Issue 27 / 22 July 2013

SCRAP the cap” has been the most unifying campaign for the medical profession since the indemnity crisis about 12 years ago.

The federal government’s decision to cap tax deductions for activities related to continuing professional development (CPD) crosses all specialties and has the potential to diminish the practice of medicine. And it appears this decision is based on bad advice from Treasury.

Sadly, only major blows to the hip pocket seem to unify us and make us vocal.

However, I have been intrigued by the silence in some quarters.

Why are the Australian Health Practitioner Regulation Agency (AHPRA), state health departments and HealthWorkforce Australia (HWA) not making a fuss? You would think these organisations greatly value medical education and would decry anything that deters doctors from improving their knowledge and skills.

The government’s decision seems to play straight into the hands of those who want more regulation of our education and less professional independence.

AHPRA is starting a “conversation” on recertification and Medical Board of Australia chair Dr Joanna Flynn has implied that current CPD arrangements are inadequate. Dissenting voices need to be heard in such “conversations”.

Meanwhile, HWA and state health departments have introduced many training and professional development programs for their salaried and visiting staff. The British NHS started this process a few years ago — the program is a very wideranging approach to recertification and education and appears to almost take over the role of other providers in this sector — so there are precedents.

The timing of the federal government’s announcement to cap self-education tax deductions to coincide with proposed changes to the way CPD is run and administered by regulatory bodies is a real threat to our independence. It will lead to a shift away from the learned colleges, that have traditionally educated our profession.

To be independent of government, a profession needs to be independently paid, independently trained, independently educated and independently regulated. Most doctors lost control of payments and regulation long ago.

Education is now well and truly under threat.

The cap is a broader issue that also affects other occupations. But why is the Business Council of Australia  silent?

The answer may be because corporations and businesses can still write off staff education on tax, as can any practitioner who is incorporated. Therefore, the tax cap is really hurting those on lower incomes for whom incorporation is not practical or affordable. In this respect, junior doctors, nurses and the lower-paid trades and professions will suffer most.

The sting will be if the Australian Tax Office decides to intervene on what defines staff training versus self-education.

Keep in mind that in medicine undertaking continuing self-education is mandatory to hold registration, so it can hardly be considered a luxury item or perk. It is a genuine business need and expense.

The only way the big end of town will act is if there are moves to make the training and education of employees subject to fringe benefits tax. The adverse effect of such a move on training and education will be even more far-reaching.

If we don’t convince the government to scrap the cap soon, the battle to maintain our education freedom and autonomy will become even harder to win.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.
 


Poll

Will the federal government's decision to cap self-funded education tax deductions to $2000 affect you?
  • Yes - greatly (82%, 137 Votes)
  • No (11%, 18 Votes)
  • Yes - in a small way (8%, 13 Votes)

Total Voters: 168

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15 thoughts on “Aniello Iannuzzi: Losing our autonomy

  1. Michael Gliksman says:

    Spot on, Aniello.

  2. Richard Burnet says:

    What are the numbers behind this tax?  How much do medical practitioners spend on further education?  How much is the Govt. anticipating in getting from it?  Further self education is ‘tools of trade’ and is the same cap applied to all trades or has the medical proffesion been specifically targeted? I dont understand what is really behind this.  Is it a grab for money or control over an independent group? 

  3. Dr Sue McCoy says:

    The Govt – alias AHPRA – doesn’t even know what CDP is, yet have the right to enforce it! I asked them what 50 hours of CPD for a non-VR Gp doing only surgical assisting should do and this was their reply.

    …it is AHPRA’s responsibility to ‘enforce’ the annual requirements of medical practitioners, which includes the 50 hours of CPD. The National Board’s role was to develop the CPD Registration Standard which is applicable to ALL medical practitioners. The Board cannot tell you exactly what CPD you need to do, it is up to you to source training, courses, seminars etc that suit your individual needs. I suggest speaking with colleagues, hospital training departments etc to assist you in sourcing appropriate CPD activities. I’m afraid there is no flexibility in the CPD Registration Standard – it is a requirement of registration as set out by the National Board and it must be met and evidence must be supplied when requested. Under section 128(2) of the Health Practitioner Regulation National Law, a failure to comply with this Registration Standard is a breach of the legal requirements for registration and may initiate disciplinary action.

    It is clear that the bureaucrats making these decisions have no idea about CPD. Maybe that’s the basis of their decision to cap deductibility – stupidity and ignorance.

     

  4. Greg Hockings says:

    Very good analysis, Aniello.  However my understanding from AMA emails is that incorporated mecical practitioners and employers will also be caught by Fringe Benefits Tax in this legislation, even though the then Treasurer explicictly denied that this would be the case when he announced the cap.

    What remains of the independence of our profession is under assault by the APHRA bureaucrats.  The Colleges and the AMA shopuld be vigorously opposing the whole idea of recertification, rather than accepting it as a fait accompli and setting up working parties to give advice as to how it should be implemented. 

    If anyone knows of a medical organisation prepared to take on AHPRA over this and other issues, please post the details so I can join. I’m confident that such an organisation would soon be inundated with requests for membership.

  5. Graham Row says:

    Aniello, the points you make are very valid.  It goes to the really big question of what exactly is CPD and what activities actually go to improving patient outcomes as opposed to altering practitioner behaviour?  The evidence for any benefit  measured by this criterion is at best very thin and patchy.  The big question then arises; what costs are imposed by these arbitrary, bureaucratically determined CPD benchmarks so elegantly described by “Surgical Assistant” and where are the data on cost-benefit?.   Medicine has become captive to the medical education industry and the cap debate has simply revealed a very large elephant in a very small room.  The scrap the cap campaign shines a tiny chink of light on the enormous cost to the public of mandatory CPD imposed by politicians for no reason other than to  “meet the publc’s expectations”.

  6. David Henderson says:

    The “cap” is a counterproductive policy in a country that faces a need to increase productivity at a time when the mining boom is receding.  Knnowledge and inovation are important drivers of productivity that will become more important as time goes on and countries that previously could not compete with the developed world improve their educational standards.  

    Your previous commentators have put their finger on it when they talk about the stultifying effect of bureaucracy.  The bureaucratic view on knolwledge and learning is exemplified in the concept of training, which provides workers with enough knowledge to do the job, and no more.  Thus management controls the knowledge.  In the well known battle between bureaucracies and professionals, what power that is available to professionals is their professional knowledge and there have been increasing efforts on the part of health departments to control that knowledge, hence the embrace of concepts such as evidence based medicine, guidelines and mandated treatment protocols.  There is not much wrong with EBM, guidelines or protocols as long as their serious limitations are realised.

    So as a policy, the cap is stupid, but stupid cunning.

    Incidently it is likely to diproportionatley harm rual medicine and the patients of other isolated doctors, just the groups we should be assisting.  another great idea.

     

  7. freddie54@hotmail.com says:

    I am a senior Surgical Trainee. After having spent more than a $100,000’s on education, conferences and college expenses over the duration of my training, I don’t see how future trainees will be able to support themselves (and their families) to do the same.

    The cap on educational expenses is thoughtless policy which will make the rigors of specialty training even more impractable. We stand to loose a lot. The government are simply apathetic. The government think that they are playing modern day Robin Hood, but they are simply delivering a slap to the face for all hard working, good intentioned doctors around Australia.

    So why not Strike, why not launch a Television Campaign, because letters and meeting have not been a match for dis-interest.

  8. Alex Wood says:

    Comments to date are very apt.  Government & Bureaucracy both have very limited knowledge or understanding in most things and AHPRA learning “on the Job” is an excellent example.  I pity the apparently worthy Dr Joanna Flynn, who has an impossible task in AHPRA, which like all dumb bureaucracies hide behind “The Act says do this” sort of statements, which mean, “please do not on any account ask us to think, it may mean we have to really sort out the mess, by doing some hard work to find out what really happens, rather than accepting Government (often prejudiced and fixed) attitude”.

    Clearly Government and its appointee AHPRA do not really understand much except numbers, money, control at this stage, in contrast to the gradually accumulated wisdom of at least Victorian State Medical Board of yesteryear.

    Strikes are one of the few things Governments do understand, so Surgical Trainee is “on the ball”!  I speak as one who endured Commonwealth Health Minister Dr Neal Blewett’s assault and fought against that.

  9. Cyril says:

    Colleges are responsible for setting the CPD requirement and thus training etc, it is up to individual Drs to decide what is valuable for their practice.  You can get away of doing minimal, but is that what is required by the government for medicine in Australia? To do minimal ?  It is the exact opposite!

    Increasingly, more regulations and rules are imposing onto Drs, I guess with best intentions.  The ever increasing paperworks and compliance etc from all sectors are increasing demand for our time to comply but less time for clinical care, counter productive in increasing productivity.

    The government and AHPRA are in fact not interested in what you do, they are only looking at the books.  To balance the “crumbling budget”, they would cut down all expenses.  Freeze MBS, increase Medical Levy, cap CPD, increase registration fees, ask Drs to take a pay cut as drs are “greedy”, work longer with redced rate, the list goes on.

    It’s merely a lip service that they actually care about the standard of medical education in this country.  It is evident from the “mass production” of medical students, ever decreasing exposure of training of specialists ( with less case load as to increase the no of trainees) and now the cap for CPD.

    It is time to stop.  It will be a time for GP and Specialists to put self interest aside and unify for the future of high standard of medicine in Australia.

     

  10. Ian Murdoch says:

    Doctors are noted for not taking part in rallies or stop work meetings.  No! What I have noticed over time is that there is a silent revolt that happens.  The country doctor realising that he cannot maintain his skills and just mixing with other doctors without significant increased cost , he will have already set in train the means to quit his rural practice at the end of the year.  The metro doctor will only attend meetings in his own city and mostly the free ones.  People will only do the minimum of CPD training to get the points. No need to expend any more money than is needed  The biggest loser out of all of this will be the governments as anything complex in general practice will be referred.  The problem is that the government does not understand this type of silent revolt.  I think this silent revolt in all its expressions will simply gather speed with all of us continuing to make money as we can adjust to the system.  We will be pushed further on CPD and then on revalidation.  Again Darwinism adaption will occur and again the government will be the loser.  Bring it on, adapt and continue to live (but make sure you develop an interest outside of medicine). Of course the ultimate weapon is retirement (if you can afford to do it)   What about the patients?  They really do not care.  We should be professionaly concerned about them but make them realise we do our best  but it is the government that lets them down.

  11. Stephen Milgate says:

    I commend Dr Iannuzzi for his insight into this issue.  Health Education England is well and truly up and running as a template for Health Workforce Australia.

  12. Bill McCubbery says:

    Dr. Iannuzzi’s comments should constitiutre a clarion call for us all – especially for the Doctors in Training who have all of this ahead of them. Ars longa. Vita breva! Only the Australian Doctors Fund consistently opposed the formation of APRHA which, from the outset, was based on misrepresentation. Mechanisms already existed to enable registration across State borders. It is a deliberate attempt to dilute the ambit of Medical Practice with “Task Substitution”. Already in the UK, Psychiatry is unattractive to Medical Graduates because of removal of automatic medical leadership from Mental Health Teams. (‘The Psychiatrist’, v37, 2013, pp210-214).The Medical Profession has always encouraged continuing professional development amongst its members – we are alwys “learning on the job” – this was the primary intended role of the Learned Colleges. The ADF has made a submission to the Parlaiment of Victoria about the downside to APHRA and this will soon be on the Public Record. “All that is required for evil to succeed is for the good to do nothing”! Stay tuned to “http://www.adf.com.au/“!  

  13. Sue Ieraci says:

    The campaign needs to draw a sound distinction between training and ”junket” meetings on the Riviera. No matter how accurate or inaccurate, the community sees the medical profession as a highly-paid and priveleged group that regularly takes luxury holidays in the guise of educational conferences. This mythology makes it easy to marginalise the profession in any public campaign. Our emphasis needs to be on informing the public that this issue is about rural practitioners and trainees maintaining their skills and getting qualifications, not about luxury holidays. I see the COlleges being central to this campaign, as they manage the educational requirements, CME requirements and examinations that allow people to gain qualifications.

  14. Bill McCubbery says:

    Dr iannuzzi’s comments should constitute a clarion call for us all – but especially for the Doctors in Training and recent graduates who have all this before them. Ars longa Vita breva! Only the Australian Doctors Fund consistently opposed the formation of AHPRA. Mechanisms already existed to enable registration across state borders. This is a deliberate attempt to dilute the ambit of Medical Practice with “task substitution”. Already in the UK Psychiatry is unattractive to Medical Graduates because of removal of automatic medical leadership from Mental Health Teams (The Psychiatrist, v37, 2013, pp210 – 214). The ADF has made a submission to the Parliament of Victoria which will soon be on the public record. The Medical Profession has always encouraged continuing professional development amongst its members. We are always learning “on-the-job” and this is the central role of most of the learned Colleges. “All that is required for evil to succeed is to do nothing”. Stay tuned to “http://www.adf.com.au/

  15. Mari Morocz says:

    Please provide evidence of doctors/medical professionals being ‘marginalized’ in any ‘public campaign’. Please provide evidence of ‘public campaign’ you have in mind as a context for this discussion.

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