AMA (NSW) non-member issue 2012 - Australian Medical ...

doctor
The official publication of the Australian Medical association (NSW)
the nsw
AMA (NSW) non-member issue 2012
Vol 4 - number 05 - June 2012
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
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THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
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THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
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A leap ahead for our
Doctors-in-Training
• Launching a Guide to NSW Health
• Meet your new Board
• AMA national conference round-up
Vol 3 - number 06 - July 2011
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AMA (NSW) campaigning
for public health and safety
Vol 3 - number 10 - November 2011
• Doctors for a Safe Pacific Highway campaign
• Continuing the fight for Doctors-in-Training
• Social impact bonds – human service funding model
NOMINATE NOW FOR THE NSW DOCTOR-IN-TRAINING AWARDS NIGHT ON 3 MARCH 2012
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Welcoming our new
medical interns across NSW
• The Dummies’ Guide to Activity Based Funding
• Orientation Week across the state
• AMA (NSW) gathers medical members of LHDs and
Chairs of MSCs to meet the Minister
Vol 4 - number 2 - March 2012
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Vol 4 - number 1 - February 2012
The fight to save rural practice
• Calling for urgent reforms to the ASGC-RA system
• Cuts to the Better Access Mental Health Program -
where to now
• Medical students and DITs go rural
• Increasing junior doctor representation in Local Health Districts
Doctors-in-Training Black & White Ball – Saturday, 3 March 2012
AMA (NSW) CHARITABLE FOUNDATION GALA DINNER, 21 OCTOBER 2011
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
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THE NSW
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
Charitable Foundation –
assisting cancer patients in NSW
• You told us: what you think of the AMA (NSW) –
member survey results
• “Every Australian Counts” – join the campaign for an NDIS
• Medical Association for Prevention of War –
A/Prof. Hadia Haikal-Mukhtar
Vol 3 - number 11 - December 2011 – January 2012
NOMINATE A COLLEAGUE NOW FOR THE NSW DOCTOR-IN-TRAINING AWARDS • NSW still up in smoke
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THE NSW
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Supporting our
experienced doctors...
Vol 3 - number 05 - August 2011
• Continuing Professional Education (CPE) seminar
• VMO contract negotiations
• Safe work hours survey: know the risks, so no risks
• Debt collection unmasked
AMA (NSW) CHARITABLE FOUNDATION GALA DINNER, 21 OCTOBER 2011
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Celebrating the best
of modern medicine
• Doctors-in-Training inaugural awards
• All the latest on national registration
• AMA (NSW) member referral bonus
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THE NSW
Vol 3 - number 05 - June 2011
winner
BEST PUBLICATION
2010 AMA
national awards
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THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
Doctors-in-Training
Black & White Ball....
Vol 4 - number 3 - April 2012
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Vol 4 - number 04 - May 2012
Demystifying Personally Controlled
Electronic Health Records (PCEHR)
• Medical registration – should you be registered
• Meet DIT of the Year, Dr Lisa Dark
• Obituary: Sir Keith Jones
• AMA (NSW) 50-year member lunch
doctor
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
Medical students...
the future is bright
Vol 3 - number 06 - September 2011
• More on Medicare Locals
• Wage cap implications for salaried and junior doctors
AMA (NSW) CHARITABLE FOUNDATION GALA DINNER, 21 OCTOBER 2011
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The many faces of the
AMA (NSW)... representing
all of the profession
• NSW Health - genuine reform
• The future of general practice
• National Disability Insurance Scheme
• A new relationship with ASMOF
• Our student councillors - where are they now
Membership of the AMA (NSW)...It’s worth it!
NON-MEMBER
ISSUE
FOR 2011
Vol 3 - number 09 - October 2011

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doctor
The official publication of the Australian Medical association (NSW)
the 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 enquiries@amansw.com.au
Website www.amansw.com.au
The NSW Doctor is the monthly publication
of the Australian Medical Association (NSW)
Limited and is published every month except
January.
Editor Narelle Schuh
Designer Nikki Zacharatos
Advertising enquiries Narelle Schuh
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.
Executive Officers 2011 - 2012
President Dr Michael Steiner
Vice President and Chair Ethics Committee
Dr Michael Gliksman
Chair of Council Dr Geoffrey White
Treasurer Dr Andrew Zuschmann
Chair Professional Issues Committee
Dr Saxon Smith
Chair Hospital Practice Committee
A/Prof. Brian Owler
Director Dr Kathryn Austin
Director Dr Pradnya Dugal
contents
features
6 Quality of general practice
10 Urgent reform to the ASGC-RA
12 4-hour rule – reasonable or flawed
14 The Dummies’ Guide to Activity Based Funding
18 New AMA (NSW) medico-legal team leader
22 Doctors-in-Training award winners
26 AMA (NSW) public health initiatives
31 2012 Medical Careers Expo
33 Medical Benevolent Association of NSW appeal
regulars
2 President’s word
3 From the CEO
3 AMA (NSW) in action
4 Medico-legal
9 To the editor
20 Federal AMA news
33 News
35 Advertorial – Investec
36 Events
38 Classifieds
39 Membership
6
12
26
Secretariat
Chief Executive Officer Fiona Davies
Medical Director Dr Robyn Napier
Director, Financial Services and Marketing
Mark Kelly
Director, Medico Legal and Employment
Relations Sarah Dahlenburg
Director, Policy and Communications
Sim Mead
22

President’s word
Farewell as AMA (NSW) President...
Dr Michael Steiner
President, AMA (NSW)
By the time you read this my term as
President of the AMA (NSW) will have
come to a close.
Much has been achieved in the last two
years, however I am concerned about
one particular program where we have
not yet been successful – the Last Drinks
Campaign. As many of you are aware the
AMA has been involved with the police,
nurses and others in a campaign to stop
new people entering a pub or club after
1.00am in an attempt to reduce the binge
drinking that occurs. A trial of this is
working successfully in Newcastle where
there has been a significant decrease
in alcohol-related violence. We at the
AMA (NSW) are not ‘wowsers’ but we
know that those of our colleagues who
work in emergency departments are all
too aware of the violence that occurs in
those who have drunk too much and keep
drinking until the early hours.
In the last three years in my own
practice I’ve seen three very sad cases
– one, a young lady who’d bumped into
another girl on the dancefloor at a club.
She was glassed and has ended up totally
losing the sight of one eye, her face is
scarred and her eye is not only blind
but quite uncomfortable and unsightly.
Another young lady was innocently
sitting at a table when a young man
and his girlfriend at another table had
an altercation. He threw a glass at his
girlfriend and it ended up hitting my
patient in one eye and she lost half the
sight of that eye. The third case was a
security man at a beachside hotel who
told a couple of young men they could
not enter because they were already
drunk. These brave heroes crept back
after a few minutes and king hit him from
the side. He’s been left with not just a
blind eye but brain damage and constant
orbital pain. He has ended up losing his
house, his wife and his family.
Those experts in the drug scene will
tell you that the drug that causes the
most family problems is alcohol. Of
course we don’t propose in any way the
idea of prohibition but if by stopping
the entrance of people to a pub or club
after 1.00am we can reduce these awful
incidents of alcohol-fuelled violence, then
we will have done well. Sadly, vested
interests in the industry seem to have
influence with all political parties and
the trial which has been so successful
in Newcastle has not been extended.
The coalition of which the AMA (NSW)
is a partner will continue the fight and
hopefully commonsense will prevail.
The two years of my presidency have
passed very enjoyably and very quickly.
Those of us who look after older patients
are often told that time passes more
quickly as they age. I explain it to them as
follows – we can only compare anything
to our total life experiences. If we think of
life as a page, the time for a three-yearold
waiting for their next birthday takes a
quarter of their page. For an 80-year-old
the column between years has become
quite narrow…and so on. Patients seem
to relate to this, however I think the
reason these two years have gone so
quickly is that they were so busy, with so
many issues and yet such fun!
I would like to thank you all for the
honour of being your President for the
last two years. I would particularly like
to thank my fellow members of Council
and the Board of the AMA (NSW), the
CEO, Fiona Davies, the AMA (NSW) staff
and the oh-so-patient staff at my own
practice who regularly had to juggle
patients and appointments and of course,
my family. I will be staying on the AMA
(NSW) Council and wish my successor all
the very best.
This edition of The NSW Doctor has been provided
to all doctors in NSW who are not members of the
AMA (NSW).
We hope it will give you a taste of the work
that the AMA does on behalf of all doctors and
their patients and encourage you to support your
profession by belonging to your professional
association.
You can JOIN THE AMA NOW using the
membership form at the back of this magazine or
online at www.amansw.com.au
Join now to receive your membership during
June at no cost and go in the draw to win one of
three free 12-month memberships.
2 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

from the CEO
Lunch with the Mt Druitt
Medical Practitioners Association
Fiona Davies
CEO, AMA (NSW)
As regular readers of this column will know, I
don’t generally turn down an invitation to catch
up with our members – whether it is Rooty Hill
or Deniliquin I am always happy to go.
Such an invitation found me recently having
lunch with the doctors of the Mt Druitt Medical
Practitioner Association (MPA). One of the
longest established and most effective of the
local medical practitioners associations, the Mt
Druitt MPA has a proud history of representing
the interests of the doctors in the Mt Druitt area.
Most members at the lunch were GPs and
inevitably the discussion centred around the
frustrations as good GPs try to manage the
growing burden of caring for more patients
who are sicker with less resources, more red
tape and more teaching commitments. This is
a conversation I am becoming more and more
familiar with as even the most committed,
passionate GPs are feeling the impact of the
failure of the Medicare system to keep pace with
the way healthcare is provided.
It is this frustration and the need to create
a log of claims for GPs that has motivated our
quality of general practice survey (see page 8
of this issue of The NSW Doctor). We know GPs
want to focus on what they can do to show their
anger and frustration this was certainly the
focus of my recent conversations with
Mt Druitt GPs.
Another feature of our discussion at
Mt Druitt was what GPs are actually willing
to do to demonstrate to politicians how angry
and frustrated they are. While this is a valid
discussion, the key to every good industrial
campaign is the “ask” – not the “walkout”. For
this reason we are turning our focus towards
discussing what GPs want to see to recognise
and reward quality general practice for their
patients now and in the future. In a good
campaign, if you get “the ask” right and you
have to “walk out” to get what you need, the
way to walk tends to become obvious. We want
all GPs to work with us in the lead-up to the
Federal election on this “ask” and on quality
general practice agenda.
By the time you read this column the AMA
(NSW) will have a new President. On behalf of
the staff of AMA (NSW) I would like to sincerely
thank Dr Michael Steiner for his presidency. The
AMA would not be the organisation it is without
the willingness of doctors to put themselves
forward to speak for the profession. There will
be more on our new President in the July issue
of The NSW Doctor.
DHAS and AMA (NSW) joint seminar – Help GPs take care of their colleagues
Part 1 – Saturday, 18 August
Part 2 – Saturday, 20 October
Evidence shows that doctors do not access
adequate independent healthcare and this
can have a negative effect on their health.
Few doctors have an independent general
practitioner – despite the advice of professional
colleges and medical boards – yet doctors have
the same risk of chronic illness and the same
need for preventive health screening as the
general population.
Topics covered at the seminars will include
doctors’ health behaviours, mental health
issues, dependency on alcohol and other drugs,
self harm and barriers to seeking healthcare.
Interested specialists are welcome.
For more information and to attend, phone
Janene Wardrop at the AMA (NSW) on 02
9439 8822 or email Janene@amansw.com.au
www.amansw.com.au I 3

medico-legal
Changes to the Unfair Dismissal laws
Information for doctors in small practices
employing fewer than 15 employees...
Doctors in small practices will now
need to think very carefully about the
management of employed staff in order
to avoid a potential unfair dismissal
claim arising in the future. Employers
have further obligations that must be
met before they can make the decision to
dismiss someone.
Under the Fair Work Act 2009 (Cth)
(“the Act”) small business employers are
given a period of 12 months to assess
whether a new employee is suitable
for the position. If you are having any
problems with a new employee this is the
time to address them. You can evaluate
whether they are doing a good job by how
well they perform their specific duties,
how they are interacting with other staff,
or whether they are coming to work on
time. It is also an opportunity for the
employee to raise any concerns they may
have with the new workplace. Employers
should decide whether they intend to
keep the new employee on in the first
12 months. If you have any concerns
about evaluating new staff please contact
the AMA (NSW).
Once the 12-month probation period
expires small medical practices that are
considering dismissing an employee will
have to comply with the Small Business
Fair Dismissal Code (“the Code”). AMA
members can obtain advice about their
obligations under the Code and
practical assistance in counselling
and dismissing staff.
Under the Act a small business
employee who has been dismissed
after the first 12 months could make an
application for unfair dismissal. Once
an application for unfair dismissal is
made, Fair Work Australia will organise
a conciliation between the employer
and the employee in order to resolve
the dispute. If the dispute can’t be
resolved the matter will go to a hearing
and you will have to provide evidence
that you have complied with the Code in
terminating the employee’s contract. If
the dismissal is considered to be unfair,
Fair Work Australia could make an order
either reinstating the employee to the
position they had prior to dismissal,
or they could order that you pay
compensation for up to 26 weeks of pay
(up to a maximum amount of $59,050). 1
You should obtain legal advice before
making the decision to dismiss someone.
The AMA (NSW) offers this service as part
of our membership.
Please note that different laws apply
to larger practices employing more than
15 employees. If you have 15 employees
or more the probation period is only six
months and you will be subject to more
onerous performance management steps
before you can dismiss an employee. Of
course all employers can still dismiss
an employee for serious or wilful
misconduct, however you will need to
obtain legal advice on whether your
reason for dismissal constitutes serious
or wilful misconduct under the Act.
1 Information obtained from www.fairwork.gov.au
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4 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012
02633_12_NSW_NSW_Doctor_Advert_May_2012.indd 1 04/05/2012 14:55

medico-legal
Medico-Legal and Employment Relations Division
of the AMA (NSW)
The Medico-Legal and Employment Relations Division of the AMA (NSW) deals with many enquiries
from NSW medical practitioners in public and private practice.
VMOs and other specialists
JMOs and interns
Private medical practitioners and
Most of the industrial assistance we The day-to-day industrial activity for specialists
provide for VMOs and other specialists Doctors-in-Training at the AMA (NSW) The AMA (NSW) has a number of services
is in respect of clarifying and negotiating centres around a number of reoccurring to assist medical practitioners in their
the terms and conditions of their
issues – leave accrual, getting leave day-to-day private practice including
employment. VMOs are of course
approved, getting overtime approved, extensive advice on issues regarding the
independent contractors.
getting underpayments (or nonpayments)
employment of staff in their practice.
The Fee-for Service and Sessional
resolved, accommodation We offer advice on issues such
Determinations that the AMA (NSW) standards, poor rostering practices and as employment of staff (terms and
negotiated with NSW Health also provide querying issues around contracts of conditions, letters of appointment
rights and entitlements for VMOs in employment.
and position descriptions) and advice
addition to their contractual agreements. The medical training workforce is one regarding performance management of
The AMA (NSW) is currently in
of the most complicated workforces practice staff and termination of staff.
negotiations with NSW Health to update in the NSW Health system with its The AMA (NSW) frequently represents
and improve these Determinations and interaction of different vocational levels, AMA members when their staff allege
have taken on board many concerns colleges and interaction with multiple unfair dismissal, has a very high rate
that VMOs have expressed recently employers in quick succession at
of settling matters before Fair Work
including more choice of contract metro and rural sites and occasionally Australia and of course provides advice
arrangements, on-call and professional interstate. The role of the AMA (NSW) to prevent unfair dismissal claims being
support payment allowances, maximum however is broader than just the dayto-day
made. We also assist doctors navigate
and reasonable on-call obligations,
with a diverse scope of practice the Modern Awards which cover private
telephone on-call payments, delayed pay ranging from college issues and appeals practice staff.
penalties and more clinician control of to registration process challenges. All The AMA (NSW) provides advice to
list management.
of these areas that regularly require private practices on a number of issues
The AMA (NSW) also provides support the assistance of the AMA (NSW) to including doctor contracts, medical
to VMOs and other specialists subjected navigate are often exacerbated by records access, death certificates,
to disciplinary and clinical investigation varying levels of administrative staffing, WorkCover, MAA and medico-legal report
by NSW Health, the NSW Coroner, the inconsistent interpretation of industrial billing and general billing questions.
HCCC and the NSW Medical Council. instruments, ambiguous rostering and We have been particularly successful in
This involves attending inquiries, raising payroll policies and in some cases poor helping doctors with WorkCover issues
objections and drafting submissions. management practices. The AMA (NSW) and their many problems with workers
We also advise and advocate on medicolegal
uses its familiarity with the system and compensation scheme agents.
issues affecting VMOs and other the administrators to resolve these
Please contact the Medico-Legal and
specialists including public/private billing issues diplomatically and in most cases Employment Relations Division of the
arrangements and obligations, medical expediently.
AMA (NSW) on 02 9439 8822 with any
indemnity coverage issues under TMF Often the key to resolving industrial queries.
and private MDOs, and clinical standards, issues in the medical training workforce
operational procedure and health policy is simply bringing everyone’s attention
initiatives.
to the policies and best practice that
currently exist then determining to
what extent they have been applied.
Unfortunately, given the antiquated
nature and lack of clarity around
industrial policy for DIT’s, this almost
always involves more time and effort
than most DITs have the capacity to apply.
The AMA (NSW) makes resolution of
industrial issues less of a burden for our
DIT members.
www.amansw.com.au I 5

feature
Rewarding quality general practice
Complete the survey online –
visit amansw.com.au/survey –
help the AMA (NSW) understand
what GPs think should be done
to reward quality general practice.
The AMA (NSW) is undertaking a survey of NSW GPs in
response to increasing feedback from our members on two
important issues – how can we better reward quality general
practice and better integrate primary care and hospital care.
According to independent research undertaken on behalf
of the AMA in 2010 and in numerous conversations with
members, GPs have expressed the view that the current
system favours high patient throughput and “minimum
responsibility” medicine rather than the delivery of quality
care. Discussion of remuneration models for GPs can be
contentious. To ensure we are representing the views of the
profession as well as we can, our online survey deliberately
asks questions that challenge the status quo and the official
AMA position on issues.
Feedback from members also suggests there is a strong
view that the lack of communication and coordination between
primary care and hospital care is not in the best interests of
patients. Much of the discussion is around discharge planning,
however there is also a view that allowing GPs access to
hospitals to care for sub-acute aged care patients would be
beneficial.
This survey is a starting point in the process of asking the
profession to identify the first steps towards finding solutions.
The AMA (NSW) anticipates the survey will be followed
by extensive consultation with members via face-to-face
meetings to develop draft proposals. A second survey will test
the proposals that arise from member consultation.
Two GP views
Have your say at amansw.com.au/survey
Former AMA (NSW) President and Council member, Dr Brian
Morton and RACGP NSW & ACT Faculty Chair, Dr Liz Marles
comment on “quality general practice”.
What is “quality general practice”
It is whole patient care, knowing a patient’s medical history
in their social and demographic context and spending time
to educate the patient, providing better informed consent,
ownership and self control of a medical problem. Managing
chronic disease and multiple co-morbidities and making
residential aged care facility and home visits are also
important.
Dr Brian Morton
GPs are specialists in people. Having an ongoing doctorpatient
relationship helps us know our patients in the context
of their lives. This, coupled with continuity of care, enables us
to be efficient diagnosticians and less reliant on investigations.
We are likely to understand our patients’ needs much better
particularly with respect to chronic disease and mental health.
Preventative care is also part of quality care, potentially saving
the taxpayer.
Dr Liz Marles
Why do you think we need to reward this type of “quality
general practice”
Quality general practice allows for better management of a
patient with sufficient time and engagement to provide better
care. It aids compliance, facilitates alternative modes of
treatment, enhances patient trust, saves costs on unnecessary
investigation, shortens waiting lists and doesn’t clog the
system with patients who could have been treated by their GP.
Dr Brian Morton
Quality general practice can take more consultation time
and time spent chasing-up reports, old notes and liaising
with health professionals. Tailored GP management plans
and mental health plans also take more time than proforma
disease based plans. Quality general practice requires
systems to conduct searches of the patient database, provide
recalls and reminders and check follow-up of patients.
Providing wholistic, patient-centred care means diagnosis
is more cost and time efficient and the patient has a better
healthcare journey.
Dr Liz Marles
6 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

Some examples of patients/situations which show the
importance of “quality general practice”
A classic example is a patient who presents for a colonoscopy
referral with no risk factors. Guidelines recommend Faecal
Occult Blood Test in that patient so quality care is the time to
explain and inform, saving the patient unnecessary exposure
to risk. This saves money and doesn’t displace another patient
from the colonoscopy list who has a real indication. Another
example is mental health and “the worried well” – taking the
time to educate and explain why a symptom is unlikely to be
cancer or a heart attack.
Dr Brian Morton
A 50-year-old patient has chronic pain and neck spasm,
generalised anxiety disorder, right shoulder pain, reflux and
irritable bowel syndrome. Symptoms have usually presented
in crisis and been managed by increasing doses of valium,
panadeine forte, endone and sometimes buprenorphine
patches. Previous attempts at taking antidepressants
were unsuccessful due to side effects. Talking with her, I
established her husband was on workers compensation and
her mother-in-law came to stay for long periods of time.
When this happened her symptoms worsened. We decided to
try another antidepressant, increasing the dose very slowly.
This has been very effective and allowed us to reduce her
benzodiazepines and narcotics. I have found it effective to book
a regular monthly appointment where we discuss physical
symptoms and stress in her life and consequently the number
of crisis visits has dropped dramatically. Dr Liz Marles
What is wrong with the current system
Medicare simply pays on 20-minute time aliquots. There
is no differentiation for complexity of the presentation or
the experience of the doctor. It encourages fast throughput
of patients and fast on-referral and does not recognise
the increasing complexity of care, the aging population or
increasing overheads of a GP’s business. Dr Brian Morton
GPs who conduct six minute consultations will earn
substantially more per hour than those conducting 18 minute
consultations. With reduced time to formulate a diagnosis, a
six minute consultation could have a greater number of flowon
costs through investigations, prescriptions and referrals.
GPs who spend time explaining conditions to patients, seeking
out prevention opportunities and providing ongoing care will
generate less income under the current system. Dr Liz Marles
What changes would you suggest
Most GPs do not believe care plans improve care because of
the bureaucratic red-tape hurdles required to gain the extra
payments. These plans need to be simplified, matched to
normal work processes and alternative methods of payment
looked at. The mentality of a free service at the point of
consultation removes patient responsibility. Exploring a
process like that of PBS script payments with a threshold to
reach and upfront fee compensation so all must pay and value
the service could be an option.
Dr Brian Morton
A blended system of fee-for-service for all encounters,
voluntary patient enrolment (with a rebatable enrolment
fee) to enable the patient to access EPC items and various
incentive payments would seem optimal. Patient enrolment
allows practices to analyse and improve their performance
while preventing skimming of high billing item numbers.
Dr Liz Marles
What do you hope the GP survey will achieve
GPs are highly trained, ethical and compassionate but they
have a right and expectation to be valued and remunerated
appropriately. The survey is important to actually ask, to find
out contemporaneous views not just based on rhetoric, or
anachronistic views. The AMA is a member organisation and
we want to serve our members. It is not a time to impose
views – we simply need to ask.
Dr Brian Morton
GPs are the providers of service and as such, need to be
rewarded for the quality of job they do. Hopefully the survey
will enable GPs to help us identify strategies to achieve this
so we can continue to provide outstanding service to the
Australian community. It is important that we suggest positive
strategies rather than have them designed and imposed on
us by bureaucrats who may have little understanding of our
actual businesses.
Dr Liz Marles
amansw.com.au/survey
AMA Family Doctor Week 2012
Family Doctor Week highlights the role
played by general practitioners, also known
as “family doctors”, in delivering high quality
healthcare in local communities all around
Australia.
This year Family Doctor Week runs from
Monday, 16 July to Sunday 22, July 2012. The
theme is ‘For A Lifetime of Trusted Care’.
The theme encapsulates the ability of family
doctors to provide skilled care for patients at
every phase of life. Family Doctor Week is also
an important reminder to the community of
the importance of having a family doctor.
The Federal AMA President’s annual
address to the National Press Club coincides
with Family Doctor Week and is scheduled for
Wednesday, 18 July 2012.
This year Federal AMA will produce several
short YouTube videos examining the various
stages of life and the key role of the family
doctor in providing specialised healthcare.
For more information visit http://ama.com.
au/familydoctorweek2012
www.amansw.com.au I 7

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to news the editor
Editor,
4 HOURS! Waiting in a hospital
emergency waiting room for 4 hours!
Who would stand for it – I wouldn’t and
I am sure those who write about this in the
medical journals and magazines would not
either. What sort of an emergency would
one have to have that would not deteriorate
while waiting for four hours If not, should
they be there at all
But the mind boggles – 4 HOURS!!!
Dr Kevin Orr FRCS. FRACS. FACS
Editor,
Describing the payments for teaching via
the practice incentive programme is woefully
inadequate may well be true. However, they are
better than the non-payment for medical students
attending non-accredited practices.
Non-accredited general practices provide an
essential service to the teaching of medical students.
Is there any evidence to suggest that students
obtain an experience any different in such a
practice than those who attend an accredited
practice
If students are allowed to experience “general
practice” in a non-accredited practice, then
payment for that practice should be the same as for
an accredited practice.
Equal pay for equal work has always seemed a
good concept.
Dr Adrian Sheen
Dear Narelle,
Thank you for the very timely article “Certifying Death” by Sarah
Dahlenburg, Director, Medico-legal and Employment Relations.
As a medical referee for a number of funeral companies and a
pension officer for veterans and their wives, the need to get this
information correctly placed on record is extremely important.
The former Medical Board (NSW) was most helpful some years
ago but the topic needs mentioning at regular intervals to retain
the standard at a high level. Thank you for keeping this before the
profession at large.
Dr Roderick Bain MBBS FRCA FANZCA
Men’s Health Week
An evening BBQ for the men in health
13 June 2012
Guest speakers will discuss some key men’s mental health issues
as they relate to medical practitioners. An opportunity for junior
doctors to socialise with senior practitioners before watching live
coverage of Game 2 of the State of Origin.
When | Wednesday, 13 June 2012 – 6:00pm
until the end of the State of Origin
Where | RMO Lounge, Royal Prince Alfred Hospital
Cost | A gold coin or paper note donation to the
Medical Benevolent Association
Cuisine | A barbeque themed dinner provided by caterers and a
range of other dishes for more diverse diets – not just
sausages, bread and sauce!
The AMA (NSW) is keen to promote the wellbeing of
Doctors-in-Training in and out of the workplace and this event
highlights significant men’s health issues relevant to the personal
health of male medical practitioners.
Strictly limited numbers – call the AMA (NSW) Senior Industrial Officer,
Glenn Tyrell on 02 9902 8136 or email events@amansw.com.au
www.amansw.com.au I 9

feature
The AMA calls for urgent reforms to the
ASGC-RA to save rural practice
by Narelle Schuh
The AMA has joined the Rural Doctors
Association of Australia (RDAA) in calling
for an urgent intervention of the flawed
new Australian Standard Geographical
Classification – Remoteness Areas
(ASGC-RA) system which replaced the
Rural, Remote and Metropolitan Areas
(RRMA) system last year.
The inherent problem with the ASGC-
RA is that it is based only on the physical
distance to the nearest urban centre
and ignores key parameters such as the
health needs and socio-economic status
of the local population, the availability
or otherwise of local health services
and whether the number of local health
professionals is adequate or inadequate
for a particular town’s needs.
Amongst other things, the ASGC-
RA is used to determine the extent of
relocation and retention incentives that
doctors receive based on their location.
Unfortunately it places many small rural
towns in the same classification category
as large regional cities, for example
Tumut and Gundagai are in the same
classification as Wagga Wagga, Port
Macquarie, Bendigo and even Hobart.
Doctors receive the same rural
incentive payments whether they practise
in the smaller towns or larger centres,
substantially reducing the incentive for
doctors to move to – or stay in – smaller
towns. Taking into account all the
professional and family supports and
little, if any, on-call responsibilities that
cities can offer it makes it extremely
difficult for small rural towns to compete
for much-needed doctors.
How the Federal Government fails
to recognise that a city with a beach,
restaurants, choice of schools, shopping
centres and a major hospital for afterhours
care is likely to be more attractive
to young doctors than a small town with
a few shops along the main street, a
statue by the public toilets and 24/7 oncall
requirements for local doctors is the
inevitable question.
Under ASGC-RA doctors working in
major coastal cities such as Townsville
and Cairns receive the same level of
relocation and retention payments as
those working in Hay and numerous
other small towns in outback NSW as all
are now classified as being in an ‘Outer
Regional’ (RA3) location. Small NSW
towns like Cowra, Deniliquin, Gundagai,
Cootamundra and many others are now
classified as ‘Inner Regional’ (RA2), or
less remote than Townsville and Cairns,
meaning that doctors receive lower
relocation and retention payments to
work in these towns than they do to work
in Townsville and Cairns.
The AMA is calling upon the
Government to support for the following
rural health initiatives:
• Review the ASGC-RA classification to
address the obvious anomalies.
• Develop and implement improved and
expanded rural generalist training,
with Federal Government leadership
and resources, to attract and train
the appropriate number of doctors
necessary for rural practice. This
requires guaranteed training places
at prevocational and vocational levels
including advanced skills training.
• Attract and retain the medical
workforce during and after completion
of vocational training including
implementing the AMA/RDAA Rural
Workforce Package. This would provide
enhancements to rural isolation
payments and rural procedural
and emergency/on-call loadings to
encourage more doctors to work in
rural areas and boost the number of
doctors in rural areas with essential
obstetrics, surgical, anaesthetic or
emergency skills.
Chairman of the AMA Council of
General Practice, Dr Brian Morton says
“Medibank was established in 1973 to
provide a universal healthcare system
for all Australians and yet it has failed
to deliver for rural Australians. Rural
general practitioners are the lifeblood of
healthcare outside metropolitan areas
and a system that does not recognise and
reward the level of expertise required
to provide quality primary health care
to rural Australia will not ensure a
sustainable workforce”.
RDAA President, AMA (NSW) member
and Gundagai GP, Dr Paul Mara said at
the national Rural Medicine Australia
Conference in October 2011, “The fact
that, out of 150 rural doctors, none of
them think the ASGC-RA has been good
for their town should send a strong
message to the Federal Government.
The ASGC-RA simply doesn’t recognise
the difference between providing medical
services in small rural communities and
larger centres, is causing rural practices
and rural communities serious grief and
needs reworking”.
“We need a dovetailed approach
to building the future rural doctor
workforce, where the right training
is followed by better recognition and
support for the advanced training
undertaken by rural doctors…and a
classification system that recognises the
rural difference,” he says.
In response to mounting pressures
in rural medicine the RDAA launched a
virtual roadshow to highlight evidence
that the ASGC-RA system is making
it significantly more difficult for small
rural towns to attract doctors. The
‘Stop the Rot’ roadshow features rural
towns across Australia that are being
significantly disadvantaged by the ASGC-
RA. You can see how your town fares
by visiting www.doctorconnect.gov.au
and searching the map for its ASGC-RA
classification.
10 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

NSW rural town case studies
Hay, NSW
ASGC-RA classification: RA3 (Outer
Regional), the same as Cairns, Townsville
and Darwin. Hay sits on the edge of the
RA3 classification area and is less than
five metres from the boundary where RA3
changes to RA4 (Remote).
A rural town of around 2,600 people
located 700km from Sydney in isolated
Far West NSW, Hay literally sits on
the edge of the RA3 (Outer Regional)
classification level. If the medical practice
in Hay was to relocate just a few metres
out of town it would then be in the RA4
(Remote) classification. Various coastal
NSW locations such as Nambucca Heads,
Bega, Pambula and Narooma are also
classified as RA3 (Outer Regional). Hay
should at least be classified as RA4
(Remote) given its isolated
inland location.
Cowra, NSW
ASGC-RA classification: RA2 (Inner
Regional), the same as Hobart and major
regional cities like Albury, Wagga and
Tamworth. One classification step less
remote than Cairns, Townsville
and Darwin.
A town of around 9,500 people located
310km from Sydney in Central West
NSW, Cowra continues to suffer from
a significant shortage of doctors. Local
doctors in Cowra work in private practice
and also provide 24/7 on-call to the local
hospital. In comparison the NSW town
of Picton is also classified as RA2, being
just half an hour from Campbelltown
and its major hospital. Cowra is more
remote and much further from major
hospital supports, thus Cowra should
be classified more remotely. There are
houses on the edge of Cowra that are
located in the RA2 (Inner Regional)
area however literally across the street
the classification changes to RA3
(Outer Regional). If a medical practice
established its surgery at Cowra Airport
it would be in the RA3 (Outer Regional)
area, with the increased relocation and
retention payments that would provide.
Deniliquin, NSW
ASGC-RA classification: RA2 (Inner
Regional), the same as Hobart and major
regional cities like Albury, Wagga and
Tamworth. One classification step less
remote than Cairns, Townsville
and Darwin.
The small town of Deniliquin, population
7,500, is 750kms from Sydney in
South West NSW. It is literally an RA2
(Inner Regional) island in the middle
of an RA3 (Outer Regional) sea. The
RA2 classification is restricted to the
town itself with an RA3 classification
surrounding it on all sides. There is
a substantial shortage of doctors in
Deniliquin and surrounds with local
doctors now providing a 1-in-6 afterhours
and on-call service. Deniliquin
is now competing directly with Cairns,
Townsville, Hobart, Darwin and other
major regional centres for muchneeded
doctors.
Scone, NSW
ASGC-RA classification: RA 2 (Inner
Regional).
Scone is 255km from Sydney with a
population of around 5,000 people and
a small 36 bed hospital. It is classified
as an RA2 (Inner Regional) location,
the same classification as the city of
Tamworth (population 50,000) which is
2½ hours north, has a base hospital with
resident doctors, an Intensive Care Unit,
and city infrastructure and services. Only
metres from Scone Memorial Hospital
the ASGC-RA boundary changes to RA3
(Outer Regional). The medical practice
at Scone believes the ASGC-RA has
seen qualified doctors and registrars
actively seeking rural placements in
almost urban areas close to Sydney eg.
Dora Creek, Nelson Bay and South Lake
Macquarie, that are also classified as
RA2.
“The provision of a high standard
of medical care to small, scattered
communities in rural Australia is a
real and constant challenge. Using
a financial incentive to achieve a
desired outcome is a well recognised
tool. As a result of the recent AMA
(NSW) survey, Fiona Davies (CEO) met
doctors from the far South-West NSW
towns of Hay, Finley and Deniliquin.
The equitable distribution of financial
incentives was one of the topics
discussed at the meeting. Hay, Finley
and Deniliquin have failed to attract
an Australian medical graduate for
more than twenty years. To date, the
ASGC-RA classification scheme and
its predecessor have failed these
communities. If this tool is to be
equitable and achieve its objective it
needs to be honed.”
Dr Taras Mikulin, Deniliquin, NSW

feature
4-hour rule – feasible or flawed
by Narelle Schuh
All Australian hospitals will need to
admit or refer emergency department
patients within four hours under
new Federal benchmarks that came
into effect on 1 January 2012. States
have committed to yearly rises in the
proportion of emergency patients they
treat within the benchmark with the
target for NSW in 2012 at 69 per cent
within four hours, an increase of 7 per
cent from 2011.
The National Emergency Access Target
(NEAT), commonly known as the fourhour
rule was announced as a key part
of Kevin Rudd’s suite of health reform
proposals in April 2010 and amended
by State Premiers last year. By the time
the policy is fully implemented in 2015
it will require 90 per cent of patients in
emergency departments to be admitted,
referred elsewhere, or treated and
discharged within four hours. Over the
next four years NSW will receive $96.9
million in assured funding from the
federal government to help it achieve
the four-hour target, plus $72.5 million
for capital investment in emergency
departments. A further $63.6 million
is contingent on annual improvements
against the four-hour threshold.
While it’s early days there is already
concern this year’s target may not
be reached with NSW behind target
in January 2012. Chair of the NSW
Faculty of the Australasian College
for Emergency Medicine, Dr Richard
Paoloni stated in the media that the
pace of change is not as fast as it needs
to be to meet the target this year and
larger hospitals are particularly going
to struggle with the benchmark as
they generally see sicker patients who
require longer consultations. He says
reorganisation and a culture change
is essential to the future success
of the four-hour rule, with radical
reorganisation of inpatient wards
necessary to make more beds available
and ease the pressure.
Medical Journal of
Australia (MJA) study
Results of the first study to analyse
the effect of introducing a four-hour
treatment target in hospital emergency
departments – MJA, February 2012 –
are promising. Doctors found the rule
reduced deaths among emergency
patients at three major Perth hospitals
by 13 per cent as a direct result of
definitive treatment.
The study raises hopes that hundreds of
lives could be saved as the policy rollsout
over the next three years. It found
emergency department overcrowding
dropped from 40 per cent to 10 per cent
two years after it was implemented at
the trial hospitals in 2009. Death rates
fell, saving 80 additional lives in 2010-
11 compared to the previous year. If the
figures were adjusted with the higher
death rate in 2009-10 and the additional
17,000 patients in 2010-11, it could
be argued 267 lives were saved that
year. Researchers found no change in
mortality rates at three other hospitals
that did not achieve reductions in the
percentage of patients facing long waits
for a hospital bed.
A separate paper in the same edition
of the MJA however sounded a warning
note, suggesting that demand on
emergency departments is rising so
quickly the targets may be unachievable
unless there is significant redesign of
the whole system. Doctors have long
expressed concern the four-hour rule
could lead to rushed decisions that
compromised patient care.
Opinion
Chairman of the AMA (NSW) Hospital
Practice Committee and member of
the COAG Expert Panel, A/Prof. Brian
Owler believes transition will not
only require focus on the emergency
department but on the hospital as a
whole. He says money should also
be spent ensuring there are enough
senior staff on-hand to make decisions
and that emergency departments are
resourced appropriately. “It will take
‘a whole-of-hospital and whole-of-
Government commitment’ to improving
service delivery throughout the hospital
system. The whole hospital, not just the
emergency department, needs to be
engaged and more resources committed
to improving capacity. Improving patient
flow through hospitals can only really be
done if the whole system is involved in
the process.”
“It should be remembered that the
reason for choosing a four-hour
timeframe is that to achieve this
target for the emergency department
a hospital needs to redesign the way it
provides care throughout the hospital.
It’s not about making staff, particularly
junior staff, work harder or faster.”
A/Prof. Brian Owler welcomes the WA
report into the four-hour rule. “The fourhour
rule is about patient safety and
improved outcomes. We have known that
access block and ED overcrowding is
associated with increased morbidity and
mortality. Although more work is needed
the findings of the study support quality
improvements that the four-hour rule
aims to achieve.”
12 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

Chair of the AMA (NSW) Doctorin-Training
Committee, Dr Kathryn
Austin agrees, “We need a ‘whole of
hospital’ reform. The four-hour rule
won’t work if there’s only one surgical
registrar. There needs to be increased
access to registrar numbers, not just
an administrative shift. We’re very
supportive of change and timely care
however it can’t come at the expense of
patient care and junior doctor education
and training. There needs to be
appropriate senior support.”
Study researchers acknowledged
junior doctors felt the targets had
undermined their training because they
were spending more time managing
new patients on the wards rather than
in ‘the protected environment of the
emergency department with many
senior staff on hand to supervise’. Dr
Austin also said the WA pilot highlighted
some documentation of bullying by
administrative staff to ensure time
targets were met.
An AMA (NSW) member active in a
regional hospital emergency department
has real concerns about NSW’s ability
to meet the four-hour rule, saying
emergency departments are already
overcrowded and hospital occupancy at
many of our hospitals is hovering close
to 100 per cent.
“Staffing levels of both emergency
departments and in-patient units
outside major city hospitals are
significantly less than those of WA,
where the 4-hour rule was piloted.
To speed-up processing of patients we
need senior decision makers early in the
patient’s care, both in the emergency
department and in the in-patient units.
The major centres struggle with this.
Outside of the major centres this just
doesn’t exist.”
This doctor says interest in the fourhour
rule from senior executive has
been slow and agrees instituting the
rule will take significant investment in
capital (beds) and workforce, which NSW
does not seem to have the finance to
support. “Hospitals in NSW still operate
08.00am-16.30pm Monday to Friday with
skeletal staffing after that. One simple
way to increase capacity would be to
extend the hours of operation of the
hospital beyond the 50-hour week. If a
factory only operated for 50 hours per
week it would be shut down!”
• The program has led to reduced mortality rates and less
overcrowding in the WA pilot but also led to some staff –
especially junior doctors – coming under increased stress
and pressure.
• The four-hour rule presents challenges with resources
and staffing.
• The focus of attention is moved from some parts of the
hospital to new parts of the hospital and resources may
need to be redirected.
The AMA position
The AMA are cautiously optimistic
with the results of the study with
Federal AMA President, Dr Steve
Hambleton saying, “This is one
of the first pieces of rigorous
research to say that a ‘whole of
system’ approach to deal with
the emergency department
deadlock works and saves lives and
certainly the numbers actually are
startlingly significant – although
we are cautious about the potential
downside to the same sort of
issues”.
The AMA says there has been
concern amongst doctors over
whether “four hours” is the right
number and whether a time target
is correct, saying better system
redesign where there’s more
efficient use of space and better
integration of the emergency
department into the hospital sector
is essential.
The AMA remains concerned
about the level of the acuity of
patients ending up on wards.
Junior doctors are concerned
that the learning experience they
are getting in the emergency
department is maintained because
it is a very important part of their
learning. With doctors involved in
higher acuity cases on the wards
they are more occupied and the
opportunity for teaching and
training is decreased. So, while we
support a better system redesign
that is clinician led, there are a lot
of caveats the AMA has concerns
about that are showing up in both
this Study and surveys junior
doctors have taken about how this
process is rolled out.

feature
by Sim Mead
The current round of health reforms
has always had two separate but related
strands. The first strand – the structure
and governance of healthcare delivery
– includes the aims of decentralising
decision-making and re-engaging
clinicians. The second strand is funding
and started with then Prime Minister,
Kevin Rudd aiming to make the
Commonwealth the dominant funder
of public hospitals in an attempt to end
the cost-shifting and ‘blame game’ that
is part of our Federal-State political
structure.
The original Rudd funding plan wouldn’t
have achieved the AMA ideal of a
single funder, arguably the only way
to genuinely end the ‘blame game’.
Unfortunately, even the Rudd plan
has been watered down as a result of
Federal-State negotiations and the end
result is a continuation of a complex
mish-mash of State and Federal
responsibilities.
There is however one very clear change
to funding arrangements that has
survived from the original proposal – the
introduction of Activity Based Funding
(ABF). The agreement is that this will be
introduced in a limited way from
1 July 2012 and there will be a gradual
transition over a couple of years to full
implementation.
What is ABF
At its simplest ABF is a funding system
that is designed to pay for the work that
is actually done (outputs) as opposed
to paying to create and maintain the
system needed to do the work (inputs).
The traditional way of doing things
(“block funding”) has been for the
Commonwealth Government to hand
a bucket of money to the States, which
in turn hands buckets of money to the
hospitals. The connection between
funding and the actual services provided
is at best tenuous and at worst nonexistent.
Various attempts to link
funding to outputs, such as waiting list
reduction programs, have had mixed
success.
The problem with block funding from the
funder’s point of view is that it is very
difficult to influence either the number
or type of activities undertaken with the
funding. The problem from the provider’s
point of view is that the funding is the
same even if the activity level is higher
than expected – payment may bear little
relation to the demand for services.
The theoretical solution is ABF. The
funder pays for the services that it
agrees should be provided and the
provider gets paid for each service that
is actually provided. Two things need to
happen for this to occur. There needs to
be a list of services for which a payment
will be made and there needs to be a
price for each service.
You might recognise this as a description
of the fee-for-service model that
applies in the private health sector.
Medicare pays for the services that the
Government agrees to provide (specified
item by item in the Medicare Benefits
Schedule) and the medical practitioner
is paid (by means of a patient rebate)
each time he/she provides one of those
services. As we all know, the rebate
has been devalued by the failure of
successive governments to increase it by
CPI or similar.
Ironically, at the same time as
governments move towards ABF/feefor-service
in the public sector, they
are moving away from it in the private
sector. It is not difficult to perceive a
trend towards a preference for block
funding in primary care policy-making.
This paradox is probably simply
explained by the observation that the
grass is always greener on the other
side of the fence.
As in the private sector Medicare model,
the two important components of the
public hospital ABF model are the
price and the list of services. Under
the Medicare model, the price is set by
the Commonwealth Government and is
unashamedly used to keep costs down.
Under the proposed public hospital
model the price will be set by the
Independent Hospital Pricing Authority
(IHPA). The independence (or otherwise)
of the IHPA will be a crucial factor in the
implementation of the ABF model.
Like the CMBS, the list of services for
which payments are made is likely to
be the less controversial aspect of ABF.
There will however be plenty of scope
around the fringes for argument about
what services should be included or
excluded (like there is with the CMBS).
Most controversial
aspect of ABF
The most controversial aspect of
the ABF model, perhaps even more
controversial and difficult than the
price for services, will be the cap on the
number of services for which a payment
is made. As noted above, one of the
primary arguments for the introduction
of ABF, which is explicitly and
repeatedly made by the Commonwealth
14 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

Government, is that hospitals will be
paid for the actual number of services
they provide.
This is not going to happen.
Activity levels at hospitals will continue
to be controlled by the State Government
irrespective of whether funding is
activity-based or block funding. The
agreement is that the Commonwealth
will pay its share of funding for each
activity. There is no requirement for
the State Government to “top up” the
Commonwealth payment to 100 per
cent of the efficient price fixed by the
Independent Hospital Pricing Authority.
The States are free to decide to pay
any amount they choose i.e. less, more
or equal to the difference between
the Commonwealth payment and the
efficient price.
Importantly, the State portion will be
capped by the service agreements that
are signed by LHDs and NSW Health.
The service agreements will specify
the activity levels that are funded and
there will be no State funding available
for additional activity. Being paid only
40 per cent (say) of the efficient priceper-activity
by the Commonwealth will
not be very attractive. Hospitals are
unlikely to be interested in undertaking
additional activity in return for less
than half the cost. On the other hand,
hospitals undertake additional activity
under the current system and receive
no additional funding. It may be that
hospitals will take the view that ABF is
an improvement on the current system
because 40 per cent is better than
nothing.
Potential benefits of ABF
Having read this far you may be
wondering if the introduction of ABF
in this form has any point at all. One
answer is that ABF is a useful tool for
driving health costs down. Whether
you think this a benefit will depend on
your point of view. Reducing costs by
driving efficiencies is an explicit aim of
the introduction of ABF. All the reform
documents, including the most recent
document from the IHPA, are based
on the concept that setting a national
efficient price will cause more expensive
hospitals to reduce costs to ensure the
services are provided at or below the
efficient price.
Secondly, ABF has the potential to
reduce the historical inequities in NSW
hospital funding. Many would argue
that despite attempts over many years
to move resources to growth areas of
the State, a high level of inequity still
exists. By definition ABF is based on
activity levels rather than historical
levels of funding adjusted each year by a
percentage increase. It is difficult to see
how this will not have a positive impact
on areas that have been traditionally
under-funded.
Services such as mental health that
have historically been under-funded
are likely to benefit from ABF in that
the funding mechanism will be more
transparent. This view does however
need to be tempered by the degree
to which the system that is actually
implemented still allows funds to be
diverted to other services.
Transition to activity
based funding
Phase 1:
The move to ABF commences in less
than six months, on 1 July this year. For
the first two years – July 2012 to June
2014 – the amount of money payable
by the Commonwealth is the same as
that which would have been paid under
the current system. Commonwealth
funding will be paid as a percentage
of the efficient price per activity fixed
by IHPA but the actual percentage will
be calculated to ensure that the total
Commonwealth contribution is the
amount of funding for that State that has
already been determined. It follows that
the percentage of the national efficient
price the Commonwealth pays will vary
from State to State (but will tend to be
somewhere in the region of 35 per cent
to 40 per cent).
Phase 2:
For the next three years – July 2014 to
June 2017 – the Commonwealth funding
will be adjusted for both price and
volume. As above, the Commonwealth
share of funding will vary between
States. However, unlike Phase 1, the
Commonwealth will pay 45 per cent of
the “efficient growth” in activity (where
efficient growth means the efficient
price for any changes in the volume of
services and the growth in the efficient
price of providing the existing volume).
In other words there will be two
different buckets of money from the
Commonwealth. The first, and by far the
larger bucket, will relate to the activity
levels in Phase 1. The Commonwealth
funding will be paid as a percentage of
the national efficient price per activity,
the actual percentage being dependent
on the amount of money in the bucket.
The second bucket will grow in size
over time and contain 45 per cent of the
efficient price funding relating to growth
in activity.
Phase 3:
From July 2017 onwards the
arrangement will be as for Phase 2
except that the Commonwealth’s share
of the “efficient growth” will rise to
50 per cent.
www.amansw.com.au I 15

The Dummies’ Guide to Activity Based Funding... con’t
The transition needs to be understood
in the context of the funding guarantee
made by the Commonwealth to the
States which provides that:
“The Commonwealth will provide
at least $16.4 billion in additional
funding through these revised funding
arrangements between 2014-15 and
2019-20 compared with the funding
that would have been provided through
the former National Healthcare SPP.”
On this understanding the States have
signed up to ABF on the basis they will
definitely not be worse off (at least until
2020) and may even have some “spare”
funding.
On the other hand the considerable
amounts of money that have been
made available through the National
Partnership Agreements (waiting list
reduction initiatives etc.) are not part of
the funding guarantee.
Issues that need to be
resolved before 1 July
2012
The Independent Hospital Pricing
Authority (IHPA) commissioned
consultants to produce a discussion
paper (“Activity based funding for
Australian public hospitals: Towards a
Pricing Framework” 21 December 2011)
that outlines the issues that need to be
addressed. In broad terms the issues
revolve around deciding the services that
will be covered by ABF and the price to
be fixed for those services.
Scope of services to be
included under ABF
ABF is intended to fund “public hospital
services”. The question of what should
or shouldn’t be included is the subject
of intense negotiations between the
Commonwealth and the States. This is
obviously a complex issue but ultimately
comes down to the Commonwealth
wanting to minimise the scope to reduce
the list of services for which it has to
pay a share. States, on the other hand,
are arguing for a very broad definition in
order to minimise the list of services for
which they will have to pay 100 per cent
of the cost.
Outpatient clinics are a major issue.
Many public hospital outpatient clinics
have been “privatised” in the sense
that Medicare is billed for the service. It
appears that the Commonwealth may be
taking the position that these services
should not be included within the scope
of ABF because they are already funded
through Medicare. The States are
arguing that any Medicare funding only
partially pays for outpatient clinics and
to exclude them from ABF would impose
a huge additional cost on the States.
The national efficient
price
Setting the price to be paid per activity
is obviously one of the most important
parts of implementing ABF. The price
will be set by the IHPA at what it judges
to be the “efficient” level i.e. the level at
which it estimates an efficient hospital
would provide the service. The actual
cost of the service will of course vary
widely between hospitals.
The discussion paper suggests that
when determining the efficient price in
the short-term the IHPA should set the
price based on “a measure of central
tendency” i.e. the mean or the median.
However the discussion paper also
proposes that in the medium and long
term a more aggressive approach to
driving efficiency should be adopted by
setting the efficient price at a lower than
average level.
Questions also arise about whether
the price should include loadings for
particular circumstances. Again, the
discussion paper takes a hard line on
this and proposes that only two loadings
should be applied – Indigenous status
and specialist services for children.
In the context of rejecting the case
for other loadings, the discussion paper
provides a contender for quote of the
year: “Introduction of national ABF
with an Independent Hospital Pricing
Authority provides the opportunity
to cleanse the Stygian stables of
accumulated negotiated arrangements,
often developed with little transparency
or evidence base”.
Setting the price for private patients
in public hospitals is also covered in
the discussion paper. The conclusion,
in simple terms, is that it should be the
public patient price excluding the cost of
those services that are billed against the
MBS and/or private health insurers.
Using the national
efficient price to drive
quality
The paper proposes that the IHPA
should adopt a US Medicare system of
penalising hospitals for what it believes
are preventable hospital acquired
conditions. The list is included in the
discussion paper and includes “surgical
site infection following coronary artery
bypass graft” and “manifestations of
poor glycemic control”. The proposal is
essentially that hospitals would not be
paid for the care associated with these
complications i.e. the hospital would
receive payment as though the hospitalacquired
condition had not occurred.
The AMA has already submitted in
the strongest possible terms that this is
nonsensical.
Block grant funding
The National Health Reform Agreement
identifies a number of services that will
be funded by block grants either as part
of a transition to ABF or on a permanent
basis.
Mental health, subacute and other
non-admitted services are to transition
to ABF by 1 July 2013. The discussion
paper proposes that mental health
services that can be funded through ABF
as part of acute hospital services should
be funded through ABF in 2012/13.
Teaching, training and research is to
be block grant funded in 2012/13 with a
transition to ABF no later than 30 June
2018.
Small rural and regional hospitals are
to continue to be funded through block
grants. We understand no agreement
has yet been reached on which hospitals
fall into the category of “small rural and
regional”. The discussion paper makes it
clear ABF should be extended as far as
possible.
www.amansw.com.au I 17

feature
Changing of the medico-legal guard at the AMA (NSW)
by Narelle Schuh
Farewell Sarah Dahlenburg, AMA (NSW)
Director, Medico-legal and Employment
Relations.
At just 34-years-old and having spent
20 years now in the workforce Sarah is
hanging up her hat with the AMA (NSW)
in August 2012 for a “seachange” with
her doctor husband, Leigh Dahlenburg,
daughter Grace and baby on-the-way.
I interview Sarah ironically on the
day of her six-year anniversary at the
AMA (NSW). Over this time Sarah has
endeared herself to our members with
her polite, friendly, can-do attitude in
an incredibly varied and important role
for our members – Medico-legal and
employment relations.
Sarah spent five years working for a
trade union representing cleaners and
security guards. She admits this was
“very different to working with doctors
and very interesting because I got to see
lots of things in life that I wouldn’t have
seen otherwise. I got an understanding
of what it was like for people living on
the minimum wage where, if they had
to pay $10 more than they budgeted, it
threw them out for the entire month. It
was a great job to have as it makes you
appreciate what you do have”.
She started work in the medico-legal
area with ASMOF for junior doctors
in 2006 and took-on a new combined
role of medico-legal and employment
relations at the AMA (NSW) in early
2007. “We’re not very silo-ed which is
good, that’s one of the best things about
working at the AMA. Fiona and Sim have
such a breadth of knowledge and have
been so generous with sharing their
information.”
Sarah was the first lawyer to be
employed in the medico-legal role at
the AMA (NSW). “ We previously haven’t
had many lawyers whereas now we are
almost all lawyers in this division. I think
the medical profession respects the
fact that you’re a lawyer and it makes
it easier to advise when they know you
have a legal background. We understand
confidentiality and members feel
comfortable talking to us.”
One of the most challenging
experiences of working at the AMA is
choosing what work you can run after
and what you can’t, says Sarah. A good
example was the issue of national
registration where members were
terribly upset, angry and frustrated
they’d lost the ability to practice
medicine and there were queues of
phone calls. It was, however, also a
rewarding time. “We really made a
difference as we got them back to work
much quicker than if they hadn’t had our
assistance.”
Despite the fact she will miss the
diversity of her role, Sarah is delighted
to hand the reins over to Andrew Took
from Avant. “Andrew was the first
person I felt would be fantastic for the
role. He understands what makes MDOs
tick so he will further strengthen the
relationships we have with medical
defence organisations, making sure
we’re working collaboratively to deal
with the really big issues.”
This “seachange” is an opportunity for
Sarah to take on new challenges with
the move to Port Macquarie an attractive
lifestyle option for her and Leigh.
Leigh, a gastroenterologist who
should gain Fellowship in January 2013,
is likely to set-up in private practice
with an established gastroenterologist
and work at Port Macquarie Base
Hospital enabling him to work in general
medicine as well as specialise. “At a
regional hospital you get a really great
variety of patients,” says Sarah. “I’m
sure I’ll have some involvement in his
practice in one way or another,” she
smiles.
As for the future, I can just see Sarah
with gumboots and new baby in the Baby
Bjorn pouch, wearing a hard hat and
giving “Grand Designs” a run for their
money on the block they hope to buy
with ocean views over Port Macquarie.
“You know how on that show they always
get really bossy” she says, “I can see
myself in my gumboots going ‘What are
you doing Where are the windows’
There’s a lot to look forward to!”
18 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

After more than 16 years with Avant,
currently as their National Medico-Legal
Advisory Services Manager, Andrew Took
is embarking on a “seachange” of his
own – joining the AMA (NSW) as our new
Director, Medico-Legal and Employment
Relations.
An accredited specialist in defending
health practitioners, hospitals and health
facilities against professional negligence
claims with extensive experience in
health law, administrative law, criminal
law, general insurance and commercial
litigation, Andrew also has substantial
clinical experience as a registered nurse
and was a founding academic member of
the Faculty of Nursing at the University of
Technology, Sydney.
It’s easy to see why his “true vocation
is direct health law” with “an absolute
commitment to providing a member
service”. Andrew’s 6 foot 4” stature
somehow seems at odds with his calm
disposition. I would hazard a guess that
I’m not alone in saying that Andrew,
who regularly lectures to a broad range
of health practitioners, informs and
impresses whomever he meets with his
dedication to – and knowledge of – health
law and genuine concern for people.
Avant has offices in most states and
operates a ‘24/7’ medical legal advisory
service to members with more than
10,000 calls annually from members
seeking advice on medico-legal issues.
This includes 3.00am phone calls,
through to Christmas Day emergencies
and an ability to provide assistance in
health law regardless of which state or
territory and at which time of the day or
night. Andrew’s move to the AMA (NSW)
is “A change from a national perspective
back to a NSW focus. It will be a luxury to
be able to focus on NSW”.
His new role will also allow him
to pursue a long-held interest in
employment law in the healthcare
industry. An advocate of social justice, he
says the best thing about his role at Avant
is that “You don’t know what’s going to
“I’m looking forward to getting out to
the general practices and the hospitals,
meeting at the coalface and making
a contribution,” he says. Certainly,
Andrew’s history of achievement at
Avant is impressive. These achievements
include:
- As National Claims Manager, guiding
the Claims team through one of the
most exciting and challenging periods
in the MDO industry as the largest glut
of civil claims in Australian legal history
were worked through.
- Heading-up the medico-legal advisory
function at UNITED and then Avant.
Training advisors, developing and
delivering continuing education content,
overseeing rostering – including
frequent stints as the on-call legal
expert for after-hours calls and medicolegal
emergencies – identifying new
and emerging issues and educating the
team on the Avant approach to this.
- Serving as an expert resource in health
and insurance law across the company
over many years. This has included
providing advice to Underwriting
and Claims Acceptance on complex
indemnity issues, advising the CEO
submissions to government agencies
on behalf of Avant members and
coordinating Avant’s response to key
emerging health law issues.
- Becoming a key spokesperson for
Avant in relation to media enquiries
and a highly regarded presenter and
facilitator.
- Acting as a key resource for member
retention and growth in the area of
medico-legal publications.
- Sitting on many industry committees as
an Avant/MDO representative.
At Avant Andrew has helped many
members negotiate their way through
complex medico-legal situations after
hours – resulting from frantic midnight
calls to the after hours service – and
through representing members in
contact with the police, is well known
to the local constabulary in many NSW
locations!
As for his new role with the AMA (NSW)
Andrew is keen to build a strong working
relationship and is “Looking forward
to working with Sarah’s expert team
providing advice on industrial issues.
I plan to listen and learn”.
happen, what’s going to come in”.
on key issues in health law, preparing
www.amansw.com.au I 19

View from Canberra
Budget bludgeon for battling GPs
by AMA President, Dr Steve Hambleton
While health came out of the Federal
Budget relatively unscathed when
compared to the slash and burn
experienced by other sectors, there
were some casualties – with GPs near
the top of the list.
Firstly, the positives. There was
the aged care package, some new
Indigenous health funding, upgraded
bowel cancer screening, new dental
services, rural health infrastructure
and a commitment to the National
Disability Insurance Scheme (NDIS).
We support all these initiatives which
will deliver good health outcomes to
the community.
While funding was found for one
area of the health system, other areas
felt the squeeze and once again it is
GPs who have been left footing the bill.
The Budget cuts to Practice Incentive
Payments (PIP) to GPs – totalling $83.5
million over four years (that is $83.5
million being ripped out of general
practice) – will have a significant
negative impact on the health system.
They penalise GPs for not meeting
new higher targets for cervical
cancer screening and specialised
diabetes care and remove incentives
for immunisation. Australia is a world
leader in childhood immunisation rates
but this decision could undermine
that reputation and undo a lot of
hard work by parents, GPs and other
health professionals who promote
its importance. The decision to
discontinue the GP Immunisation
Incentives Scheme kicks another leg
out from the tripod that supports this
good work. There was no consultation
on the increase in targets for the PIP
Cervical Screening Incentive and the
PIP Diabetes Incentive which may put
the brakes on successful prevention
and care programs.
These cuts are a big hit to the
viability of general practice and
its responsibility to deliver quality
patient care. The Budget follows
cuts made in recent Budgets to joint
injection rebates and mental health
rebates, the loss of Medicare practice
nurse rebates, earlier cuts to the GP
Immunisation Incentives Scheme and
the imminent loss of the after hours PIP.
These measures, along with changes
to the e-health PIP, could potentially
undermine successful preventive
health programs. They go against the
Government’s stated objectives of
championing preventive health and
being a world leader in electronic
health and place an even greater
burden on hardworking GPs under
pressure in suburbs and towns, making
their practices less viable.
The Government introduced a
requirement that general practices
must choose to participate in the
Personally Controlled Electronic
Health Record (PCEHR) system
if they are to continue receiving
e-health PIP funding. This is not a
requirement – it is a threat and comes
on top of the Government’s failure
to provide any new funding for the
new clinical service GPs are being
asked to provide in helping patients
prepare a shared health summary
as part of the PCEHR. It represents a
substantial roadblock to its effective
implementation and threatens
Australia’s efforts to be a world leader
in e-health. The PCEHR is an opt-in
system so the Government is going
to make funding to a general practice
contingent on the decision of a third
party over whom they have no control.
Sadly, the valuable service provided
by GPs appears undervalued and
under-appreciated by the Government.
GPs are being asked to do more –
much more – for less.
AUSTRALIAN MEDICAL ASSOCIATION

AMA warns budget cuts could GP push fees up,
crunch bulk billing
The AMA has ramped-up the pressure
on the Federal Government to overturn
Budget cuts to practice incentive
payments, warning the move could
force GPs to increase fees and reduce
bulk billing.
The Government’s decision to scrap
practice incentives for immunisation
and increase treatment targets for
pap smears and diabetics is likely to
increase out-of-pocket expenses for
patients and cut bulk billing rates.
“When the support for GPs falls you
really have got two choices. You can
either close-up shop or you can charge
patients a fair fee and I think GPs
will choose to charge fair fees, which
means out-of-pocket costs will rise.
We have seen the bulk-billing rate fall
before and I am suspicious it will start
to fall again,” says Dr Hambleton.
The blunt warning comes amid
mounting anger over the hit to doctors
in the Budget and concern about the
effect of the cuts – particularly to
immunisation incentives – on public
health. The Government expects
to save $83.5 million over the next
four years by scrapping the GP
Immunisation Incentives Scheme
which provided incentive payments
of up to $4,500 to practices that
pushed immunisation rates among
child patients above 90 per cent, as
well as pushing up the threshold for
other incentive payments. Under the
changes, practices will have to ensure
70 per cent of eligible patients are
given pap smears – up 5 percentage
points – to qualify for the payment of a
incentive and prepare care plans for at
least 50 per cent of diabetic patients,
up from 40 per cent.
The Government nonetheless
expects to save a net $225 million in
health expenditure in the next four
years and the AMA is seeking urgent
talks with Health Minister, Tanya
Plibersek to try to have the incentive
cuts reversed. In a post-budget
speech,Tanya Plibersek said the
savings made were “based on clinical
and economic evidence of what’s good
for patients and for the long term
sustainability of our health system”.
Government faces slow start on electronic health records
AMA President, Dr Steve Hambleton
has warned the Federal Government
there may be little take-up of
personally controlled electronic health
records (PCEHR) without significant
changes to its scheme.
In a speech to a recent health policy
forum attended by Health Minister,
Tanya Plibersek in Melbourne last
week, Dr Hambleton cautioned that
although doctors were enthusiastic
about the potential for electronic
health records to substantially
improve care, the Government
was endangering support for their
introduction by rushing ahead with a
system that was little understood and
inadequately resourced.
Dr Hambleton said that under
government arrangements, the cost
burden for PCEHRs would fall most
heavily on GPs and other medical
practitioners. “General practice will
have to make the most investment in
the PCEHR both in time and money
and will realise the least amount
of benefit from it. The legislation
underpinning the PCEHR carries a
lot of new obligations for medical
practices, hospitals and other
organisations providing healthcare.
“Medical practitioners who decide
to use the system will have to adapt
their clinical workflows and train their
staff to work within the requirements
of the legislation,” he added, warning
that doctors would have to take
these additional costs into account
in deciding what fees to charge their
patients. “As things stand, GPs are
being asked to provide a new service
for free. Without specific MBS items for
this work it will have to be absorbed
into the standard consultations.
“GPs will work with their patients to
ensure that a complete and accurate
summary is available to be used by
other healthcare providers in their
clinical decisions,” he said. “It is
only reasonable that patients should
receive an additional Medicare rebate
for this very important additional
service.”
Dr Hambleton said the Government
had to provide support for medical
practices that are private businesses
to invest in the infrastructure that is
needed to make the PCEHR work
and that there needs to be a business
case. “Doctors need greater support
than what is on offer if the PCEHR is
going to truly work to improve patient
care and reduce waste and risk in
healthcare.”
www.ama.com.au I 21

feature
Doctor-in-Training of the Year – Dr Lisa Dark
Nominated for her exceptional conduct
and commitment as a junior doctor, Dr
Lisa Dark recently received the Award
for Doctor-in-Training of the Year at the
2012 AMA (NSW) Doctor-in-Training
Black & White Ball.
Dr Dark is a hard-working and
exceptional registrar working primarily
within the field of neurology at the
John Hunter Hospital in Newcastle.
The dedicated mother of three lovely
children, she previously worked in
hospitality for many years, her passion
for working with people carrying through
to her career in medicine. Her sense of
compassion and ability to relate to the
experiences of others shows through
her unrivalled level of care to her
patients and interaction with senior and
junior colleagues.
Dr Dark’s readiness to come to the
aid of interns struggling with their
first night shift is well-known and it is
not uncommon to hear a sigh of relief
when a junior doctor realises she is the
registrar to be called for assistance.
Dr Dark is highly regarded by her
supervisors, consultant neurologists
and medical, nursing and allied health
colleagues and continues to pass on her
wealth of knowledge to junior doctors
and medical students, both formally and
informally, in a clear and palatable way.
Locally, Dr Dark has presented at
Grand Rounds a number of times not
only for the Department of Medicine
but in other disciplines as well. She
has also presented the findings of her
original research “Botulinum Toxin as
a Treatment for Refractory Trigeminal
Neuralgia” at an international
conference and is a lecturer for the
Hunter Postgraduate Medical Institute.
Why do you think you were nominated
for this award
It’s hard to know for sure but I’ve always
loved medicine and feel very lucky to
be working in this sort of profession.
When I’m working with patients, senior
colleagues and junior colleagues I
always try very hard to do my best and
never take shortcuts.
I also try to maintain a human side
and remember most of us have been
in similar situations where you’ve had
a relative who’s been sick, or you’re a
struggling intern or medical student –
sometimes things can get quite difficult.
As I progress through my career I try to
make sure I never forget how it felt to
be in that situation. When I’m working
with interns and medical students, or
patients and their families, I try to put
the extra effort in to help people.
What made you want to become a
doctor
I think it was a combination of things –
there’s the intellectual and academic
side of it, so it’s quite challenging
but always incredibly interesting and
rewarding. It’s nice to gain skills in an
area but at the same time be in an area
where there’s always more to learn.
On top of that I just really enjoy and
love working with people. I worked in
hospitality for many years and always
really loved it. I came from a science
background before medicine and
medicine actually seemed like quite
a nice way of combining science and
hospitality.
What has been the highlight of your
career so far
I’ve been able to get into the training
program for neurology. For me a
highlight has been being able to train in
an area I love and I feel lucky I’m able to
work in an area I enjoy. The more I do it,
the more I love it.
What have been some of the challenges
you and your colleagues have had to
deal with
Challenges can come in many forms.
There’s the personal side of things like
trying to get through medicine and all
the training and hours that go with
it combined with trying to balance a
personal life with family, raising children
and financial stresses.
The exams are always a very tough
process to get through but it’s incredibly
rewarding when you’re through them.
It can also be quite tough being on-call
and doing the night shift. I think it’s very
important as you get a bit more senior
to be very supportive of your junior
colleagues and make sure they’re not
isolated.
Why do you think it’s so important to
recognise the work of DITs
I think it’s important in every field and
with people in general to recognise hard
work – it’s all too easy for mistakes to be
pointed out and criticisms to be made. I
think when people are genuinely trying
hard and you’re training and learning,
you’re going to make mistakes along
the way. It’s incredibly important to
recognise when people are doing a good
job and are trying hard. People need to
feel valued and appreciated.
22 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

feature
Doctor-in-Training Supervisor of the Year –
Dr Sergio Diez-Alvarez
Dr Sergio Diez-Alvarez – Associate Professor of Clinical Medicine at the
University of New England and senior lecturer at the UNSW Rural Campus
Dr Sergio Diez-Alvarez is a highly respected staff specialist at the Coffs Harbour
Health Campus and was awarded Supervisor of the Year at the recent 2012 AMA
(NSW) Doctor-In-Training Black & White Ball due to his outstanding commitment to
JMO education, training and wellbeing.
With the permission of Dr Diez-Alvarez, The NSW Doctor has published his
acceptance speech – affectionately dubbed the ‘vomit-bag speech’ due to it having
been written at short notice on an air sickness bag during a return flight to Sydney –
the inspiring words of which show the true value of an exceptional supervisor.
Esteemed guests and colleagues,
I would like to thank the AMA adjudication committee for this honour of Supervisor of
the Year.
Bruce Borton stated: The five steps in teaching an employee new skills are preparation,
explanation, showing, observation and finally supervision.
I like to think that we offer supervision more broadly with the provision of guidance and
feedback on matters of personal, professional and educational development, all in the
context of patient care.
In my mind we are less supervisors and more role models or mentors.
I am a staff specialist general physician and it is ironic that only three years ago
I underwent a year’s supervision in a regional hospital as part of the specialist
recognition pathway by senior colleagues. During that year I recognised that
supervision can encompass a broad spectrum of interactions and that it can be very
individual in the way it is carved out.
Over the last three years I have had the honour to supervise many talented junior
medical officers and medical students and have realised that supervision is a two-way
process; the reflection and sharing is carried out by both parties and I have found that
supervision has enriched me both professionally and personally.
What are the attributes of a good supervisor One that would encourage the trainee to
grow in confidence, help them create a professional identity, encourage critical thinking
and ensure they feel valued and respected, encourage them to reflect on their personal
and career goals and share their own experiences.
However, I have realised that in order to be a great supervisor one needs to be able
to share their passion. A passion for clinical medicine, for education and for lifelong
learning. A passion for uncompromising patient care and a motivation to find learning
opportunities in even the most mundane of clinical interaction.
I want to challenge our junior medical officers to become role models in their own right,
to share that passion through mentoring colleagues and students. After all, we are an
extended family.
I again want to show my appreciation for this accolade desired by many of my fellow
supervisors but I hope to think that rewards for excellent supervision are not essential.
When one is passionate, one does not need motivation.
I would like to thank my family and especially my wife Deborah. She really taught me
the value of reflection and listening, skills essential in supervision.
I would like to finish off with words from Galileo Galilei that I hope will inspire you all.
“You cannot teach a man anything. You can only help him discover it within himself.”
www.amansw.com.au I 23

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feature
Doctor-in-Training Volunteer of the Year –
Dr Ryan Snaith
Dr Ryan Snaith is an
inspiring, compassionate
and hard-working
individual who was
awarded Doctor-in-
Training Volunteer of the
Year at the recent 2012
AMA (NSW) Doctor-In-
Training Black & White
Ball for his work in
community healthcare in
Western Kenya.
Currently an emergency registrar at
Nepean Hospital, Dr Snaith has travelled
to Kenya many times over the past eight
years and in 2003 was the first to help
establish and work at the Shikunga Clinic
in regional Kenya. On return visits he
has held staff and community training
sessions at the clinic, treating up to 200
and sometimes 300 patients a day.
“I went to Kenya for a medical
placement elective at the end of first year.
I was inspired by the place and met some
pretty inspiring people,” Dr Snaith says.
“Shikunga’s a rural village out in the
western Kenyan province with about 30-
40,000 people. Poverty is a big issue out
there – there are no roads, electricity or
water and until about 2006, no healthcare
facilities whatsoever. It was a pretty dire
situation and something needed to be
done about it.”
It was this exposure to the plight of
the Shikunga community that gave Dr
Snaith the conviction and determination
to take action. “I was pretty keen to
do something about it when I got back
home so I got a few mates together and
went from there.” In 2006 Dr Snaith
founded and assumed presidency of
the NGO Kenya Aid which is dedicated
to improving healthcare outcomes in
Western Kenya. He believes knowledge
is one of the keys to lasting change and
for this reason Kenya Aid’s programs are
community-oriented and place a heavy
emphasis on education and prevention
strategies.
The achievements of Kenya Aid over
the past few years are a true testament
to Dr Snaith’s focus and determination.
The Kenya Aid volunteer team have
constructed a rural hospital in the
Shikunga region and implemented a
number of community-based health
programs including a free child
vaccination program, HIV counselling and
testing, health education home visits and
antenatal services.
“After opening up the hospital last
year we started some fundraising to
purchase an ambulance,” Dr Snaith
says. As of April this year Kenya Aid was
able to raise enough funds to buy an
ambulance which will become one of only
five ambulances in the entire Western
Province – with a population of 4.1
million. “In the Kakamega district alone
there are about 110,000 people with no
ambulance service whatsoever. Hopefully
in the next few months we’ll have the
first ambulance service in the Kakamega
district up and running.”
Along with his volunteer work Dr
Snaith manages to remain equally
committed to his responsibilities as
an emergency registrar in Nepean and
raising a young family. He has been
described as a ‘great guy and fantastic
to work with’ and is a constant source of
inspiration to his colleagues. He is viewed
by his superiors as a model trainee,
balancing his volunteer work with the
recent birth of his son and passing the
primary Emergency Medicine exams
while simultaneously working to a heavy
ED shift roster.
Dr Snaith remains incredibly humble
in the face of his accomplishments in
Kenya. “It’s definitely a team effort,”
he says. “We have a team of people –
including my wife – who all work hard on
the projects and discuss what our next
steps are.” The Kenya Aid team certainly
have their work cut out for them. Apart
from establishing the ambulance service
in the Kakamega district, next on the list
is developing and implementing a fullscale
HIV program by the end of the year.
“There’s still a lot of work to be done at
the Shikunga hospital as well,” Dr Snaith
says. “In the near future we would like
to make obstetric and surgical facilities
available for the region.”
To find out more about Kenya Aid
including how to donate or get involved
visit their website at http://kenyaaid.org/
or email the team at info@kenyaaid.org
www.amansw.com.au I 25

feature
Child safety initiatives
by Elyse Cain
Sometimes it seems as though a week hasn’t
gone by without another tragic story in the
media of a child drowning in the backyard
pool or plummeting from an apartment
window. Eight children have already been
admitted to the Children’s Hospital at
Westmead (CHW) with serious injuries this
year alone after falling from a window or
balcony. The sad reality is this number will
continue to rise throughout the year.
In 2008 the CHW identified falls by children from
residential buildings as an increasing cause of
injury, often with serious and fatal outcomes. Data
collected during the period of 1998 to 2008 by the
Centre for Trauma Care, Prevention, Education and
Research at CHW indicates that fall incidents are
linked to two key areas of buildings: windows and
balconies. For the same period, admissions to CHW
due to falls from windows and balconies were also
greatest in young children aged 2-4 years.
Parental supervision plays an important role
in the prevention of child falls from windows
and balconies, however evidence from the CHW
Centre for Trauma showed that in the majority
of cases reported during 1998-2008, specific
building components – such as a low window sill
or balustrade height, fully open or freely openable
windows, flyscreens which gave a false sense of
security – were contributing factors.
As a result of these findings the CHW established
the Working Party for the Prevention of Children
Falling from Residential Buildings, who last year
successfully lobbied the Australian Building Codes
Board (ABCB) to include amended provisions

for barriers for openable windows
and balustrades of newly constructed
buildings in the National Construction
Code (NCC) from 2013 onwards.
While this is a welcome achievement,
child falls from the windows or balconies
of high-rise residential buildings is an
increasing issue and therefore forms one
of the major elements of an AMA (NSW)
campaign aimed at reducing the number
of child deaths and injuries in NSW. The
AMA (NSW) and the CHW working party
have now joined in a campaign to push
the NSW Government to act on ensuring
the safety of children in existing high-rise
residential buildings.
The other equally important element of
the AMA (NSW)’s campaign for improved
child safety is that of child drownings or
near-drownings in backyard pools. Since
last year the AMA (NSW) has engaged in
discussions and organised media events
with Bruce Barbour (NSW Ombudsman
and Convenor of the Child Death Review
Team), the Samuel Morris Foundation,
Kidsafe NSW and the Royal Lifesaving
Society NSW in joint support of this issue.
This has already begun to yield results.
The positive response to the AMA (NSW)
campaign from the public and NSW
Government initiated the release of
the Swimming Pools Act 1992 Review
– Discussion Paper by NSW Minister
for Local Government, Don Page in
January this year. The paper was a direct
response to the increasing incidence of
child drownings and near-drownings in
backyard pools and acknowledged that
while a number of minor amendments to
the Swimming Pools Act 1992 were made
in 2009, the NSW Deputy State Coroner,
the NSW Child Death Review Team and
other pool safety advocates including the
AMA (NSW) have consistently called for a
further strengthening of the Act.
Anecdotal evidence suggests that while
numbers of child deaths from drowning
remains relatively low, faulty barriers
continue to be a major contributing factor
to drownings with between 60 and 80
per cent of barriers suspected of being
non-compliant. The NSW Government
discussion paper has therefore proposed
a number of amendments to the
Swimming Pools Act 1992 to improve
current swimming pool legislation
particularly in regard to fencing safety
and owner responsibility, key factors that
have been the focus of the AMA (NSW)
campaign. Submitted in February 2012,
the AMA (NSW) worked with the Royal
Life Saving Society NSW on a response to
the discussion paper and in doing so has
strengthened the push for amendments
to pool fencing legislation necessary to
decrease the risk of child drownings in
backyard pools.
A/Prof. Brian Owler, known as the face
of road trauma prevention for the RTA
and AMA (NSW) Don’t Rush road safety
campaign, recently lent his support to
The Daily Telegraph’s push to make CPR
part of the national school curriculum
saying certified CPR training was an
essential skill for life at any age and in
any location. The campaign, backed by
the AMA (NSW), is also supported by St
John Ambulance, Royal Life Saving NSW,
Surf Life Saving, the Teacher’s Federation
and the P&C Association.
While lifesaving techniques are taught
by organisations such as junior surf
lifesaving clubs, A/Prof. Owler said it
was crucial CPR training be certified as
students need to practice what they are
taught and be assessed to ensure they
are using the correct technique. “While
you can talk about it (in the classroom),
actually doing it and practising on a
mannequin and making sure you’re doing
it correctly is an important part.” Studies
have shown that patients left without
CPR for five minutes had poor outcomes
compared to those who had resuscitation
attempts made immediately.
To sign The Daily Telegraph’s petition visit: www.ipetitions.com/petition/telegraph-campaign-for-certified-cpr-training/
www.amansw.com.au I 27

feature
Air clears around smoke-free legislation for
outdoor public places
We all love a classic song but when smoke really
gets in your eyes and it’s not yours, you wonder why
you put up with it.
You may not have to any longer. Once NSW lagged
behind the rest of Australia by lacking smoke-free
outdoor legislation, however non-smokers – a
whopping 86 per cent of the state population aged
over 16 years – can now rejoice in the fact this is all
changing.
Last February NSW Minister for Health, Jillian
Skinner announced an immediate smoking
ban in playgrounds, public sports grounds,
swimming pools, public transport stops and
entrances to public buildings, with a smoking ban
in commercial outdoor dining areas from 2015
onwards. Numerous studies had already found that
exposure to second-hand smoke in outdoor areas
where people congregate can be as high as those
measured indoors, making the case for reducing
community exposure to second-hand smoke in
outdoor areas increasingly clearer.
The new smoking ban follows months of intense
campaigning on behalf of non-smokers and
public health advocates everywhere. In November
last year representatives from the AMA (NSW),
Cancer Council NSW, Heart Foundation, Action on
Smoking and Health (ASH), Asthma Foundation
NSW, SIDS and Kids NSW and members of the
public packed the gallery at NSW Parliament to
hear the discussion on a petition of more than
11,000 signatures to introduce a ban on smoking in
outdoor public places.
The positive response from Members of
Parliament present was enough to prompt the
organisations involved to continue the campaign
with strengthened resolve, with the resulting
smoking ban announcement proof that the hard
work had paid off.
In response to the announcement, AMA (NSW)
President Dr Michael Steiner said, “After many
months of hard lobbying, it is extremely heartening
to see that the NSW Government has listened
to our concerns and taken such a positive step
towards reducing the impact of smoking on the
health of the community”. NSW Heart Foundation
CEO, Tony Thirlwell agreed,”This is an historic
moment in our State’s history and one that will help
to protect the thousands of people in NSW who
don’t smoke”.
While these new measures must still be
introduced through a Bill in the NSW Parliament
in the coming months it is hard to imagine there
will be much opposition to the smoking ban. The
facts speak for themselves – smoking-related
illness accounts for around 5,200 deaths and 44,000
hospitalisations each year in NSW alone with an
annual cost of around $8 billion to the
NSW economy.
Further evidence shows exposure to secondhand
smoke increases, among other things, the
risk of heart disease, cancer, respiratory problems
and macular degeneration. Even more alarming
perhaps is the fact that in NSW more than 50 per
cent of babies reported as dying of sudden infant
death syndrome (SIDS) were exposed to secondhand
smoke. It is plain to see why something had to
be done.
“The dangers of smoking are well-known to all
and I’m very glad the NSW Government is taking
action against this harmful and addictive activity,”
Dr Steiner said. “This smoking ban will significantly
decrease community exposure to second-hand
smoke and the health risks that come with it.”
28 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

Genetic skin cancer research leads to solarium ban
The recent NSW Government decision
to ban the use of solariums for tanning
purposes from 31 December 2014
was a welcome move for public health
advocates across the state. It was
certainly a huge cause for celebration
for cancer researcher Professor Graham
Mann and the rest of his team, whose
findings late last year prompted the
Government to take swift action on the
use of solarium tanning beds in NSW.
A research collaboration led by
Professor Mann between the Westmead
Millennium Institute for Medical
Research, The University of Sydney,
University of Melbourne, Melanoma
Institute Australia, Cancer Council
Victoria and Cancer Council Queensland,
the Australian Melanoma Family Study
investigated the genetic, environmental
and lifestyle factors important in the
incidence of melanoma.
In the only Australian study of its kind
to date, the team of researchers worked
with families who present with a high
risk of melanoma to sequence every
gene from their DNA. A mutation in the
Microphthalmia-associated transcription
factor (MITF) gene – known to control
skin cells that become malignant in
melanoma – was discovered in high risk
family members. According to Professor
Mann, an estimated 200,000 Australians
have the gene mutation that more than
doubles the risk of melanoma in the
people who carry it.
The study also investigated lifestyle
factors associated with melanoma
including the link between the use
of solariums by young people and
melanoma incidence. Research
showed that where people had gotten
melanomas under the age of 30 and had
used solariums, 75 per cent of those
melanomas were attributable to
solarium use.
This reinforced the findings of a
2007 Queensland Institute for Medical
Research study which found that
solarium use in people under the age
of 35 doubled their risk of developing
melanoma. The University of Sydney
researcher and epidemiologist, Dr Anne
Cust – who also worked on the Australian
Melanoma Family Study – estimated 120
cases of melanoma could be avoided and
10 lives saved each year if solarium use
is banned.
While the solarium ban prompted by
the Australian Melanoma Family Study
is an immense achievement, the team
of researchers also hope the study’s
findings will lead to better treatments for
people at risk of melanoma. “Hopefully
(the discovery of the gene mutation) will
make both prevention and detection of
melanoma more efficient by taking into
account genetic information like this,”
Professor Mann said.
The findings have been published in
the international weekly journal of
science, Nature.
www.amansw.com.au I 29

feature
2012 AMA (NSW) Medical Careers Expo
On Saturday, 5 May 2012 the AMA (NSW)
hosted its annual Medical Careers Expo
at the Sydney Showground, Sydney
Olympic Park. More than 300 medical
students and junior doctors attended
the Expo to talk to representatives of 20
exhibitors including CareFlight, Rural
Health Workforce Australia, General
Practice Training, General Practice
Registrars Australia, NSW Health, Medic
OnCall, Medical Protection Indemnity
Society, LML Medical Recruitment and
medical colleges.
Speakers included CareFlight Retrieval
Specialist, Dr Sam Bendell; former
AMA (NSW) President, A/Prof. John
Gullotta, AM; Editor of the MJA, Dr
Annette Katelaris; Former AMA Federal
President, Dr Andrew Pesce; and AMA
(NSW) Student Councillor, Ben Veness.
A highlight of the day was the NRMA
CareFlight chopper that travelled from
Northmead to land at Cathy Freeman
Park with a crowd of Expo onlookers
gathering to watch the trauma team
demonstration.
Upon registration attendees were
given “passports” with which to enter a
draw, providing they visited every stand
and had their passport signed-off by
each exhibitor. First place was awarded
to Michelle Fang who won a $300 gift
voucher donated by the AMA (NSW).
Sylvie Gjerde came second, winning a
$200 gift voucher donated by the AMA
(NSW). Nicholas Moor won the third
prize, a $100 gift voucher donated by
Cutcher & Neale.
Gold sponsors
Silver sponsors
www.amansw.com.au I 31

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news
Please give generously to the Medical Benevolent
Association of NSW annual appeal
“Being a Doctor is not something I do,
it is something I am.”
I am not sure if the same is true for
other professions or if this is one of
the ‘privileges’ of being a doctor. What
I do know is true is that when a doctor
is unable to work, the effect on every
aspect of his/her life is immense.
The effect of financial stress on ill
health can delay recovery by months
and possibly years. Many doctors
put off asking for help because they
are embarrassed, however the delay
can compound problems, banks can
foreclose on mortgages and cars can
be repossessed. If being a doctor is
something you are, don’t delay asking
for help or put you career and family in
jeopardy.
“I have come to understand rather
personally the importance of financial
stability for health and wellbeing.
The MBA carried us through a critical
period of time. We are not completely
out of the woods but for now we are on
much safer ground than we have been
for some time.”
The Medical Benevolent Association
of NSW can provide financial assistance
and counselling support for doctors and
their families. The Association’s Annual
Appeal letter will be arriving in your
mailbox any day now. Please consider
a donation to help your colleagues in
need and their families regain some
stability. You can donate online at
www.mbansw.org.au or by contacting
the Finance Officer on 02 4739 2409.
The Council of the Medical Benevolent
Association of NSW wisely carries the
heavy burden of ensuring doctors in
need receive the support they need.
If work pressure, financial stress or
ill health are occupying your mind, or
you are concerned about a colleague
please contact the Medical Benevolent
Association of NSW through its Social
Worker, Meredith McVey, either at
www.mbansw.org.au or by telephoning
02 9987 0504. All discussions with
Meredith are confidential.
Assessing Fitness
to Drive 2012
The National Transport Commission
and Austroads have released Assessing
Fitness to Drive, the 2012 revised
national medical standards for driver
licensing. Health professionals have an
important role in supporting road safety
through their management of fitness
to drive. The standards aim to ensure
health professionals are aware of the
road safety implications of medical
conditions and understand the licensing
authority systems for managing
medically at-risk drivers. A copy of
the publication has been mailed to all
registered GPs. Further copies can be
purchased online via the Austroads
website www.austroads.com.au with
an electronic version also available as a
download from the site.
2012 MIGA Doctors-in-Training
Grants Program
The Doctors-in-Training Grants
Program is open to doctors who are
either enrolled in an accredited training
program or who have completed their
accredited training program within the
last two years and seek to undertake
additional training opportunities
beyond the scope of training prescribed
through their College or Society.
The theme for the 2012 MIGA DIT
Grants Program is Supporting skills
development amongst Doctors-in-
Website for junior doctors
Training. MIGA is offering up to four
individual grants of $5,000 each to
assist in covering the costs incurred
by the doctor in funding their training
opportunity which can include travel,
accommodation and program fees.
Applications close 5.00pm Friday,
26 October 2012. To be considered for
a Grant you must complete the 2012
DIT Grants Program Application Form
available on the MIGA website
www.miga.com.au
The DHAS (NSW) website dedicated to the health of junior doctors under the
banner: “Are you OK” is designed as a cache of important self-help and referral
tools to support junior doctors who feel they may be in need of some help but are
unsure or do not know where to turn for assistance. Check it out at:
www.jmohealth.org.au
www.amansw.com.au I 33

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advertorial
Practice made perfect – specialist advice when
setting up your practice
Medical professionals are often
surprised to find that, when it comes to
arranging finance for either a personal
or business loan, the big banks tend to
treat them like everyone else. Despite
strong business fundamentals banks
are still not prepared to invest in
medical businesses without insisting
on substantial security – usually the
family home. If there is insufficient
equity in the property, allowing the
bank to use the home as security
may still not be enough to secure
the necessary finance which is why
Investec Specialist Bank’s products
and services are so important.
“Medical professionals are a unique
group,” says Investec’s Andre Karney.
“That allows us to treat them very
differently to the general banking
market. The amount of flexibility we
have and the kind of things we can do
is outstanding.”
Although other financial institutions
lend to the profession it isn’t easy for
them to be flexible just to suit those
individuals. “We’re looking at the
individual and structuring something
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their circumstances,” says Andre
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an asset.”
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In 1974 three young entrepreneurs
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Investec Group established its first
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Brisbane, Adelaide and Perth. They’ve
continued to grow in good and bad
economic climates by building welldefined
specialist banking services.
Going to a specialist makes sense
when it comes to exploring ways to
finance your medical practice. For
example, “A loan in return for the bank
taking security over your property is
not a business loan – it’s a mortgage,”
explains Stafford Hamilton of Investec
Specialist Bank. “That’s not what
our clients want. They need a bank
that understands their business and
will invest alongside them. We back
the individual and their practice and
generally do not need to take the
property as security. This alone gives
the client a lot more freedom.”
Allowing a bank to stake a claim on
the family home not only mixes up
personal and business finances it can
have numerous implications later
on. “It is very common for borrowers
to underestimate what they have to
pay back to the bank when they come
to sell their home because the bank
will claim back any money that was
used to purchase business assets,”
says Stafford Hamilton. “If the bank
takes the money from the equity, you
lose all of the tax advantages usually
associated with that loan and that can
be disastrous.”
Through collaboration and advice
Investec can invariably come up with a
well thought through solution. “We are
here to work with our clients and help
their business grow and through our
discussion process they can see we
know what we are talking about. We
want them to expand sustainably and
implement growth strategies with the
appropriate tax planning in mind.”
“The important thing with medical
clients is it’s not just about the interest
rate you can offer them,” Andre
Karney adds. “It’s about how you treat
them.”
Disclaimer | Investec Professional Finance Pty Ltd ABN 94
110 704 464 (Investec Professional Finance) is a subsidiary
of Investec Bank (Australia) Limited ABN 55 071 292 594
(Investec Bank) AFSL/ACL 234975. All finance is subject to our
credit assessment criteria. Terms and conditions, fees and
charges apply. Investec Professional Finance is not offering
financial or tax advice. You should obtain independent financial
and tax advice, as appropriate. Whilst the information in
this document has been prepared using all due care it is not
intended to be relied upon in making financial or investment
decisions.
www.amansw.com.au I 35

events
MEMBER INFORMATION
seminar
Tax planning for DITs –
top tips for preparing your tax return
Date | Thursday, 26 July 2012
Time | 6.30pm-9.00pm
Where | AMA House, St Leonards
Cost | AMA members: $20, Non-members: $50
RSVP | Phone Janene Wardrop 02 9439 8822 or
email: events@amansw.com.au
Preparing your tax return might seem like a pretty
straightforward exercise at this stage of your career but
if you get it wrong you could be missing out on valuable
deductions.
In this informative session, medical accounting
specialist Jarrod Bramble will point out the pitfalls and
show you how to maximise your return.
Jarrod will also give tips on:
• How to use debt to your advantage.
• The benefits and pitfalls of negative gearing.
• The shortest path to home ownership.
• The power of superannuation.
DOCTORS-IN-TRAINING SEMINAR
INTERVIEW TECHNIQUES
Doctors-in-Training Interview Techniques
– (SRM0 positions and Colleges)
This workshop is designed for junior doctors who are
planning to apply for SRMO positions or College training
programs.*
Judy Muller, one of the most experienced JMO Managers in
the state, will discuss the interview process regarding the
SRMO positions at hospitals.
The presenters will take questions on the night.
Date | Thursday, 21 June 2012
Time | 7:00-9:00pm (light refreshments available from
6:30pm)
Place | AMA House, St Leonards
Cost | AMA members – $20
RSVP | For more information or to make a booking
phone Janene Wardrop on 02 9439 8822 or
email: events@amansw.com.au
This event is for AMA members only. Limited places are
available so please book early to avoid disappointment.
*This is not intended to cover surgery and obstetrics, as a seminar relating
to these colleges was held in April 2012.
events
the pcehr AND PRIVACY – WHAT DOCTORS NEED TO KNOW
Welcome to the new era of Personally Controlled Electronic Health Records (PCEHR).
Mr Andrew Took, formerly National Manager of Medico-legal Advisory Services at Avant Mutual Group (Avant) and new
Director of Medico-legal and Employment Relations at the AMA (NSW), together with other experienced speakers will
demystify and answer your questions on the PCEHR.
Date | Wednesday, 15 August 2012 Time | 7:00pm-9:00pm
Where | AMA House, St Leonards Cost | AMA members: $20, Non-members: $50
To register phone Janene Wardrop on 02 9439 8822 or email events@amansw.com.au
36 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

events
President’s Cup – 26 April 2012
The President’s Cup was held on
26 April 2012 at Monash Country Club
in perfect weather conditions with very
little wind. The players agreed that the
course was in immaculate condition
and were delighted to be playing as
last year’s event was rained out. The
Monash greens certainly lived up to
their reputation as the scores showed.
“Like putting on ice” was one doctor’s
comment.
The winner of the President’s Cup
for 2012 was Dr Michael Burke. Dr
Burke won the cup with a score of 34
Stableford points. It was a very close
contest and Dr William Benz was the
runner-up on a count-back, also with
34 points.
The 2 Ball Best Ball was also closely
contested with the winners being
Mr David Page and his lovely wife
Jacquie on 40 points. Runner-ups were
Dr Michael Burke and Dr John Lewis
on 39 points.
Other results:
Highest Score by a Golf Society Guest –
Mr David Page (39)
Nearest the Pin (3rd Hole) –
Dr John Grey
Longest Drive – Dr Terry Mahony
AMA International Shield
Queenstown, New Zealand
14-22 October 2012
The AMA (NSW) Golf Society
International Shield will be held in
Queenstown, New Zealand this year
with golfers staying at the exclusive
St Moritz Hotel.
Experience eight nights
accommodation at the St Moritz Hotel
overlooking the lake and play six
rounds of golf on spectacular courses
including Jacks Point, Michael Hill,
Millbrook and Kelvin Heights. There
are only a few places remaining as
numbers are strictly limited.
Economy airfares, breakfasts, a day
tour and more are included in the
package.
For more information contact
Sue Connell at the AMA (NSW) on
02 9439 8822 or email
Susan@amansw.com.au
We connect.
That’s what
makes the
difference....
www.tresscox.com.au
TressCox has over 100 years experience
representing Medical Practitioners in various
areas of Health Law.
Our Health Services Group is one of the largest
and most experienced in Australia. We are
well connected to the health industry, its peak
bodies and key professionals, so we offer a deep
understanding of the issues.
Some of our areas of expertise include:
• Employment and Industrial Relations
• Business Structures and Contracts
• Administrative law
• Wills and Estate Planning
• Professional Conduct
• Medicare Investigations
• Dispute resolution and litigation
When professional, ethical and commercial issues
compete, our legal advice is sensitive to every
nuance and reality for one particular reason:
our health team has specialist expertise gained
through long term relationships with the industry.
We connect. That’s what makes the difference.
Scott Chapman
Phone 02 9228 9317
Mobile 0411 196 208
Scott_Chapman@tresscox.com.au
Dominique Egan
Phone 02 9228 9261
Mobile 0404 851 403
Dominique_Egan@tresscox.com.au
Don Munro
Phone 02 9228 9219
Mobile 0419 880 797
Don_Munro@tresscox.com.au
Medical DEBts
collected professionally
Don’t give up on your bad debts!
Guardian Collection Agency has been servicing the
medical profession for more than 20 years with an
exceptional success rate.
We offer a simple, commission-only fee structure and
a reputation for integrity, efficiency and 100 per cent
personal service.
Forget the large, run-of-the-mill impersonal agencies,
we offer:
: No cost to you unless we collect.
: Wholly committed to debt collection.
: Unique ‘counselling’ approach to debtors -
we address patient’s problems.
: Stable, professional and family
owned and operated.
Phone 02 9488 8597
Fax 02 9988 4207
Email guardian@sydney.net
t w i t t e r. c o m / Tr e s s C o x
linkedin.com/company/tresscox-lawyer s
www.amansw.com.au I 37

classifieds
DALE STREET MEDICAL
SPECIALISTS, BROOKVALE
Northern Beaches, well appointed rooms
for sessions. Full admin.
Support if required.
Phone: Patrick Coleman 0409 871 156.
ROOMS TO RENT, ST LEONARDS
St Leonards Specialist Clinic, rooms
available in newly built premises. Full
secretarial and accounting support if
desired.
Phone: John Cosgrove 02 9439 2469.
HIGHLY EXPERIENCED PRACTICE
MANAGEMENT CONSULTANT
Establishing a new practice, moving or
expanding Does your practice need
streamlining Exp. practice manager can
find a solution to your needs. Short-term
projects pref. Ongoing assistance if req.
Phone: A. Bagot 0488 333 036 or
annettebagot@gmail.com
FOR SALE – TV, 60 INCH LG.
MONITOR. OFFER
Phone: Karin 0400 417 796 Monday to
Friday 9.00pm-5.00pm or SMS.
RICHMOND FOR LEASE –
PERFECT FOR MEDICAL OFFICE
Central Richmond position with high
exposure, plenty of ‘off street’ and ‘on
street’ parking, approx 118m2 including
a main area, storage area & washroom.
Close to chemists. On local bus route and
close to trains & ambulance.
View by appointment. $2,022pm + GST
Phone: Brendan Nott 4578 3933 or
0433 831 875.
Email: brendan.nott@wiseberry.com.au
CONSULTING ROOMS FOR LEASE –
75sqm – 19 BROUGHTON STREET,
KIRRIBILLI
Level garden entry to excel mod suite.
Lge bright Reception / Waiting Room,
1 Surgery, 1 Consultation, ample amens,
a.c., 2 carspaces. In boutique office bldg
main road village shop strip opp Rail
Stn & Bridge Stairs. Busy Harbourside
residential area, new & old, historic
houses, private schools, theatre, cafes.
Phone owner 02 9968 4123 / 0429 520
223 / 0412 207 655.
FILL THIS SPACE...
All classified advertisements $250 plus GST.
AMA (NSW) members – 50% discount on all classified advertisments.
2012 Continuing Professional Education (CPE) seminar
for experienced clinicians
2012 Continuing Professional Education (CPE) seminar
for experienced clinicians
The AMA (NSW) will host its 11th annual CPE Seminar on Saturday, 23 June and Sunday, 24 June 2012.
These seminars assist retired practitioners to meet their annual CPE requirements for medical registration.
The weekend course will cover current developments in medical practice including updates in the treatment of
diseases, preventive health and public health issues.
Date
| Saturday, 23 June – 9.30am-4.00pm (Registration from 9.00am)
Sunday, 24 June – 9.00am-1.00pm
Venue | X5B Lecture Theatre 1, Macquarie University (Entrance via Balaclava Rd)
Cost
| AMA member $150.00. Non-member $200.00. Includes morning teas and lunch on Saturday.
Parking provided. Gold coins not required.
AMA members | register online at www.amansw.com.au
For more information or to make a booking contact Janene Wardrop on 02 9439 8822 or
email: events@amansw.com.au
38 I THE NSW DOCTOR I NON-MEMBER ISSUE I JUNE 2012

Join AMA (NSW)
now and receive June
for free.
Yes join me up!
1 By post – fill out this form and return it to PO Box 121 St Leonards 1590.
2 By phone – call our friendly membership staff on (02) 9439 8822.
3 By fax – complete this form and fax it to (02) 9438 3760.
4 Online – go to joinamansw.com.au and enter your details.
I wish to become a member of the Australian Medical Association and the Australian Medical Association
(NSW). I agree to observe the principles stated in the Declaration of Geneva and the Rules of the AMA.
PREFIX AND NAME
go
into the draw
to win
one of THREE
annual
memberships*
*Competition open to members joining in June
only. Free membership from January 2013.
gender
ADDRESS
DOB
SUBURB
POSTCODE HOME PRACTICE
Telephone
email
HOSPITAL
MOBIle
(Required for member only website access)
DISCIPLINE
Would you like to receive a copy of AMA (NSW) annual report No Email Hard Copy
REASON FOR JOINING
2012 Rates (Promotion from 1 June)
Tick
Category **Monthly or 6 Monthly Rate
Specialist $113.58 $681.50
General Practice $101.08 $606.50
Intern $16.67 $100.00
2nd year Doctor-in-Training $29.25 $175.50
3rd year Doctor-in-Training $29.25 $175.50
4th year Doctor-in-Training $54.00 $324.00
5th year Doctor-in-Training $62.42 $374.50
Non specialist Salaried Medical Officer $92.33 $554.00
Part time positions-engaged 11-25 hours pwk $60.00 $360.00
Part time positions-engaged up to 10 hours pwk $28.33 $170.00
NB: Discounted rates are available for doctors on parental leave, joint spouse, overseas doctors, retired and over 70 years
old. Contact our friendly membership team for more information on 02 9439 8822. All rates are inclusive of GST.
I want to join AMA (NSW) and pay
**Monthly 6 Monthly Rate
AMOUNT $
PAYMENT DETAILS
AMEX MASTERCARD VISA DINERS
Card Number ____ ____ ____ ____ / ____ ____ ____ ____ / ____ ____ ____ ____ / ____ ____ ____ ____
Expiry Date
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CARDHOLDER’S SIGNATURE ____________________________________________________________________________________________________
or enclose a cheque made payable to AMA (NSW).
Thank you for submitting your application to AMA (NSW). We look forward to the contributions you will be making to the
future directions of the AMA (NSW).
**A minimum of 6 months subscription period applies.
www.amansw.com.au I 39
The AMA (NSW) Privacy Policy | Please go to the website www.amansw.com.au/privacy-policy

The AMA – your
professional association
Join now and you will not only get access to a wide range of member benefits and
services but also ensure doctors continue to have a strong and influential voice when it
comes to policy-making at both State and Federal level.
Legal and Industrial Services
Whether you’re an employee or an employer, a
doctor-in-training or a specialist, a public employee
or a private practitioner, your membership gives you
access to highly-qualified and experienced staff who
are able to provide the legal and industrial advice you
need, including:
• Advice and support for doctors-in-training for both
industrial relations issues and training issues
• Advice and support for employed and contracted
doctors, both public and private
• Practice management advice for private
practitioners, including staff management and
where necessary, management of disciplinary
action and termination
• The AMA schedule of fees
• Advice and support for VMOs for industrial and
contract issues
Educational and Social Events
AMA members get exclusive or heavily-discounted
access to a wide range of events designed
specifically for doctors, including:
• Opportunities for doctors-in-training to network
with senior members of the profession
• Interview techniques training seminars for doctorsin-training
applying for College programs
• CPE opportunities for retired doctors
• Information seminars on important industrial, legal
and OH&S issues
• Practice management seminars for private
practitioners
• Taxation and financial advice seminars from our
commercial partners
Advocacy and Lobbying Services
The AMA is your professional association – the only
organisation that represents the interests of the
entire medical profession. With your support we will
continue to:
• Make sure that the welfare of patients is at the top
of the health agenda
• Ensure that doctors’ interests and those of their
patients are well-represented in the media and
political debate
• Campaign to “close the gap” in health outcomes for
indigenous Australians
• Advocate for equity of access to health services for
all Australians
• Campaign on key public health issues to keep them
on the political agenda and help increase health
awareness among Australians
• Undertake regular surveys of members to ensure
that AMA policy reflects members’ views
Commercial Benefits
Membership gives you access to a wide range of
commercial benefits, including:
• Discounts and priority service on a range of
products useful to doctors
• Great deals on loans for homes, practices and cars
through Investec Specialist Bank
• Excellent service on income protection, general and
life insurance from Experien Insurance Services
• Accounting services through Cutcher & Neale –
specialists in assisting doctors
• A vehicle buying agent to make purchases easier,
cheaper and quicker
• Club discounts with Qantas and Virgin

As a member of the
Australian Medical
Association (NSW),
we think you
deserve special
treatment.
That’s why when you switch to Commonwealth Bank,
you’ll pay no joining fee and enjoy preferred rates on
merchant services. For a little special treatment,
contact the AMA team today.
Call member services at AMA (NSW)
on 9439 8822 or email
services@amansw.com.au
commbank.com.au/business
Commonwealth Bank of Australia ABN 48 123 123 124. CBABM0787

How to avoid the
biggest mistake
you can make
when starting in
private practice.
Starting or buying into a private practice can be one
of the most rewarding career moves you’ll ever make.
But if you don’t have the right accountant by your side,
you could be in for a world of fi nancial pain.
We’ve been helping medical professionals like you for
almost 60 years. That wealth of experience in every
aspect of starting and running a highly successful,
lucrative practice is at your disposal.
Make no mistake.
Before you make a move,
you need to talk to Cutcher & Neale.
For a no obligation, no charge conversation,
contact Jarrod Bramble on 1800 988 522.
CN1
12143
■ Freecall 1800 988 522
cnmail@cutcher.com.au