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Members’ Forum

AMA Chair of General Practice Dr Brian Morton said bulk billing hid the true cost of providing health care. He said it worried him to see registrars who had been discouraged and demoralised by what they saw as the churn of patients through practices, stimulated by bulk-billing. One member shares his view.
Thanks for the article. It’s a matter of great interest to me at the moment as I’m going through the process of analysing the viability of opening a new practice in a relatively low socio-economic, outer metropolitan area (am I mad….?)

Part of this involves trying to foretell what might happen with Medicare under a new Government. The particular area I am looking at is relatively under-served (with a number of doctors practising solo coming up to retirement), and an important consideration is the practical, coal-face difficulty in privately billing patients because of genuine financial constraints.

To start up a new practice and speedily grow lists on a private billing basis is, I believe, an unrealistic business plan that is doomed to failure. Obviously, the corporates can ride this growth period out due to size, and the fact is that the GP is simply a loss leader to drive work through profitable areas of the business, such as pathology and radiology. But not all of us want to be such a small cog in a big machine.

The AMA’s lists of suggested private fees appear to be pie in the sky, outside of the most affluent areas, which are already well served. Hence, it seems there will inevitably be perpetual inequality in access to primary care across Australia, not just in rural or remote areas, but also in outer metropolitan, low socioeconomic city areas (which do not attract rural incentive payments, or the 10991).

Perhaps the only solution is to have a much more sophisticated weighting of Medicare rebates, based on an individual’s income, or maybe postcode, rather than the current one size fits all model, to encourage more doctors to set up in less affluent (and probably more clinically challenging) locations?

Submitted by Dr Richard Newton (not verified)

AMA President Dr Steve Hambleton said chiropractors should be banned from manipulating the skeletons of children until they can prove it helps instead of harms. Many AMA members share their concern.
Remember thalidomide? I do, and that is just one medical disaster. Here is another – the Tuskegee Experiment. Rural black men in the USA [were] deliberately infected with syphilis to study the effects on humans in a controlled experiment that lasted for around 40 years. (

The list is almost endless if you choose to look. Thousands, if not millions, harmed, maimed and killed by misguided medicine, making a mockery of the lofty principle of, “First do no harm”. If Steve Hambleton applies the same rules to medicine that he is seeking to foist on chiropractic, then most of medicine would come to a grinding halt. A ‘swallow does not make a summer’, Steve!

One adverse incident, that may or may not have been caused by a chiropractic adjustment, does not justify the hysterical attack you are mounting. Historically, medicine has attacked chiropractic when it is, itself, under attack – as it is now by the optometrists, the pharmacists and the nurses. From all those attacks, chiropractic has emerged stronger, more resilient and has actually expanded. It does so, often in spite of itself (it is all too frequently its own worst enemy) because it is seen by the public to have value and is worth sustaining, in much the same way as is medicine. (For the record, I advise that I hold registrations in chiropractic, osteopathy & pharmacy as well as medicine.)
Submitted by Dr Malcolm Rutledge (not verified)

Chiropractors seem to offer short term relief of musculoskeletal problems. However, they are registered practitioners, and need to provide proof that their advice is evidence-based, not just a treatment made up or a hunch.

As for their foray into the field of immunisation – they appear to have no training in this area, and should leave it to those who do.

In the past, they have been critical of GPs who have undertaken post graduate study in musculoskeletal medicine, and who practice manipulations of the spine. The GPs have a solid grounding in anatomy, physiology, biochemistry and orthopaedics, and musculoskeletal medicine is an extension of these disciplines. Since when is immunology a part of the chiropractic degree?

Lastly, I recall with horror a case 25-plus years ago when parents took a baby with Haemophilic meningitis to a chiropractor for neck manipulations, instead of a hospital for antibiotics. Chiropractors were not registered then, and certainly this chiropractor did not have the expertise to recognise a sick baby who needed proper medical attention. The baby died. Chiropractors should stick to what they do best. A few decent court cases may sort this out.
Submitted by Maureen Fitzsimon (not verified)

Chiropractors are also cash obsessed. Getting people to pay thousands to have as many treatments as they need within a timeframe? An effective therapy would only need limited treatment and an effective diagnosis would give the required number of treatments. Try a good physio or a good structural osteopath.
Submitted by canyondave (not verified)

A number of years ago I visited a Chiropractor twice a week for about a year. Till this day I wonder whether I got any real long term benefit out of it. I actually think it may have caused more long term problems than nothing at all.
Submitted by Robert (not verified)