appears Nation Builders and Baby Boomers work/ worked more hours than the younger generations. In this instance however the difference in work hours may have more to do with the specialities chosen and the locations in which the respondents work/ worked. Despite the long hours both Baby Boomers and National Builders commented that they didn’t miss out on too many family events. Nation Builder Specialist did say however that “my children always comment that they never saw me. They always said they would never marry a doctor and they will never do medicine themselves- and they never did.” Generation Y noted “with younger people coming into the profession it is more of a team approach”.
“Amalgamation of other practitioners and encouraging them to join forces is a positive thing as it allows doctors to take time off,” National Builder GP reflected.
Generation Y (born 1980–1994)
Positives and negatives
The two things most agreed upon by all generations was red tape, litigation and paperwork were the most negative changes seen in the profession and the best thing about being a doctor was working with people and helping them to get better. Nation Builder Specialist said “the best thing about being a doctor was the fact you deal with people all the time. These people need help and mostly you can help”. While every single respondent said they would recommend medicine as a career to others our Nation Builder Specialist noted
“medicine is the best career because you are with people all the time. If you are not a people person, go away and do something else”. The opinions expressed in this article are from different doctors across different ages, fields and locations. This is not a full and disclosing representation of each generation. Q
“This change has come gradually and it is a good idea from the family perspective. But in my time it was not available,” Nation Builder Specialist said.
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CURRENT ISSUES
Queensland Health’s recent decision to stop funding TB clinics in the Torres Strait has raised some political, ethical and diplomatic arguments. Policy Advisor Zoe Levendel explains.
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he Torres Strait Treaty (the Treaty) was signed in December 1978 and is an agreement between Australia and Papua New Guinea. The Treaty sets out the boundaries between the two countries and how the sea area may be used.
and the freedom of movement of people seeking treatment, the failure to prevent TB transmission within the South Fly District creates a high risk that TB will be transmitted across the Torres Strait to mainland Australia.
The Treaty allows free movement (without passports or visas) between Australia and Papua New Guinea for traditional activities in the Protected Zone and nearby areas. This is restricted to Torres Strait Islanders and the coastal people from Papua New Guinea who live in and keep the traditions of the region. Traditional activities under the Treaty include gathering foods, hunting, fishing, ceremonies, social gatherings and traditional trade.
As stated above the lack of access to effective treatment services within PNG for PNG patients suffering from TB has broader ramifications and has triggered:
A ramification of this freedom of movement is the transfer of disease. It is not surprising that many PNG nationals suffering from tuberculosis (TB) take the relatively short boat ride to Australian clinics to enable them to access medical treatment. This freedom of movement is only, in theory, available to a cluster of border communities. For the purposes of the Treaty, medical care is not included, nevertheless it has been estimated that up to 2,500 PNG nationals visit the Torres Strait islands each year to seek medical treatment. Despite the fact that many PNG nationals who make the trip to Australian clinics are not technically ‘allowed’ to access such services, as reported in the Sydney Morning Herald1 (9 September 2011) “such protocols have not always been observed by doctors and nurses in Australian clinics.”
The failure to prevent TB transmission within the South Fly District creates a high risk that TB will be transmitted across the Torres Strait and to mainland Australia. The number of cases of TB being diagnosed among PNG citizens in the Torres Strait Island health clinics has been increasing since 2000. Ineffective and poorly organised treatment programs are likely to exacerbate the situation by creating chronic infectious cases and by facilitating the emergence of drug resistant strains of TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB in this population was first noted in 2001 and it is now estimated that 25 per cent of PNG patients diagnosed with TB in Torres Strait health clinics have MDR-TB. The high incidence of MDR-TB in these patients is evidence of the failure of TB treatment strategies in PNG. Other health problems in the region have the potential to amplify TB transmission pathways. An epidemic is likely, particularly within the South Fly District of the Western Province of PNG. Unfortunately there is a lack of sufficient public health and clinical infrastructure in PNG to provide adequate TB control services to this area. This epidemic is not being controlled. Because of the close proximity 22
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a humanitarian response from clinicians who perceive that their duty of care and ethical responsibilities are to reduce human suffering, irrespective of the nationality of the patient; and a public health response in order to protect the Australian population from acquiring TB, which is particularly problematic due to the prevalence of the MDR-TB. The decision by Queensland Health to stop funding the Torres Strait clinics, which are Australian funded clinics on Saibai and Bougu Islands, was originally set to take place in June 2011, would have forced seriously ill PNG patients to rely on the failing PNG health system for treatment. This decision led to political, ethical and diplomatic debate and functioned to highlight PNG’s neglected TB epidemic and the broader health issues in the area. In response to countless warnings by clinicians that people would die (irrespective of nationality), the Federal Government has initially agreed to spend $631,000 to keep the clinics open until February 2012. It is unlikely that this time frame is long enough to ‘hand over’ care to the PNG health system. The Commonwealth has expressed the view that PNG should do more to provide health care for its people and the responsibility has been given to AusAid to provide assistance in the relevant areas so that PNG can develop the capacity to address TB. However, to address such an endemic health problem in PNG’s underdeveloped health system, where a gap exists in skill, expertise and infrastructure, is likely to be a decade-long process. The risk is that during this capacity-building phase the incidence of TB, especially the MDR TB, will continue to rise and will be an on-going threat to Australia. National and International bodies involved in global TB control such as The National Tuberculosis Advisory Committee (NTAC), the World Health Organisation (WHO) and the International Union Against Tuberculosis and Lung Disease endorse a policy where TB management is the responsibility of the jurisdiction in which the TB case was diagnosed. The NTAC stance is that all patients identified with TB in Australia should be fully treated in Australia unless they can be transferred to a setting where they are likely to undergo effective treatment. The WHO will conduct an independent assessment of TB services in the Western Province in October 2011 and AMA Queensland will be closely monitoring this assessment. Q 1 Sydney Morning Herald “Aid failing to prevent PNG’s health catastrophe” 9 September 2011
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To help you answer these important questions more accurately, QSuper has launched a new online Retirement Income Calculator. The new calculator will help you answer these questions, and also let you explore the effects of taking a career break, making additional contributions, or entering your partner’s details to estimate a combined retirement income.
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How much income am I on track to receive? How much you are on track to receive is the easier question to answer - naming the actual dollar amount you’ll need to live on can be more difficult, and the answer will vary considerably from person to person. However, having enough to live comfortably and to at least maintain their current lifestyle is the common theme that runs through many members’ responses.
Visit the QSuper website today at qsuper.qld.gov.au/retirementincome to see how the new calculator can help you!
Easy steps to use the Retirement Income Calculator
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Go to qsuper.qld.gov.au/ retirementincome
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Select the annual income you think you’ll need to fund the lifestyle you want in retirement (our online tool can help with this).
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CURRENT ISSUES
The Pharmacy Guild of Australia met the public’s ire all over the place recently with news of partnerships with Blackmores and Pfizer. Editor Michelle Ford Russ discusses the issue that has caused outrage over the past few weeks.
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he Pharmacy Guild of Australia might usually fly under the radar, but they’ve certainly been getting some negative press in the past few weeks. No sooner had they been condemned by patients, politicians and health groups about their co-promotional partnership with Blackmores, than news emerged of an agreement with pharmaceutical giant Pfizer. To give you some background, the Pharmacy Guild had an agreement with Blackmores that involved being paid to promote complementary nutritional supplements to go with four commonly-used prescribed medications. So, if a patient fills a prescription for antibiotics, blood pressure drugs, cholesterol medicine and proton pump inhibitors, a suggestion would pop up on the pharmacist’s computer to recommend a Blackmores product. Anyone familiar with a value meal at McDonalds knows how bundle selling works – you might walk in for a Big Mac, but you’re inevitably asked “do you want fries with that?” Bundle selling works on the principle that the seller uses the relationship created from selling the initial product to then sell another product. Bundling is used by marketers to take advantage of the
The pharmacist is then leveraging that relationship of trust to sell a new product. high demand for one product and sell another simultaneously or to increase the demand for both products through a perceived synergy between the products offered. These definitions raise a couple of points: one, that in ordering prescription medication at the pharmacy, a relationship is created whereby the patient trusts the pharmacist to give them the correct medication and provide advice on taking that medication. Simply put, the pharmacist is then leveraging that relationship of trust to sell a new product. Blackmores CEO Christine Holgate commented, “pharmacists are among the most trusted health professionals and they are well positioned to understand the needs of their patients. This range ensures the pharmacist becomes the advisor on supplements to take with prescription medicines as they have the expertise to make this recommendation.” Kos Sclavos, National President of The Pharmacy Guild of Australia said, “as the most readily available health professionals, pharmacists are ideally placed to assist consumers to make informed decisions about complementary medicines and nutritional supplements.” Two, that there is a perceived synergy between a medication prescribed by a doctor and a nutritional supplement prescribed/recommended/suggested by a pharmacist. Does it create an expectation 24
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that because your doctor has said you need this medication, that the supplement is just as important to buy? There was some fairly active debate about the necessity for the complementary medications: many argued that only a small amount of patients suffered nutrient deficiencies with these medications and that if this did occur, then it should be diagnosed and treated by a GP. AMA President Dr Steve Hambleton said at the time, the arrangement would destroy the trust between GPs and pharmacists and between pharmacists and patients. After condemnation aimed at pharmacists, Blackmores and the entire naturopathy profession, the whole deal was called off. Blackmores maintained that while the agreement was still essentially a good idea, “we have listened to the feedback on the Companions range and it is apparent that there is considerable confusion regarding the positioning of this range which we believe is detracting from the potential underlying benefit of these products to consumers”. Not long after this debacle left a sour taste in patients’ mouths, the ABC revealed the Pharmacy Guild also had a relationship with Pfizer whereby pharmacists were paid to sign up patients to a Pfizer support program, where they would receive more information about their Pfizer medication. Pfizer Managing Director John Latham said the deals were hardly the same thing. Latham argues the $7 payment per patient is merely an administration fee, to cover the time the pharmacist explains the program and enrols the patient. The pharmacist is helping the patient receive more information about their existing medication, not recommending a new product. Chris Walton from the Association of Professional Engineers, Scientists and Managers, which represents some pharmacists, said “unfortunately the pharmacy owners’ guild has done another grubby deal which trades on the good name of pharmacists to get more sales for a drug company”. “It’s a slippery slope when health professionals such as pharmacists are induced to make recommendations on the basis of dollars rather than the interests of patients,” he said. AMA President Dr Steve Hambleton said that while it’s quite a different relationship to the proposed one with Blackmores, it’s not a great look. “In this case there’s support for individuals staying on their medication but there’s also a payment to a third party, and when those third party payments occur that raises the conflict. And that’s when an independent observer might say, ‘Well we think there’s a problem here’,” said Dr Hambleton. Whether the agreements are seen as good marketing or dirty deals, the Pharmacy Guild’s gold cross has taken a bit of tarnish. It might just be that the bad press makes doctors and patients alike a little more cautious about the Guild’s true intentions. Q
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CURRENT ISSUES
Manager Workplace Relations, Training and Policy Andrew Turner gives us an update on the latest changes to the nurse practitioner collaboration.
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s the first nurse practitioner-led clinic opened in Brisbane in September and the role of the nurse practitioner becomes more prominent in the health system, AMA Queensland has received a number of queries from members wanting to know the current state of play. A nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. This position was formally introduced in 2006 in Queensland. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include, but is not limited to, the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations. First and foremost all members must be aware that AMA Queensland supports a team-based approach and believes effective collaboration is in the best interest of patients and members of the collaborating team. Without true collaboration there is the potential for fragmentation of patient care and the delivery of high-quality care is at risk.
The background
From 1 November 2010, the Commonwealth Government reforms meant eligible midwives and nurse practitioners could provide some services that are funded through the Medicare Benefits Schedule (MBS) and prescribe certain medications subsidised under the Pharmaceutical Benefits Scheme (PBS). To date there are about 143 registered Nurse Practitioners and the large majority of them work for Queensland Health. The practice scope of the nurse practitioner position must be well documented and provide clarity about the: health service setting; service capability of the health service setting or accreditation standard; clinical specialty of the nurse practitioner model of care; and scope of clinical practice of the nurse practitioner position (clinical parameters within which the nurse practitioner may use their extended practice privileges to make informed and autonomous preventive, diagnostic and therapeutic decisions).
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The practice scope of the nurse practitioner position must be defined for a nurse practitioner to act under the Drug Therapy Protocol for Nurse Practitioners (the Protocol). The Protocol states the circumstances in which, and the conditions under which, a nurse practitioner may prescribe, give a written or oral instruction, supply and administer a stated controlled or restricted drug or poison under the Health (Drugs and Poisons) Regulation 1996.
What you need to know
In September 2010 AMA prepared a guide Collaborative Arrangements - What you need to know to help answer many of the questions doctors have about collaborative arrangements and how they should be structured, as well as identify key issues that doctors should take into account when considering being part of a collaborative arrangement. The guide covers some frequently asked questions including indemnity insurance, obligations to participate in collaborative arrangements, remuneration and best practice guidelines. Of most interest to members is the definition of a collaborative arrangement. The Health Insurance Act 1973 and associated regulations defines a collaborative arrangement as: The midwife or nurse practitioner is engaged or employed by a medical practice, or A patient is referred to the midwife or nurse practitioner by a medical practitioner, or The midwife or nurse practitioner has in place a written collaborative arrangement with a medical practitioner(s) covering one of more patients, or The midwife or nurse practitioner has in place an individual collaborative arrangement with a medical practitioner(s) for a patient, detailed evidence of which is kept in the patient’s clinical notes – including evidence of the consent of the collaborating practitioner(s). Q
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CURRENT ISSUES
The establishment of Acute Primary Care Clinics (APCCs) have caused a number of concerns for AMA Queensland members. Policy Advisor Zoe Levendel gives us an update.
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MA Queensland has been closely monitoring the gradual roll out of Acute Primary Care Clinics (APCCs), which are basically bulk-billing, co-located private practice clinics in Queensland Health facilities and will now be established state-wide. These clinics are being touted as general practice clinics. While they may provide some primary care services they do not provide cradle to grave continuous care by a family doctor who provides a full range of services and support to patients. We have expressed our concerns to Queensland Health that the establishment of APCCs are in breach of the National Healthcare Agreement and the Health Insurance Act 1973. AMA Queensland has been advised that Queensland Health have sought legal advice on the matter and in order to comply with the National Healthcare Agreement and the Health Insurance Act 1973, APCCs must be staffed by senior medical officers exercising a right of private practice. The APCCs are to be located within the hospital but separated from the Emergency Department or an existing Outpatient Department and that signage and general information should clearly identify the APCC as a separate service. AMA Queensland has not seen the legal advice that has been provided to Queensland Health and consequently we have unresolved concerns about the legality of the bulk billing operations of APCCs within Queensland Health. We have called for an immediate moratorium on the rollout of these clinics across the state and for Queensland Health to cease MBS billing at all APCCs until these concerns are addressed. The fact that Queensland Health employees are bulk billing services provided at these clinics means there will be an impact on the District of Workforce Shortage calculation. Doctors who staff APCCs will be required to use their provider number to claim against Medicare. This makes doctors vulnerable to a Medicare audit. Doctors must closely monitor how their provider number is being used by Queensland Health, as they are personally liable for any misuse. This is particularly problematic when other medical staff or APCC administrators use provider numbers for billing purposes. Doctors are required to adequately record and justify services billed to Medicare, in order to be prepared for a Medicare audit. All doctors who provide or initiate a service for which a Medicare benefit is payable should ensure they maintain adequate and contemporaneous records. These records should clearly identify the name of the patient; contain a separate entry for each attendance by the patient for a service; indicate the date on which the service was rendered or initiated; contain information which explains the type of service rendered or initiated and be sufficiently comprehensible that another practitioner, relying on the record, could effectively undertake the patient’s ongoing care. Doctors must be able to justify through sufficient clinical notes why they are ordering further investigative tests. If a Medicare auditor find the tests unjustified, the doctor may be required to pay to Medicare the full cost of the tests as well as additional penalties. This represents an area of risk for Queensland Health employees.
It also needs to be highlighted that a vast majority of consultations under MBS item numbers are claims that can only be made in relation to the actual time spent with the patient; this means that the doctor must be physically present at the time that the claim is being made. Consequently, there exists the potential for a Medicare fraud claim to be brought against the doctor whose provider number may be misused. If referrals are made to other doctors, then the referring doctor is required to clinically justify this referral. If the Medicare auditor is not satisfied that a fully substantiated referral has been made the doctor may potentially have to incur the costs.
Substantiating that a patient attended a service
Doctors who are not familiar with Medicare billing practices should ensure they keep complete clinical notes. Please see below for documents that may be required in the first instance to substantiate that a patient attended a particular service: Payment receipt; Daybook or other note created during or as soon as practicable after patient attended; Any document created during the attendance; and An excerpt from the patient’s clinical file.
Substantiating that a specific treatment was performed
Medicare guidelines are not exhaustive and a doctor can respond to an audit using any document they believe substantiates the concerns raised. Any document created during or as soon as practicable after the treatment that clearly demonstrates that the required treatment occurred, the patient’s name and the date the treatment was performed should be provided. Examples of more specific documents include: An operation report; Diagnostic imaging report; A pathology report; and An excerpt from the patient’s clinical files detailing the name, the date of the service and enough text to indicate that all components of the treatment, procedure or investigation were performed.
In review
When a medical audit takes place the doctor must be able to provide sufficient detail for a Medicare auditor to be able to understand the clinical justification for such aspects as: (a) the time actually spent with the patient; (b) investigative requests (particularly if this was to be Medicare billed); (c) reviewing the patient in a clinically approved time period; and (d) any referrals that have been made. Q
Please note information contained in this article does not constitute legal advice.
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New member service now available!
www.amaq.com.au/econnect e-connect offers members the opportunity to organise an appointment with an AMA Queensland representative either by teleconference, video conference or using Skype. AMA Queensland’s expert advice and support is now available at the touch of a button and face to face contact is accessible from your practice, hospital, home or wherever is most convenient for you, regardless of where you are. HoW: Log on to www.amaq.com.au/econnect and organise a meeting with the following AMA Queensland departments: • AMA Queensland CEO or President • Workplace Relations • Membership • Business Support Service / Administration and Bookkeeping aVailabilitY: Appointments are available every Tuesday from 7am to 1pm and every Thursday from 12.15pm to 6.15pm. Appointments with the AMA Queensland President are only available on Tuesdays. If these times do not suit, please contact AMA Queensland on (07) 3872 2222 to discuss alternative options.
For more information contact AMA Queensland on (07) 3872 2222
FOUNDATION
On behalf of the AMAQ Foundation, we wish you a very Merry Christmas and a restful and happy holiday. Thank you for your generous support in 2011.
2 0 1 1 highlights Supported AMA Queensland’s See the Signs mental health campaign, following Queensland’s summer of disasters.
SEE THE
SIGNS Continued support for Royal Children’s Hospital, Red Hill Special School, Muscular Dystrophy patients and public health education in Cambodia.
AMAQ Foundation President Dr Steve Hambleton accepts a thank you card from Red Hill Special Schoool student Madeleine Shoobridge.
Continued to distribute Dr Chris Schull’s book Common Medical Problems in the Tropics 3rd Edition to medical centres in developing countries: Vanuatu, East Timor, Sri Lanka, Somaliland and Malawi.
Three AMAQ Foundation Scholarship holders graduated from James Cook University.
Above: Christine Pirrone, Andrew Cross from QML, Brooke Davies and Lincoln Dinh.
AMAQ Foundation donation form Mail to: AMA Queensland Foundation PO Box 123, Red Hill, Queensland 4059 or Fax (07) 3856 4727 To:
The Executive Officer AMAQ Foundation PO Box 123 Red Hill QLD 4059
From: Address: Phone:
I wish to make a donation of $ I wish to make an annual donation of $250, charged in equal quarterly instalments of $64 to my credit card (includes credit card fee) My cheque for $ is enclosed. Please make cheques payable to AMAQ Foundation. Please charge my credit card for the amount of $
Card number: Expiry date: Cardholder’s name: Cardholder’s signature:
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NOVEMBER 2011 DoctorQ
Visa
Mastercard
Amex
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AROUND THE REGIONS
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
Toowoomba
Monthly dinner meetings are generally held on the fourth Thursday of each month.
Members and non members can keep an eye out on the website for details on upcoming events and meetings or contact the Association on info@tddlma.org.au.
Venue: Maroochydore Surf Club Function Room, Alexandra Parade, Cotton Tree Time: 6.30pm for 7pm Convenor: Jo Bourke Phone: (07) 5479 3979 Fax: (07) 5479 3995 Email: jobo@squirrel.com.au For further information or to join visit www.sclma.com.au
Fraser Coast For information on meeting dates and how to join, contact Fraser Coast Local Medical Association President Dr Shaun Rudd. Address: PO Box 1347, Hervey Bay, Qld , 4655 Phone: (07) 4128 3644 Fax: (07) 4124 0660
Gold Coast You will find all the latest news and information on the Gold Coast Medical Association (GCMA) at www.gcma.org.au. To join, simply visit the website and download an application. You can contact the GCMA on: Phone: (07) 5575 7054 Fax: (07) 5575 7551 Email: info@gcma.org.au
Membership of the Toowoomba and Darling Downs Local Medical Association is just $50. To join go to tddlma.org.au/ membership.html and download an application form.
Redcliffe & District For information on upcoming meetings please contact Tracey Jewell, Meeting Convener on (07) 3049 4429, 0411 223 073 or email tracey.jewell@qml.com.au. Venue (for all but the last meeting): Renoir Room at the Ox, 330 Oxley Ave, Margate. Time: 7pm for 7.30 pm 2011 Meeting Dates 25 November - End of Year Networking Function
Brisbane Northside Local Medical Association For upcoming meeting information or to join, please contact: Margaret MacPherson Meeting Convenor Phone: (07) 3121 4043 Email: Margaret.MacPherson@qml.com.au Website: http://northsidelocalmedical.wordpress.com 2011 Meeting Dates 13 December at Brett’s Wharf
If your Local Medical Association does not appear above or your details are incorrect, please email Kathleen Bertini at k.bertini@amaq.com.au with corrections, contact details, how to join, web address, dates for upcoming meetings and who to contact for further information.
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NOVEMBER 2011 DoctorQ
AROUND THE REGIONS
Rural Doctors’ Association Queensland President Dr Ewen McPhee tells how threatened bed closures, rural doctor shortages and expanded MBS billing is at the forefront of the agenda for RDAQ.
R
ural Doctors Association of Queensland has noted a number of concerning developments reported in state wide media over the last month.
Threatened Bed Closures
Governments. The massive growth in employment opportunities and consequent influx of workers means most rural doctors are putting in big hours. The increased patient case loads, after hours on call, is seeing signs of burn out amongst clinicians.
Doctors from the bush are just as concerned about bed closures being mooted in the states two largest tertiary referral hospital the PAH and the RBWH (Courier Mail 24 September 2011) as their metropolitan and regional colleagues.
Many long-term doctors are walking away, after many years putting their own health and their families first. Rural doctors in Queensland are working very hard for their communities, but there are only so many hours in the day and you have to get some rest at some point.
These hospitals are where our sickest patients are referred, our severe head injury patients, patients needing ICU beds or patients with multiple complex medical problems who need to be airlifted out of small communities by the RFDS. Bed closures like this effect the whole state.
This is nothing new to RDAQ, who has been working for rural doctors and their local communities for over 20 years. RDAQ calls on the local, state and federal government, mining, rural industry associations and local communities to support rural doctors.
Rural doctors are deeply concerned these closures will adversely affect their patients.
BUSH DOCtors BURNING OUT?
The acute shortage of rural doctors continues to put strain on those working in rural Queensland. The number of working doctors in the bush and regions has not kept pace with growth as the resources boom takes off across the state. The boom cycle in the resources sector is reaping generous royalties for the State and Federal
Collaborations between all levels of government and industry are critical for a future that provides for healthy communities and healthy doctors.
Expansion of Queensland Health MBS Billing
Over this year RDAQ has heard concerns from members regarding the expansion of MBS billing activities by Queensland Health. The Association has been active with a range of stakeholders in attempts to bring these concerns to Queensland Health and seek some remedy to them. We continue in these efforts and remain concerned regarding the implementation of these strategies site to site, implications for participating doctors and implications for general practice. RDAQ has applied three guiding principles to our efforts in this issue: RDAQ affirms the position that each rural community has different issues. RDAQ will engage with Queensland Health to facilitate the cooperation between public and private sectors. RDAQ reaffirms its support of private medicine in Queensland and advocates that any emerging models must support the role of private practice. RDAQ request that Queensland Health indemnifies doctors participating in bulk billing in public hospitals against any actions the Commonwealth may take in relation to liabilities generated by the administration of billing under MBS. It is an important time for all to be fully informed regarding their responsibilities under the Health Insurance Act 1973. RDAQ is happy to hear from you if we can provide further information or support. Q
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conference
The eleventh annual AMA Queensland conference was staged in Prague from 18 – 23 September. Conference Coordinator Neil Mackintosh gives us a wrap up on one of the most successful conferences ever.
T
he 11th annual AMA Queensland conference was staged in the magnificent city of Prague during the period 18 – 23 September. And what a wonderful experience it was. The host city was just wonderful. A mixture of old world and new, modern, relaxed, friendly and completely safe. It provided a perfect setting for delegates to learn and enjoy each others company. The event kicked off with a pleasant cocktail reception in the hotel hosted by AMA Queensland President, Dr Richard Kidd. Special guests were Ruth Pearce, Australian Ambassador to Poland and the Czech Republic and Dr Zdenek Mrozek, Vice President of the Czech Medical Chamber. It was an absolute pleasure to have these local people with us. In the conference room our delegates were educated and entertained by a line-up of speakers of world renown, with the conference theme being Innovations in healthcare – Doctors leading the way. With every session packed with enlightening presentations and generating enthusiastic discussion and debate. The conference was formally opened by Ruth Pearce, Australian Ambassador to Poland and the Czech Republic. Ms Pearce addressed the delegates on a wide range of bi-lateral issues including diplomacy, commerce, medical research and co-operation. She was quickly followed by Professor Claire
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NOVEMBER 2011 DoctorQ
Jackson, President RACGP and Professor in General Practice and Primary Healthcare, University of Queensland. Claire delivered sessions on Innovations in Healthcare, Clinical Strategies for Practice Innovation (with Dr Richard Kidd) and Future Thinking for Healthcare (with Colleen Sullivan) And then Dr Liz Kenny spoke on new technology in treating head and neck cancer and multi-disciplinary teams, with Dr Beres Wenck. Other Australian keynote speakers to present were Dr Bill Glasson AO on the role of the Queensland Clinical Senate and Dr Dilip Dhupelia on national health reform (Navigating the Maze). Dr Rod Thelander (GP from Perth) gave a fascinating talk on his experience teaching medical students in Somaliland and AMA Queensland CEO Jane Schmitt updated delegates on Innovations in Medical Profession Representation and Communication. Carmel Brown and Carolyn Ingram teamed up for a session on technology and innovative tools for your practice and Colleen Sullivan presented on social media and where it might fit in a medical practice. From the UK we had the pleasure of the company of Professor Trisha Greenhalgh who spoke on England’s National Program for IT and joined with Dr Richard Kidd and Carmel Brown for sessions on Personally Controlled Electronic Health Records.
conference Conference sponsors Ross Noye, Anthony Brown, Katharine Philp and Stuart Tait, together with Carolyn Ingram, conducted a most informative workshop on business imperatives for a successful healthcare practice. Our local guest speakers from Prague were Jirina Novakova who entertained delegates by speaking about Czech history, customs and culture and Dr Zdenek Mrozek, Vice President of the Czech Medical Chamber on developments in healthcare in the Czech Republic and Central Europe. The program continued with valuable presentations by Ross Noye (Wilson HTM) on Financial Security and Business Planning. Anthony Brown (Medico-Legal Insurance Group) on Effective and Affordable Insurance issues and a Check List for Business. Stuart Tait (Family Care Medical Services) on Medicare Locals and the new world of afterhours patient care. With Katharine Philp from Tress Cox Lawyers speaking on the very important issue of mandatory reporting. AMA Queensland President, Dr Richard Kidd, wrapped up the formal sessions with an insightful presentation on the conference theme Innovations in Healthcare – Doctors leading the way.
the famous Charles Bridge, with a private concert thrown in. A visit to Prague Castle was another highlight that will remain in our thoughts for a long time. Outside Prague a true highlight of the conference was our trip to the historic town of Cesky Krumlov. This architectural jewel was included in the UNESCO list of World Cultural Heritage Sites in 1992 and should be on all Bucket Lists of must sees.
THE GRAND FINALE
Conference week concluded with a farewell dinner and what a way to wrap up a great week. The venue was the stunning and historic Lobkowicz Palace, within the Prague Castle complex, where delegates celebrated a wonderful week in style, enjoying dinner of local produce and classic Czech entertainment.
OUR SPONSORS
Our wonderful sponsors received a special vote of thanks at the dinner. We were most fortunate to have the support and company of Anthony Brown (Medico-Legal Insurance Group), Ross and Mandy Noye (Wilson HTM), Stuart and Joanna Tait (Family Care Medical Services), Katharine Philp (Tress Cox Lawyers) and Carolyn Ingram and Colleen Sullivan representing AAPM.
The final conference session was an Issues Open Forum chaired by Dr Bill Glasson AO. Issues significant to the future of medicine were addressed and hotly debated.
So that was Conference 2011, a wonderful experience for all concerned and a visit to a country so friendly and enjoyable that it will stay in our minds for a very long time. It certainly exceeded many expectations.
EXPLORING PRAGUE AND BEYOND
Finally, a big thank you to AMA Travel Queensland, Ros and Andrea, for yet another successful and co-operative operation.
Outside the conference sessions delegates had opportunities to explore this wonderful city and regions beyond. Some particular highlights within Prague were a walking tour of the Old Town, Wenceslas Square and over
Keynote speakers Professor Claire Jackson and Professor Trisha Greenhalgh.
Visit the AMA Queensland web site at www. amaq.com.au for a more comprehensive picture gallery. Q
President Dr Richard Kidd, Ruth Pearce, Australian Ambassador to Poland and the Czech Republic, CEO Jane Schmitt and Katharine Philp from TressCox Lawyers.
Business panel discussion.
Group discussions.
TESTIMONIALS “There was a wonderful balance between the new technologies discussed and the gorgeous history of Prague.”
“The conference was a fantastic opportunity to find others interested in key topics and hear some different points of view.”
“Thank you once again for a well-planned conference and associated tours - our time in Prague was well spent.”
AMA queensland’s 2011 confereence was proudly sponsored by:
DoctorQ NOVEMBER 2011
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PEOPLe & EVENTS
Workplace Relations Training: Fraud, insurance and the Safe Work Act 31 October, 1, 3, 7, 9 and 10 November
Gold Coast, Toowoomba, Sunshine Coast, Brisbane, Cairns, Townsville, Mackay.
WOR K PLAC E RELATIONS TRAININ G
The training includes identifying serious misconduct and outlining your responsibilities when a serious allegation is brought to your attention. It will also cover managing the insurance process and look at the different types of insurances and when you need them. There will also be an overview of the 2012 Safe Work Act. Register: www.amaq.com.au/events or George Sotiris (07) 3872 2280 or g.sotiris@amaq.com.au
50 year Member Morning Tea 2 December
Hunstanton, Kelvin Grove Membership Celebration
INTERNSHIP MORNING TEA
AMA Queensland celebrates milestones with loyal members. Register: www.amaq.com.au/events or Rebecca Byrnes on (07) 3872 2269 or r.byrnes@amaq.com.au
How to stayDraHead of tHe game John Smith AMA Queensland President Dr Richard Kidd extends a special invitation to celebrate your continued and valued membership with AMA Queensland.
TOP 10 TiPs
James Cook University Intern Workshop: Unwritten rules of the game
Friday 2 December 2011
hArd10.00am COrr for 10.15am start
special presentation to be made at 10.30am the verandah, ama queensland 88 l’estrange tce, Kelvin grove parking is available both onsite at ama queensland and also via nearby street parking
MOCA FAQ
Your response by 25 November 2011 would be very much appreciated. Please phone Nikki Knowles on (07) 3872 2247 or email n.knowles@amaq.com.au.
in the wOrkplACe
get Ready!
14 December Riverview Tavern, Townsville AMA Queensland invites medical students to an essential and practical workshop presented by their future colleagues and industry experts. This workshop will alleviate fears, and enable a confident transition from student to medical practitioner. Register: www.amaq.com.au/events or Thy Pham on (07) 3872 2201 or t.pham@amaq.com.au
AMA Queensland Annual Conference 2012 23 - 29 September
Madrid, Spain Following on from the very successful 2011 Annual Conference in Prague, the 2012 conference will be held in Madrid. The topic for next year’s conference will be Prevention is better than cure - Preventative Health Strategies for the 21st century. Register: For more information, contact Neil Mackintosh on (07) 3872 2267. Please register by 27 January 2012 for early bird rates.
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NOVEMBER 2011 DoctorQ
THE PLACE FOR HEALTH SERVICES THE LANE LEASING NOW
Opportunities exist for medical, retail, cultural and service providers to join a national supermarket and other great retailers.
Contact Kevin Ramsey
0433 101 196
www.thelanesouthport.com.au
19009
An exciting range of spaces are now available in Southport’s most dynamic urban retail centre, The Lane.
MEMBER NEWS
Directory of Members 2012 The 2012 Directory of Members is now being compiled. AMA Queensland has contacted all eligible members to verify your details are correct and to ensure you wish to be listed in the 2012 directory. The new 2012 directory will be posted out to members early in 2012 with the member renewal kits.
August
September
Junior Doctors
Junior Doctors
Dr Chris Garland
Dr Mathew Davis
Dr Maia McFadden-Gummeson
If you are interested in promoting your practice in the directory contact AMA Queensland and we will forward you an advertising kit. AMA members receive significant discounts off the standard rates.
Dr Christine Kilcawley
Dr Anthony Baird
Dr Paul Bready
Should you have any queries regarding the 2012 Directory, please contact Karen Fitzgibbons on (07) 3872 2248 or via email k.fitzgibbons@amaq.com.au
Dr Surekha Puri
Dr Kenneth Yang
Membership Renewals for 2012 Your 2012 membership renewals will be posted to all members in December 2011 and are due on 1 January 2012. You can refer a colleague to join AMA Queensland and take advantage of the Member Get a Member program which offers an outstanding financial incentive for existing members to introduce new doctors to join. With each new member you introduce, you receive a 25 per cent reduction off next year’s membership: introduce four new members and your membership next year will be free! Start recruiting today and be sure to call the Membership team on (07) 3872 222 once you have recruited your new member so we can ensure we record the details and your discount is applied.
ANNOUNCING NEW MEMBER PARTNER - LEXUS
Dr Sangeetha Makielan Dr Maria Barker-Mott
General Practitioners
Dr Jatheesh Pala Valappil Dr Timothy Lynch
Dr Bee Kho Dr Saibal Ghosh
Dr Thushara Pussella
Dr Jody Waters
Dr Barry C Legg
General Practitioners
Dr Charles Wu Dr Vahid Sherafati
Dr Fereshteh Mahani
Dr Michael Yang
Dr Davina Miller
Specialist Practitioners
Specialist Practitioners
Dr Melissa G Luckensmeyer
Dr Balu Bhaskar
Dr Raefe Gundelach
Dr Janet Huang
Dr Bruce Hammonds
Dr Rebecca Greenup
Dr Muhammad Kahloon
Dr Victoria Shepherd
Dr William H Watts
Dr Suvenesh Prasad
Part-time Practitioners Dr Bel Zoughi
Dr Suresh Perera
Part-time Practitioners
AMA Queensland is delighted to now offer members and their fulltime staff access to the Lexus Corporate Program benefits on all new cars across the entire Lexus range. The benefits of the Lexus Corporate Program include: Three year/60,000km complimentary scheduled servicing Reduced dealer pre-delivery fee Four year/100,000km (whichever occurs first) warranty Complimentary service loan cars and pick-up/drop off during servicing Lexus DriveCare providing 24 hour roadside assistance Lexus Magazine Lexus Premium Ticketing Priority invitations to Lexus of Brisbane Group corporate events Dedicated Lexus/AMA Queensland contact person for all enquiries
Dr John Osborne
Dr Bevereley Grehan
Dr Daphne Liu
Dr Amanda Casperson
Dr James E Coombe
Dr Joanna PM Loftus
Dr Paul Varcoe
Dr Jane Richardson
This is a privilege currently offered to BRW Top 500 companies in Australia so we are delighted it has been extended by Lexus Australia for AMA Queensland members. The Lexus of Brisbane Group looks forward to our partnership with the AMA Queensland and their members. For any queries, please feel free to contact Peter Thomas, Lexus Concierge on (07) 3327 1777.
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Dr Emily Yorston
NOVEMBER 2011 DoctorQ
Salaried Practitioners
Dr Loretta Deuble Dr Lily Ooi
Dr Nicole Fairweather
Dr Marelise Pretorius
Dr Andrew Humphrey
Salaried Practitioners
Dr James Bowman Dr Vikram Masurkar
Dr Charles Mutandwa
Dr Pradeep Koloth Narayanan
Dr Carl O’Kane
Dr Ulrich Orda
Dr Vanitha Math
Dr Kumar Vigneswaran
Dr Jacobus Du Plessis
Academic Members
Academic Members
Dr Keith Grimwood
Dr Michael Hutchison
MEMBER NEWS
Get more value from your membership
For a full list log into the members only page on our website to download all contact details and specials for these benefits or contact the Membership Team on (07) 3872 2222 or membership@amaq.com.au
Advocacy, representation and support Member support, services, policy and workplace relations
Business Services
Adventure and recreation activities
cable access travel lounge Advertising car discounts
Member Services
DHAS
Doctors’ Health Advisory Service
AMAQ Foundation supporting rural medicine
after hours Medical support
Council of Residents and Registrars supporting DITs
professional training and development
assisting impaired medical professionals
personal health insurance
legal representation PROFESSIONAL TRAINING and DEVELOPMENT courses
ABCs OF HEALTHY LIVING
doctor recruitment
community aid for children
Accounting, finance, investment and insurance Insurance brokers credit card and merchant facilities taxation, Accountancy and business advisory services
financing
investment life insurance
administrative support EFTPOS merchant facilities office supplies manuals, fact sheets and Publications for your practice
Travel lounge
Events and conferences AMA Queensland organises and designs events to satisfy educational and professional development needs as well as social networking opportunities among your peers. events + training newsletter
Publications and medical resources Directory of Members AMA List of Medical Services and Fees
it solutions books, DVDs and software
Entertainment, leisure, automotive and travel
Magazines and e-newsletters
corporate and leisure travel
books, DVDs and software
ENCORE
IPHONE APP AND WEBSITE
wine provider gym membership
aLL ABOUT YOU MAGAZINE ONLINE
Cinema car hire
DoctorQ NOVEMBER 2011
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MEMBER PROFILE
often dealt with by staff in the face of challenging physical conditions and resources. We have not been disappointed. The Torres Strait is an archipelago of islands scattered across 48,000 square km between the Cape or tip of Australian mainland and Papua New Guinea. It includes 21 populated islands and five Northern Peninsula communities with an official population of 8,510 but a more realistic
It is quite confronting arriving on a small island, pushing through a crowd of PNG warriors who speak little English and then proceeding to intubate an unconscious child to try and get control of a clinical situation all the while trying to explain in hand signals (and my terrible Pidgin) what is happening so that the crowd stays comfortable and relaxed.
DR alex kippen Dr Alex Kippen reflects on his life as a registrar in the torres strait.
I
n January 2010, my wife Felicity, son Noah and I decided to move up to Thursday Island to experience something different by living in and contributing to a remote indigenous community and hoping to have a bit of an adventure as a family in the process in a unique part of the world. What prompted the move was that I had been fortunate enough to experience a rotation out of Cairns Base Hospital as a resident three years earlier and had not been able to shake the idea of returning for a more permanent stint. I had been attracted to the completely different way of life, complex chronic disease, high frequency of exotic tropical pathology, critical illness and complex medical conditions,
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NOVEMBER 2011 DoctorQ
one approaching 13,000. It is the most northern part of Australia and has an amazingly vibrant culture including influences from Aboriginal, Melanesian, Papua New Guinean, Japanese, Chinese and Portuguese heritage. Saibai and Boigu Islands to the North-West are about five km from PNG mainland and Papua New Guineans and Australian Torres Strait Islanders travel freely across the border under the Torres Strait Treaty. The western province of PNG is very remote, even by PNG standards and the health facilities in the region are significantly understaffed and under-resourced (Osteomyelitis gets oral Amoxycillin and Aspirin if there has been a recent resupply and there is no snake anti-venom available). This means that in addition to the remote setting and high burden of disease within indigenous health, there are also very sick Papua New Guineans who have managed to survive the travel to one of the Australian outer island clinics. The lifestyle is quite unique and very remote but wonderful. Torres Strait culture has a wonderful emphasis on family, which has made for some truly lovely moments shared by all three of us. The medicine has been everything I had hoped for. In preparation of coming to the Torres Strait, I completed a year of
ICU and a year of anaesthetics. As a result, I took a position as a Senior Medical Officer (pre-vocational) and my job now involves great diversity. Some weeks I will be rostered to look after the general inpatient ward which may include the usual exacerbation COPDs, cellulitis’, Community Acquired Pneumonias, unstable Diabetics, Acute on Chronic Renal and Cardiac failures and the dehydrated kids with Ds and Vs that most rural hospitals would deal with. In addition to this is the Multi-Drug Resistant TBs, Melioidosis’, Acute Rheumatic Fevers and PSGN patients that are perhaps less common in mainstream Australian rural hospitals. Other weeks I cover the Emergency Department which also sees the usual array of chest pain, trauma and sepsis. This is made all the more fascinating with the occasional PNG case of severe snake envenomations, rare tropical disease and the multitude of weird and wonderful ways in which Tuberculosis can present. Late presentation due to the week or more that a family may have travelled to present to an outer island clinic, complicates what would otherwise be more routine cases of machete traumas, simple pneumonias or bacterial meningitis. I take part in the anaesthetic roster which mainly involves anaesthetising for obstetric cases (C-sections, ectopic pregnancies, retained placentas and products of conception), GA dental lists for kids, GP surgical lists (appendicectomies, skin excisions and grafts etc) and then cases for the visiting Orthopedic and General Surgical teams who arrive from Cairns Base Hospital every two to three months to do a week of consulting and operating. On average, I work one to two days per week as a GP in the Queensland Health-run Primary Health Care Clinic on Thursday Island, the rest of the time at the hospital and then helicopter to two outer islands for overnight GP clinic visits every three weeks. One of the more interesting and challenges jobs is manning the on-call phone where you are required to assess patients over the phone following their presentation to one of the Nurse run outer island clinics. Most patients can be managed over the phone using the set resources in these island clinics, others need to be brought into TI Hospital via commercial flight to be assessed in person and yet others need to be retrieved by helicopter. I usually accompany the helicopter retrieval crew for the more critical patients and have had some great challenging retrieval experiences over my time here. It is quite confronting arriving on a small island, pushing through a crowd of PNG warriors who speak little English and then proceeding to intubate an unconscious child to try and get control of a clinical situation all the while trying to explain in hand signals (and my terrible Pidgin) what is happening so that the crowd stays comfortable and relaxed.
TI Hospital has to stabilise and care for acutely unwell patients. The minimum retrieval time would be approximately four hours from phone-call to getting the Cairns plane in the air (if it happens to be instantly available), touching down at Horn Island, transferring patient to the helicopter to transfer from Thursday Island to Horn Island and then transferring into the RFDS plane. However, the RFDS plane has to fly over a lot of Cape communities on their way to Thursday Island, communities that don’t have the procedural capabilities, medical staff, onsite lab and XR and Ultrasound services that we have on TI, so retrieval planes frequently get re-tasked to retrieve critical patients who are in facilities with much lower capacity than TI. This means we often have to more robustly stabilise patients on TI, commencing invasive ventilation, inserting central lines and running inotropes etc. For those interested, there is also a great Primary Care focus and the opportunity to take on a PHO position. Cases I saw in one seven-day period on TI: Flat five-year-old severely dehydrated Shigella dysentery Four-month-old with bilateral pneumonia and pH of 7.01 but only requiring bubble C-PAP Three-year-old infected VP shunt and septic PNG neonate with bacterial meningitis and seizures Head injury on one of the outer communities requiring a night-time chopper retrieval, intubation and stabilisation on site before rendezvousing with the retrieval plane on the Horn Island airstrip at three in the morning 60-year-old with necrotising fasciitis and multi-organ failure requiring inotropic support and intubation and ventilation Five-year-old with meningococcus sepsis Other memories of TI: Malaria and influenza outbreaks An outer island clinic trip: patients in the morning and spear fishing in the afternoon Taking Felicity and Noah on one of my helicopter island clinics, flying over reefs and white sandy islands, dolphins, dugongs and turtles Catching and filleting my first GT and spearing my first crayfish Being invited to a tombstone opening ceremony Exploring new islands and reefs in clear blue water with not another boat in sight Seriously consider a career as a rural generalist but also the many amazing and challenging experiences and adventures one can have on their journey through their junior doctor years - it can only stand you in good stead in both your clinical and personal life! Q
One of the factors that really makes our job interesting (and satisfying) is that we often have relatively long retrieval times for the Royal Flying Doctor Service to pick up a patient being transferred to Cairns Base Hospital due to the distances involved, as well as the higher capacity that
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BUSINESS TOOLS
Scott Stewart from AMA Queensland Insurance Solutions explains why not having management liability insurance could cost you thousands.
Scott Stewart AMA Queensland Insurance Solutions 1300 883 059 scott.stewart@amaqis.com.au
L
ast year I wrote about the importance of securing the financial health of your business by arranging to take out a good management liability policy. Given the great spike in claims we have witnessed in the first half of the current year primarily involving employment practices and fidelity notifications we at AMA Queensland Insurance Solutions now feel the need to reinforce our message that no practice or business should be without this cover. This message is made even more significant given that the average costs of a claim now reaching over one hundred thousand dollars. Private company directors and managers and even employees are increasingly facing the very real risk of personal litigation from many sources including, but not limited to, employees, minority shareholders, regulators, creditors, environmental groups, customers and suppliers. Although you may consider that an allegation against the company or its directors by an employee or third party is completely baseless or without merit, without insurance you leave yourself exposed to expensive and time consuming litigation to successfully defend any allegation. Management Liability insurance is designed to protect the personal assets of the insured entity (business) and directors and officers (officers = employees) by providing indemnity for any loss arising from a claim, as a result of a Wrongful Act, committed while they are carrying out their duties and obligations in their positions as directors and officers.
Without insurance you leave yourself exposed to expensive and time consuming litigation to successfully defend any allegation. A good Management Liability policy should protect directors and officers for any legal liability they may incur personally in managing a corporation and should also cover the business itself for certain types of claims such as wrongful dismissal and sexual harassment, claims relating to the staff superannuation fund, crisis management costs etc. Due to complex legislation surrounding employment
related issues, cover for legal action brought against you or your business by an employee(s) is very important. Companies are finding they are vulnerable from the initial recruitment process through the exit interview, even if the individual was never hired, or only at the company a matter of days. The costs involved in defending against allegations brought against you by employees for issues such as unfair dismissal/termination, sexual harassment and discrimination are not cheap. With this in mind it is very important to ensure that Employment Practices Liability is included in any Management Liability policy you hold. Employment Practices Liability Insurance is a relatively new form of liability insurance and is designed to help employers minimise the risk and potential cost of claims taken against them by employees. It provides protection for an employer against claims made by employees, former employees, or potential employees. It covers discrimination (age, sex, race, disability, etc), wrongful termination of employment, sexual harassment, and other employment-related allegations. Another important cover that should be integral to any good Management Liability Policy is Fidelity Insurance. Any employer needs to be concerned with employee dishonesty and any business handling cash or utilising electronic transfers will need Fidelity cover. In simple terms, Fidelity Insurance protects a business or organisation against financial loss as a result of an employee’s and/or officeholder’s dishonesty which can include loss of money, securities, or inventory resulting from crime. Common Fidelity claims allege employee dishonesty, embezzlement, forgery, robbery, safe burglary, computer fraud, wire transfer fraud, counterfeiting, and other criminal acts. Whether you choose to purchase Management Liability Insurance or not the simple fact is that without the protection of a suitable policy your business and all its directors and officers are exposed to a management liability claim – a claim which could lead to personal financial impairment. AMA Queensland Insurance Solutions welcomes any inquiry you may have in relation to Management Liability Insurance; please do not hesitate to contact us to discuss the benefits of this or any other Insurance Policy. Q
AMA Queensland Insurance Solutions is a joint initiative of AMA Queensland and Insurance Advisernet Australia Pty Limited ABN 81 072 343 643 AFS Licence 240549. AMA Queensland Insurance Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Authorised Representative No: 320115. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.
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NOVEMBER 2011 DoctorQ
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AMA Queensland Insurance Solutions is a joint initiative of AMA Queensland and Insurance Advisernet Australia Pty Limitied ABN 81 072 343 643 AFS Licence 240549. AMA Queensland Insurance Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Authorised Representative No: 320115. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.
Phone: 1300 883 059
Web: www.amaqis.com.au
333
ple
BUSINESS TOOLS
Nobody likes paying tax – even more so if it could be avoided. Julie Smith from William Buck explains some of the additional taxes that can be overlooked.
Julie Smith William Buck (07) 3229 5100 julie.smith@williambuckqld.com.au
W
hen planning to minimise tax we naturally tend to think of the big ticket items first, such as income tax or capital gains tax. However, some of the most irritating taxes can be those smaller state taxes such as land tax, payroll tax and stamp duty. These taxes are often overlooked in day to day operations and if not considered and planned for, they can become a costly ongoing annual irritation. Land tax is a state based tax determined with reference to the unimproved value of investment property land that you own at 30 June each year. The unimproved value of land is the value of the land as assessed without reference to any property that may be on the land. An easy way to find this out is with reference to your rates notices. Because of the uncertainty surrounding the share market, many medical practitioners are looking back towards property as a potential investment. If you are one of these potential investors, it is important that you consider the application of land tax to any upcoming purchases. Like income tax, there is a land tax threshold, a level at which it does not apply. For individuals, this threshold is $600,000 but for trusts and companies, this threshold is $350,000. Also, the rate of the tax for trusts is much higher than for individuals.
Some of the most irritating taxes can be those smaller state taxes such as land tax, payroll tax and stamp duty. These taxes are often overlooked in day to day operations and if not considered and planned for, they can become a costly ongoing annual irritation. For example, say you are looking to purchase two investment properties. The unimproved land value of each property is $250,000 giving a combined total of $500,000. If you purchase these properties in your spouse’s name, and provided they have no other investment properties, there will be no land tax payable. If however you purchase both properties in an
investment trust, the annual land tax assessment will be approximately $4,000. A land tax assessment is something that will definitely make you go AARRGGHH! If you find that you have purchased property in the wrong entity and then wish to restructure to try and minimise the land tax, the next tax to consider will be stamp duty. Moving assets from one entity to another will incur this tax and it will be payable on the market value of the asset being transferred. This is regardless of whether the transfer is to a related party or not. The key to minimising land tax and stamp duty is proper planning prior to any purchase. Seek out advice before undertaking a purchase and make sure all taxes have been considered and explained to you regarding any investment. The final state tax I will cover in this article is payroll tax. From 1 July 2008, changes to the state based Payroll Tax provisions have meant that payments that may have not previously been subject to payroll tax are now caught. The changes reviewed here relate to payments made to ‘contractors’ which have, in the most part, been excluded from consideration for payroll tax in the past. The most common example of this for medical practitioners is contractor payments to doctors from a general or specialist medical centre. The term ‘contractors’ is generic and includes subcontractors, consultants and outworkers. The name and description given to the worker is not relevant. The important factor is that under the contract, the worker provides predominately personal services. Another important factor is that these provisions apply regardless of whether the contractor provides the services as a company, trust or sole trader. We regularly see medical practices that have not taken the time to review their existing arrangements with contracting doctors. If you own or operate one of these practice I urge you to speak with your advisors to see if payroll tax could be applied to your business. It is better to speak with your accountant now than to have a visit from the auditors from the Office of State Revenue – AARRGGHH! Q
The information contained in this summary is general in nature and should not be applied or relied upon without seeking additional professional advice. William Buck has a dedicated team of superannuation and taxation experts who are happy to speak with you regarding your self managed superannuation fund or any other issues regarding superannuation you may have.
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NOVEMBER 2011 DoctorQ
Feel like your accounting and finances are in a mess? We can help.
At William Buck, we have one simple goal - to simplify, clarify and systemise your finances and take the stress out of your life. We’re more than just a leading accounting and advisory firm. We become true partners with our clients and work hard to keep you one step ahead.
William Buck (Qld) GPO Box 563, Brisbane QLD 4001 Telephone:+61 7 3229 5100 Facsimile: +61 7 3221 6027
williambuck.com
CHARTERED ACCOUNTANTS & ADVISORS
BUSINESS TOOLS
The Australian dream of buying your own home is getting harder as house affordability puts it out of reach. Barry Lanesman from Investec Medical Finance explains why dreams can still come true. Barry Lanesman Investec Medical and Dental Finance 1300 131 141 www.investec.com.au/ medicalfinance
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eal Estate in Australia has been one of the best performing investments available over the past 15 to 20 years. Many doctors have used the reliable cash flow from their practices to invest in property and eventually retire comfortably on the substantial capital gains. Purchasing one’s own home is a priority for many young doctors, however how many think about and then act on buying their own medical suite? Commercial property still provides reasonable yields and who could be a better tenant than you? Let’s look at some numbers that might explain why your landlord is always smiling! As an owner occupier, consider your position at retirement. You now own a practice property worth over $3,000,000 with a loan (if you have chosen not to pay off) of $700,000. What are your choices: a. Sell the property. Being able to sell your property together with your practice is a very attractive proposition for a prospective purchaser. In addition, under current capital gains rules, you may be eligible for substantial tax relief. The prospective $2.3m (pretax profit) will be substantial, relative to the sale value of your practice. b. Hold the property as a retirement investment. Even if you still have the loan, you have created an income in excess of $200,000 for yourself. Even in today’s money, that could be almost $80,000 per annum.
Ye a r P r o p e r t y
Of course if it was all that easy, all doctors would own their own properties. In reality there are major difficulties including: Finding a suitable site Current lease commitments Finance Cash flow concerns Security of tenure Financial security Owning investment property is the goal of many doctors. Combining this with having the best tenant available, higher yields on commercial property and minimal or no cash outlay, allows you to develop a strategy that gives you peace of mind and financial security. Too many doctors get to their 50s with a lovely home, but few other assets. Consider using cash flow that is paid in rent anyway to assist your investment strategy. Barry Lanesman from Investec Medical Finance is a registered dentist with private practice experience and over 20 years involvement in financing dental and medical practices. He has played a key role in the development of specialist finance for the medical and dental professions. Q
Va lued $ (6% pa gro w th )
I n teres t Pa id (8% pa f ixed )
As s um ed Re nt (7 % pa Yie l d)
2010
700,000
56,000
49,000
2015
937,000
56,000
65,590
2020
1,254,000
56,000
87,780
2025
1,678,000
56,000
117,460
2030
2,245,000
56,000
157,150
2035
3,004,000
56,000
210,280
$1,400,000
$1,984,000
Total
Investec Investec Medical Finance Pty Ltd ABN 94 110 704 464 (Investec Investec Medical Finance) is a wholly owned subsidiary of, Investec Bank (Australia) Limited ABN 55 071 292 594. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. The information in this editorial has been provided in good faith and has been taken from sources we believe to be reliable. It is general in nature and is not tailored to your individual needs. You should obtain independent financial, taxation, legal and other advice to assist you in making your own decisions and assessments as to the appropriateness of the products discussed in this editorial. Whilst all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, we do not represent and warrant that this information is accurate or complete. To the extent permitted by law, all liability is disclaimed.
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NOVEMBER 2011 DoctorQ
ADVERTORIAL
Q
ueensland has now introduced nationally driven reforms to the disability parking permit scheme. These reforms include a nationally recognised permit, national eligibility criteria and minimum standards for parking concessions.
What does this mean?
Blue permits have been transitioned to the Australian Disability Parking Permit (ADPP). Blue permits no longer exist. Red permits are no longer issued to new applicants. They will only be issued to current five year red permit holders, provided they meet the red permit eligibility criteria. Temporary red permits are no longer issued.
Australian Disability Parking Permit
The ADPP is a mobility scheme. The eligibility criteria are based on an applicant being severely restricted in their ability to walk. It is not based on intellectual, psychiatric, cognitive or sensory impairment, unless in addition to this impairment, the person also has a severe impairment to their functional ability to walk. Disability parking spaces are limited in Queensland. It is vital permits are only granted to applicants who meet the eligibility criteria to ensure spaces are allocated to those who most need them. A new form ‘Australian Disability Parking Permit Application (Individuals) form (F4814)’ V01 Oct 2011, has been developed to assist with this. Previous versions of the form are no longer accepted. For more information or to download the new form visit: www.tmr.qld.gov.au/Travel-and-transport/Disability-access-and-mobility/DisabilityParking-Permit-Scheme.aspx#medical
Mates rates in NZ
Visit New Zealand and receive a friendly $40 off your weekend rental.* And at Hertz our weekends stretch from 2pm Thursday to the following Tuesday at 8am, so take your time and relax. Visit hertz.com.au and quote CDP# 283826 and Promotion Code 158270 or call 13 30 39. * Subject to location opening hours. Offer available at all Hertz New Zealand locations on selected vehicle types for rentals of minimum 3 days and maximum 4 days. Discount applies to daily rate and applicable GST only. Valid to 6 September 2011, Hertz standard terms, conditions and credit qualifications apply.
DoctorQ NOVEMBER 2011
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LIFE
Ross Noye from Wilson HTM says now is the time to take control of your retirement plans.
I
Ross Noye Wilson HTM (07) 3212 1068 0438 77 99 55 ross.noye@wilsonhtm.com.au
Ross Noye is an executive shareholder and senior financial and investment adviser at Wilson HTM Investment Group and a licensed representative of Wilson HTM Ltd. Readers should seek their own advice.
t’s time to take back control of your retirement plans: review, reset and restructure.
The global financial crisis knocked a gaping hole in many retirement plans when the market dropped a whopping 54 per cent. Tragically, many investors sold everything in those fearful times and missed the big rebound over the following six months. The massive loss of wealth caused by the GFC put many retirement plans on hold and caused lots of people to return to work, worried they will run out of money in retirement. The reality is most people have no idea how much money they will need for retirement, which can lead to high anxiety and a feeling of helplessness when markets are in decline. This feeling of loss of control can be debilitating, but can also be easily fixed. Of course, not everyone is saving and investing for retirement, priorities change depending on our stage in life, but the sooner we start, the bigger that nest egg will be. To take back control try these three simple steps: Review: your existing retirement and investment strategies, portfolios and tax structures Reset: your retirement targets. (This can be easily done in under two minutes) Restructure: your tax arrangements, investment holdings and strategies required in order to hit your target. As a guide, the Association of Superannuation Funds of Australia (ASFA) states that a couple looking to achieve a comfortable retirement will spend $54,954 a year, while those seeking a modest retirement spend $31,519 a year. ASFA defines a modest retirement lifestyle as:
Buy second home Fund children’s education
RETIREMENT SAVINGS
Begin retirement planning
Retirement
And a comfortable lifestyle as: “Enabling an older, healthy retirees to be involved in a broad range of leisure and recreational activities and to have a good standard of living through the purchase of such things as household goods, private health insurance, a reasonable car, good clothes, a range of electronic equipment, and domestic and occasionally international travel.” As a rule I suggest clients aim for $100,000 and work up from there simply because they want better stuff, not just reasonable stuff and of course, then there’s the kids and grandkids to help. But keep in mind that our overall spending will reduce as we get older. The most important step is to agree on a financial target. Once you have your target everything else falls into place pretty quickly. Over the long haul, you can reasonably expect your nest egg to grow by two to three per cent a year above the inflation rate with around 30 per cent to 40 per cent in growth assets and around six to eight per cent if you have a heavier weighting in equity type investment such as shares and property. A net eight per cent annual return would see your super double in value in under 10 years. Remember, a lower tax on your investments will mean a higher after-tax return, so saving and investing via your super fund will mean you will hit your target sooner. Apparently this fear of the unknown is more widespread than first thought. A large super fund member survey showed the more time a member spent in retirement, the more confident they became, with about 70 per cent of retirees stating they felt “confident their savings will be adequate’’ but that dropped to less than half for those still working. So, as we head into the holiday break take time to take back control and stop the worry. Review, reset and restructure your retirement planning and investment portfolios, it will provide you with so much more peace of mind to enjoy your holiday with family and friends. Stay safe over the break. Q
Purchase home
First job
Need #1 Develop savings plan
LIFE TIME 48
Find post-retirement employment
“Better than a pension, but still only able to afford basic activities.”
NOVEMBER 2011 DoctorQ
Need #2 Develop retirement plan
Need #3 Develop income management plan
Need #4 Spend your last dollar on your last day
We am pleased to welcome officially our latest corporate partner for investment and financial advisory services, Ross Noye, Executive Shareholder and Senior Investment and Financial Adviser at Wilson HTM Investment Group. Many of you may already be familiar with Ross and his team from regular article contributions in Doctor Q, keynote speaking at personal development events, an active Director of the AMAQ Foundation and proud supporter of AMA Queensland’s Annual Conference for over 11 years. With more than 27 years in the investment and finance industry, Ross brings an impressive wealth of knowledge and experience for our members to utilise including: • Stock broking • Retirement planning • Self managed Super Funds establishment and portfolio management • Super fund investment strategy development, documentation and implementation • Personal investment portfolio management and asset allocation advice
Benefit for members: As a member of AMA Queensland, this partnership provides you with an initial consultation by teleconference or in person at no cost. The AMA Queensland has also negotiated attractive fee reductions across all services including brokerage rates, investment management, retirement and financial planning advisory fees. We encourage you to take advantage of the comprehensive services package provided by Ross and his team, which includes: • Investment portfolio review and restructuring • Retirement strategy review and restructuring • Developing a zero tax retirement strategy or reviewing your current retirement strategy • A special low $450 fee for establishing your Self Managed Super Fund • Margin lending without margin calls (exclusively for doctors) • Access to managed direct share portfolios with $22.50 trades • Strategies to protect your investment capital from losses • Why you should be moving from managed funds to Exchange Traded Funds
How to contact Ross: Go to AMA Queensland website and click on his logo
Phone: (07) 3212 1068 Mobile: 0438 779 955 Email: ross.noye@wilsonhtm.com.au
LIFE
Gather up your castanets - we’re headed to Madrid for the 2012 AMA Queensland Annual Conference!
P
assion, food, art and culture… what is Spain not famous for!
We are pleased to announce that the AMA Queensland’s conference in 2012 will be held in Madrid, Spain. Spain has charmed travelers since the beginning of time, now you have a chance to explore this country of such great diversity. Art and culture are inter-twined to showcase a very proud and strong history. Creating a world of passion through dance, music, food and tradition. Artists such as Goya and Picasso may be amongst some of the most famous in the world but they are by no means all Spain has to offer. The Prado Museum in Madrid is Spain’s largest and most famous art museums. The building itself, a work of art! The fine arts and architecture, while famous is probably not what Madrid is best known for. When King Felipe II chose Madrid as Spain’s Capital in 1561, the city was no more
than a provincial outpost. The cuisine suited to bolster the hunger over a cold winter more so than any culinary tradition. As the population gravitated towards Madrid they brought with them recipes, ingredients and traditions from all corners of Spain, adding depth and flavour. This in turn over the centuries has delivered Madrid into the proud position of being known as the “Gastronomical” capital of Europe. Tapas is so popular that the saying “ir a tapear” (going out for tapas) is always on the tip of everyone’s tongue. Unlike in Australia where we may select one restaurant to dine, a true tapas aficionado in Madrid will seek out the specialty dishes in a restaurant, wash it down with drink and then move onto the next tapas bar to start the whole process again. For foodies the Michelin Guide is the hallmark of gastronomic perfection. Madrid currently boasts ten Michelin star restaurants. If
Please contact Stephanie or Ros at AMA Travel Queensland for more information on this and other wonderful travel experiences.
PHONE: 1800 262 885 FAX: (07) 5556 7200 EMAIL: travel@amaq.com.au WEB: www.amaq.worldtravel.com.au 50
NOVEMBER 2011 DoctorQ
something a little more casual is your style, Madrid offers over 3,000 restaurant options. Not only has the food developed over the centuries, so has the music and dance. The famous Flamenco is a traditional song and dance of the Gypsies of Andalusia. The art form has developed and by early 19th century was a very popular café entertainment. After even more changes you can now experience the excitement, colour and passion of a performance you will always remember. The Spanish over the centuries have got lifestyle down to a fine art! With many delegates already registered for the AMA Queensland 2012 Conference we suggest you contact us to receive your copy of the brochure. Plan ahead and look forward to this enchanting destination. Ole! Q
LIFE
Travelling to one of Australia’s iconic wine regions can present some daunting challenges, especially if you’re time poor, but as Phil Manser explains you can see so much in such a short time. Phil Manser Wine Direct 0400 251 168 phil.manser@winedirect.com.au
Premium Wines Direct is now Wine Direct and has a new logo.
M
cLaren Vale is one of Australia’s most varietally diverse yet compact wine regions to visit - just a 40 minute drive from the CBD. There’s plenty on offer for lovers of big ballsy shiraz, rich chocolately cabernet and full bodied, complex chardonnay but dig a bit further under the surface and you’ll unearth a treasure trove of emerging varietals. At the forefront of these emerging varietals are the usual suspects led by Coriole who boast a lovely aromatic Fiano, a white variety popular in Southern Italy.
and a hit list of other wineries to visit championing similar varietals. The SA Travel guides will send you to the likes of Rosemount, Hardys and co, all great destinations but for that ‘X’ factor you’ll reminisce about these are high on my list of must do’s. If you’re going to do McLaren Vale remember the Justins and give me a call on 1800 649 463. Q
The winery itself looks back across the valley over rolling hills and vineyards and features an award winning restaurant/café – a must do. Further up the road is Samuel’s Gorge, a compact range of wines featuring a tempranillo of amazing depth and balance made by Justin McNamee who’s talent for handling old world varietals is only matched by his his passion for the late great Bob Marley. Perhaps the most intriguing place I’ve found of late is Alpha Box and Dice, Olivers Road just down the hill from D’Arenberg. As cellar doors go this is a cracker, old concrete floors poured around the turn of the 20th century, exposed bluestone walls and a heavy wooden door you can barely open on your own.
Samuel’s Gorge
As you enter an old wooden counter displays a compact range of mostly Grenache based reds showing the many faces of this iconic variety. Wine maker Justin Lane oozes an infectious passion for wine and if you’re lucky (as I was) he’ll treat you to a visit to the barrel shed where an array of young reds lay in wait such as Touriga Nacional, Tannat and Nebbiolo. You’ll leave Justin with renewed enthusiasm for wine
Coriole
Alpha Box and Dice DoctorQ NOVEMBER 2011
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PEOPLe & EVENTS
Bridge to brisbane
brisbane, saturday 11 september
T
LEFT: Matthew Roberts, Dr Jen Williams, Dr Michael Bonning and PresidentElect Dr Alex Markwell ready to clock up their five kilometre run.
he AMA Queensland team ran the annual Bridge to Brisbane fun run this year and came in at a respectable 23rd. Dr Larry Gahan and Dr Carole Gahan ran the 10km leg.
drinks & dits fortitude valley, friday 30 september
A
MA Queensland’s Council of Residents and Registrars met with Doctors in Training in Brisbane for casual drinks and nibbles. The CoRR team gave guests an update on MOCA negotiations, working conditions and payroll issues.
Melinda Stanton and Peter Stickler.
Dr Mark Jones and Dr Jennifer Williams.
Dr Saul Felber and Dr Malaika Perchard.
Dr Alex Markwell and Dr Peter Piliouras.
Natasha Behrendorff, Dr Chris Arnott and Dr Josh Lawson.
Dr Ross Fowler, Dr Rob Zeller and Dr James Gardiner.
AMA parliamentary dinner parliament house, canberra, wednesday 17 august
A
round 200 of the nation’s leading politicians, doctors, health administrators, public servants and policy experts gathered for the 2011 AMA Parliamentary Dinner in the Great Hall of Parliament House in Canberra in August. Guests of honour were Prime Minister Julia Gillard, Opposition Leader Tony Abbott, Health Minister Nicola Roxon, and Shadow Health Minister Peter Dutton. Prime Minister Julia Gillard, Opposition Leader Tony Abbott and AMA President Dr Steve Hambleton delivered speeches on health policy and health reform.
Minister for Health and Ageing Nicola Roxon with AMA President Dr Steve Hambleton.
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NOVEMBER 2011 DoctorQ
Immediate Past President Dr Gino Pecoraro, President Dr Richard Kidd with Shadow Minister for Health and Ageing Peter Dutton with CEO Jane Schmitt and Dr Wayne Herdy.
Prime Minister Julia Gillard.
PEOPLe & EVENTS
2011 bancroft oration
Thank you for your excellent organisation and presentation of the Bancroft Oration last night. It was a delight to meet again so many of one’s colleagues and mentors. The whole occasion was for me, a timely reminder that without realising it, we have been surrounded by and often participated in important world advances in medicine and surgery. I agree with Daryl Wall in his analysis that this phenomenon is driven by a desire to improve the lot of our patients coupled with professional respect across professions and remarkable self-effacing modesty. Long may AMA Queensland continue to reflect these values.
paddington, wednesday 7 september
Associate Professor Daryl Wall was this year’s Bancroft Orator. Associate Professor Wall spoke about Queensland’s impact on international surgical advances over the past 40 years.
Dr Graham Row
Past Bancroft orators Professor David Tudehope AM, Dr John Herron, Associate Professor Darryl Wall AO, Professor Tess Cramond AO OBE OStJ and Professor Sam Mellick CBE.
Associate Professor Darryl Wall AO (left) and President Dr Richard Kidd (third from left) with Joseph Bancroft’s great granddaughter Josephine Bancroft and great grandson Dr David Mackerras.
President-Elect Dr Alex Markwell (left) and President Dr Richard Kidd (right) present Associate Professor Darryl Wall AM with the Bancroft Oration medal.
Dr Jennifer Kennedy, Professor Nicholas Bellamy, Dr Denis and Barbara Campbell.
Sarah Emmett with Dr Margaret Emmett.
William, Ian and Mary Ridley
CEO Jane Schmitt, President Dr Richard Kidd, Leading Seaman Laura Morris and Kristin Giannasca from Defence Force Recruiting, Associate Professor Darryl Wall AM and President-Elect Dr Alex Markwell.
CEO Jane Schmitt, President Dr Richard Kidd, Julie Miller from William Buck, Associate Professor Darryl Wall AM and President-Elect Dr Alex Markwell.
The Bancroft Oration was also sponsored by AMA Queensland Insurance Solutions.
Erika and Wylie Gibbons.
Dr Peter and Jill Millroy. DoctorQ NOVEMBER 2011
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PEOPLe & EVENTS
2011 ES Meyers lecture the university of queensland, tuesday 27 september
T
he Honourable Michael Kirby AC CMG, the former Justice of the High Court of Australia and Commissioner of the UNDP Global Commission on HIV and the Law, was the annual 54th ES Meyers Lecturer. This year’s topic was HIV/AIDS and Law Reform: Desperate Need to Move Mountains. Mr Kirby spoke about the reaction at the beginning of the AIDS pandemic and how Australia’s quick response was commendable. He spoke about how he was personally affected when many of his friends died of AIDS and how he remembered those friends when serving on World Health Organisation’s Global Commission on AIDS (1988-92); President of the International Commission of Jurists, Geneva (1995-8); as UN Special Representative Human Rights in
Dr Jim Houston entered the lively question and answer session following the lecture.
Lecture co-convenor Jessica Phillips-Yelland with ES Meyers’ son Dr Derek Meyers, Professor John Pearn AO RFD and AMA Queensland President-Elect Dr Alex Markwell.
Cambodia (1993-6); a member of the UNESCO International Bioethics Committee (1995-2005); a member of the High Commissioner for Human Rights’ Judicial Reference Group (2007-) and a member of the UNAIDS Reference Group on HIV and Human Rights (2004-). Mr Kirby spoke about different rates of infection around the world and how prohibitive laws and attitudes towards gays and sex workers often increased those rates. For example, Australia and New Zealand has low rates amongst injecting drug users, but were the quickest to adopt needle exchange programs. Mr Kirby was a very popular speaker, with many law students also attending the lecture. Q
Michael Kirby AC CMG answers questions from the crowd.
Professor John Pearn AO RFD presents Michael Kirby AC CMG with the 54th ES Meyers medal.
amaq foundation book handovers vanuatu, east timor, sri lanka, somaliland and malawi
D
r Chris Schull’s textbook Common Medical Problems in the Tropics - Third Edition has been supplied to health workers in Vanuatu, East Timor, Sri Lanka, Somaliland and Malawi, thanks to sponsorship from the AMAQ Foundation. Dr Chandanie Wanigatunga, the Senior Lecturer and Head of the Department of Pharmacology at the University of Sri Jayewardenepura in Sri Lanka accepted the books and said that they would greatly benefit their medical, paramedical, nursing and pharmacy students.
Students at the Vanuatu Health Training Institute gratefully accepted the books and were happy to finally have their own textbooks.
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NOVEMBER 2011 DoctorQ
Meanwhile, Dr Rupert Gude, a retired UK GP working in Vanuatu has presented the books to students at the Vanuatu Health Training Institute. There are only 11 practising doctors in Vanuatu, but the books were given to the 22 students there, which accounts for 14 studying to be nurse practitioners and eight midwifery students. Dr Gude said the students haven’t had their own books to refer to and even have them open in class, which is a bit unnerving for the tutors! Nikole Fry, a medical student from Griffith University, has donated the book to
paramedics while on placement treating and caring for disadvantaged children in a small hospital in Blantyre in Malawi. Medical students who are trained by visiting Australian doctors will benefit from the textbooks in Somaliland. In East Timor, the texts will be used by paramedics in community clinics. If you are planning a visit to work in a developing country, contact the AMAQ Foundation’s Executive Officer Neil Mackintosh on (07) 3872 2267. Q
Dr Chandanie Wanigatunge presents the books to Professor S. Sivayogan from the Department of Community Medicine at the University of Sri Jayewardenepura in Sri Lanka.
LUXMAN A SYMPHONY IS BACK! IN SPEAKERS LEGENDARY PERFORMANCE
Vienna Acoustics speakers are designed by musicians and manufactured in Austria. With technology that seems to transcend woofers & tweeters & test tones, Vienna Acoustics simply aims to reproduce the musicians’ performance - just as it was intended. And to that end they are simply remarkable. From your first experience with
Founded in 1925, Luxman has long been one of Japan’s most highly regarded audio manufacturers. Throughout the 1970’s and into the 1980’s, Luxman’s tube preamplifiers and power amplifiers occupied the top shelves of high performance retailers, and to many Australian audiophiles, the Luxman name is a familiar and esteemed brand. Luxman’s combination of rich, warm sound, superb build quality, and indelible industrial design made its products fully competitive with other brands then considered the world’s best.
Vienna Acoustics speakers you know that you’re in for something special. The timber veneers and paint finishes are immaculate and calls for your touch. Tall, slim and elegant, they sound as good as they look.
COME IN FOR A DEMONSTRATION, BRING IN YOUR FAVOURITE CDs AND HEAR THEM FOR YOURSELF. EXCELLING IN THE REPRODUCTION OF ACOUSTIC MUSIC BE IT CLASSICAL, JAZZ OR ROOTS AND PRICED FROM $2,499 THERE IS A VIENNA ACOUSTICS MODEL GRAND $2499 TO SUIT EVERY MUSIC LOVER.
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Shop 2B / 9 Doggett Street Fortitude Valley Qld Tel 07 3254 1263 www.trimira.com.au
Getting started with EFTPOS Broadband What is EFTPOS Broadband?
Why choose EFTPOS Broadband?
EFTPOS Broadband is a unique solution that enables you to process credit and debit card transactions over a broadband connection. Because it uses your existing broadband service, it saves you money and accelerates your transaction processing.
With EFTPOS Broadband you can: > Process transactions faster, using your existing broadband connection instead of a dial-up line. > Save money, with no need to rent a separate dial-up line. > Use your existing broadband connection, with your choice of internet service provider. > Connect directly. Our solution connects your business directly to us. For you, that means lower costs, fewer opportunities for outages and faster transaction processing. > Keep your customer’s financial data secure, with state-of-the-art Secure Socket Layer (SSL) and Triple-DES 128 bit encryption.
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You plug one or more terminals into your broadband modem
Your EFTPOS terminal processes transactions over the internet
Partnering with
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COMMONWEALTH BANK OF AUSTRALIA IS THE PREFERRED SUPPLIER TO AMA QUEENSLAND FOR MERCHANT SERVICES ONLY
The internet
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Broadband Modem
For more information on EFTPOS Broadband, call us on: NEW CUSTOMERS:
dial-up line as a back-up
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1800 730 554 If your broadband is down, you can use your dial-up line as a back up
EXISTING CUSTOMERS:
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DoctorQ NOVEMBER 2011
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DENDY MOVIES Anonymous Opens: 1 September Cast: Rhys Ifans, Vanessa Redgrave, Joely Richardson, David Thewlis, Xavier Samuel Set in the political snake-pit of Elizabethan England, Anonymous speculates on an issue that has for centuries intrigued academics and brilliant minds, namely: who actually created the body of work credited to William Shakespeare? Experts have debated, books have been written, and scholars have devoted their lives to protecting or debunking theories surrounding the authorship of the most renowned works in English literature. Anonymous poses one possible answer, focusing on a time when scandalous political intrigue, illicit romances in the Royal Court, and the schemes of greedy nobles lusting for the power of the throne were brought to light in the most unlikely of places: the London stage.
The Twilight Saga: Breaking Dawn - Part 1 Opens: 17 November Cast: Kristen Stewart, Robert Pattinson, Taylor Lautner
A Few Best Men
The Iron Lady
Opens: 26 January Cast: Xavier Samuel, Kris Marshall, Kevin Bishop, Tim Draxl, Rebel Wilson and Olivia Newton-John.
Opens: 26 December Cast: Meryl Streep, Jim Broadbent, Olivia Colman, Nicholas Farrell, Susan Brown, Roger Allam, Anthony Head, Julian Wadham, Pip Torrens, Nick Dunning, Richard E Grant, David Westhead, Angus Wright and John Sessions.
From the director of The Adventures of Priscilla Queen of the Desert, and writers of Death at a Funeral, A Few Best Men features a stellar cast. When English lad David (Xavier Samuel) announces he is getting married to an Australian, his hapless mates give a whole new meaning to the phrase ‘for better or worse’! The chaos-filled wedding day tests their new marriage, challenges David’s relationships with his three best men, and risks turning what should be the best day of their lives into the worst. A Few Best Men is a hilarious culture clash between his friends and her family - because blood is thicker than water, and so are David’s mates!
In the highly anticipated next chapter of the blockbuster The Twilight Saga, the newfound married bliss of Bella Swan and vampire Edward Cullen is cut short when a series of betrayals and misfortunes threatens to destroy their world. Bella and Edward travel to Rio de Janeiro for their honey moon, where they finally give in to their passions. Bella soon discovers she is pregnant, and during a nearly fatal childbirth, Edward finally fulfils her wish to become immortal. But the arrival of their remarkable daughter sets in motion a perilous chain of events that puts the Cullens and their allies against the Volturi, the fearsome council of vampire leaders, setting the stage for an all-out battle.
The Iron Lady tells the compelling story of Margaret Thatcher, a woman who smashed through the barriers of gender and class to be heard in a male-dominated world. The story concerns power and the price paid for power, and is a surprising and intimate portrait of an extraordinary and complex woman. The film stars Academy Award-winners Meryl Streep as Lady Thatcher and Jim Broadbent as Denis Thatcher. The rest of the cast of family and friends, politicians and advisers, is made up of the very best of British acting talent.
WIN MOVIE TICKETS FOR TWO Name: Postal address: Portside Wharf, Remora Road, Hamilton Ph: (07) 3137 6000 www.dendy.com.au 56
NOVEMBER 2011 DoctorQ
Phone:
FAX BACK TO (07) 3856 4727 or email editor@amaq.com.au by 30 November
CULTURE Pygmalion – Queensland Theatre Company 7 to 27 November, Playhouse Is it possible to survive being dressed up and dragged into a tier of society that’s utterly unfamiliar? Eliza is about to find out. In George Bernard Shaw’s renowned play, uppity phonetics professor Henry Higgins plucks Eliza Doolittle off the streets in an effort to pass her off as a duchess. Boasting all the lavishness of a period piece, Pygmalion also captures the razor wit and sharp-edged banter of Shaw’s original text, highlighting the vital themes which remain every bit as relevant in society today.
Rock of Ages From 16 November, Lyric Theatre Whether you’re a fan of the great rock anthems of the ‘80s, a lover of musicals, or a rock god who wants to relive those great rock moments... Rock of Ages has something for everyone. From the hits - We Built This City, Don’t Stop Believin’, The Final Countdown, I Want To Know What Love Is - to the iconic rockers Foreigner, Journey, Styx, REO Speedwagon, Poison, Starship, Pat Benatar and Whitesnake - to the love story - as a small-town girl meets a big-city dreamer, you know you’re guaranteed a great night of theatre and music.
Looking Through a Glass Onion - John Waters 25 November, Concert Hall John Waters returns in his critically acclaimed production Looking Through A Glass Onion - a homage to the music, mystery and memory of John Lennon. The show is not a cut-and-paste biography of Lennon or an emulation of the original recordings. On stage, with shadows from the lighting arrangement fluttering over his face as he explores the essence of the man through song and spoken word, Waters becomes synonymous with Lennon.
Arj Barker - Eleven 30 November to 2 December, Concert Hall Arj Barker returns to the shores of Australia (although we’re not positive he ever left) with his new show, featuring an hour of the inventive stand-up comedy for which he is known and loved. Join Arj as he fearlessly tackles 11 of the most controversial topics around, including 3D movies, death, Google Maps and prawns.
Name:
WIN DOUBLE PASSES TO PYGMALION
Postal address:
Phone:
FAX BACK TO (07) 3856 4727 or email editor@amaq.com.au by 30 November DoctorQ NOVEMBER 2011
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IN PRINT
cautionary tales John murtagh
Doctor Q has a copy of Cautionary Tales to give away. John Murtagh’s Cautionary Tales is drawn from over 30 years experience as a General Practitioner. Taken primarily from Professor Murtagh’s own practice in rural Victoria, these cautionary tales are authentic cases in clinical practice and the mistakes and problems GPs can encounter. Each story is an engaging example of the common mistakes which can occur in general practice and provides the reader with valuable insights. Each tale is enriched with psychological, social and environmental
factors that form part of every patient problem. An invaluable source for students, educators and practicing GPs of all ages. Cautionary Tales is published by McGraw-Hill and retails for $114. Q
To go in the draw to win a copy of this book, simply fill out your details in block letters on the form below and fax it back to Doctor Q on (07) 3856 4727.
Name:
______________________________________________________________________________________________________________________
Postal Address:
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Telephone:
FAX TO: (07) 3856 4727 or email editor@amaq.com.au by 30 november
Competition winners qpac WINNER Dr Nigel Dore and Dr Catherine Reid won tickets to the Kawai Piano Series at QPAC.
BOOK WINNER The winner of last edition’s In Print giveaway was Dr Paul De Jong. Dr De Jong won a copy of Current Diagnosis and Treatment: Emergency Medicine, Seventh Edition.
DENDY WINNERS Double pass winners: 1. Christine Lonergan 2. Henry Douglas 3. Charles Chabert 4. Arnold Dela Cruz 5. Jeffrey Forgan-Smith 6. Camilla Andrews 7. Cecilie Lander 8. Wendy Bourke 9. PM Johnson 10. Michael Tuch
Winners for the exclusive premiers for the eVENTS+Training newsletter:
Eye of the Storm 1. 2. 3. 4. 5. 6. 7.
Paul McEniery Alfred Lam Jess McMicking Stephen Tonge Romi Das Gupta Dr Anne Kynaston Dr Caron Forde
member survey ipad winner Congratulations to Dr Beryl Turner and Dr Deryck Charters, our prize winners from the Member Survey for 2011. Dr Turner and Dr Charters have each won an iPad.
Up Market Shop Front for lease SHOP 7, 710 BRUNSWICK STREET, NEW FARM
• $150k fit out waiting for you • Prominent retail position • Easy access and free parking • Available now $52,000 P/A Ph Jenny Best 0401 525 259 Online search number 5887841 at www.realcommercial.com.au
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NOVEMBER 2011 DoctorQ
8. Roxanne Kempster 9. Wendy Christie 10. Michael Tuch 11. Ashleigh Bates 12. Alexandra Evans 13. Judith McEniery 14. Stephanie Cruice
CLASSIFIEDS
Virtual Assistant & Transcription Service OUR ADVANTAGES
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Reliable Professional Confidential 100% Australian owned & operated
Phone: 0438 973 998 Email: anna@morseadmin.com.au www.morseadmin.com.au
Professional On-site IT Support • Initial practice set up and relocations • Repairs, upgrades and virus removal • Networking and remote access • Software upgrades and support A J Technology (Aust) Pty Ltd has extensive experience providing IT support to medical practitioners throughout the Greater Brisbane and Moreton areas. Find out more about AJ Technology at www.ajtech.biz or phone (07) 3888 6084
Dr Sue Taji, Paediatric Dental Surgeon BDS DClinDent (Paediatric Dentistry)
Ph: 3839 8000 Fax: 3720 0400 Web: www.qdg4kids.com.au
Specialising in the management of Dental Trauma & Early Childhood Caries Provision of treatment under local and general anaesthesia Surgical Accreditation at St Andrew’s Hospital and The Wesley Hospital Specialising in dental treatment of children from infancy to adolescents and those with special needs Referrals are welcome at the following locations: Main Branch: Silverton Place, Ground Floor, Suite 12, 101 Wickham Terrace Spring Hill Consulting Locations: Wesley Medical Centre (Auchenflower), Taylor Medical Centre (Annerley)
woolloongabba auction SIMPLY THE BEST ‘Nechoma Court’ a well know icon in the Woolloongabba prcinct. • 6 Fully leased 2 bedroom units • Close to Mater Hospital • Transport on the doorstep • Close to all amenities • Easy links to CBD and local areas
AUCTION: Saturday 19/11/2011 @ 11am if not sold prior
Contact: Jim Wicks Phone: 0416 126 353 Email: jimw@firstcommercial.com.au
Dr Ian Mannion
GENERAL PRACTITIONER NOW PRACTICING AT:
SPECIAL INTERESTS INCLUDE:
109 Vulture Street West End QLD 4101
• Otitis externa-microscopic cleaning • Travel medicine yellow fever • Dive Medicals
PHONE:
(07) 3844 4111
FAX:
Medical Suite available for sessional lease at St. Andrew’s Place Directly opposite St. Andrews Hospital and connected by walkway over North Street. Pleasant north-east aspect overlooking Spring Hill. Receptionist support available if required. Price on application.
Please phone 07 3839 1288 or 0411 695 159
(07) 3844 9111
Expressions of interest invited The Principal of a long-established Consultant General Surgery Practice in the central part of the Sunshine Coast, Queensland, invites expressions of interest in assumption of that Practice. Excellent private and public hospitals support surgical needs in the area, most Specialist groups are well represented and population growth is assured. Expansion of the already-existing support facilities is underway and a major, new Public Teaching Hospital is only a few years away. The opportunity clearly exists for expansion of speciality interests within the offered Practice, but its present scope is wide and the referring G.P. base expects willingness from the Consultant to accept a similar breadth of referrals. Interested surgeons are requested to email brief particulars to: vonledeber@hotmail.com The Principal and the Practice Manager will provide details to genuinely interested surgeons.
Complete Floor Executive Medical Space Golden Triangle Heritage Classic Building 283 Elizabeth Street Brisbane CBD Well-proportioned for executive medical suites. • Golden triangle • Your own balcony overlooking Elizabeth Street • Parking station opposite • Public transport at door • Restaurants and shops opposite in Eagle Street Owner Dr John Corbett Phone: (07) 5557 0005 Mobile: 0438 400 400 admin@corbett.com.au Or Agent Ben Sikalas of Chesterton Phone: (07) 3222 3014 Mobile: 0403 733 630 bsikalas@chesterton.com.au DoctorQ NOVEMBER 2011
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Medical and Dental Finance
gift Our
to you
Be rewarded with a gift voucher of up to $5001, towards your 2012 AMA subscription. Simply settle an eligible finance agreement2 with Investec Medical Finance between 1st September and 30th November 2011.
To find out more, contact one of our Finance Specialists On call 1300 131 141 www.investec.com.au/medicalfinance
Your finance. Our specialisation. Asset Finance • Commercial Property Finance • Deposit Facilities • Goodwill & Practice Purchase Loans Home Loans Professional Overdraft • Income Protection and Life Insurance • Medical Indemnity Investec Professional Finance Pty Ltd ABN 94 110 704 464 is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL/ACL 234972. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. 1 The value of the gift voucher will be based on the value of the contract settled during the promotion period; $100 for commercial contracts up to $75K, $200 for commercial contracts from $75K to $150K, $300 for commercial contracts from $150K to $500K, $500 for commercial contracts over $500K and $250 for residential mortgages. Eligible clients will receive a gift voucher at the end of the promotion period. Gift vouchers are only eligible for redemption of 2012 AMA (QLD) subscription fees and must be used by 31st March 2012. Only one gift voucher per contract/client. This promotion is not available with any other offer. 2 Finance agreements are limited to commercial loan contracts and residential mortgages only. Contracts must be settled within the promotion period to be eligible.