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AMA makes its stand « Previous | |Next »
June 18, 2008

I see that the AMA has come out fighting against the proposed extension by the Rudd Government of Medicare to nurses and allied health professionals (such as psychologists and physiotherapists) in response to the shortage of GPs. It is another plank in their resistance to reform as can be seen in campaigning against the government's GP Super Clinics and the doubling of the Medicare surcharge levy threshold.

The core bit in their latest media release, in association with other doctor organizations, states that the Government’s proposed National Primary Care Strategy should ensure that:

  • Australians continue to have access to high-quality general practice services;

  • General practices are given additional support to allow them to deliver more preventative health care services and tackle the growing burden of chronic disease;

  • General practice is the gateway to allow patients enhanced access to other health professionals - including general practice nurses and allied health service providers such as physiotherapists and dieticians;

  • Primary health care services in workforce shortage areas such as rural Australia are improved through incentives and assistance to get more general practitioners and primary health care teams in these parts of the country;

  • General practice training opportunities and incentives are enhanced so that many of the new medical school graduates choose to enter general practice over the next few years.

Australians, it says, have confidence in their general practitioners having overall responsibility for their primary care needs and that the future of primary health care in Australia should build on this system not undermine it.

I've listed these points in the media release to show how much the AMA is in flight from reality. Two points show this. First, the AMA 's only solution to the lack of GP's in rural and regional Australia is for the commonwealth and state Government to provide incentives and assistance to GP's to get more general practitioners and primary health care teams in these parts of the country. But here already are health professionals there delivering primary care. So why not utilize them? Why not extend Medicare in these parts of Australia to help those who are sick and unwell. Why cannot patients be able to access Medicare-subsidised care without a referral from a GP?

So what does the AMA say in response?:

Reforms that do not support the important role of general practice will progressively erode the health system’s function, patients will experience more fragmented and uncoordinated health care, and primary health system costs will inexorably rise.

Note the phrase--'erode the health systems function'. It has already has been eroded. The reforms are addressing it.

Secondly, the AMA says:

General practice is the gateway to allow patients enhanced access to other health professionals - including general practice nurses and allied health service providers such as physiotherapists and dieticians

Why should the GP be the gateway for a consumer to see a dietician, psychologist or a chiropractor? Why cannot we see them direct?

These two points highlight how the AMA is simply protecting its turf --a demarcation dispute hidden by the rhetoric of public safety and quality health care.

| Posted by Gary Sauer-Thompson at 6:49 AM | | Comments (14)


Hawk: Pilots union.
Howard: wharfies.
Rudd: Doctors Union.

And life goes on.

I don't think that the ACTU will come out in support of the AMA do you?

I see that one of the signatories to the media is the RDAA--the Rural Doctors Association of Australia They are also in the local media opposing the reforms to country health in South Australia. Nothing good can come out of these long term reforms in their view.

"General practice training opportunities and incentives are enhanced so that many of the new medical school graduates choose to enter general practice over the next few years" The government should help prop up our membership numbers to help ensure that we can continue to our crusade against the government - a proposition the government would find most attractive.

I expect the ACTU to support the doctors union in about the same fashion as they supported the pilots union. In my view they are/were all rent seekers and they all needed to be dealt with.

I see that the AMA has portrayed the Government's planned 31 "super clinics" in areas short of health services to attract doctors and other health professionals, including physiotherapists, pscyhologists and dieticians as potential death traps, where lethal diseases could go undiagnosed because of a shift in care from doctors to nurses and other health professionals.

In her National Press Club address Dr Capolingua, the President of the AMA, has ridiculed the proposal for a "one-stop shop" health centre as a "myth" and that this would result in the fragmentation of care. She spoke of a scenario where a patient has a brain tumour undiagnosed after going to a super clinic with a weight problem and being referred to a dietician and psychologist.

Only GPs are capable of diagnosis and coordination of care for the AMA. Allied health professionals cannot diagnose. They also want the Government to invest in GP's to enhance primary care.

Charles in comment one, you've ommitted Carr: Workers Comp and Personal Injury lawyers

Mike Steketee describes plenty of cases where a GP referral is both unnecessary and wasteful, and calls the AMA for what it is - a union.,,23885954-7583,00.html

The RDAA--the Rural Doctors Association of Australia is oft refered to as "The Maddies"

Gary, well said. I think that it is time that the AMA stopped believing their own hype and started engaging in dialogue on reform in good faith rather than act purely in self-interest. Or at the very least, acknowledge the self-interest and we can work from there.

Mike Steketee says some truthful things when he says that Medicare was deliberately designed to make doctors the gatekeepers of the health scheme.

In industrial relations it would be called a restrictive work practice. In the days before labour market deregulation, unions would go on strike over a shearer being asked to pick up a fleece or a plumber asked to disconnect a piece of wiring. These days it is the Australian Medical Association that defends with religious fervour the exclusive right of doctors to issue prescriptions and to make or at least supervise any number of procedures that a junior nurse can perform. Even in remote areas where there seldom is a doctor in sight, woe betide any other health professional who suggests taking over some of their duties.

He adds that:
Health Minister Nicola Roxon wants to do something about a situation that discriminates not only against highly qualified nurses but also other allied health professionals such as physiotherapists, psychologists, dieticians, podiatrists and diabetes educators. It could be one of the most significant of the many health reforms on her plate, if she can carry it off.

Rightly said. It's about time it was openly said in the media. Steketee deserves a pat on the back for saying what everybody knew but no politician was willing to say openly.

[... I wanted to voice my ongoing displeasure with the Australian Medical Association (AMA) and their seeming inability to separate self-interest with the interests of Australians more broadly... there is some interesting back and forth at Gary Sauer-Thompson's Weblog...]

Steketee's piece struck me as saying a lot of things that need to be said. Good on him and may others in the media do something worthwhile for a change and follow his example.

Capolingua's comment about a patient with a brain tumour was one of the most offensive public statements I've ever heard. Had my father's GP had access to a psych nurse's expertise his tumour could have been diagnosed much sooner and the three months between diagnosis and death could have been extended. Nurses in palliative care could have spotted it sooner. I'm sure there are plenty of other people with similar stories.

If any good comes of this Capoligua person's public profile it will be exposure of this farce for what it is. If I wasn't such a coward I'd email Steketee with our story of how a man with a brain tumour was repeatedly misdiagnosed by a GP. Not the GP's fault, but allied health professionals had no choice but to refer him to a GP given that they weren't authorised to know what was going on.

its more complicated than The RDAA--the Rural Doctors Association of Australia being "The Maddies".

Their very political campaign against health reform in country South Australia--eg., demonstrations on the steps of state Parlaiment--- is being run by the decrepit Liberal Party.

Maybe they are maddies for allowing this to happen ---being seen as a front for the Liberal Party.

That perception is what is happening to the AMA.