AS we count down to the federal election, most doctors will express their medicopolitical opinion in corridor conversation, but how many have any direct influence?
In the past 50 years, governments — understandably — have increasingly engaged in health both as a political tool and legitimate social responsibility, so in practical terms, practising medicine invariably requires some interaction with government.
The question is, who is best qualified to determine the terms of what many doctors see as government intrusion into the patient–doctor relationship? Let’s face it — politicians, bureaucrats, competing professions, patients and doctors all have an agenda.
My political activism arose serendipitously when divisions of general practice were first established. I had reservations about the potential for government to use divisions as a tool to impose its will on private general practice, which I see as the foundation of quality health care. I have similar concerns about Medicare Locals.
Private practice is not perfect, but the market economy is an important component in developing efficient innovation and improvement. I like the model where doctors own the practice and work together with allied support and private specialist colleagues, backed up by an insurance system requiring copayments, and a strong public sector safety net.
Paradoxically, I was elected chair of the local division, now closed. Despite the frustrations of the whim of government in calling the shots, we did achieve quite a lot at the local level, and I had the good fortune to work with a great team of people, both medical and administrative, and found it stimulating.
However, the omnipotence of government prevailed and it was frustrating to be constrained in management and opinion. Having written one letter of complaint too many to the state AMA president, I was challenged to nominate for a seat on state AMA Council, leading to a term as president. Subsequently I was elected to federal AMA Council and Council of General Practice, and other committees, and then Executive Council and Treasurer.
I admit, it is difficult to find time away from a busy practice to pursue these activities, and it can be an imposition on colleagues and family. However, when support has been so willingly given, it heightens the sense of obligation, and you find ways of making it work — to give something back to a profession which is fulfilling and worthwhile.
The AMA experience has been liberating, as it represents the considered and independent opinion of a range of colleagues, and has the resources of a terrific Secretariat. Not only does it deal with the vagaries of commercial matters, but it also addresses issues in society, advocating for Indigenous health, child care, aged care, mental health and ethical issues through policies developed by its various committees and agreed by the Federal Council.
There have been occasions when I have had a particular view but after sometimes exhilarating debate and advice, been persuaded to an alternative position.
Although the AMA has been seen as fearless and outspoken, it is important that its messages are delivered responsibly to retain credibility in the community. There are many skilled players in politics and bureaucracy, and respect is essential in arguing a case because there will always be new debate on another day.
While politicians look to the AMA to appreciate the depth of policies and to speak for the profession and patients, there have been impasses which have created barriers and problems. That does not mean capitulation, but it does require skill and persuasion, which I find an interesting art form — a bit like sales and marketing.
Like many deserving causes, perseverance is required. When in 2005 the AMA commissioned Access Economics to cost our proposal for a funding increase for Indigenous health at more than $450 million, which seemed an enormous amount, we met resistance, but it eventually happened and has been exceeded.
When the Australian Health Practitioners Registration Agency (AHPRA) was created, the AMA led the offensive, because of concern about the cost and practicalities. We were also concerned about political threats to the independence of the profession and the Australian Medical Council in determining standards. While we supported national recognition of registration, we certainly refined some of the initial AHPRA proposals which we saw as preposterous.
In the area of care for the aged — for which I have advocated for many years — there has been a profound lack of progress. Unfortunately governments are disinterested in the medical aspects — except briefly when a scandal occurs. There is a glimmer of hope around changing regulations and red-tape for prescribing in nursing homes, another AMA initiative.
While election to office bearer of the AMA has been a privilege, organisations run on the strength and energy of the team and the membership, which is ultimately more important.
The members are the backbone of process and opinion, and it is highly satisfying to be part of it, especially seeing the energy and ideas of students and young doctors — I recommend engagement.
Dr Peter Ford, a GP in Adelaide, stepped down as treasurer of the federal AMA at its conference earlier this year. When presenting Dr Ford with the AMA President’s Award, the president, Dr Steve Hambleton, described him as one of the driving forces for governance reform in the AMA.