the nsw doctor The official publication of the Australian Medical association (NSW) COLLEGIALITY creating a better community ELECTION WINNERS new 60 PRINT POST APPROVED PP255003/00999 AMA (NSW) secures registrar positions Vol 7 - number 03 - May/June 2015 Tour Highlights in 2015 and early 2016 Wallace in the Malay Archipelago Paediatrics in China 8 – 25 September 2015 Gain insight into the Chinese approach to paediatrics and child care while learning about the history and society of this extraordinary country. 16 – 27 October 2015 Midwifery and Childcare in Vietnam Ophthalmology and Eye Care in South India Explore compact yet remarkably diverse Ecuador and cruise on a private yacht around the Galapagos Islands. 15 – 26 November 2015 16 – 29 November 2015 See a side of Vietnam well off the tourist trail and learn about the midwifery system in this beautiful and welcoming land. Immerse yourself in South India’s culture and natural beauty and examine eyecare through professional visits and talks. Obstetrics, Gynaecology and Fertility in Cuba Medicine in Sri Lanka Medicine and Society in Cuba Travel through Sarawak, Singapore and Indonesia in the footsteps of one of the greatest naturalists in history. Ecuador and the Galapagos 14– 27 November 2015 19 – 30 November 2015 There is only one Cuba. Experience Cuba’s music, culture and healthcare system against a stunning natural backdrop. 12 – 25 October 2015 17 – 30 January 2016 Sri Lanka is crammed full of cultural treasures, wildlife and unspoilt landscapes. Examine the culture and medical system of this exciting new destination. For full itineraries and more tours please contact: Jon Baines Tours (Melbourne) Tel: +61 (0)3 9343 6367 Email: [email protected] www.jonbainestours.com Medical History Mediterranean Cruise Learn about the region’s medical and military history in boutique comfort. Includes lectures and shore excursions. 4 – 15 February 2016 One of our longest running tours, this itinerary takes you to the heart of Cuba’s society, culture and healthcare system. contents the nsw doctor The official publication of the Australian Medical association (NSW) The Australian Medical Association (NSW) Limited ACN 000 001 614 Street address 69 Christie Street ST LEONARDS NSW 2065 Mailing address PO Box 121, ST LEONARDS NSW 1590 Telephone (02) 9439 8822 Outside Sydney Telephone 1800 813 423 Facsimile (02) 9438 3760 Outside Sydney Facsimile 1300 889 017 Email [email protected] Website www.amansw.com.au The NSW Doctor is the bi-monthly publication of the Australian Medical Association (NSW) Limited. Printing by A.R. Rennie Printers, Caringbah. Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor. The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA. Executive Officers 2014-2015 President Dr Saxon Smith Vice President Professor Bradley Frankum Chairman of Council Dr Michael Steiner Honorary Treasurer Dr Andrew Zuschmann Chair, Hospital Practice Committee Dr Ian Woodforth Chair, Professional Issues Committee Dr Adrian Cachia Director Dr Sandy Jusuf DIT Representative Dr Danielle McMullen features 11 Internship: the good, the bad, the ugly 14 Beyond the GP co-payment battle 16 Freezing specialists’ fees 18 GP Toolkit on the small screen 20 AMA (NSW) scores major wins in state election 22 Talking about sexual harassment in medicine 26 Industrial relations’ success stories 28 Life-saving research in Tanzania 30 March on Machu Picchu for cancer research 32 Reaching youth at risk of extreme ideologies 40 Women in medicine regulars 2 President’s word 3 From the CEO 4 AMA active 6News 8 DIT diary 24 Medico-Legal 35 Events 38 Golf events 42Members 14 20 18 28 22 44 Member services Secretariat Chief Executive Officer Fiona Davies Medical Director Dr Robyn Napier Chief Financial Officer Walter Edgar Director, Medico Legal and Employment Relations Andrew Took Director, Policy & Communications Sim Mead Director, Services Kerry Evripidou Editor Andrea Cornish [email protected] Designer Nikki Zacharatos [email protected] Advertising enquiries Michelle Morgan-Mar [email protected] 18 14 President’s word Dr Saxon Smith President, AMA (NSW) Creating collegiality It is through the support of peers that we become better doctors and deliver better care to patients and the community. The image of a doctor emotionally breaking down outside a hospital in America after the death of a 19-yearold patient has captured widespread mainstream and social media attention. This is a scenario that is repeated daily around the world as doctors try to help their patients when they are at their greatest need. But usually it is not captured or shared in such a public way; rather it is our colleagues, friends and loved ones who see the impact of one of those days. It is a poignant reminder of the importance of those social foundations that keep us together even on the toughest of days. It has been 20 years since I started my journey through medical school, internship and specialist training; and 10 years since I began my involvement with the AMA. In fact, some of the problems splashed across recent media are the same reasons why I decided to get involved with the AMA in the first place. I wanted to champion a culture change in the profession – one that supported you when you were sick; allowed part-time training and work when your personal circumstances needed it; looked after its junior doctors to develop the future healers and leaders; and, accepted its own human frailties. My career has been interrupted, turned upside down and inside out due to health problems. I was diagnosed with [email protected] ulcerative colitis (the other inflammatory bowel disease to Crohn’s disease) in the last year of medical school. This began a rollercoaster ride with chronic illness, which at the time robbed me of my passion, confidence, fitness and even my image of self. I was obsessively diligent with my medications in an attempt to control this disease – at one point taking 16 tablets a day, as well as using embarrassing topical therapies. Despite all of this, at its worst I still needed to visit the bathroom 20 times in a morning due to severe abdominal pain. After my weight dropped to 60kg (from 75kg prior to being diagnosed), I then ballooned to nearly 100kg as a complication of long term high dose oral steroids. As an intern, every morning was a struggle to get to work – trying to time the 10-minute drive between episodes of urgent painful need to visit the bathroom. All my sick leave and holiday leave was taken up by hospital admissions, investigations and simply being sick. This was not the life I had dreamed for myself nor a way for anyone to live and work. I subsequently had long periods not working and three major surgeries to remove my entire large bowel (colon) over a 12-month period, which were associated with significant complications, and subsequent years of piecing my life and health back together. During this incredibly hard time I was @drsaxonsmith 2 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 lucky that I had family and friends around me to pull me up when I was at rock bottom. I also had amazing support from colleagues and hospital administration. I even had a random visit in hospital from a cousin of a family friend who lived in rural Queensland, but had been through the same thing. I was also aware that I was one of the lucky ones, as I know other people with whom I worked were not as supported by the system around them. They felt isolated by colleges, hospital administration and, at times, even by colleagues. This left them trapped, lost or pigeon-holed in their careers due to the limitations of their health. This inequity is what drove me to join the AMA and turn up to my first doctors-in-training meeting. Collegiality is a living thing that is fed or starved by our actions and interactions with each other. It is important to stand with and stand up for our colleagues. It is through this support of peers that we become better doctors and deliver better care to patients and the community. dr. www.facebook.com/amansw From the CEO Working for you Fiona Davies CEO, AMA (NSW) From policy and advocacy, through to supporting doctors through industrial and medico-legal services, the AMA (NSW) is working on behalf of doctors, the health system and patients. We would like to welcome members and non-members to the annual state-wide edition of The NSW Doctor. This is the edition we send to every doctor in NSW. The edition provides those doctors who are not currently AMA members a chance to see how much work the AMA does on behalf of doctors, our health system and our patients. We rely on the support of doctors and with this support, we know we make a unique and critical difference to health in NSW and in Australia. In this edition, we showcase just how significant that work has been with the AMA delivering major achievements at a state and federal level for all doctors. At a federal level, there has been considerable focus on the GP copayment and we cover this story on page 14. We continue to also be very mindful of the implications of the freeze in MBS indexation, which is now proposed to run until 2018. Federal AMA has also been active on the issue of public hospital funding. The AMA also stood up for health in the NSW State Election. We put forward a package of policy priorities. This package went beyond standard hospital infrastructure and covered the broad range of issues impacting on our healthcare system, from increasing involvement of GPs in hospitals and hospital-based care, to better resourcing of end-of-life decision making. However, the AMA is more than just policy and advocacy; we also work to support you professionally through our industrial and medico-legal services. Our highly experienced medico-legal and industrial team understand that you want to be able to focus on being a doctor and caring for your patients. We are there to help with contracts, staffing, disputes or any issue where you need expert guidance. In between all of the politics and the industrial and medico-legal services, the AMA also takes the time to have some fun. Some of my favourite events in the AMA year are the Women’s High Teas. Once again, we held two events, one in Sydney and one in Newcastle. While both events were very different, they were both wonderful opportunities for female doctors to connect with each other and talk about how we can better support each other. I would like to thank all of the doctors who attended the events. If you are not an AMA member, please take the time to see what we have been doing for you and consider lending your support by joining the AMA at ama.com.au/join-renew dr. [email protected] 14TH ANNUAL Continuing Professional Education (CPE) seminar This 1½ day seminar covers current developments in medical practice with updates in the treatment of diseases, preventative health issues and is designed to assist experienced practitioners towards meeting the CPE requirements. Date | Saturday, 25 July – 9.00am-4.00pm and Sunday, 26 July – 9.00am-1.00pm Venue | Y3A Theatre, Macquarie University (enter Balaclava Road) Cost | AMA members $150.00. Non-members $200.00. Includes morning teas and lunch on Saturday. This seminar will be submitted for QI&CPD points approval by the RACGP QI&CPD Program. Register online: www.amansw.com.au For more information or to make a booking Jenni Noble phone 02 9902 8140 or email [email protected] www.amansw.com.au I 3 Media AMA active AMA (NSW) President, Dr Saxon Smith, spoke to The Sydney Morning Herald about Phenergan: AMA (NSW) President, Dr Saxon Smith, and Councillors, Dr Fred Betros and Dr Kean-Seng Lim, spoke to ABC TV about health in western Sydney: AMA (NSW) President, Dr Saxon Smith, spoke to Triple M and 2GB about lower crime rates in Kings Cross following pub lockouts: AMA (NSW) President, Dr Saxon Smith, spoke to ABC’s PM about the AMA (NSW) psychiatrist survey: AMA (NSW) President, Dr Saxon Smith, was one of the experts to talk about important health matters for the 2015 NSW State Election in this Herald story: AMA (NSW) President, Dr Saxon Smith, spoke to Channel 7 about the importance of vaccination: Health Project Services Health Project Services provides a comprehensive range of consultancy services, including research, strategic planning, property search and acquisition, project delivery, and medical property management. It also offers ad hoc consulting services to clients already running their own project, who may need some expert advice along the way. For more information visit healthprojectservices.com.au. 4 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Health Project Services is offering one member the opportunity to use its services. Submit your property development proposal directly to dean.c@ healthprojectservices.com.au for your chance to win this exclusive offer. FREE Self Managed Superannuation and Investment Update Are you getting the best from your super? This inforrmation-packed Cutche er & Neale presentation will revveal th he power of SMSF to build and preserve p your y wealth. Presenters Shan Pres ne Morg gan (Pa art rtne nerr and d head of th the e Su S pe era ann n ua ation o Div i is i ion)), Phil i Smith (Parttne ner and head of the Investment Divisio on) n and nd Stu tuar arrt Ch Chan an (Director of the Specialist Medical Services Division) will sh s ow w you: Q Q Q Q Q Q Q Q Strategies for successful SMSF investing in the current econom mic climate The impact of the latest legislative changes to SMSFs Key superannuation strategies tailored for medicos What you can and can’t do in your fund Buying a practice through your SMSF Insights into the local and international investment environments Medium and long term investment trends Outcomes for medicos from the 2015 Federal Budget And more... Whether you already have a SMSF or you’re contemplating one, this event is not to be missed! Date Thursday June 4th, 6.30pm – 8.30pm Venue AMA House Conference Centre Ground Floor, 69 Christie Street, St Leonar ards d To reg e isste terr em emai ail me m diical@cu utcher.com.au u or phon ph hone on ne (0 ( 2)) 9923 18 1817 817 17 126867 PREFERRED ACCOUNTING PARTNER Call 02 9923 1817 [email protected] Innovative thinking. Traditional values. News Oral Health: A User’s & Practitioner’s Guide This Active Learning Module has been approved by the RACGP QI&CPD Program. Total Points: 40 Category 1 points 15 August 2015 9am – 5pm $315 Holistic dentist Dr Ron Ehrlich gives a clinically focussed and handson workshop designed to provide medical practitioners and allied health professionals with a practical and systemised approach in assessing the oral cavity, detecting the important signs of local and systemic disease that manifest there, and managing these appropriately for their patients. Register here: drronehrlich.com/oral-health/ Mental Health funding confirmed Mental health services will have their funding renewed in a move to give them certainty, Minister for Health Sussan Ley announced in April. Ms Ley said the 12 month extension – worth almost $300 million – would allow frontline services to continue to be delivered while work progressed on the current Mental Health Review. Ms Ley thanked the sector for their patience and said negotiations would commence immediately, with priority placed on frontline services. “This review will allow Government to form long-term plans to ensure our high quality mental health services continue to provide the right care at the right time in the right setting. “However, most people also recognise that to achieve this, improvements need to be made in the way mental health is organised and funded in Australia and it’s important this opportunity for positive reform isn’t rushed. “Therefore extending funding for another 12 months will provide frontline mental health services with clarity and certainty while we work through the complex issues raised in the review.” Ms Ley said the Abbott Government had tasked the Mental Health Commission to complete a review into the mental health sector following an election commitment. Ms Ley said the Government was currently working through the findings of the review and it would be released soon. The announcement was welcomed by the Australian Medical Student’s Association (AMSA). AMSA President, Mr James Lawler, said this was particularly important in order to provide certainty for the mental health sector until the release of the National Mental Health Commission report. “AMSA congratulates Minister Ley on this decision – without it, the mental health sector and its clients faced an uncertain future after June 30,” Mr Lawler said. “Forty-five per cent of Australian population will suffer from one or more mental health conditions during their lifetime. “Young people in particular are at risk of poorer mental health, and services which provide early intervention, long-term treatment and public health awareness are vital.” dr. 6 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Australia Day Honours 2015 Special congratulations to Campbelltown surgeon Dr Andrew Gatenby, who received an AM for significant service to medicine, particularly as a colorectal surgeon, and to the community of south west Sydney. The semi-retired colorectal specialist started practising in 1978, and was appointed to the newly-opened Campbelltown Hospital as a young surgeon. Dr Gatenby was a general surgeon before following an interest in colorectal and bowel cancer. AMA (NSW) would also like to congratulate Prof David Lubowski, who received an AM for significant service to medicine in the field of colorectal surgery as a clinician and researcher, and to professional organisations. Prof Lubowski is Head, Department of Colorectal Surgery, St George Hospital and holds senior teaching positions with the University of NSW. He currently has operating priviledges at Hurstville Private Hospital, St George Public Hospital, St George Private Hospital and Prince of Wale Private Hospital. In memory of Dr Charles Rowland Bromley Richards AMA (NSW) would like to acknowledge the passing of Dr Charles Rowland Bromley Richards, a longstanding member of the association and esteemed member of the medical profession. Dr Richards passed away peacefully after a short illness at Manly Hospital on 26 February 2015 at age 99. A revered gunner medical officer of 2/15 Rd Rgt, Dr Richards was one of the last surviving doctors forced to work on the Thai Burma railway, also known as the Death Railway, during World War II. Born 8 June 1916, Dr Richards was the beloved husband of Beth (dec), father of David and Ian (dec), grandfather of Charlie and Belinda, Guy-Barratt, Lee-Bromley, Angela, Robert, Tim and Salli. He was a civilian doctor, teacher, researcher and leader, as well as a friend and confidant to numerous individuals over several generations. dr. RENT WITH HERTZ AND SAVE Hertz offers great rates to AMA Members on all our vehicles, including our Prestige Collection of BMWs. Just quote this CDP number: 283826 when you make your booking*. *Terms and Conditions: Customer Discount Program (CDP) number 283826 must be quoted at time of reservation. For full terms and conditions, please visit the Hertz section on your intranet. www.amansw.com.au I 7 DIT diary Dr Eliza Milliken Junior Doctor Equality must be for all All forms of discrimination equate to one thing: anti-humanism. Since vascular surgeon Dr Gabrielle McMullin’s comments regarding sexual harassment ignited a national debate, female doctors (including Dr Carolyn Tan) have been compelled to come forward with their own accounts of sexism at work. For myself, the media commotion was timely − it hit just two days after the AMA (NSW)’s Women In Medicine Sydney High Tea, where a panel of medical women at the top of their fields deliberated on the role of women in medicine’s past, present and future. My impression of the experiences shared in that room by talented, empathetic and ambitious women was, whilst great advances have been forged by admirable trailblazers, the path of medicine remains a minefield for female candidates. Something about Dr Tan’s story struck me that seems to have been otherwise lost in the noise of ‘blowjob gate’. Dr Tan called Australian surgeons an ‘Anglo-Saxon male boys’ club’ and this is a critical adjective. Shirley Chisholm, the first African American US Congresswoman and the first woman to run for a US Presidential nomination once said, “In the end, anti-black, anti-female, and all forms of discrimination are equivalent to the same thing: anti-humanism.” The thing about boys’ clubs is not only do they refuse admission to women but they also only admit one type of boy; one who fits certain criteria in regards to looks, interests, socioeconomic background, sexual preference and even ethnicity. This is not to say that I do not think the female doctors in training both past and present have a claim to wrongdoing and mistreatment. However, I also believe that despite being a woman, being Caucasian, able bodied, heterosexual and comfortable with identifying as the gender I was assigned at birth (now sometimes called cisgendered as 8 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 opposed to transgendered) has also offered me relative advantages in comparison to some other junior doctors. I have had conversations with colleagues who felt strongly that workplace opportunity, including progression in training programs was being limited by their race, their religion or their sexual orientation and could offer solid anecdotal evidence that this was the case. Bullying and fear affect not only women, but can affect any outsider. Sensitivity to minority issues is sometimes painted as ‘political correctness gone mad’. Journalist Miranda Devine responded to Dr Tan’s story by labelling it part of the hysteria for “man bashing”. Devine rejected that “anyone sensible” would have thanked Dr McMullin for “turning neurosurgery into a gender battleground”. However, if political correctness is the price for making a safe environment for all-comers then it’s a small one − besides, it’s basic professionalism. We are all elevated by remembering that oppressing women is often part and parcel of cultural structures and institutions where one type of person has achieved dominance and prevents other types of people (read: minorities) from achieving success on their own terms, without conditions. Gender equality is a battle not yet won and it requires our attention. But we also need to recall that differently abled people, people of colour, those with different sexual preferences, and individuals who don’t identify with the gender they were assigned at birth, will all be protected by a ‘club’ that is for all persons and not just for those who fit a narrow definition of ‘boys’. dr. Dr Eliza Milliken is a doctor-in-training and will be writing a regular column for The NSW Doctor, giving a fresh perspective on issues affecting the medical community. Q:Who sets the standard in winning cases for its members? Dr. Michael Nguyen Avant member Avant. Experience when it matters most. You’ve worked hard to earn your reputation. We’ll work even harder to protect it. We’re Avant. And for over 120 years we’ve been defending doctors’ good names. We’re Australia’s largest MDO. We have over 40 specialist medico-legal experts in-house ready to defend you. We’re on-call 24/7 for the best advice and support whenever you need it. And you can be sure we’ll dedicate to you the same superior defence that won many landmark cases such as Varipatis v Almario. Not all doctors are the same. The same goes for MDOs. That’s why you need to choose one with more expertise and more experience. Avant is owned and run purely for the benefit of its doctor members. So if you’re looking for an MDO that’s dedicated to defending your reputation, Avant is the answer. To find out more, contact our NSW State Business Manager Kimberley Darby 0466 779 109 or 02 9260 9000 [email protected] mutual group Your Advantage *IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. Feature Dr Neil Jeyasingam Psychiatrist How to prepare for internship Dr Neil Jeyasingam shares his advice on how to survive your internship, choose a specialty wisely and balance work/life commitments. I had no real interest in medicine when I first went into university. This ambivalence didn’t prepare me well for experiencing internship, which comprised bullying, deception, betrayal, and frequent disappointment – and that didn’t even include the nurses. It was also one of the best years of my medical career. My experience will almost certainly not echo yours, but many of the pivotal moments are worth consideration… “What is your reason for doing medicine?” If it’s “to help people” or “for the betterment of society” – congratulations. There’s not too much I need to encourage apart from reminding you that this should not be the entirety of your existence. Now suppose your goal is career advancement. You may be disappointed with the hospital you’ve been allocated and cursing that you didn’t stack your preferences. Generally, no one cares which hospital you did your internship in. Plus, don’t be disappointed if you didn’t get one of the “cruisy” hospitals – an easy term prevents you from learning anything, a harsh and confronting term makes you a better doctor in the end – if handled well. Don’t be mistaken, you are still here to learn. As a general rule, reading up about at least one patient a day will keep you in good stead, and if you are able to start this habit early enough you will see the benefits pretty soon. Now, say you entered medicine with a particular specialty in mind. Firstly, can I say that hardly anyone I knew in my batch ended up doing the specialty that they thought they were going to do. Don’t discount other experiences – instead, choose your terms in order to complement and facilitate the decision. If you’re interested in colorectal surgery, do a gastroenterology term. If neurology, do a psychiatry term. If general practice, do a surgical term. If cardiology, do a respiratory term. Emergency and intensive care terms are great for rapid acquisition of multiple practical skills, whilst surgical terms actually tend to have you doing more general medical work as most of your time will be spent in ward care. Keep your options open – the best way to avoid learning is to convince yourself that you’re never going to use information in that domain. It’s not rationalisation, it’s laziness combined with self-deception. And when it comes time to choose? Find a second year registrar in the specialty you are thinking of, and then ask away. Don’t ask consultants – we’re all keen to have protégés to boost our egos and will always provide an idealised version of our field. You only know your specialty decision is correct after the first year of the training program, and never before. Lastly, do not make the single most common mistake and choose a specialty based on a charismatic individual. You probably want to become that doctor, but not necessarily in that field. And if you entered the field for money… oops. “What is my life’s passion going to be?” If your first response is “not medicine”, congratulations. You’re on track to a healthier attitude to work. Medicine is a profession – that is true, it shapes us as we try to live in it. But there actually is an outside world, and if ignored it will disappear by the sixth month of traipsing fluorescent-lit linoleum. It is crucial to maintain a life outside of medicine – your relationships will now be far more important to you. Family, friends, love, hobbies – any interest beyond the hospital will be harder to maintain, but must be done in order to centre yourself. If you haven’t already, take up a sport, something reasonably scheduled that you can afford to miss occasionally (depending on overtime rosters). Holiday preparation will also become harder, and you’ll find that often the initiator for holidays comes from your family and friends rather than yourself. Allow time for yourself as well – use your ADOs and remember to explore the world. I don’t remember too much stitching from my surgical term in the country, but I have an irreplaceable collection of photographs of sunrises over the foggy fields that I still treasure. Why is the social dimension so important? Well, unfortunately I’m too aware of the literature regarding mental illness and strain for house officers. It’s not going to be helpful to go into it here, but it is worth thinking about. “How bad is it going to be?” I had a nightmare registrar once who made it his personal mission to belittle every resident he had out of earshot of his consultants. As a young doctor without awareness of boundaries of practice, but also aware that I was still early in my career, I did not realise what my rights were until after he was fired for gross misconduct. I would have dropped out of medicine if it wasn’t for my then-girlfriend cushioning the www.amansw.com.au I 11 How to prepare for internship...con’t mental blows and helping me to reorient myself. But I still kick myself now for not responding differently – not just for myself, but for my patients. Likewise I had a difficult term with responsibility for several teams. It was a never-ending juggling act of haemodynamically unstable patients and a profound lack of support. But my strongest memory from that was going out for drinks with friends from high school, sitting there thinking, ‘I am talking with an accountant and a manager, and for the entirety of tonight, unlike every hour of the last eight weeks, I do not need to think at all about medicine’. Be aware of your rights and responsibilities, and also about workplace codes of conduct. It actually does matter to know the difference between performance feedback and bullying – but it is useful to have a first response to criticism as being, ‘is there something about myself that I can improve?’ You absolutely must have a general practitioner, and talk to them or trusted parties if there is any problem whatsoever. Fix problems early, and never, ever suffer in silence. “How good is it going to be?” Brilliant. I worked with a great bunch of people who all helped each other out – doing each other’s cannulae, picking up shifts, that sort of thing. We held parties, complained about our experiences, and had this dizzying camaraderie that only happens from people embarking on an incredible shared experience. We fortunately learned early on that we knew nothing whatsoever and got used to asking questions, which worked. We may have been bright, but we were inexperienced, and everyone else knew more than we did. Amongst our superiors, there were good and bad clinicians, but I received the best advice of my career from a urology registrar who advised me, “You learn something from every person you meet. Sometimes, you learn what not to do.” Once you work out that your career – and life – is about growth, and becoming a better person every day, it’s amazing where things will go. So enjoy your internship, and make the right decisions early. And hopefully it too will be one of the best years of your career. Because it will mark the point at which every following year becomes even better. dr. healthcare Skin Cancer Clinics Busy clinics Do you have a special interest in Skin Cancer Medicine? Join Australia’s fastest growing Skin Cancer Clinic network! 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For more information or confidential enquiries please contact: Kim Pryce-Lunt on 0439761921 or alternatively email Kim at [email protected] 12 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Excellent income potential A great team environment with training and support programs available for new Doctors Clinical Independence Our Corporate Programme provides benefits for you. • Complimentary scheduled servicing* • Total of 4 years Mercedes-Benz roadside care • Reduced dealer delivery fee Mercedes-Benz vehicles are renowned for quality, safety, luxury and performance. That’s why cars with the Mercedes-Benz three-pointed star are the choice of those who demand the best. That choice is even easier if you qualify for our Corporate Programme. Our Corporate Sales Consultants at authorised Mercedes-Benz dealerships can provide eligible members with a range of privileges including complimentary scheduled servicing.* In fact, the benefits you receive with your new Mercedes-Benz may evoke more envy than the badge. For full details, call 1800 888 170 or visit www.mercedes-benz.com.au/corporate * Up to 3 years or 75,000km from new (whichever comes first). AMG (excluding V12 vehicles) 3 years or 60,000 km from new (whichever comes first). All V12 vehicles 3 years or 50,000 km from new (whichever comes first). Feature Facing the freeze The AMA has faced down several threats to general practice, but one critical policy remains in place – the indexation freeze for all Medicare schedule fees. The past 12 months have been tumultuous for general practice, with threats to general practice shapeshifting from a $7 patient co-payment, to a $5 cut to the Medicare rebate. The rise and fall of ill-thought out health policies has already been a battle of epic proportions, but one more challenge lies ahead – and it could have an even greater impact on general practice. Freeze on Medicare rebates While the Coalition government recently dumped its hugely unpopular $5 cut to rebates, its freeze on Medicare indexation rates remains on the table. The rebate freeze was originally introduced by the Labor government to take effect November 2013 to July 2014. It was then extended by the current Coalition government for another two years. Now the Government is threatening to keep the freeze in place until 2018. The costs of running a general practice have risen substantially in this time, yet Medicare rebates remain frozen. As a result, many GPs are being forced to look at ways of maintaining the viability of their practice. For some, this means they will have to start charging a fee, or increase the fees they already have in place. For general practices in socio-economically disadvantaged areas, where patients would be unable to pay higher fees, it could mean they would have to close down altogether. How much will it cost? New research reveals that a continuation of the indexation for all Medicare schedule fees until July 2018 would result in GPs charging around half their patients an $8 co-payment to survive. According to research published by the Medical Journal of Australia, the indexation freeze could result in a loss of income for GPs of $384.32 per 100 eligible consultations, or more if the GP is rural based. Researchers from the Family Medicine Research Centre at the University of Sydney used data from the Bettering the Evaluation and Care of Health (BEACH) program between April 2013 and March 2014 to assess “direct encounters between patients and GPs for which at least one Medicare Benefits Schedule or Department of Veterans’ Affairs general practice consultation item was claimable”. They assessed the effect on GPs’ income of both the indexation freeze and the now retracted $5 rebate reduction, both individually and together. 14 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 The researchers found that the freeze would cost GPs $384.32 (in the 2017–18 financial year) per 100 consultations, requiring an $8.43 co-payment per nonconcessional patient consultation. “Even though the rebate reduction has been retracted, the freeze will have greater impact with time – nearly double the amount of the rebate reduction by 2017–18”, the researchers wrote. “For economic reasons, the freeze may still force GPs who currently bulk bill to charge co-payments.” The pain would be even greater for rural GPs, they found. “As the rural incentive is higher than the urban, GPs claiming the rural bulk-billing incentive item would face a greater relative loss in rebate income due to inflation: 10 cents more per nonconcessional patient in 2015–16 ($2.84) and 29 cents more in 2017–18 ($8.72).” The research backs what AMA President A/Prof Brian Owler has been warning the public about for months. Early in the fight to oppose cuts to general practice, A/Prof Owler pointed out that Medicare rebates have already been frozen for almost two years, and the Government’s plan will see that freeze extended for a further four years, while inflation grows at an average annual rate of 2.5 per cent. AMA fights the co-payment in 2014/15 FActs and figures 3 More than 7000 emails to MPs via doctors4health.com.au 3 In January 2015, the AMA’s leaders were quoted in more than 600 interviews, communicating to an audience of over 44 million media consumers 3 A MA supported the RACGP’s ‘You’ve been targeted’ petition information for practices and patients 3 A MA provided practices with posters, letters for patients and information from The new arrangement essentially delivers GPs, specialists and allied health professionals a six-year pay cut – reducing the money they have to operate their practices, including paying staff wages and rent, utility costs, medical supplies and training and IT charges. “What’s going to happen is that as specialist and GP practice costs rise, they’re going to have to stop bulk billing, they’re going to have to stop using nogap schedules, and people are going to have to pay more out of their own pocket,” A/Prof Owler said. What is the AMA doing now? The AMA continues to consult with government, doctors and the public on the indexation freeze and its impact on general practice. The AMA has had good success in garnering opposition to the Government’s earlier co-payment strategies, and should the indexation freeze remain on the table, it will continue to advocate strongly on behalf of general practice. AMA (NSW) will be distributing leaflets to GP offices throughout the state, raising public awareness about the Medicare freeze and how it will affect general practice. dr. www.ama.com.au. Since 1 January, there have been more than 11000 hits on the information for practices page of www.ama.com.au. 3 GPs in local communities gathered to stand against the proposed changes. They put iPads on reception desks to encourage emails to MPs. They arranged to meet local MPs, they organised local events and they educated their patients about the value of general practice. The GP co-payment: from cradle to grave (and back again) May 2014: The Abbott government proposes a mandatory $7 co-payment for general practice, pathology and diagnostic imaging in the budget. While doctors could keep the $7 copayment, the government sought to cut the Medicare rebate by $5. Dec 2014: Growing opposition from the AMA and other groups forces the government to change direction. It reduces the co-payment to $5 and exempts children and concession card holders. The government also cuts the rebate by $20 for consultations under 10 minutes to combat so-called “sixminute medicine”. Jan 2015: Newly appointed as Health Minister, Sussan Ley takes the Government’s controversial changes to Level A and Level B consultations off the table. March 3 2015: Minister Ley announces the co-payment plan and the $5 cut to the rebate have been dumped; however an indexation freeze on the Medicare Benefits Schedule remains in place. www.amansw.com.au I 15 Feature Specialists: the impact of the freeze The Government’s freeze on Medicare rebates for specialists will increase out-of-pocket costs for patients. While much focus has been directed on the GP co-payment issue, the AMA is also warning the public about the impact of the ongoing freeze on specialist fees. According to AMA President A/Prof. Brian Owler, the continued freeze means fewer specialists will participate in nogap schemes, which is turn means the out-of-pocket expenses for patients will skyrocket. It is currently proposed that all CMBS rebates will be frozen until 2018, meaning that by 1 July 2018 rebates will have remained static since 1 November 2012, a period of five years and eight months. Of course, there is no guarantee that there will be an adjustment in July 2018. The response from private health insurers has been mixed. Some insurers have indexed their schedules but are unlikely to continue to do so in the face of such a long Government freeze on indexation. In these circumstances, if specialists increase their fees and charge more than the no-gap schedule, the private health insurer reverts back to covering only 25 per cent of the MBS schedule fee. As costs increase and Medicare payments remain the same, it will inevitably lead to more patients with out-of-pocket 16 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 expenses. Increases in healthcare costs could also encourage people to reconsider their private health cover. Not only would this increase pressure on the public system, it could lead to higher private insurance premiums. AMA (NSW) President Dr Saxon Smith said he has been conscious of keeping consultation costs down to date, but eventually he will have to look at restructuring fees to ensure the viability of his practice. “I haven’t increased my fees for the past two years in a bid to make consultations as accessible as possible for my patients. Unfortunately, the Government’s proposal to maintain a freeze on indexation rates will eventually force me to look at charging patients more.” He added, “While the freeze will impact procedural costs, there is also a significant impact on consulation costs. Patients with chronic conditions will especially be hit hard.” This is an issue the AMA is already lobbying the Government on and it will continue to do so until the issue is resolved. This issue also has important implications for fee-for-service (FFS) VMOs in NSW because of the direct link between CMBS increases and FFS VMO remuneration. dr. As a member of the Australian Medical Association NSW, you deserve special treatment. When you switch to CommBank, you’ll pay no joining fee and enjoy preferred rates on merchant services. For a little special treatment, contact the AMA NSW team today. Call member services at AMA NSW on (02) 9439 8822 or email [email protected] Stay Connected: commbank.com.au Visit: commbank.com.au/business Commonwealth Bank of Australia ANB48 123 123 124 www.amansw.com.au I 17 Feature It’s time to talk AMA (NSW) created a video based on the GP Toolkit for doctors on providing care to victims of domestic violence. The NSW Doctor reports. “One in five women disclose domestic violence for the first time to their GP and you could be the only person they tell,” said Dr Deborah Bateson, Medical Director of Family Planning NSW, in a video recently developed by AMA (NSW) for doctors providing care to victims of domestic abuse. The video highlights important information from the GP Toolkit, a domestic violence resource created specifically for doctors. Helen Campbell, executive officer at Women’s Legal Services NSW – the organisation that produced the toolkit – also appeared in the video to give doctors advice on listening with compassion. “Many women won’t necessarily disclose [domestic violence] immediately – they may drop some hints, see if the doctor responds compassionately and that will help the woman be encouraged to talk about what’s happening to her.” Dr Bateson added that sometimes the questions need to be a bit more direct. “If you have got suspicions of domestic violence you might want to say something like, ‘Are you ever frightened of your partner?’, ‘Do you mind if I ask, have you ever been hurt, or hit, or slapped by your partner?’ And sometimes it’s useful to say, ‘I actually ask a lot of my patients these questions.’” According to Dr Bateson, doctors need to keep in mind that many women want to talk. “Sometimes we can feel a bit nervous around asking, but we well know through the evidence that women really want to be asked.” Once a woman has confided, both Dr Bateson and Ms Campbell indicate 18 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 it’s critical the doctor listen respectfully and without judgement. “It’s very important to respond in a way that validates the woman’s experience and to assure her that whatever is happening is not her fault and that it’s not ok to feel unsafe in your own home and that there are ways that we can assist that woman to find a safe way out of that situation,” Ms Campbell said. When patients do indicate they are experiencing domestic violence, it is imperative doctors discuss a safety plan. Check for immediate concerns: does she feel safe going home after the appointment? Are her children safe? Does she need an immediate place of safety? Does she need to consider an alternative exit from your building? “We need to ensure that we listen to the woman’s concerns. She will be a very good judge of her safety. It may be that you need to contact the domestic violence line within the consultation. I’ve certainly done this on many occasions. It may be that you need to involve the police straightaway at that time,” Dr Bateson said. For many women, the time they decide to leave the situation is actually the time when the danger will be greatest. Women’s Legal Services NSW outlined a wide range of referral sources in the GP Toolkit, so practitioners can guide women to appropriate support centres – refuges; counselling and or access to legal services, should patients need to take action to get a protective order from the court. In the video, Ms Campbell explains the importance of taking detailed notes during consultations with women experiencing domestic violence. “There are ways the legal system will respond to or compensate her for injuries. And in those circumstances, the doctor’s notes may be a very important part in helping that woman get the protection she needs from the legal system. Make sure the notes are signed and dated. They need to state the facts, rather than providing general opinions. Instead of putting, ‘my patient seemed distressed,’ you need to be able to say, ‘my patient was shaking, she was crying, she had difficulty speaking about the situation she was in.” And in cases where the children of the relationship are experiencing violence, doctors have a duty to report to Child Protection Services. “Doctors are mandatory reporters when it comes to the protection of children. “However, there is no obligation to disclose a confidence where there is an adult woman who is experiencing abuse in her home. Those decisions are a matter for that woman to make for herself,” Ms Campbell said. dr. For more information about the GP Toolkit, or to view the video go to itstimetotalk.net.au or vimeo.com/ amansw Save the date AMA (NSW) Charitable Foundation Gala Dinner The 11th annual AMA (NSW) Charitable Foundation Gala Dinner will be held Friday, 23 October 2015. The special guest speaker will be Rosie Batty, family violence campaigner and Australian of the Year 2015. This year’s event will support the Luke Batty Foundation, which was established in February 2014 after Luke Batty was killed by his father at cricket practice in Tyabb, Victoria. www.amansw.com.au I 19 Dr Fred Betros, AMA President Dr Saxon Smith and Dr Kean-Seng Lim face the media Feature Winning the election While candidates fought to win their seats in the NSW State Election, it looks like the real winners were the AMA (NSW)’s priorities for health. The ballots have been counted and despite a state-wide swing of more than 9 per cent toward Labor, the Coalition has retained government with a strong margin. In the lead-up to the election, AMA (NSW) lobbied both the Coalition and Labor parties – meeting with key people including the Health Minister, Shadow Health Minister, the Premier, and associated personnel from their offices. In addition, AMA (NSW) organised a series of meetings between grassroots AMA members and their local politicians (both MPs and candidates). AMA (NSW) outlined its key goals in the AMA (NSW) 2015 State Election Priorities for Health. The policy papers focused on eight specific areas: Increasing GP involvement in the public health system; Improving the health of rural and regional communities in NSW; Improving access to health services; Improving end of life care; Improving health funding certainty; Improving health outcomes through public health initiatives; Providing world-class medical education and training; and Increasing the involvement of medical practitioners in decision-making. NEW TRAINING PLACES The first of the AMA (NSW) priorities for health, Improving the Health of Rural and Regional Communities in NSW, was launched in Dubbo. AMA (NSW) President, Dr Saxon Smith, visited Dubbo Base Hospital to meet with local doctors and media to highlight the goals outlined in the policy paper. He called for funding of $30 million over four years to boost doctor numbers in rural and regional NSW. “Forty per cent of the NSW population lives outside of Sydney and it is well known that patients from rural and regional areas face higher costs and longer travel times to access medical care,” Dr Smith said. “Medical graduate numbers have doubled in the last five years as part of a plan to address the severe medical workforce shortages in NSW and Australia. “We must not waste this once-ina-lifetime opportunity to provide an 20 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 adequate medical workforce in regional NSW,” he added. Shortly after, the Coalition government announced its plan to base 60 new registrar positions in outer metropolitan and regional hospitals. “Given time, this will help solve the doctor shortage being experienced in country NSW,” Dr Smith said in response. In the lead-up to the election, the Coalition made several other promises that were closely aligned with AMA (NSW) priorities. Key pledges included: • Nearly $1 billion for upgrades to Westmead Hospital, this was in addition to several multimillion dollar promises for other hospital upgrades around the state • Funding for 700 new doctors • Prior to the election, AMA (NSW), ASMOF and Health Minister Jillian Skinner signed a memorandum of understanding making feedback from senior doctors an important part of hospital managers’ annual reviews Dr Colin McClintock, Dr Randall Greenberg, AMA President Dr Saxon Smith and Dr James Yeung at Dubbo Base Hospital In the lead-up to the election, the Coalition pledged nearly $1 billion for upgrades to Westmead Hospital. • Funding the Foetal Alcohol Spectrum Disorder Clinic at Westmead Hospital, taking over from the pilot program FARE started • Removing the co-payment on chemotherapy for public patients, as well as other drugs for conditions such as HIV, Alzheimer’s, Crohn’s disease, ulcerative colitis, cystic fibrosis, psoriatic and rheumatoid arthritis, severe allergic asthma and rare diseases • The Coalition pledged not to introduce nurse-led walk-in clinics co-located at hospitals • Five paediatric surgeon positions for the Children’s Hospital Network and a commitment to improve paediatric services in NSW While the Coalition won the election, it should be noted that by election day, Labor was also pledging nearly the same amount of money as the Coalition for Westmead upgrades, it also pledged to remove co-payments for chemotherapy, and had promised significant spends on hospital infrastructure. dr. Jillian Skinner has been reappointed as Health Minister Going forward Shortly after the election Premier Mike Baird announced his cabinet. Significantly, Jillian Skinner will retain the Health portfolio. “AMA (NSW) has a good working relationship with the Minister and I look forward to continuing to work with her towards better health outcomes for people in the state,” Dr Smith said. He added, “AMA (NSW) welcomes the news Pru Goward has taken over the mental health portfolio. “This also presents a good chance to improve the health of people in NSW. “A new minister will bring a fresh perspective and I will be happy to work with Ms Goward on improving mental health services, particularly those in the public sector,” Dr Smith said. “It’s especially pleasing that Ms Goward has been named the Minister for Prevention of Domestic Violence and Sexual Assault. “Domestic violence is a problem that crosses many jurisdictions – health, law and order, and community services to name a few – and I’m glad the Government appears to be making this a priority. “I look forward to discussing with the Minister the role doctors can play in helping to fight this scourge,” Dr Smith said. AMA (NSW) looks forward to continuing to advocate on behalf of a better health system for doctors and patients in 2015. Feature Sexual harassment and the medical profession by AMA President A/Prof Brian Owler This opinion piece was first published in The Age, The Sydney Morning Herald and The Canberra Times on 25 March, 2015 As President of the AMA, I am proud of Australia’s medical profession and those within it who provide such high quality care to the Australian community. It is challenging to hear assertions that members of our profession act in a way that is unacceptable, particularly when it comes to sexual harassment. As the former Victorian Police Commissioner, Ken Lay, recently wrote, it is easy for an organisation or profession to become defensive when faced with such an issue. I can understand that many members of the profession who have acted faithfully as mentors for young men and women in their early careers feel affronted by the accusations that sexual harassment is rife. When these accusations were raised, I had a similar reaction. But in response I wrote to all AMA members about the issue and asked for their feedback. Our State and Territory AMAs have also sought to gain information by surveying our members. I don’t know whether sexual harassment, bullying, or other unacceptable behaviours are ‘rife’. What I do know from the feedback, independent of the recent media, is that it exists and this is unacceptable. As AMA President, I have undertaken to address this issue. It does matter how frequently this occurs, and at what level. However, the threshold for deciding whether to act on it is not the frequency, but whether it exists at all. Other professions face similar problems. As for the medical profession, we should set the example. We should be the benchmark. 22 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Unlike local health services or the medical Colleges, the AMA is not an employer, and we have minimal punitive measures that we can enforce. However, the AMA is unique in covering the breadth of the profession, and has a leadership role. The Federal AMA’s mission statement is to ‘Lead Australia’s doctors and promote Australia’s health’. Therefore, we are in a unique position to address these and other issues. Last week, I called a number of College Presidents and asked them to attend a meeting in Canberra to address the issue of sexual harassment in the medical profession. The AMA Federal Council supported my proposal to host a Roundtable, which was held in Canberra to address this topic. No one should expect that one meeting will ‘fix’ this issue. Rather, I hope that the meeting is an opportunity for the medical profession to map an agenda for work in three main areas. The first is to ensure that we have the procedures and policies in place through the Colleges, and also in the workplaces. For many trainees, the Colleges are a major focus. But it must be remembered that we have prevocational doctors whose only relationship is through their employer, which is the relevant jurisdiction’s department of health via their local health district. For others, the employer may be a corporate body, such as the case with salaried general practitioners. All of these groups must have the proper policies in place. The second, and more difficult, area is that of protection and security in accessing appropriate reporting procedures. While I continue to disagree with the assertion that doctors should keep quiet about sexual harassment for fear of jeopardising their careers, we need to ensure that doctors, at any stage of their career, can lodge a complaint without fear of reprisal or discrimination. We will only successfully tackle this issue if we provide such protection. The AMA and others need to ensure a safe environment for victims to speak out. Finally, we need to change the culture within the profession. The surgeons have been singled out, but the feedback that I have received indicates that the issue is much more widespread. Much of the problem is what could be described as more insidious and lower level, but just as destructive. Negative comments and putdowns can be devastating to the growth of a young person’s career even though they may not reach the threshold for that person to lodge a complaint. I remember two distinct ‘pearls’ from my days as a medical student and intern. The first was sitting in a microbiology lab at the University of Sydney when Professor Yvonne Cossart pointed to Royal Prince Alfred Hospital and said ‘those guys are really mean to each other when it comes to politics, but when one of them is in trouble they will do everything they can to help’. She had a lot of respect for ‘them’. The second was when Professor Chris O’Brien said to me that ‘we are all colleagues; we may have different seniority, but we are all members of the profession’. They may have both passed on, but I remember those words like yesterday. To me, their words embody a sense of what it means to be part of the medical profession and, indeed, explain a good deal of my motivation to be AMA President. It is about being part of the ideal that puts the care of others as the pinnacle of a career in medicine. As medical professionals, we may be competitive, but my colleagues - who make sacrifices to care for others are deserving of my care too. To me, the fact that sexual harassment exists is unacceptable. I have spoken to others, such as General David Morrison and former Commissioner Ken Lay, who have dealt with similar issues. Our issues and roles are somewhat different, but our resolve is not. The medical profession must set the benchmark. However uncomfortable it is, we must look at our behaviours and pull up the behaviours of others. The AMA is taking this issue seriously. If we cannot look after our own in the medical profession, then how are we able to look after the Australian public? dr. Professional Professional Transcription Transcription Solutions Ltd Solutions Pty Pty Ltd Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider Web-based - Dictate and receive reports from anywhere Double-edited with over 99.5% accuracy Fast Turnaround within 24 - 48 hours, as required All medical and surgical specialities covered in Australia’s largest teaching hospitals Rapid documentation of recorded HR interviews, Research and Expert Reports Guaranteed cost savings Data held securely at a State Government Cultural change A cultural change is needed within the medical industry to wipe out sexual harassment, agreed members of a medical roundtable meeting in April. The meeting, which was attended by more than 40 industry leaders and convened by Federal AMA discussed the need to protect whistleblowers within the medical industry. “Apart from the stigma and shame that those making the complaint may feel, there is concern about the repercussions that may follow such a complaint,” said A/Prof Brian Owler. “This must change. We need safe environments that all members of the profession can access to discuss their concerns about the behaviour of colleagues and be able to voice complaints without fear of recrimination. This needs to be followed up by action, with due process, and protection of the complainant.” The round table meeting took place in response to widespread accusations in the media that sexual harassment in the medical community is prevalent. The media storm was sparked by senior surgeon Dr Gabrielle McMullin, who suggested to women entering medicine that “complying with requests” accredited data centre for sex from male colleagues is a safer option than reporting the harassment. Her comments have since provided a springboard for discussion. Commenting to The NSW Doctor, Dr McMullin said, “I was astounded by the response to my comments about sexual harassment and had no idea how widespread it was.” She added, “I am amazed that the medical community and in particular the College of Surgeons has reacted so strongly, which indicates what an enormous problem they have been presented with. “I am very pleased with how much action has occurred and it seems sincere. The issue is an enormously difficult one to manage however and I have no illusions about that. There are many different dimensions to the problem. One of the major issues is producing a process that victims trust so that they will report incidents and then there needs to be a process to deal with the abusers. “We need more women at the highest levels and quotas may have to be considered to achieve this.” Free PTS IPHONE/Android App to dictate and securely upload to our server Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements Call us now for a free no obligation trial Free Olympus voice recorder for AMA (NSW) Members (Conditions Apply) Contact us now: 1300 768 476 Email : [email protected] Web : www.etranscriptions.com.au www.amansw.com.au I 23 Medico-Legal Director, Medico-Legal and Employment Relations – Andrew Took Senior Legal Advisor Rebecca Haynes Policy and Legal Advisor Andrew Campbell Policy and Legal Advisor Ivy Tseng Changes to the international criminal history check for AHPRA First announced last November, the National Boards and the Australian Health Practitioner Regulation Agency (AHPRA) have implemented a new procedure for checking the international criminal history of medical practitioners, as of 4 February 2015. This new approach requires certain applicants and practitioners to apply for an international criminal history check (ICHC) from an AHPRA approved vendor, which is Fit2Work. Practitioners must apply and pay for the ICHC from Fit2Work before submitting their AHPRA registration application. You will be given an ICHC reference page and check reference number which will need to be included in your AHPRA registration application. Once the results are available, Fit2Work will notify both you and AHPRA as well as send the results directly to AHPRA. People who will be affected by these changes to the international criminal history checks are: •N ew applicants who have declared a criminal history outside of Australia and/ or have lived in one or more countries other than Australia for six consecutive months or more since the age of 18; •R egistered practitioners who are seeking to renew their registration if: o there has been a change to their criminal history in one or more countries other than Australia since they last declared to AHPRA, or oa t any time of the year have informed the relevant National Board that they have been charged with an offence outside Australia that is punishable by a sentence of imprisonment of 12 months or more, or oh ave been convicted of, pleaded guilty to or are subject to a finding of guilt by a court for an offence, outside Australia, that is punishable by imprisonment; • Practitioners who are registered under Trans-Tasman Mutual Recognition (TTMR) from 4 February 2015 who declare a criminal history outside of Australia and/or have lived, or been primarily based in one or more countries other than Australia for six months or longer, when aged 18 years or more. There are no changes to the existing domestic criminal checks. For more information and a link to Fit2Work, you can visit the AHPRA website. For any other registration enquiries, please contact AHPRA on 1300 419 495. dr. Policy and Legal Advisor Sarah Connor Policy and Legal Advisor Katie Pearce Solicitor Kym Gardner 24 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Paralegal Officer Eden Weller ACCC focus on medical practitioners and the health sector The Australian Competition and Consumer Commission (ACCC) has announced their new compliance and enforcement priorities for 2015, one of which includes competition and consumer issues within the health sector. Rod Sims, chairman of the ACCC, commented at the launch of the 2015 edition of the ACCC’s Compliance and Enforcement Policy in Sydney in February that competition and consumer issues in the medical and health sector needed to have increased attention. As a new priority area for the ACCC, Mr Sims highlighted that there were numerous issues of concern including: •A llegations about attempts to limit access to products, patients, procedures or facilities; •A nti-competitive conduct by medical professionals, especially in regional areas; and •A range of consumer issues including allegations of unconscionable conduct and misleading and deceptive conduct by medical professionals. The ACCC also commenced a review of the private health insurance industry that was focused on the adequacy and transparency of information about private health insurance. The ACCC has flagged the possibility of a review of the health sector as well. The aim of the ACCC is to increase awareness both within the medical profession and the broader health industry about the rights and obligations of both consumers and businesses under the law. To read the media release on the ACCC’s announcement of new priority areas for 2015, as well as the full speech given by Mr Sims and the 2015 Compliance and Enforcement Policy go to www.accc.gov.au dr. Candid camera – can you provide evidence in court by video-conferencing? We receive many calls from members who have been subpoenaed to appear as a witness in court. Occasionally the subpoena requires that the doctor give evidence at a time when the doctor will be interstate or overseas. Once you have been served with a subpoena to attend court and give evidence, one of the options you can request if you will not be within the jurisdiction at the time of the trial is to ask the party who has issued the subpoena to seek orders from the court to allow you to give evidence by telephone or audiovisual link. NSW Courts have “a broad discretionary power to make orders for the taking of evidence by audiovisual link”, which is subject to the Uniform Civil Procedure Rules 2005 (NSW) (“the UCPR”). Rule 31.3 of the UCPR provides that “if the court so orders, evidence and submissions may be received by telephone, video link or other form of communication.” The Evidence (Audio and Audio Visual Links) Act 1998 (NSW) (“the Act”) allows the NSW Court to direct a person to give evidence to the court by audio link or audio visual link from any place (other than the actual courtroom or wherever the court is sitting) in or outside of Australia. Section 5B (2) of the Act also outlines situations where a direction to provide evidence by audio or audio visual link should not be made, including if the facilities are unavailable, or the evidence can more conveniently be given at the courtroom. If there is any objection to the court making a direction to use audio link or audio visual link, the court must not make the direction unless the party making the application satisfies the court that it is in the interests of the administration of justice for the court to do so. Factors that will influence the court in deciding whether to approve a witness to give evidence by audio visual link include: whether the evidence is centrally important, whether adequate facilities are available, the presence of technological difficulties, and the length of time required for cross-examination. Ultimately a court must decide whether allowing a witness to give evidence by audio visual link would be practical and fair. If you find yourself in a situation where you have been served with a valid subpoena to give evidence and at a time when you will be interstate or overseas please contact the Medico-Legal team at AMA (NSW) for advice. dr. www.amansw.com.au I 25 Medico-Legal Industrial Services in action The following case studies highlight how AMA (NSW)’s Medico-Legal and Employment Relations team assists members. Case study 1 | Individual Flexibility Arrangements Dr X runs a private medical practice. One year ago he employed a medical receptionist (Ms Y). When Ms Y agreed to start work at the practice, she and Dr X arranged for an above award pay rate in lieu of overtime and penalty rates. There was also an agreement she would receive three weeks annual leave instead of four. Ms Y would take leave without pay when the practice closed at Christmas. About one year into the role Ms Y resigned and asked to be paid out the extra annual leave and overtime. Dr X then contacted the AMA for help. Firstly, we looked at whether the agreement he had with Ms Y was what is referred to as an Individual Flexibility Arrangement (IFA) in the Fair Work Act 2009, the Health Professionals Support Services Award 2010 and the Nurses Award 2010. Secondly, we considered whether the arrangement was properly made and enforceable. What is an IFA? An IFA is an agreement to vary a term or terms of an award or enterprise agreement to suit the genuine needs of an employer and their individual employee. Only certain terms can be varied. Under Section 7 of the Health Professionals and Support Services Award 2010 and the Nurses Award 2010 these are: •A rrangements for when work is performed, such as working hours • Overtime rates • Penalty rates • Allowances, and • Leave loading Typical agreements include above award salaries in lieu of annual leave loading or flexible working arrangements where parents start and finish early to collect children from childcare or school. What are the employer’s obligations? The employer has a responsibility to ensure that the employee is better off overall than if there was no IFA. The employer’s ‘better off overall’ assessment will usually involve comparing the employee’s financial benefits under the IFA with the financial benefits under the award. The employee’s personal circumstances and any nonfinancial benefits which are significant to the employee can also be considered. An IFA must be in writing and signed by the employer and the employee. If 26 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 the employee is under 18 years of age, it must also be signed by the employee’s parent or guardian. Once an IFA has been made, the employer must ensure that a copy of the IFA is given to the employee. The employer should also retain a copy. Can an IFA be signed at the same time as an employment contract? No, an IFA can only be made after the employee has commenced employment and is entitled to the minimum award conditions prescribed by their award. This means an employer cannot ask a prospective employee to agree to an IFA as a condition of employment. How is an IFA terminated? The IFA should include information about termination. Generally, an IFA may be terminated by agreement or by either party giving the required notice. The Health Professionals and Support Services Award 2010 and the Nurses Award 2010 require 13 weeks’ notice. IFAs made prior to 4 December 2013 require 28 days’ notice. What happened to Dr X? Dr X’s agreement with Ms Y was probably not an IFA as it was not in writing and was made prior to employment. Further, it attempted to vary annual leave, which is a minimum entitlement under the National Employment Standards. To prevent the matter escalating, we assisted Dr X to negotiate with Ms Y an informal resolution. Dr X and Ms Y were finally able to part ways on amicable terms. Help! What should I do if I want to have an IFA? If you are thinking of having an IFA with either a prospective or existing employee contact the AMA Medico-Legal Division on 9439 8822 for advice. We can help you negotiate an arrangement that complies with the awards and legislation. We can also help to formalise this in a written agreement, using one of our many employment law templates. Case Study 2 | VMoney issue A VMO member, Dr A, telephoned us at AMA (NSW) because her payment claims were consistently being processed late, or in some cases not at all. Dr A was quite inconvenienced by the late payments, as she had mortgage payments and other financial commitments which depended on the prompt payment of her payment claims. Dr A sought our assistance with recovering her unpaid claims, as well as seeking to ensure that future claims would be paid on time. We asked Dr A a number of follow up questions to establish the background circumstances, as well as for her to forward us copies of the outstanding payment claims. Action taken Under the VMO Determinations, the Public Health Organisation (PHO) is required to make payment to a VMO within 30 days of the receipt of a valid payment claim. As this had not been occurring, we made contact with the appropriate VMO processing centre to determine where the problem was occurring. In this particular case, it became apparent that Dr A’s PHO had inadvertently not been forwarding her payment claims to the processing centre for payment. In light of this information, we then made contact directly with the PHO to discuss Dr A’s issue. Result As a result of our discussions with the PHO, all outstanding VMO claims were settled promptly. All subsequent payment claims to date have been paid within the stipulated 30 day period. It is also of interest to note that, under the VMO determinations, payment claims that remain unpaid after 45 days of receipt begin to accrue interest (the applicable rate at the time was 6.5% p.a.). The PHO was happy to make the payment which helped to compensate Dr A for the inconvenience caused. Follow up With the introduction of the online payment claiming system “VMoney” across most PHOs in NSW, some of the issues with the paper based system may disappear, and we anticipate that new issues and challenges may arise. AMA (NSW) is currently consulting with a number of different stakeholders to assess the success of the new electronic system. We welcome any and all feedback from VMO members. Please contact the AMA NSW Medico-legal and Employment Relations team at 02 9439 8822 or [email protected] to discuss VMO payments or any other VMO matters. dr. THE BMW END OF FINANCIAL YEAR SALES EVENT. GET THE CONVERSATION STARTED WITH BMW ADVANTAGE. 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Terms, conditions, exclusions and other limitations apply, and can be viewed at bmw.com.au/advantage Feature Giving children a chance Prof Robert Booy is conducting life-saving research in Tanzania to determine whether vaccination can prevent children with HIV/AIDS from catching pneumonia. One experience during Prof Robert Booy’s last trip to Tanzania in 2014 painfully underscored the importance of his research. He was on his first paediatric ward round, when he was urgently called to a fly-ridden room with few beds and even less medical equipment. “I didn’t even realise it was the intensive care ward – it looked like a kitchen,” he recalled. A 14-year-old girl, called Anna, was lying unconscious and unresponsive, with a blank stare in her eyes and making deep respirations. Prof Booy wasn’t the treating doctor, but he watched as the other medical professionals gave her sugar water through a drip. He described the plastic dextrose bottle as leaking from multiple punctures and ants circling inside the surface. The team turned the girl on her side to perform a lumbar puncture and within seconds she died. “The lumbar puncture released pressure and caused her brain to cone … I watched over the course of two or three minutes minimal efforts being made in the so-called intensive care ward, as doctors performed a lumbar puncture – which actually killed her.” Prof Booy took the fluid from the spinal tap to the laboratory and looked at it under the microscope. “It was pneumococcus – so the very thing we wanted to prevent, someone had just died from in front of my eyes.” Since 2009, Prof Booy has been conducting research on whether vaccines to prevent pneumonia, which are readily available in first world countries, are effective at preventing children with HIV/AIDS from catching the germs that cause pneumonia from colonising in their throats. 28 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 “There’s no intensive care unit for looking after these kids so prevention is so much more important. Once they get sick, it’s very difficult to stop them from dying,” he said. Pneumococcal colonisation of the nasopharynx is especially common in young children and is a pre-requisite for pneumococcal disease. Those with immunosuppression, such as HIV, are at higher risk of colonisation and disease, especially at older ages. Currently, vaccination schedules are only offered to children less than six months of age, despite the large impact of pneumococcal disease in older unvaccinated children with HIV. Prof Booy conducted a study to assess the prevalence of, and risk factors for, pneumococcal carriage in HIV-positive children aged less than 15 years. He found the overall carriage rate was 81% and was at least 76% in those aged Prof Robert Booy with members of his research team in Tanzania Tanzanian women with multicoloured kanga in front of the hospital 5 to 14 years. The results also indicated weight gain (due to an increase in health as a result of antiviral drugs) and exposure to caregivers with respiratory symptoms as being risk factors for pneumococcal carriage. His latest research, which is currently being analysed and the results of which will be finalised in the next month, addressed whether vaccination can prevent the acquisition of carriage and so protect against the disease. Prof Booy first became interested in infectious diseases when he was a medical student more than 30 years ago, when AIDS started to become more prevalent. Ten years on from that, he was working in London’s St Mary’s Hospital with children who had HIV, many of whom came from Africa. It was there he saw the impact of pneumonia, which was really a death sentence for children with immunosuppression. He spent the next 10 years trying to work out how to design his study on nasopharyngeal carriage of streptococcus pneumoniae and eventually set up a research study with HIV/AIDS orphans in Kenya. Unfortunately, civil unrest in Kenya in 2007 shut down the research pilot and he was forced to start again in Tanzania in 2008/09, with the help of Dr Geofrey Makenga and Dr George Mtove. Prof Booy described the many challenges he faced over the last decade as being extremely frustrating and laborious. “Every country has its own bureaucracy. To get through all the red tape and the paperwork – both locally and internationally – as well as getting the financial assistance to run the project took several years to make it happen.” Prof Booy added, “Before the dawn came the extreme darkness and I wrote a poem about how difficult it was to get the project started. I literally had no water and no power and was dealing with a very Harunor, a Tanzanian farmer with polio Prof Robert Booy with Dr Geofrey Makenga slow bureaucracy. And then there was the heat. But suddenly things came good and we got started.” Prof Booy worked with Joint Project Malaria in Tanzania and received grants and vaccines from Pfizer and Sanofi Pasteur, as well as some anonymous donations. As a result of Prof Booy’s research, 225 kids with HIV received vaccinations, who otherwise would not have. “We managed to get a supply to not only vaccinate the kids, but to show how effective the vaccines were at preventing children from catching these germs in their throat.” He added, “The next steps are to complete the analysis and if we do show the benefit we expect to, we will strongly recommend that the World Health Organisation provides recommendations and people on the ground to conduct catch up vaccinations for all children with HIV/AIDS from six months until 16 years old.” dr. www.amansw.com.au I 29 Feature Spiritual journey Doctors Padmini and Daya Howpage will trek Machu Picchu in May to raise money for cancer research in honour of their daughter, Sashie. 30 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Photo courtesy of Hill Shire Times One week before Dr Sashie’s Howpage’s 24th birthday she developed crippling chest pain that was so intense she collapsed. The irony of the situation was that she was working a night shift as a junior doctor and was too stressed to really think about the cause of the pain. According to her mother, Dr Padmini Howpage, Sashie dismissed her symptoms and to her family’s horror, she declared her intention to do the night shift the following day. “She felt strongly about not letting her colleagues and patients down,” Padmini explained. “As parents we were concerned, but she was an adult.” The next day, Sashie woke with terrible pain and decided to check the small, firm lymph node she had felt on her neck about a week previous to the pain. The radiographer who took her X-ray invited her to step in to the reporting room to have a look at the scans. She was alone. “The echoes of the telephone call my husband received still lives with us. She was crying loudly in the waiting room oblivious to the horrified patients looking at her: ‘Dad, it’s cancer. I know it is. I’ve seen this kind of chest x-ray before’.” CT scans later revealed parts of her lung collapsing under a mass. Sashie was diagnosed with Hodgkin’s Lymphoma in May 2012 and underwent radiotherapy and chemotherapy at Westmead Hospital Cancer Centre, where she had been placed as a medical student three years earlier. “Life changed forever for us,” Padmini said. “We met wonderful professionals and realised how amazing our friends and family are. We survived the storm. It’s such a cliché, but learning to enjoy what you have now is something our family is better at doing. We are happy, but isn’t that an irony that happiness becomes a relative term?” The portacath left Sashie with an obvious scar, in addition to the radiotherapy tattoo on her chest. “We like them,” Padmini said. “It’s confronting, but a lifelong reminder of all that it was.” Sashie is now one year into remission and is working as a doctor at Royal Prince Alfred Hospital. “There is something wonderful, something beautiful about realising how resilient, how strong and how brave your daughter is, and how her only brother Sajith did everything he could to keep his sister happy. For us, as parents, grief paved the way to hope and ability. As her parents it was an enormous relief to walk through a pathway with modern technology and advances in medicine. It eased our pain. Now we want to plant trees for others who would find themselves on a journey similar to ours. We want to raise funds for cancer research.” Climbing Machu Picchu is very special for Padmini and her husband Daya, as only four months prior to Sashie’s diagnosis she climbed to the heart of the Inca Empire, blissfully unaware of what was growing inside her. Padmini and Daya will complete the trek on Sashie’s 26th birthday. “Such a coincidence cannot be missed,” Padmini said. “It will be a spiritual journey through a very sacred area. I want to experience what she experienced three years before – standing in the ruins on her birthday with the first light of the day filtering through the mountain tops and wild horses running below. I want to reassure myself there is hope for Sashie and for all of us. I want the affirmation that life is very beautiful with my family.” dr. To donate to the Howpage’s trek, visit trektobeatcancer 2015.everydayhero. com/au/Padminisadventure. The Howpage family hopes to raise $10,000 by June. www.amansw.com.au I 31 Member profile Dr Breshna Zakarya Turning Young Afghan Australian Lives Around Dr Breshna Zakarya, Sebastian De Brennan and a small committee are working with young boys at risk of violence and extreme ideologies. Sebastian De Brennan Dr Breshna Zakarya is familiar with the impacts of immigration on diaspora communities. Born in Afghanistan, Dr Zakarya fled her homeland in 1982, crossing the border in Pakistan. “We were under extraordinary threat from the Soviet Union army as my father was a well-known figure,” she recalled. After spending several years as a refugee, she immigrated with her husband to Australia in 1986. Shortly after arriving, she learned English and then gained entry into medical school at the University of New South Wales. Dr Zakarya undertook further training at St Vincent’s Hospital, and now works in the emergency departments of Sydney Adventist Hospital, Norwest Private Hospital and Blue Mountains Hospital. But it was while Dr Zakarya was preparing for her emergency medicine primary exams that she was first exposed to the kinds of issues youth of migrant communities face. During this time, she started working in NSW Justice Health Clinics – a medical service for persons in custody. “I met many, many young individuals from the Middle East with great potential, but who got tangled up in the legal system for easily avoidable mistakes arising from social unawareness and failure in school.” This experience combined with her own journey as a migrant to Australia convinced her of the need to identify and engage with young people at risk through an education project and one-on-one mentoring. More than two years ago, Dr Zakarya teamed with Sebastian De Brennan, a criminal defence and human rights lawyer in Sydney to create TYAALA (Turning Young Afghan Australian Lives Around) to offer post crisis assistance to youth and their families in the form of rehabilitation, reintegration, education and employment. Mr De Brennan explained that he was motivated to help launch TYAALA as a result of his own experiences working with young men in custody. “I had a couple of extremely insightful but profoundly depressing moments at correctional centres with two young men of Middle Eastern heritage who had joined outlaw motorcycle gangs. During those discussions, the muscles and bravado momentarily went away and we had some really honest conversations. They spoke to the contradictions of the criminal enterprise, the fickle nature of brotherhood, the preying on religious factors and other influences and decisions that had led them astray. Both males said, ‘I wish I had my time again…I wish I could speak to some of the younger boys and tell them the truth about this life’. I thought wouldn’t it be great if these individuals were given the opportunity to tell their stories – if some of this could be imparted to younger generations? I spoke with Dr Zakarya and – as a direct consequence of her drive and energy – TYAALA was born.” The organisation works in three areas: prevention, crisis assistance and post crisis. Prevention involves identifying young people at risk, examining the risks they face, such as disenfranchisement and marginalisation from mainstream communities, and looking at means of intervention – for example, through education and mentoring. “The line between unpleasant social 32 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 behaviour and criminal behaviour is less understood in new arrivals with different ethnicity and religion,” Dr Zakarya said. “As well, acceptable social behaviour in Australia would be considered criminal back in their homelands. “I remember talking to a family which had a son in trouble. They blamed the authorities for criminalising Middle Eastern youth; and they labelled the mistake of the young man as ‘boys’ mischief’. I think addressing such issues by educating ethnic communities and building bridges between community and police will reduce the level of resentment among young Middle Eastern men.” TYAALA also provides crisis assistance through psychological support and counselling for families and those caught up in the criminal justice system, as well as educational assistance, legal assistance, and support programs. Their goal of post crisis intervention involves: rehabilitation, reintegration, education and employment. “We started our work with a small group from one community as a trial, and if the outcome is promising, we hope to expand and showcase the model to other communities,” Dr Zakarya explained. Several challenges face the TYAALA team, not the least of which is funding. At present, the organisation is completely funded by its members. Dr Zakarya said other challenges for exist as well – such as identifying kids in need of this program and finding an appropriate mentor for each child and family. For more information or to contribute to the organisation, visit www.tyaala.com dr. Experience something special on your next NEW CAR purchase. Save up to 10% on the RRP of most new cars. Avbs AustrAlAsiAn Call 1300 76 49 49 or visit www.avbs.com.au Personalised Service Impartial Advice Right Price No Stress AustrAlAsiAn VEHIclE BUYING SERVIcES Preferred provider This is an exclusive (free) member service and is available on all makes and models of new cars. AMAAVBS0001 Advertorial Evan Krawitz Business Insurance Adviser Experien General Insurance Services 1300 796 577 [email protected] www.experien.com.au Why you need to have a professional review of your medical indemnity insurance In the lead up to June 30, Evan Krawitz from Experien General Insurance Services explains the importance of Medical Malpractice Insurance, provides tips on ensuring you make certain disclosures to maximise you ability to claim on your medical indemnity insurance policy and shares valuable claims stories. As you know, Medical indemnity insurance (MII) is compulsory to have within Australia. Yet, few are advised on how best to set up their cover and many have gaps and other exposures. One large gap seems to be coverage for the legal entities that operate the medical practice, the beneficiaries of those entities, the liability of other staff and also the liability between multiple professionals working in one practice. A traditional MII policy works fine if there is a sole practitioner with no staff. But add in an assistant, add in a service company, or other staff, and cracks start to appear. What if an assistant loses a blood result? Suppose a patient is seen by one Doctor and then returns and is consulted by another Doctor, and a mishap happens along the way. Which Doctor is liable? Another exposure could arise if there are service companies or other various company structures with spouses and others involved as trustees, directors or shareholders. These individuals could be called to defend legal complaints brought against the practice for medical negligence claims. The question is, who covers them? Most of the scenarios mentioned above can be covered by an over-arching practice MII policy that supplements each Doctor’s individual MII cover. This is where a professional insurance adviser can help to identify the gaps and remedy with an appropriate solution. It is interesting to consider the following two case studies to highlight when practice MII cover would be essential: •F ailure to sterilise instruments correctly. An autoclave was filled but not turned on, following which a staff member failed to recognise that this was the case and removed the instruments which were re-used. Claims made by patients that may have been either infected or suffered mental anguish as a result of the testing process would be covered under a practice medical malpractice policy; •A nurse receptionist failed to advise a patient to go to an emergency department following description of symptoms by the patient’s wife, saying that there were no appointments available with the GP’s. The patient subsequently suffered a serious complication and a claim was made against the medical practice. 34 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Another issue we have seen as MII advisers is where Doctors incorrectly renew their MII cover and expose themselves by (innocently) incorrectly advising the insurer of their category of practice or their billings. This may leave them exposed to claims that may end up not being paid. The documents that are provided to assist with this are very lengthy and can be confusing. Appointing a professional adviser such as Experien to assist you through this process and ensure that you are getting the right cover at the right price can be invaluable. There are no obligations or additional costs in getting your cover reviewed and, whilst brokers represent you, their fees are generally paid by the insurers. Most Doctors will be renewing their MII cover in the coming month. We have seen healthy profit results in recent years from the insurers and we are hoping to see reductions in premiums for the policies which are coming up for renewal. If you are not seeing this then you may want to have your cover reviewed. Events Czech Mate The NSW Doctors Orchestra will be presenting music by Czech composers at their annual fundraising concert to be held Sunday, 24 May. Australia’s premier Quality Improvement Awards in Health Now Open! Australia’s premier quality improvement awards in the health sector – the Australian Council on Healthcare Standard’s Quality Improvement Awards 2015 are now open for entries. ACHS Chief Executive Officer Dr Christine Dennis, said that awards are an important focus in the Australian healthcare industry, promoting the development of excellence in achieving quality improvement. Travel down one of Bohemia’s greatest rivers with Smetana’s symphonic poem Die Moldau at this year’s annual fundraising concert performed by the NSW Doctors Orchestra. Presenting music by Czech composers including Dvorak, Janacek, Weinberger and Smetana, Czech Mate will also feature Dvorak’s Cello Concerto in B minor performed by one of Australia’s most accomplished cellists, David Pereira. The NSW Doctors Orchestra, also known as Musicus Medicus, is a talented orchestra of doctors and medical students who come together from both metropolitan and rural NSW and from across the medical disciplines to share a passion for music and to raise money for medical charities and young musicians. The orchestra, which includes 70 to 80 musicians is conducted by Dr David Banney, winner of the 1995 ABCWestfield Australian Young Conductor of the Year Award. This year, the NSW Doctors Orchestra is raising money in support of Perinatal Research and Maternal Medicine (PRaMM) at the Kolling Institute, Royal North Shore Hospital. The purpose of PRaMM is to find solutions to problems in pregnancy, improve the provision of maternity healthcare, and ensure a better start to life for all children. Funds raised from the concert also support the arts. The NSW Doctors Orchestra has an ongoing relationship with Sydney Eisteddfod, funding the NSW Doctors Orchestra Instrumental Scholarship for 16-25 year olds, worth $10,500 annually. This scholarship is a major highlight of the Sydney Eisteddfod program, attracting the finest talent from Australia. Since beginning in 2006, almost 350 aspiring instrumentalists have performed on its stages. This scholarship has contributed some $90,000 to the cultural capital of the nation by making it possible for nine outstanding young musicians to study abroad. In addition, the orchestra supports the Young Virtuosi Program run by Fine Music 102.5FM, funding the 3rd prize in the competition. dr. Czech Mate will be performed at 2.30pm on Sunday, 24 May at the Concourse Concert Hall in Chatswood. Tickets prices are as follows: Adults $45, Concession $35, Child $25 and Family $95. To book tickets, visit www. theconcourse.com.au or ticketek.com. au. Alternatively, you can purchase tickets at The Concourse Box Office, 9am to 6pm, Monday to Friday, (02) 8075 8100. “Each year the QI Awards provide a window into the strong, innovative thinking that is occurring across healthcare in Australia and overseas, as the Awards highlight the range of advancements taking place annually,” Dr Dennis said. Applications for the 2015 QI Awards are now open, and the closing date for entries is Friday 3 July, 2015 at 5.00pm AEST (GMT +10:00). “For the last few years the number of entries received has increased – with more than 100 entries received last year. Entering the 2015 QI Awards is an opportunity to be recognised by your peers, as well as being an ambassador for quality healthcare and celebrating your achievements,” she said. The three main entry categories are: • Clinical excellence and patient safety • Non-clinical service delivery • Healthcare measurement Applications are open to local, national or international ACHS member healthcare facilities and ACHS Clinical Indicator Program members. For further information about the Awards please contact Dr Mark Burgess, ACHS Project Officer on +61 (0)2 9281 9955 or email [email protected]. www.amansw.com.au I 35 Events High Tea camaraderie AMA (NSW) is pleased to report its Women in Medicine High Tea events held in Sydney and Newcastle were a resounding success. The NSW Doctor presents the highlights. The AMA (NSW)’s Women’s High Tea events, held 28 February in Sydney and 21 March in Newcastle proved to be excellent opportunities for women in medicine to network (as well as indulge in cake and champagne!). The Sydney event included guest speakers Dr Katie Ellard, A/Prof Susan Neuhaus and Anne Trimmer, who shared their vast experience and insight with attendees. Dr Amanda Badam attended the Sydney function with her sister Dr Caroline Badam, as well as her daughter, Clara Badam. “It was a pleasure meeting, networking and seeing so many impressive colleagues that make us so proud to be female doctors juggling life as well as work,” she commented. “It is very important for women working in medicine to network – to learn from each other, to be mentors and role models for the new generation of women in medicine, to empower and support each other and instil values of commitment and a sense of accomplishment that it has been done before and can be done, even better.” Dr Amanda Badam indicated the event was particularly inspiring for her daughter, who is a second year medical student. “For her it was an eye opener to be inspired and gain valuable insight from such role models.” Dr Caroline Badam commented, “it was very encouraging and invigorating to see that women can achieve, be successful and well rounded, secure and lead a balanced life and dictate the type of work they want to do rather than succumb to the pressures of the ever competitive world of medicine in hospitals and progress up the ranks of the academic realm to just fit in or prove themselves, which is looked upon very favourably albeit they fail themselves in other aspects of their personal life. “Also, it was very liberating to have a women’s only forum where matters that are essential for women in medicine are discussed without reservation.” Response to the Newcastle event was equally enthusiastic. Almost 30 women attended the event – topics of conversation ranged from how to achieve a work/life balance, to accusations in the media regarding sexual harassment in medicine. dr. Service beyond self A/Prof Susan Neuhaus and Sharon Mascall-Dare recount stories of women who served as doctors and medical specialists during wartime in their book Not For Glory. High Tea event speaker A/Prof Susan Neuhaus recently published a non-fiction book detailing inspirational stories of women in medicine who contributed to our nation in wartime. Dr Kerryn Phelps commented, “I thought I knew about the history of women in medicine until I read Not For Glory, the compelling stories of Australian women doctors who served our country on the battlefields of war. The battles faced by these remarkable pioneers were not just nation against nation. They also had to battle the dominant medical and military hierarchies of their time for professional recognition, respect and acceptance. Their inspirational stories exemplify the very best of feminist and humanist principles. 36 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Those of us who have had the privilege of being leaders in our profession owe so much to the medical women in our history who defied convention, forming the vanguard for those of us who followed.” Not for Glory can bought through ABC bookshops or ordered through Boolarong Press: http://www. boolarongpress.com.au. You can also get more information from the Facebook site: https://www. facebook.com/notforglory2014. dr. Golf events 2BBB runners-up Reuben Jackson and Gary North with Dr Robyn Napier AMA (NSW) Autumn Cup Despite the challenging weather, the AMA (NSW) Autumn Cup was a great success. For the superstitious among us, the date for the 2015 Autumn Cup – Friday 13 March – might have caused some concern. The venue, New South Wales Golf Club, certainly lived up to expectations. The course, one of the most picturesque in Australia, is also one of the most challenging and with rain threatening and a very brisk 30 knot south-easterly blowing it was apparent from the start that the scores would be less than spectacular. And so it was with only four players returning a score of 30 or more stableford points. Therefore, it was a magnificent effort by Alec Harris who won the Cup with 37 points. It is rumoured that his many supporters celebrated well into the weekend. The runner-up was Reuben Jackson with 31 points and third place went to Steve Nielsen with 30 points on a count-back. The 2BBB winners were Alec Harris and John Grey with 44 points and runners-up Reuben Jackson and Gary North with 41 points. The nearest the pins were won by Gary North and Ross Glasson. Well done to all for such a great effort on what was a very challenging day. A special welcome was extended to some first-timers including Ian Meakin and long-time players we hadn’t seen for some time, including Di Hart and Roger Scurr. Following the presentations, Dr Robyn Napier announced the destination for the 2015 AMA International Shield would be Miyazaki / Kobe, Japan. The full program is now available from Claudia Gillis in the AMA office, phone 9439 8822 or email [email protected] The day raised $500 for the AMA (NSW) Charitable Foundation and the Golf Society thanks the players for their generous contribution. The next event is the Presidents Cup to be held at Stonecutters Ridge on Wednesday, 15 July. In the meantime, good golfing to all our Golf Society members. If you are a golfer with a Golf Link number, why not join us on future events. We also welcome partners who are golfers. dr. Winner of Autumn Cup Alec Harris with Laurie Pincott AMA (NSW) Golf Society Events for 2015 Presidents Cup – Wednesday 15th July at Stonecutters Ridge -registrations now openSpring Cup / AMA (NSW) Charitable Foundation – Thursday 17th September at Terrey Hills Golf Club BMA Cup - Thursday 10th December at Concord International Shield – Japan, 7th October to 15th October -Bookings now open- ____________________________________________________________________ Registration Forms can be downloaded from our website: amansw.com.au/membership-benefits/member-activities-and-groups Or contact us directly: Contact AMA (NSW) Golf Society Co-ordinator: Claudia Gillis Phone: 9439 8822 email: [email protected] _____________________________________________________________________ 38 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 designed and built for life PREmIUm HOmES to create a home that matches your lifestyle and personality you need a company who understands that your home should be as unique as you are. 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On the national front, MWS NSW actively campaigned against the proposed GP co-payment. It was also a strong opponent of “Zoe’s Law,” which proposed “fetal personhood” for unborn foetuses less than 20 weeks gestation or at less than 400g. On the international stage, MWS NSW supported the NSW Doctors for the Environment Group and had a presence at the Global Climate Change Rally. They have also supported actions to fight the Ebola crisis. In addition, MWS NSW raised awareness of the closure of women’s refuges due to withdrawal of government funding; and the Bring Back Our Girls campaign, which was developed to draw attention to the kidnapping of more than 250 school girls who were abducted in Nigeria. The MWS NSW also passes on information to members about events that are relevant to medical women. In the past, this has included events run by the Royal Australasian College of Surgeons “Women in Medicine – The 21st Century Profession”, the Australasian Centre for Leadership for Women’s Sustaining Women’s Empowerment in Communities and Organisations Award, the Women’s Legal Service’s launch of their new GP Toolkit to work with victims of domestic violence and talks run by the Australian Human Rights Commission. Members receive their e-Newsletter, are invited to a networking dinner held bi-annually and are given the opportunity to be involved in our mentoring program. In the future, MWS NSW hopes to arrange workshops for medical women focusing on leadership and communication, preparing a CV, and developing financial management skills. To join this inspiring group of women simply • Download and complete the membership form at http://mwsnsw.wordpress.com/membership-information/ • Pay your annual fees ($125) • Send your email address to Wendi at [email protected] According to MWS NSW, involvement in the society’s activities can encourage medical women to recognise the importance of not only working as a good clinician for individual patients, but to also engage in creating a better community. Membership of the MWS NSW will closely link medical professionals to a group of women who can provide you with advice, encouragement and networking opportunities as you progress through your career. For more information phone 0411 22 82 32. dr. 40 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 MWS members at an open day promoting health equity MWS members volunteering with Rotary International in PNG MWS members engage in teaching and education of local health workers in order to ensure service delivery sustainability in PNG Dr Brindha Shivalingam is introduced as a guest speaker at the most recent MWS meeting Newest members of MWS for 2015 including international guests from China and Malaysia Did you know 83% of Australian’s say they have insurance for their car? Yet only 31% have income protection. For the equivalent of an average annual car insurance premium you can insure your cumulative loss of income to age 70 (in excess of $2,000,000).* Experien is the preferred life and general insurance provider to the AMA NSW and one of the few national brokers that specialise in the medical sector. Speak to Matt or Tracey for a complimentary consultation and review. P 1300 796 577 Life Insurance services are provided by Experien Insurance Services Pty Ltd ABN 99 128 678 937. Experien Insurance Services Pty Ltd is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367. General Insurance services are provided by Experien General Insurance Services Pty Ltd trading as Experien Insurance Services ABN 77 151 269 279 AFS Licence No. 430190. This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and obtain independent professional advice before acting on the information contained in this publication. *Based on an average annual car premium of $900.00. Comparison based exclusively on Male, non smoker, age 28, $5,500 monthly benefit and accurate as of 02/02/2015. Statistical source: lifewise.org.au E [email protected] Members A warm welcome to all of our new members this month. Get more from your membership today and utilise our medico-legal and industrial relations team for advice, our preferred partner advantages, member services and events throughout the year. To find out more phone our membership team on 02 9439 8822. Dr Adrian Buckley Dr Kirby Campbell-Wood Dr Benjamin Cheah Dr Martin Hong Dr Isabelle Kapterian Dr Johnny Siu Dr Shelley Stokes Dr Caroline Traill Dr Rebecca Lindsay Dr Nicola Mason Dr Lisa Raven Dr Muhamed Abdul Gafoor Dr Melissa Chin Dr Sukhi Hegde Dr Dumindu Katupitiya Dr Kata Kraljevic Dr Anthony Le Dr Joshua Rajaratnam Dr Mohammad Rehmanjan Dr Natasha Devitt Dr Susie Kwon Dr Georgina Learmonth Dr Linda Liu Dr Ji Hyun Moon Dr Bernard Myers Dr Jessica Rainert Dr Melinda Sirmais Dr Samuel Vo Dr Kellie Wallace Dr Karen Waller Dr Carmen Wong Dr Peter Xie Dr Lucinda Donlon Dr Therese Bewes Dr Megan MacLachlan Dr Emma O’Leary Dr Samuel Orton Dr Daniella Phillips Dr Amelia Street Dr Linda Tang Dr Kenneth Boldery Dr Charlotte East Dr Andrew McGregor Dr Scott Simpson Dr Sarah Andvik Dr Sonia Henry Dr Jonathan O’Donnell Dr Haylee Solomons Dr Natalia Zygocki Dr Vivek Ashoka Menon Dr Camilla King Dr Amanda Penberthy Dr Alexander Yuile Dr William Yates Dr Stuart Allison Dr Kate Anderson Dr Jennifer Brady Dr Jeremy Crawford Dr Alison Crofts Dr Emma De Tassanyi Dr Jane Friedrich Dr Angela Gates Dr Kristen Haeney Dr Stephen Henry Dr Linh Luft Dr Dorothy MacLeod Dr Keshia Nagra Dr Elizabeth Northcott Dr Leesa Osborne Dr Elyce Rossiter Dr Michael Russell Dr Saipriyadharshan Ruthirakumar Dr Paul Stewart Dr Theresa Stockwell Dr Daniel Stone The AMA (NSW) offers condolences to family and friends of those AMA members who have recently passed away. Dr Allan Bryson Dr Thomas Claffey Dr Gordon Clowes Dr Keith Feller Dr Colin Friendship Dr Douglas Harbison Dr Karen Kirwan Dr Paul Knight Dr Thomson Leckie Dr Montague Lewis Dr Robert McInerney Dr Gisele Mouret Dr Henry Nathan Dr Theodora Pawloff Dr Charles Richards Dr Douglas Stuckey Dr Richard Wingate Dr Gerald Wong Dr William Woods Classifieds Consulting Rooms Full/Part time – Auburn, NSW Medical consulting/Treatment suites available - Pyrmont NSW BURWOOD SPECIALIST CENTRE – CONSULTING SUITES FOR LEASE • 3 designated consulting rooms available in converted free standing house. Brand new state of art medical and dental clinics with focus on cosmetic procedures. Modern suites in the heart of Burwood’s medical precinct: • Suites on a sessional basis. • Secure parking. • Full practice management services. • Meet/greet/billing patients. • Appointment booking. • Transcription/posting letters. • Filing/storage of patient records. • Home sleep study facility. • BAS statement preparation. • Private hospital billing. • Off Street Parking – Ground level Entrance (no stairs) • Large Waiting & Records Rooms • Practice Management & Reception Services available • Public & Separate Staff Toilets and Kitchen Facilities Please contact Vicki for more info: Ph: 02 9649 6488. Email: [email protected] Would suite cosmetic physician, GP with interest in cosmetic medicine, dermatologist or any specialist practitioner to match the profile of highly regarded cosmetic dentists. For more info email: [email protected] SOUTHERN SUN HEALTHCARE Join Australia’s fastest growing Skin Cancer Network! Full time/Part time GP’s with a special interest in skin cancer medicine required for our Skin Cancer clinics. Professional and supportive environment. Phone Kim on 0439 761 921 or email [email protected] for more information. 42 I THE NSW DOCTOR I NON-MEMBER ISSUE I MAY/JUNE 2015 Contact Raji on 0401 144 119 or email [email protected] Advertorial Owning your practice property through your SMSF Whether on the cusp of retirement or in the full swing of your medical career, owning your practice property through your SMSF may have savings and tax benefits. Australians have long understood the benefits of investing in property and for medical professionals at various life stages there are a range of reasons that it could make sense to buy your commercial premises. If you are one of the many doctors transitioning from practice to retirement, topping up your super to retire comfortably may be your first financial priority. This may be especially true for Baby Boomer doctors, who were working long before compulsory super was introduced. However, it can be very difficult to beef up your retirement savings when you are paying a hefty rent on your practice premises. We are seeing savvy medical professionals borrow through their SMSF to acquire a property in a way which utilises and grows super capital now. By using the current balance of your super as a loan deposit you can pay the rent of your tenancy which you would pay your landlord, to yourself. To take advantage of these many benefits, the ownership of the property and the loan need to be structured in the correct way. The details are quite complex but your adviser will be able to set up the trust that you will need to hold the property in your SMSF. As experts who understand your business, BOQ Specialist can help leverage more of your super capital. We could lend up to around 90% of the value of property that you are using for your professional rooms and up to 80% for other property, at a competitive interest rate. For early or mid-career doctors, having a secure tenancy is another very good reason for considering a practice property purchase if it is within your SMSF investment strategy. The certainty that you will not have to vacate your surgery unexpectedly, perhaps leaving tens of thousands of dollars’ worth of fit-out investment behind, allows you to do what you do with a sense of control and security. You also don’t want to make improvements on an asset you don’t own, nor do you want to slow your productivity or professional development with out-of-date technology and rooms. Owning your own premises through your SMSF could give you the confidence to invest in the expensive infrastructure and equipment that may help your practice to succeed well into the future. It could also ensure continuity for your patients, who we know take great comfort in your convenient and consistent location. Things to remember when considering borrowing through your SMSF: • It is important to have legal, tax and financial advice early in the process. • Ensure that the proposed property purchase fits in with the SMSF’s strategy. It will be necessary to provide a written copy of the strategy • Carefully consider the loan structure (e.g. fixed rate versus variable rate on the basis of the cashflows that are expected through the SMSF). • Make sure that you can manage your gearing level under the Superannuation Industry (Supervision) legislation. • Remember that SMSF contribution limits could change so you need some flexibility in your approach. • Choose your banker carefully. Refinances are possible, but can be very complex. Disclaimer | Financial products and services described in this document are provided by BOQ Specialist Bank Limited ABN 55 071 292 594 AFSL and Australian Credit Licence 234975 (BOQ Specialist). BOQ Specialist is a wholly owned subsidiary of Bank of Queensland Limited ABN 32 009 656 740 (BOQ). BOQ and BOQ Specialist are both authorised deposit-taking institutions in their own right. Neither BOQ nor BOQ Specialist guarantees or otherwise supports the obligations or performance of each other or of each other’s products BOQ Specialist is the credit provider. Terms and conditions, fees and charges and lending and eligibility criteria apply. We reserve the right to cease offering these products at any time without notice. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. Stafford Hamilton NSW State Manager +61 2 9293 2000 E: [email protected] www.boqspecialist.com.au www.amansw.com.au I 43 Membership has its rewards AMA (NSW) has the most comprehensive Medico-Legal and Employment Relations advice in Australia. are available for members for a nominal fee. In addition, below are a list of our member service partners to assist you whatever the need. Make your membership more rewarding everyday! AMA (NSW) Member Service Partners Membership has its rewards Cutcher & Neale AMA Auto Buying Service TressCox Lawyers AMA (NSW) has the most comprehensive Medico-Legal and Employment Relations advice in Australia. Expert legal advice for the medical A free service specialising in the Just some of the services that are and available advice andprofession. updates, court representation, Members are entitled toneeds! a Cutcher & Neale are the solution forofinclude all your accounting and financial Cutcher & Neale acquisition, funding disposal all of awards unique duty solicitor scheme mediation and humanmakes resource consulting. A comprehensive range of legal packages and draftoffering contracts and models of motor vehicles. one freemedical consultation (referral required). specialise in accounting, taxation and business advice for practitioners of all disciplines. are available for members for a nominal fee. In addition, below are a list of our member service partners Assign Medical to assist you whatever the need. Accountants/Tax Advisers Panel to source competent, AMA (NSW) has the Assists mostmembers comprehensive Medico-Legal and Employment Relations advice Australia. Experienced accounting firmsin who Some key services friendly and committed staff for your can updates, assist you with your personal and Just some of the services thatAMA are available include awards and court representation, (NSW) Member Serviceadvice Partners professional accounting and taxation • Developing appropriate structures business or practice. mediation and human resource consulting. A comprehensive range of legal packages and draft contracts needs. Select the firm most suitable for • Limiting exposure to Payroll Tax are available for members a nominal ofrequirements. our member your AMA Autofor Buying Servicefee. In addition, below are a list TressCox Lawyers service partners Commonwealth Bank Expert legal advice for the medical • Developing appropriate service arrangements to assist you whatever the need. A free service specialising in the Offering a special merchant facility at a Membership has its rewards acquisition, andmost disposal all low fee offunding 0.68% for creditofcards. makes and models of motor vehicles. AMA (NSW) Member Investec Experien Specialist finance to meet the personal Assign Medical AMA Auto Buying Service and practice needs of members. Finance AMA (NSW) Member Reward Card profession. Members are entitled to a • Developing tailored practice KPIs Significant savings every year with one free consultation (referral required). • Developing tax deductible debt reduction strategies tourist attractions. • Developing business premises acquisition strategies Accountants/Tax Advisers Panel TressCoxExpress Lawyers American Experienced accounting firms who Expert legal advice for the medical • Streamlining accounting and cashflow reporting Offering corporate affinity programs and can assist youMembers with yourare personal and profession. entitled to a special discounts topackaging members for credit • Effective salary for key personnel professional accounting and taxation unique solicitor scheme offering cards andduty merchant facilities. needs. Select the firm most suitable forstrategies one free consultation (referral required). • Tax-effective superannuation your requirements. Auscellardoor AMA (NSW) Wine • Practice valuations – including Accountants/Tax Advisers Panel goodwill Society AMA (NSW) Member Reward Experienced firms whoCard Boutique winesaccounting at specially negotiated • Practice audits Significant savings every year with unique duty solicitor scheme offering Service Partners participating restaurants, hotels and Assists members to source competent, A solutions free service in the Established in 1953, Cutcher & specialising Neale’s practice requirements, friendly and for committed staffexpertise for your motor acquisition, funding and disposalproperty of all vehicles, commercial/residential is built on an intimatebusiness understanding or practice. of the makes and models of motor vehicles. and overdraft facilities. unique requirements of the medical profession Commonwealth Bank Assign Medical Gow-Gates acquired over almostOffering sixty years. a specialGroup merchant facility at a Assists members to source competent, Complete insurance and financial services low fee of 0.68% for most credit cards. friendly and committed for your with special packages staff for AMA members. can assist you with yourmonth. personal and prices for members every participating and professionalrestaurants, accountinghotels and taxation Servicesorinclude: Wealth Creation, Risk business practice. Investec Experien Call our Member Services team to find out more about having a FREE telephone or web-based tourist attractions. Caltex needs.StarCard Select the firm most suitable for Management, Doctors’ Practice Insurance Specialist finance to meet the personal Consolidate your vehicle fuel expenses your requirements. consultation with Cutcher & Neale and Superannuation. Commonwealth Bankon 02 9439 8822! American Express monthly statement and practice needs of members. Finance onto one easy-to-read Offering a special merchant facility at a Offering corporate affinity programs and with access to the following fuel solutions for practice requirements, motor AMA (NSW) Member Reward Card Medprac Super low fee of 0.68% for Fund most credit cards. special discounts to unleaded, members for credit discounts: 2.5cpl off 95 Significant savings every yearVortex with vehicles, commercial/residential property The perfect super fund for doctors, cards and and merchant and Diesel 1.5cplfacilities. off Vortex 98.and participating restaurants, hotels MEDPRAC andwith overdraft facilities. no entry fees. Have the option of SUPERANNUATION Investec Experien tourist attractions. managing your fund using a range of Auscellardoor AMA (NSW) Wine Hertz Specialist finance to meet the personal Gow-Gates Group As the official car rental partner for AMA, investment Society American Express and practice managers. needs of members. Finance American Express |and Corporate Complete insurance and financial services Hertz offers discounted rates negotiated a range affinity programs and discounts on Boutique wines at specially Offering corporate affinity programs and Whichever card you choose you’ll solutions for practice requirements, motor BOQwith Specialist Bank Limited a range of six all unique credit cards. of member benefits year month. round. special packages Prosper Group for AMA members. prices fordiscounts members every special to members for credit BOQServices Specialist delivers distinctive vehicles, commercial/residential property enjoy the special benefits and extra value we’ve negotiated for you. include: Wealth Creation, Risk A property advisory (buyer’s agent) cards and merchant facilities. Qantas Club banking to niche market and solutions overdraft Doctors’ facilities. Caltex StarCard Management, Practice Insurance who can source, perform due diligence Discounted rates for AMA members. segments. Our focus, experience and Consolidate your vehicle fuel expenses Auscellardoor (NSW) Wine negotiate your home, investment andand Superannuation. Qantas Club | Discounted rates saves you hundreds of dollars on Save up to $365 onAMA membership. dedication to our clients Gow-Gates Grouphave enabled onto one easy-to-read monthly statement properties or commercial premises, Society Fees as follows: Joining $200; Joining fee withmembership. access to the following fuel $240, save $140; one year membership us to Complete become insurance experts inand a number financial services Boutique wines at years specially negotiated saving you time and money. One year $265; Two $465. Medprac Super Fund $390.60, save two year discounts: 2.5cpl off $119.30; unleaded, Vortex 95 membership $697.50, save $227.50. of professional niches. Weforaim to members. withperfect specialsuper packages AMA prices for members every month. Partner Joining Fee: $200, Partner 1 Year The fund for doctors, Partner rates (GST inclusive) and Diesel and 1.5cpl off Vortex 98. add value to and build partnerships MEDPRAC Services include: Wealth Creation, Risk Other benefits: with no entry fees. Have the option of SUPERANNUATION Membership Fee: $340, Partner 2 Year Membership Fee: $600. with our clients and we have been Caltex StarCard Management, Doctors’ Practice managing your fund using a rangeInsurance of Hertz AMA (NSW) hasautomatic theproviding most comprehensive Medico-Legal and Employment advice in Australia. Receive subscriptions to the following publications: Consolidate your Relations vehicle fuel expenses specialist banking in and Superannuation. As the official car rental partner for AMA, investment managers. Hertz | Hertz is the official car rental partner for the AMA offering ofAustralia Medical Services Fees Book onto one easy-to-read monthly statement forthat overand 20 years. Just somen nofAMA theListservices are available include awards advice and updates, court Hertz offers discounted rates and a range representation, with access to the following fuel AMA member services for the discount code. discounted rates. Contact n The NSW DoctorMedprac Super Fund of member benefits all year round. Prosper Group mediation nand human resource consulting. A comprehensive range of legal packages and draft contracts Introduce a new member to AMA (NSW) and receive discounts: 2.5cpl off unleaded, Vortex 95 super fund for doctors, n n The Medical Journal ofperfect Australia AThe property advisory (buyer’s agent) Experien Insurance Services a cheque equal to 25% of theand new1.5cpl member’s and Diesel off Vortex 98. MEDPRAC Qantas Club are available for members for afees. nominal fee. In addition, below areTressCox a list of our member service partners Lawyers | Expert legal advice and duty solicitor scheme withcan no entry Have the subscription via our Member Get Member nSUPERANNUATION n Australian Medicine who source, perform due diligence Specialist insurance advisers tooption the of Discounted rates AMA members. with one freeforconsultation (referral required). managing your fund usinginvestment a range Hertz program. There areSave no limits. to assist you whatever the need. and dental professions. Our of and negotiate your home, n n AMA up to $365 on membership. Actionmedical (e-newsletter) As the official car rental partner for AMA, investment service includes researching all the properties ormanagers. commercial premises, Fees as follows: Joining $200; Hertz offers discounted rates and a range majorsaving insurers find the right you to time andyou money. OneVirgin year $265; Two years $465. The Lounge | Significantly reduced rates with no of memberAustralia benefits all–year round. Prosper To take advantage of Group your benefits call AMA (NSW) Member Services on (02) 9439 8822 Preferred partners Member services Membership has its rewards 25% R E B AT E AMA level (NSW) policy with the appropriate of Member Service Partners joining fee and savings of $100 per year. Aatproperty advisory (buyer’s cover the best possible price.agent) areas) Other benefits: or 1800 813 423 (outside Metropolitan who include can source, due diligence Products Lifeperform Insurance, Receive automaticAMA subscriptions to the following publications: Auto Buying Service and negotiate your home, investment Income Protection, Medical Indemnity nn AMA List of Medical Services Fees Book premises, properties or commercial Insurance. Aand freeBusiness serviceand specialising in the saving you time and money. The NSW Doctor acquisition, funding and disposal of all n n The Medical Journal of Australia makes and models of motor vehicles. Other benefits: nn 25 25% R E B AT E Qantas Club 4www.nswama.com.au % R ETressCox B legal ATLawyers E for the medical Expert advice Discounted rates for AMA members. Save up to $365 on membership. AVBS | Independent, impartial advice on any make or model of Fees as follows: Joining $200; vehicle. Source at highly competitive One year $265; Twovehicles years $465. profession. Members are entitledprices. to a For greater savings Introduce a new member AMA (NSW) receive Programmes call the AMA (NSW)’s and to easy access to and the Corporate duty solicitor scheme offering a cheque equal to 25% of the unique new member’s corporate motor vehicle buying service AVBS on 1300 76 49 49. one Member free consultation (referral required). subscription via our Member Get n n Australian Medicine Advisers Receive automaticAccountants/Tax subscriptions to the following publications: program. There are no limits. n n AMA Action (e-newsletter) BMW Corporate Programme | Members can enjoy the benefits of Provide aMedical comprehensive range of Assign n n AMA List of Medical Services and Fees Book Accountants/Tax Advisers Panel this Programme which includes complimentary scheduled servicing personalmembers and professional accounting Assists to source competent, Experienced accounting firmson who n n The NSW Doctor for 4 years/60,000 km, preferential pricing selected vehicles and services. Introduce a new member to AMA (NSW) and receive To take advantage of your benefits AMA (NSW) Member Services on (02) 9439 8822 friendly and committed staff call for your can assist you with your personal and reduced delivery charges. n n The Medical Journal of Australia a cheque equal to 25% of thedealer new member’s or 1800 813business 423 (outside Metropolitan areas) or practice. n n Australian Medicine 4www.nswama.com.au accounting and taxation subscription via our Memberprofessional Get Member the firm most suitable for can enjoy the program. There are no limits.needs. Select Mercedes-Benz Corporate Programme | Members your A special merchant facility at low benefits of thisrequirements. Programme which includes complimentary scheduled Commonwealth Bank rates. AMA members pay no joining servicing for up to 3 years/75,000 km, preferential pricing on selected Offering a special merchant facility at a fee. New CBA merchant clients are vehicles and dealer delivery Also included is access To take advantage of your benefits call AMA (NSW) Member Services onreduced (02) 9439 8822 charges. AMA (NSW) Member Reward Card low fee to of60.68% credit cards. eligible monthsfor freemost terminal rental to complimentary pick-up and drop-off, access to a loan vehicle during Significant savings every year with or 1800 813 and 423a free (outside Metropolitan areas) business account when car servicing and up to 4restaurants, years of Mercedes-Benz participating hotels and Road Care nationthey sign upExperien their merchant facility with wide. www.mercedes-benz.com.au/corporate Investec tourist attractions. CBA and settle the funds to a CBA Specialist account. finance to meet the personal Call AMA (NSW) member services on 02 9439 8822 or email American Express and practice needs of members. Finance [email protected]. Visit our websites www.amansw.com.au www.ama.com.au Offering corporate affinity programs and solutions for practice requirements, motor nn Commonwealth Bank AMA Action (e-newsletter) 4www.nswama.com.au vehicles, commercial/residential property and overdraft facilities. Gow-Gates Group MEMBER 44 I THE NSW DOCTOR I NON-MEMBER ISSUE services I MAY/JUNE 2015 Complete insurance and financial with special packages for AMA members. Services include: Wealth Creation, Risk discounts to members Disclaimer:special AMA (NSW) may financially benefit fromfor its credit relationship with Preferred Partners. Please Products facilities. is not affiliated with AMA (NSW) or Federal cardsnote: andAMA merchant AMA. AMA Products is a separate business entity. Auscellardoor AMA (NSW) Wine Society Boutique wines at specially negotiated prices for members every month. Just someservices of the services that are available include awards advice and updates, court representation, Member mediation and human resource consulting. A comprehensive range of legal packages and draft contracts Take the stress out of buying a property. Not happy with your current Property Manager? How Prosper Group can help with your next property purchase Save time We do all the searching and evaluation for you, taking you straight to the short-list stage Access to unadvertised property As our client, you will have access to a broader range of properties including off market/silent listing properties Reduce stress and risk We will remove the stress of dealing with pushy agents. Each property we will short list for you must pass our rigorous due diligence process Professional advice and support We work for you and support you through every step of your purchase property management. “ Running a busy practice leaves me little time to look for property, I engaged Prosper Group to source and negotiate an investment property. They negotiated an outstanding deal for me – almost 19% off the purchase price.” - Dr. B Young We are extraordinarily satisfied with the service Prosper Group provided, and have no hesitation in recommending your service to our similarly time-poor colleagues and friends”. - Dr. J Le Prosper Group helped us through each step of the acquisition. They really take the hard work out of finding an investment property. - Dr. W Mitchell “ Save money As your independent property buyer’s agent, we will find your ideal property and then negotiate on your behalf 3 MONTHS FEE FREE* Are you thinking about buying a property? Call us now on 1300 664 373 to see how we can help you. For more information go to www.prospergroup.com.au/ amanswpropertybuyers Residential Buyers Agent Commercial Buyers Agent Residential Property Managers Commercial Property Managers *This offer is not available to certain suburbs Like fine wine, your SMSF should get better with age Investing in residential or commercial property within a SMSF can be quite complex. That’s where we can help. Our financial specialists have extensive experience in helping clients leverage their SMSF which means that, when the times right, you may be able to put your feet up and enjoy some of that fine wine. Visit us at boqspecialist.com.au/medical or speak to our local financial specialists on 02 9293 2000. Equipment and fit-out finance / Credit cards / Home loans / Commercial property finance / Car finance / Practice purchase loans SMSF lending and deposits / Transactional banking and overdrafts / Savings and deposits / Foreign exchange Financial products and services described in this document are provided by BOQ Specialist Bank Limited ABN 55 071 292 594 AFSL and Australian Credit Licence 234975 (BOQ Specialist). BOQ Specialist is a wholly owned subsidiary of Bank of Queensland Limited ABN 32 009 656 740 (BOQ). BOQ and BOQ Specialist are both authorised deposit-taking institutions in their own right. Neither BOQ nor BOQ Specialist guarantees or otherwise supports the obligations or performance of each other or of each other’s products. BOQ Specialist is the credit provider. Terms and conditions, fees and charges and lending and eligibility criteria apply. We reserve the right to cease offering these products at any time without notice. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. BOQS001163 01/15
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