One profession. One voice. One vision. - Australian Medical ...

Be rewarded with a gift voucher of up to $500 1 ,towards your 2011 AMA subscription. Simply settlean eligible finance agreement 2 with Investec Experienbetween 1st September and 30th November 2010.To find out more, contact us on 1300 131 141 Australiawide or visit www.investec.com.au/professionalfinanceInvestec Experien Pty Ltd ABN 94 110 704 464 (Investec Experien) is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 (Investec Bank). All finance is subject to our credit assessment criteria. Terms andconditions, fees and charges apply. Deposit products are issued by Investec Bank. Before making any decision to invest in these products, please contact Investec Experien, a division of Investec Bank, for a copy of the ProductDisclosure Statement and consider whether these products suit your personal financial and investment objectives and circumstances. We reserve the right to cease offering these products at any time without notice.1The value of the gift voucher will be based on the value of the contract settled during the promotion period; $100 for commercial contracts up to $75K, $200 for commercial contracts from $75K to $150K, $300 for commercialcontracts from $150K to $500K, $500 for commercial contracts over $500K and $250 for residential mortgages. Eligible clients will receive a gift voucher at the end of the promotion period. Gift vouchers are only eligible forredemption of 2011 AMA (NSW), AMA Queensland, AMA Victoria or AMA (WA) subscription fees and must be used by 31st March 2011. Only one gift voucher per contract/client. This promotion is not available with any otheroffer.2Finance agreements are limited to commercial loan contracts and residential mortgages only. Contracts must be settled within the promotion period to be eligible.

AMA (NSW) in actionJuly12 Appeared in Peninsula News onshortage of GPs on the Central Coast.23 Met with Mayor, Councillor AndrewPetrie of Woollahra Council on GapPark Masterplan.29 Met with NSW Minister for Healthon health reform.30 Interviewed and appeared inThe Sydney Morning Herald on thebreakdown of scanning equipment atBlue Mountains Hospital.August2 Met with Director General of NSWHealth on health reform.Issued media release calling on Stateand Federal Governments’ to commitfunding for the Gap Park Masterplanand welcomed Coalition commitmentif elected.5 Issued media release on NSWGovernment’s plans to give localdoctors a role on local public hospitalgoverning bodies. Interviewed by ABCRadio and The Sydney Morning Heraldon this.The Sydney Morning Herald, 6 August:“Dr Steiner said ‘lines on the map’were less important provided thesystem was sufficiently flexible toallow doctors to continue ‘their normalreferral habits’ and for patients tobe treated in the most appropriatehospital.”11 Issued media release oncommitment needed from NSWGovernment to ensure sufficient internplaces in NSW. Interviewed by TheMedical Observer on same.15 Issued joint media release with theRDA (NSW) on local doctors devastatedat Greater Western Area HealthService’s decision to close Gulgonghospital without notice.16 Issued media release on questionmark over plans to establish CoffsHarbour GP SuperClinic.17 Met with NSW Shadow Minister forHealth, Jillian Skinner.Calendar of eventsSeptember 2010Tuesday 7, 7.30pmCouncilAMA House, St LeonardsFriday 10 - Saturday 11AMA (NSW) Workplace Relations &Medical-legal issues seminarCitigate Hotel, SydneyWednesday 15, 6.00-8.00pmUsing your superfund to investin propertyThe Hunter Room, Newcastle CityHallTuesday 28, 7.30pmProfessional Issues CommitteeAMA House, St LeonardsTuesday 21, 7.00pmBoard of DirectorsAMA House, St LeonardsTuesday 21, 6.00-8.00pmUsing your superfund to invest inpropertyThe Point, BallinaThursday 23, 6.00-8.00pmUsing your superfund to invest inpropertyNovotel Northbeach, WollongongFriday 24 - Sunday 26AMA (NSW) Golf Society CountryWeekendMagenta Shores Resort, CentralCoastEditor’s noteWe hope you enjoy the AMA (NSW) non-memberissue of The NSW Doctor for 2010. Medicine is oneof the few professions that the majority, after yearsof study and training, stay in for life and when youbecome a member of the AMA you are making avaluable contribution to your professional future.Whether a student, a doctor-in-training, a GP, aspecialist or retired, the AMA (NSW) is the onlyAssociation to represent and unify all medicalprofessionals.One profession. One voice. One vision.Narelle SchuhEditor, The NSW DoctorDear EditorI read with interest the article by SMH HealthEditor, Julie Robotham, “Stressed out surgeonsor tomorrow’s easy riders” (SMH, 7 Aug 2010,pp.3). In brief it was a survey of medical students’perspectives on the “chasm between thedisciplines they deem most prestigious and thosethey believe support a life beyond doctoring”.Recognition of this critical dilemma of a properwork-life balance saw the recent creation of aCreative Doctors Network in Sydney. Its simplemantra is to nurture creativity within the medicalprofession. Founded by myself and supported byAMA (NSW), the Network meets quarterly. At therecent ‘20/20 Vision’ Film Night (5 August 2010),doctors and students showcased their entertainingand inspiring films. In the Q&A that followed, seniordoctors spoke about desperately trying to revivetheir creative passions brutally suppressed by thelong years of study, ongoing training and workcommitments. Whereupon hearing this, medicalstudents replied they would not let this happen tothem. They strongly believe they can continue theirartistic pursuits in parallel with medicine. Bravo!This was exactly what I wanted to hear. Medicinecan be all-consuming if you let it.Dr Tony ChuPresident AMA (NSW) Creative Doctors Network(CDN) www.amansw.com.au I 3

The AMA (NSW) members on the frontcover of this issue of The NSW Doctor wererandomly selected from our membershipdatabase and kindly donated their time toattend a photo shoot recently at AMA (NSW)House in St Leonards.Sarah Challis is a second year medicinestudent at the University of NSW andinterested in studying psychiatry.“I think it is important to be part of anorganisation such as the AMA that representsthe medical community and embodiesthe values and goals of doctors all aroundAustralia.”Photography: Lindsay Ross. Painting by Ben StackOne profession. One voice.One vision.The AMA (NSW) representing all medical professionals.Professor Simon Willcock, MBBS (Hons),PhD, FRACGP is Discipline Head of GeneralPractice at The University of Sydney andAssociate Dean for Postgraduate MedicalEducation and Training in the Sydney MedicalProgram. His education and researchinterests include musculoskeletal medicine,generational change in the medical workforceand doctors’ health.“Membership of the AMA provides theprofessional advocacy and security thatallows me to focus my energy on patients,students and family.”Dr John Knight, AM is chairman of the Medi-Aid Centre Foundation which he founded in1973 and dedicated to the care of elderly,disabled and disadvantaged people throughpurpose-built accommodation. A graduateof Sydney University he is well known asAustralia’s Media Medic, Dr James Wright,dispensing advice and health tips for morethan 40 years.“A week after graduating in February 1953like most others I joined the AMA (then theBMA) and have been an active member eversince. Best of all was the camaraderie. It wasalso a meeting point for selecting consultantsfor my patients. The AMA is the onlysignificant body the government recognisesand continually fights for improved conditionsfor all doctors. The benefits are enormous.If not a member, don’t be a freeloader –consider joining today. Without the AMA, GPscould still be getting “ten shillings” ($1.00)for a consultation as in 1953. Don’t laugh –we need this enormous non-stop fightingmachine. Become part of it!” www.amansw.com.au I 5

featureGrowing with the AMA...The AMA is changing to give you a greater say...Now is a time ofdramatic change inour health system. Thegood news isthe AMA (NSW) ischanging to make sureyour voice is not lostin the debates thatwill have a profoundinfluence on how yourcareer develops in theyears to come.

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featureA year ago the AMA (NSW) conducted amajor survey of its membership as wellas doctors who had chosen not to jointhe Association.The findings of this survey werestark. Different parts of the professionhad different priorities and wanted theAMA to reflect these concerns. Mostrespondents said they valued the policyand advocacy role the Associationplayed but wanted a greater say in theactual issues the AMA addresses.We took this as a firm statement fromthe profession that you wish to maintainthe AMA’s strong voice in health but alsobe more involved in our campaigns. Weran with the invitation from you to openup our processes and spend more timetalking with you about the issues thatmatter – essentially giving the agendaback to you.The AMA (NSW) used this informationto shape its priorities over the last12 months. If you have noticed moreopportunities to provide us withinformation through surveys, that’sbecause we are asking more questions.If you have been invited to take partin more professional events, that’sbecause we are organising more. Ifyou have noticed we are revampingour communications to give you moreavenues to get involved in the AMA,that’s because we have.Rather than simply looking at theprofession as a monolith we have beendesigning new agendas and campaignsfor key areas of membership – GPs,public hospital specialists and doctorsin-training– while simultaneouslyreaching-out to the broader public bysupporting public health initiatives.General practiceThe AMA (NSW) has been the drivingforce behind efforts to invigorate theAMA’s presence in primary health. Withmajor national reform occurring we aredetermined that the role of GPs at theheart of the system not be lost.In late 2009 the AMA conducted amajor research project with the generalpublic, identifying their attitudes toGPs and expectations of primary care.The results were fascinating and haveshaped our thinking about wherewe stand in our patients’ eyes. Theresearch reinforced the high regard forfamily doctors and their central rolein diagnostic care. By talking to ourmembers through a series of one-ononeinterviews and online focus groupswe got a real sense of the pressuresGPs are facing, not the least the gradualerosion of Medicare by the failure ofsuccessive governments to adequatelyindex the MBS.The next six months willallow the AMA (NSW) todevelop these strategiesinto fully fledgedcampaigns. All sectionsof our membership willhave issues to raise atthe State Election inMarch 2011 and – asnever before – will havethe chance to have theirvoices heard.The result of these consultationswas that the AMA nationally developedan agenda for ‘family doctors’ basedaround key issues such as access,improvements to the MBF and moresupport for GPs through the expansionof practice nurses. Establishing thisforward-thinking agenda has beenvital in a dynamic political environmentand allows us to clearly articulateour concerns with issues such as thediabetes plan. This effort chrystalisedduring the federal election where AMA(NSW) members hosted communityroundtables with federal electioncandidates as part of the national‘Support Family Doctors’ campaign.Public hospitalsToo often the interests of doctors arelost in the public health debate withwell-oiled government spin machinescontrolling the flow of information.Determined to give AMA membersa voice we have developed a regularfeedback-loop with members to ensurethe government is held to account.When the Garling review was releasedin November 2009 we had alreadysurveyed our members so we couldestablish the benchmarks on effectivereform. Before the State Budget wegave surgeons a chance to put theirviews before the public. More recentlywe called for comprehensive feedbackfrom members regarding the federalproposals to create Local HealthNetworks (LHNs).The federal process has been aclassic example of how the AMA (NSW)new approach can work for members.The changes announced by the FederalGovernment were comprehensive andfar-reaching. They were also set ona time horizon that could see currentissues ignored against the promise oflong-term reform.The AMA (NSW) determined a threestageresponse to the federal reforms.Firstly, we continued to highlight theurgent need for reform, that change wasnot an option, highlighting conditions athospitals like Westmead where surgeryis regularly cancelled to managebudgets. Secondly, we explained theimpact of the changes to our members8 I THE NSW DOCTOR I september 2010

featureBreaking down the Boys’ ClubOri sunti ditia sam alitati bustiis volupti dolupta quatiaque cone num aut facillab imin placerum quo ea quametmagnatia sam, sendis inihili tatur, odisquo dipsand erepracus et, que placesto bernat. Equodi omnimporem et,nimendita velibusam am voluptatur, venim simporrooccum la volorerunt fugiasp elisti aperiame sequatibus asmincil est pratumente simint reped mi, sum

Have you heard this old chestnut?A man and his son are driving in acar one day when they have a seriousaccident. The man is killed instantly.The boy is knocked unconscious but heis still alive and is rushed to hospital forimmediate surgery. The doctor entersthe emergency room, looks at the boy,and says: “I can’t operate on this boy, heis my son”.How can it be?Well, hopefully for more and moreof the Australian population this ishardly a riddle – the doctor is obviouslythe boy’s mother. The fact that thisclassic trick tale revolves around adoctor and not some other professionspeaks volumes for the way medicinehas traditionally been perceived. Eventhough 50 per cent of doctors enteringthe workforce are now women medicinehas, until recently, been considered avery masculine domain. It’s perhapsunsurprising female doctors feelin some ways that the profession isyet to have caught-up fully with thisdemographic shift.The AMA (NSW) recently carried-outout extensive surveys into the key issuesconcerning doctors in the state. In thecoming months female doctors will besurveyed by the AMA (NSW) to find-outhow the medical careers of womendiffer from men and how the professioncould potentially change to introducemore balance.As a prelude to the survey The NSWDoctor spoke to three women in variousstages of their professional lives to findout how they think their gender has andwill affect their careers.Jane Gray, whom we profiled inthe February 2010 issue of The NSWDoctor, is an established family doctorwho works at a large practice with herhusband and father in Camden.Kathryn Austin is an SRMO inObstetrics & Gynaecology at The RoyalHospital for Women. Tiffany Fulde isa final-year medical student at theUniversity of NSW.When it comes to day-to-day workthere was agreement amongst thewomen that gender is not really a bigissue, although that’s not to say theplaying field is entirely level even today.“You’re a lot more likely to be askedif you’re a nurse by patients, staff andeven people at the local café if you’re awearing a hospital ID,” Tiffany says. “I’veeven been told by some registrars thatmy blond curly hair is particularly likelyto make people think I’m a nurse!”According to Tiffany this stereotypingand tradition can even affect careerpaths. “For many female med studentsit can affect specialty choice. They tendto avoid perceived ‘boys’ clubs’ suchas surgery, although for the most partI think it doesn’t have a major impact.I think individual factors are moreimportant than gender stereotypes.”Kathryn Austin agrees. She sayswhen it comes to being a female DITit’s the big picture where gender startsto become a genuine issue. “Day-todaywork is no different at all at a DITlevel however as a female there is theconsideration of when to potentially planto have a family,” Kathryn said.In fact the time and effortnecessary to have and raise childrenis unsurprisingly the biggest issueraised by all three women.“When you’re a DIT pregnancy andmaternity leave need to be factoredinto your proposed training,” Katherinesaid. “There is often more need for timeaway in the early years of training forKathryn Austinmaternity leave and this is not alwayswell supported by training programs– driving females away from certainmedical professions or moving femalestowards the more family-friendlyspecialties such as general practice.”The pressure on women to stick to a‘family friendly’ area of medicine is oftenapplied subtly – although sometimesit can be far more direct. “I was talkingto a female medical student who wouldlike to do surgical training,” Tiffanyrecalls. “While she was scrubbed intoan operation she was asked by thesurgeon: ‘Do you want to do surgery?’To which she replied, ‘Yes’. The surgeoncountered with ‘Do you want to havekids?’”“I think there is a perception outthere that some of the more demandingspecialties are impossible if you havechildren and there is a need for morestrong role models to show this isn’tnecessarily true.”In Tiffany’s case she doesn’t haveto look far – both her parents wereworking doctors while she and hersister were growing up. “I think thereare a lot of different approaches outthere that work. You just have to www.amansw.com.au I 11

featureJane GrayTiffany Fuldefind one that works for you and yourpartner.”Dr Jane Gray should know – she’sbalanced raising four sons with abustling medical practice in Camden.Jane says that although a combinationof motherhood and medicine can beincredibly demanding it can also offerbenefits that aren’t talked about asoften. “When our biological clocks tickloud, things change. It usually hits whenwe are starting our specialty training sowe get distracted suddenly by domesticissues and kids. We also simultaneouslybecome part of the sandwich generation– as the meat – when we care for agingparents and young kids.”“The upside I guess is an increase inempathy. I do sometimes wonder abouthow good a doctor I was before kids.Motherhood has taught me more thanall the textbooks combined.”As a family doctor Jane points-outthat being a woman and a mother canput a strain on the relationship withpatients. “Patients often view femaledoctors in terms of whether we arelikely to leave them in the lurch whilegoing off and having another baby. I’vehidden four pregnancies from patientsbecause of comments about being‘unavailable to care’ for them!”Although many of the conflictsbetween maternity and a medical careerseem intractable, female doctors insistthat the profession can do more.For Kathryn a lot of the battle issimply about getting the concernsof female doctors out into publicdiscussion. “The AMA should beloud in voicing the need for publicrecognition for flexible maternity leavearrangements for all DITs across allspecialties,” she said.“It would improve lines ofcommunication for training andworkplace acceptance for theimportance of parental leave. All femalespecialty trainees need to have equaland appropriate access to maternityleave and this should not jeopardisetheir training. We also need to enablepractical support systems such assuitable work/hospital-based childcareoptions.”Tiffany thinks that a lot of the timefemale doctors shy away from beinglabelled as having particular ‘women’sissues’. She believes the way to changethis is through more guidance fromestablished female doctors to youngerwomen coming through.“I think role modeling is veryimportant – sharing experiences andadvice and showing that there aremany ways to be a female doctor. We’veseen a lot of success at the universitylevels of Women in Med nights wherefemale doctors come and share theirexperiences. It’s important not toassume all female doctors have thesame issues and many shy away frombeing labelled as having ‘women’sissues’ but facilitating communicationand mentoring would be really positivefrom the AMA.”“Encouraging further femalerepresentation and contribution onAMA committees would also be aninteresting area to explore.”Jane agrees that the AMA canplay an increasing role in supportingfemale doctors but should also focuson trumpeting their role a little louder.“The AMA could probably publicisemore case studies on how they help,”she says. “For example they helped mehugely through an industrial issue thatwas impacting me and therefore myhusband and four sons. Also the AMAcould probably offer more refreshercourses to get some women back in theworkforce and confident after kids.”AMA (NSW) has...• Assisted many DITs, both male andfemale, in dealing with their hospitalor area health service to accessparental leave.• Run a landmark case beforethe Anti-Discrimination Boardto highlight the limitations of thecurrent policy in limiting accessto parental leave entitlements forregistrars who are required to moveinterstate for training. We alsosecured the support of the RoyalAustralasian College of Surgeons inrunning the case.• Advocated for changes tocontractual arrangements andinformation for DITs to ensure moreare able to access parental leaveentitlements.There is much, much more to doand we look forward to continuingthe fight.12 I THE NSW DOCTOR I september 2010

State goverments listens to AMA on LHNsArea Health Services are ‘out’ and Local Health Networks ‘in’according to the NSW Government’s recently released discussionpaper on health reform. By Sim MeadThe core element of the proposed newstructure for hospital services in NSW isthe creation of 15 Local Health Networksbased on geographic areas and replacingthe existing eight Area Health Services.Another two specialist networks willoperate outside the LHNs – the SydneyChildren’s Hospital Network (Randwickand Westmead) and the Forensic MentalHealth Network.The 15 proposed geographicalLHNs across NSW are Sydney, SouthWest Sydney, Western Sydney, SouthEastern Sydney, Northern Sydney,Nepean/Blue Mountains, Illawarra,Central Coast, Far West, Central West,Hunter / New England, Northern NSW,Mid North Coast, Southern NSW andMurrumbidgee. Each will have its ownChief Executive and Governing Council.Crucially, the NSW Government hasagreed to include clinical representativesof the Governing Councils of the LHNsfollowing pressure from the AMA (NSW).Deputy Premier and Minister forHealth, Carmel Tebbutt said the proposedmodel had been shaped by consultationswith clinicians, health professionalsand local communities. “There was astrong view expressed that cliniciansshould be able to serve on their localGoverning Council,” Ms Tebbutt said.“The Government supports that view andbelieves local clinicians will play a vitalrole in helping shape health services tomeet local needs.”AMA (NSW) President, Dr MichaelSteiner said the proposed model forGoverning Councils was good news fordoctors, nurses and patients ensuringmajor decisions are made with a viewto the delivery of frontline care. Manyquestions remain to be answered,however. The discussion paper statesclinical representatives will be chosenby the State Government not selected asrepresentatives of any external group.A recent major survey of 1,450 publichospital doctors by AMA (NSW) andASMOF found 69 per cent of clinicianssupport a model whereby hospitaldoctors nominate colleagues to be onGoverning Councils. “It’s important toget the fundamentals right and doctorswho serve on the governing bodies ofLHNs are nominated by colleaguesrather than appointed by bureaucrats,”Dr Steiner said.It is unclear how the proposedstructure will deal with cross-borderissues. “Genuine reform meansLHNs are established around naturalcommunities and patient flows sosome LHNs will cross state boundaries.The AMA will advocate for cross-stateLHNs where local clinicians and localcommunities believe it to be appropriate.”The NSW Government’s health reformdiscussion paper is available at www.health.nsw.gov.au. The AMA (NSW) willcontinue to consult extensively withdoctors and make a detailed submissionto the NSW Government reflectingconcerns.Public hospital doctors’ survey resultsTop 5 factors deciding boundariesof LHNs• Transport and distance issues.• Existing clinical service networks.• Local community and clinician views.• Existing referral patterns.• Existing clinical training networks.Centralise or decentralise?• “Bread and butter services shouldbe based on LHNs but all tertiaryand quaternity services should berationalised and statewide services.”• “Super-specialised services such asneurosurgery, cardiothoracic and somepathology services should operateoutside and above LHNs and servicethe whole state.”• “Genetics services are currentlyrelatively centralised and it makessense to review how services toregional and remote areas are providedto ensure equity for all.”• “Efficiency tends to occur in a‘community environment’ where thesmaller size allows staff and patients toknow each other better.”• “Economy of scale is crucial if we are toprovide world-leading treatment for ourpatients.”Medical staff on Governing CouncilsHow should they be chosen?Chosen by the Minister 1%Nominee of medical staff 69%Both 27%Neither 1%Don’t know 2%• “First priority is to get the hospitalsback on-track with a return of clinicianengagement and effective influence.”• “Clinicians, not bureaucrats must havea much greater role in determiningpolicy – these must be practicingclinicians, not doctors and nurseswho no longer treat patients but havemoved full-time to administration.”• “Both internal and external clinicalinput is desirable – internal peopleknow their patch, external peoplecan help remove perceived bias frominternal clinicians ‘protecting theirturf.’”• “The proposal to have externalclinicians involved in governance willcompletely alienate and disenfranchiselocal clinicians if adopted.” www.amansw.com.au I 13

featureA day in the life of a PresidentBy Tanzeem ParkarIt’s been a busy 24-hours for AMANational President, Dr Andrew Pescewho’s been up since the crack of dawnafter receiving a phone call from afellow doctor and patient at 3.00am.“I got the call today while the patientwas in labour. She was entering laboura bit early and had come into hospitalwith ruptured membranes. She wasconsidering a C-section but I wasn’tconvinced that it was needed so at5.00am I went in to have a chat withher and around 7.00am performed theCaesarean,” he says.Last year the Sydney obstetrician andgynaecologist made headlines afterbeing elected as the new face of theAMA but his path to medicine beganmuch earlier, as a little boy at the ageof four he says. “I’ve wanted to be adoctor for as long as I can remember.My grandmother was someone whoencouraged me and I’m sure at thatyoung age it was her putting the ideain my head. She had wanted to be adoctor but had never been given theopportunity to study.”He goes on to paint a picture ofhis family doctor while growing up,describing him as a larger-than-lifeman who made house calls to treat hisfamily of two siblings. “When we weresick he was always there and caring – ifI had to think of a human face to theprofession it would always be associatedwith his. Our family doctors are highlytrained, highly skilled and dedicatedto their patients but they are underenormous pressure. My vision is to keepfamily doctors at the heart of health.We need to work hard to deliver this asan outcome and improve funding forgeneral practice but I think we’re wellpositioned to do this”.Dr Pesce is working a hectic scheduleto call on all parties to make healthpolicy the top priority when I interviewhim in the weeks prior to the Federalelection. “It has definitely been busierthan average so far and I imagine asthe final weeks approach it will be morehectic.”Dr Pesce says there is still a lot ofunfinished business in the area ofhealth reform but he remains positiveciting the words of Confucius: “Manwith low expectations is seldomdisappointed”.“I want to see good outcomes inour hospitals as part of the NationalHealth and Hospitals Network butthe challenge for us ahead is tomaintain the position of influencewe have certainly at a Federal andalso at a State level.” He says thekey to this is to ensure the AMA,rather than complaining, always hasgood, constructive policy to supply todecision makers that provide crediblealternatives and are in the publicinterest.“This is important to re-engagingwith and impacting on State andFederal Government policy and we’veseen wins with this approach onmany occasions such as collaborativearrangements of MBS requirementsfor midwives and nurses – convincingthe Government to improve theiroriginal legislation on MBS access andimprovements for midwives. There’sbeen a lot of great achievements forthe profession and a lot of work by a lotof people but the AMA is only relevantto the extent that it is perceived by itsmembers and the Government. If ourmembership is not representativeof this we are not succeeding in ourrepresentative obligations. It’s reallyimportant if we’re to continue with thisrole and produce such wins for theprofession that we have the supportof the medical profession – and thatmeans membership.”He says his vision for the future is toreorganise the way the AMA discussespolicy with its membership and themedical profession in general. “I’d liketo see the use of digital and internettechnology to provide members andthe profession with an avenue tocommunicate with us and enablethem to take part in policy makingdecisions so we are truly the singlemost representative group for theprofession.”On Presidential duties Dr Pescespends at least one to two days a weekin Canberra but despite the somewhathectic schedule, he remains calm andrelaxed. “As an obstetrician you neverhave a sense of an organised life butI enjoy what I do. I get to know mypatients and their partners and sharein their happiest moment. I love thatmore than anything in my professionalcareer. In this speciality you’re alwaysresponding to calls when your patientsare in labour and it’s much the samewith being AMA President. I guess I’mused to having to be in two to threeplaces at once. It’s about adjusting myschedule slightly but I’m also assisteda lot and very grateful to my practicepartner, Dr Seng Chua, who covers mewhen I have AMA commitments.Aside from being on-call for doctorduties Dr Pesce takes daily calls fromjournalists chasing comment on healthpolicy and reform. “I’ve made myselfavailable and accessible to journalists,they have my mobile phone number.”He says one of his goals in becomingPresident was to re-establish the AMAas the first point-of-call for mediacommentary on health matters andpolicy. “I think we’ve achieved that now.Very often we’re approached as the firstchoice opinion leaders in the healthsector, which I think is very importantin light of health reform and the14 I THE NSW DOCTOR I september 2010

Government and Opposition proposalsand policies.”When he isn’t working Dr Pesceenjoys spending downtime with hisfamily and reading. When I talk to himhe’s reading ‘The Prophet’ by KhalilGibran. He says the secret to findingthat balance in life is to make the verybest of family time – make hay whilethe sun shines.Written prior to the outcome of theFederal Election 2010.Dr Andrew Pesce talksabout...• Doctors and Governmentdecisionmaking: “Doctors are atthe coalface of the system andconstantly see the impacts ofGovernment decisions. They knowhow to make the system work bestfor patients. The AMA’s policiesgive voice to what works best forpatients.”• Clinicians and administrators:“What we’ve seen in recent years is,because of a failure to engage andconsult local clinicians, solutionsare coming from above whichdon’t address the concerns andclinicians don’t place any credibilityin them or work hard to implementthem. We have this disconnectbetween clinicians at the coalfaceand administrators referred toby Mr Garling in his review of theacute hospital system in NSW asthe “great chasm”. There are tworeally important parts of the healthsystem that currently aren’t workingtogether.” www.amansw.com.au I 15

doctors4health roundtablesThe AMA (NSW) recent Doctors4Healthroundtables highlighted the importanceof taking a local approach to healthcarewith each discussion exposing differentissues affecting the medical profession.The meetings between doctorsand their Labor, Liberal and Greenscandidates in marginal NSW electoratesproved a great way to help politiciansunderstand what the health systemneeds. Ironically, the day of the firstDoctors4Health roundtable on theCentral Coast was one of the biggestdays of the campaign for health news.That day Health Minister, Nicola Roxonalso travelled to the Central Coast toannounce another GP SuperClinic andin Sydney, Tony Abbott announced theCoalition’s health policy.Chaired by AMA National Vice-President, Dr Steve Hambleton theroundtable covered the electorates ofDobell and Robertson. Issues includedthe need for more locally trained doctors,the Government’s SuperClinic programand the requirement for doctors to havecontrol over their own area’s healthsystem.Dobell Labor MP, Craig Thomsontold the meeting problems facinghealthcare on the Central Coast now willbe experienced around Australia beforetoo long. “When it comes to health, if youwant to pick an area that will look like therest of Australia will look in 10 to 15 yearstime then the Central Coast is that area,”he said. Liberal candidate for Robertson,Darren Jameson was very supportive ofGPs saying they can relieve pressure onhospitals.The key issues at the AMA’s secondroundtable in the western Sydneyelectorate of Macarthur, were agedcare, GP funding and the needs oflocal hospitals. Labor candidate NickBleasdale and his Liberal opponent,Russell Matheson heard first-hand theproblems facing doctors in their area.Chaired by AMA National President,Dr Andrew Pesce the meeting broughttogether a good mix of GPs andhospital doctors to discuss a broadrange of issues.Dr Jane Gray described aged carein the seat of Macarthur as a “comingtsunami” and asked both parties to investmore in treatment for the elderly. Doctorsworking at Campbelltown Hospitalsaid they want to double the numberof existing beds and improve surgicalservices. Professor Brad Frankumsaid Campbelltown Hospital is one of thebusiest teaching hospitals in NSW andneeds to grow fast or it will not survive.The candidates left the meetings witha better understanding of the importanceof ensuring local doctors in both hospitaland general practice settings are givendirect opportunity to advise on localsolutions. When the focus switches fromfederal to state politics next year theAMA (NSW) will hold moreDoctors4Health roundtables toensure a voice at state level. www.amansw.com.au I 17

featureDr Praful ValanjuBy Tanzeem ParkarEarlier this year at the Australian IndianMedical Graduates Association dinnerAMA (NSW) Councillor, Dr PradnyaDugal gave a presentation on bridgingthe generation gap. Dr Dugal spokeabout her father, Dr Praful Valanju, aGP who began practising in Walgett, farnorth-west of NSW almost 40 years ago.This was a time when independence,self-reliance and multi-skilling weremust-haves. Dr Valanju likens theexperience of being a GP in ruralAustralia to that of Lord Brahma – aHindu god with three heads and fourarms – “You had to have a couple ofhands here and a couple of heads there!You had to beand do everything. You were thephysician, surgeon, obstetrician,radiologist, pathologist and more, allrolled into one”.In 1970 Dr Valanju made the move toAustralia alone from Mumbai, India aftercompleting his medical education andtraining and began a career spanning20 years in rural medicine followedby another 20 in family medicine inmetropolitan Sydney.At the time of his arrival here it wasnot compulsory for international medicalgraduates to start-out practicing ina rural area or other areas of need.It was his own decision to practicerurally which he enjoyed despite thelong and irregular hours. Admitting itwas challenging Dr Valanju says theexperience was diverse and interesting.“It was a very hard decision to move inthe beginning but one I’m glad I made.I had experiences I will never forget in ahurry,” he says with a chuckle.“There were quite a few occasionswhere I’d be snowed-under with work18 I THE NSW DOCTOR I september 2010

Family medicine practitioner, Dee Why Family Medical Centreand something would come up thatneeded extra attention. I would feelreally low because I didn’t have thatextra bit of energy or help. I was workingat the hospital 24/7 because I was theonly doctor in town. The doctor in thenext town was about 60-70 miles away.”To cover these vast distances Dr Valanjubecame one of the original “flyingdoctors”, obtaining his pilot’s licence andflying his own plane to provide medicalservices to remote areas.No stranger to life’s struggles DrValanju describes India at the time ofhis leaving as a place of tumult andupheaval. “India had recently becomeindependent and was still struggling tofind its place in the world.” His parentswere involved in the independencemovement and it was the sacrifices theymade, he says, that saw him throughmedical school. “Both my parentsworked very hard to put me throughschool – my father never had time for hisown education and missed out on a lotof things.”Through his medical education inIndia Dr Valanju was exposed to theclinical aspects of medicine earlyon.“Wedid anatomy and dissections inour first year. Dissection groups werea major part of our studies.” Demandson hospital services in India were quitehigh, with outpatients continuouslyoverflowing. As a student Dr Valanju wasintrinsically involved with patient care athis teaching hospital; dressing wounds,giving injections and performing surgicalprocedures from the very beginning.After completing his educationand training Dr Valanju worked as aMedical Officer in a Primary Healthcareand Family Planning Centre in ruralMaharashtra outside of Mumbai. “InIndia doctors try to understand theirpatients’ problems and help them asbest as they can with the resourcesavailable to them. We have a populationrich in culture with people speakingdifferent languages and belongingto various religions – Parsis, Sikhs,Hindus, Muslims. As doctors we needto be multilingual as very few patientsknow a language different from theirown. We also have to be aware ofcultural and religious differences andcustoms.”Dr Valanju spent seven years inWalgett before moving to Port Macquariefor 13 years. When his two childrenreached the age they would leave hometo pursue further education he and hiswife decided to move to Sydney. Todayhe practises family medicine in DeeWhy but even now there are times whenhe misses rural medicine: “Being inmetropolitan practice I’m not involvedwith hospital care anymore but wehave no choice. I’ve had some acuteemergency cases I would have loved totreat myself but can’t. Often it’s hard tofollow patients up which I feel sad about.It’s also a little harder here to establishthe same sort of close rapport with allpatients as in a small, close-knit ruralcommunity.”While he enjoys family medicine DrValanju fears difficulties in the area asincreases in fee structure fail to keep-upwith inflation. “Family doctors are beingforced to continue working and takingpay cuts. We try to maintain a familypractice here and many of our patientsconsider our practice to be a part of theirown family but sadly there has been alot of Government changes and fundingreduced over the years. It’s becomingincreasingly difficult to carry-on thesame services and level of practisewithout extra funding.”Dr Valanju says he would like to seethe AMA play a bigger role in healthpolicy, assisting the Governmentto formulate how health should bedelivered to the community, withevidence-based medicine. “At themoment we see the Governmentnot paying enough attention to theAMA, doctors and other medicalorganisations, making decisions ontheir own and regulating the professionwithout any consultation.”AMA National President, Dr AndrewPesce says “MBS indexation has notkept pace with increasing costs ofrunning a practice. The fee chargedby a doctor must cover all of the costsof running the practice includingstaff wages, rent, electricity, healthequipment, computers and professionalindemnity insurance. To maintain a highrate of bulk billing and remain financiallyviable practices have had to increasecharges for patient-billed services. Thepatient-funded gap on patient-billedservices has therefore increased”.The AMA believes family doctors arethe heart of the health system and rana ‘support your family doctor’ campaignprior to the Federal election to helpensure family doctors are properlysupported by the Government to care forpatients. The AMA has been advocatingfor the Government to cut red tape toenable doctors to spend more time withpatients and produce a more rationalMBS structure that gives patients bettersupport, increasing not cutting MBSpatient rebates. www.amansw.com.au I 19

featureDr Kelvin KongBy Narelle SchuhDr Kelvin Kong’sbackground isentwined with severalmedical ‘firsts’. Hismother was one ofthe country’s firstIndigenous registerednurses and oldertwin sisters the firstIndigenous students tograduate from SydneyUniversity with medicaldegrees.As Australia’s first Indigenous surgeonand member of the AMA (NSW) for morethan 10 years, Dr Kong chose ENT asa specialty after being inspired by theear, nose and throat fraternity includingDr Peter Carter and Professor PaulFagan early-on in his medical career.“Both have a passion for education andgiving to the community. In a funny,most respectful way, they are my non-Indigenous elders. The wisdom andinspiration they create has permeatedENT in Australia forever.” Recognisingthat ear disease is particularly prevalentin Indigenous communities alsoencouraged Dr Kong to the specialty,“It remains a travesty and a blighton Australian health authorities. Itshouldn’t be so tragic”.Dr Kong readily admits that ratherthan being Australia’s first Indigenoussurgeon he would prefer to be thehundredth. Fortunately, the numberof Indigenous people in medicine isslowly increasing. “There has beenprogress,” says Dr Kong, “With a beliefand a dream there has been much effortin recent years across a broad front ofAustralian universities to recruit ATSImedical students, particularly UNSWwith 27 current Indigenous students”.He believes The Healthy Futures reportand A blueprint for action: Pathways intothe health workforce for ATSI people,combined with the LIME network– Leaders in Indigenous MedicalEducation – have been instrumental inachieving the 140 ATSI medical studentswe now have nationally.Dr Kong supports progress thatimproves access to healthcare for allAustralians saying Australia is lucky tohave one of the best health systems inthe world. He acknowledges howeverhis frustration with the implementationof service delivery and increasinghealth costs. “The state of ATSI healthin particular is a sad indictment onour society. As a doctor ATSI healthis interesting because no matterwhat topic you raise it will be overrepresentedon all the poor outcomes.Social determinants of health areequally important to address.” Usinga simple medical analogy of cancersurgery he says, “We can develop allthe surgical techniques in the world butif we don’t address the cause – socialdeterminants of health – we will neverclose the gap”.While Dr Kong is not keen to exposeall the different facets of Indigenoushealth projects he is involved in, joking“my wife will find out and she knowsone thing we are poorly taught inmedicine is to say NO”, he is excitedby their direction particularly thoseassociated with the Royal AustralasianCollege of Surgeons (RACS) which hesays as a group has embraced the greatwork achieved in ATSI health.Dr Kong sees the primary ongoinghealth issues for Indigenous Australiansas ear disease and hearing due to itseffect on learning, development, growth,mental health, general well being,employment and complete healthcare.As for the health status equality and lifeexpectancy between Aboriginal and non-Indigenous Australians in 20 years time20 I THE NSW DOCTOR I september 2010

featureProfessor Brad FrankumBy Narelle SchuhThere’s nothing like a hospital crisisto help shape one’s views on healthand hospital reform. Just nine-monthsinto the job as Macarthur Health’snew Director of Medicine all eyes wereon Prof. Brad Frankum to explaindeaths due to alleged poor care atCampbelltown and Camden hospitals.The media were having a field day andthe public was outraged.Six years later Prof. Frankum admits“I became the accidental reformadvocate! There’s no incentive quitelike finding yourself in the middle of afurore to sharpen your focus on what’swrong with the system and look forways through it. My motivation is thatI don’t want any other clinicians in oursystem to be subjected to the appallingtreatment that was dished-out tomy colleagues at Macarthur HealthService by an incompetent governmentand bureaucracy desperate to deflectattention from their own failures andaided and abetted by an ignorant andrapacious media.”I think we need more of adiversity of people in leadershippositions in the AMA. Isometimes feel a bit intimidatedto make comments aboutreform to general practice andprivate medicine because it candraw quite a strong response!I do, however, run a limitedprivate practice and moreimportantly, I’m married to a GPwith strong opinions about theimportance of general practiceand the threats it is facing.There aren’t enoughclinical academics andstaff specialists in theAMA. There remains aperception the AMA isthe domain of the privatepractitioner and we needto change that.“The system failed some of thepatients of Macarthur and the doctorsand nurses were made the scapegoats.It would have been a lot worse if not forthe support of the AMA. I can’t thinkof a better reason for every medicalpractitioner to be an AMA member.”An active member of the Hospital22 I THE NSW DOCTOR I september 2010

Clinical Dean, Macarthur Clinical School at Campbelltown and Camden HospitalsProfessor of Clinical Education, University of Western Sydney School of MedicineClinical Immunologist, Member of the Hospital Reform Group, AMA (NSW) CouncillorReform Group (HRG), Prof. Frankumsays he is humbled by belonging to sucha highly stimulating and accomplishedgroup of people from a diversity ofclinical, academic, business andpublic service backgrounds. “We havemet with a variety of key politiciansand bureaucrats over the years andI’d like to think we have influencedsome of their decision-making. Thereare elements within the FederalGovernment’s reform packages that wehave canvassed and we’d like to thinkwe had some influence there. Havingsaid that, the post-COAG version of thereforms I am less enamoured with.”I get a lot of feedbackfrom colleagues abouthow the AMA haschanged in recent times– and the feedback is allpositive.A member of the AMA (NSW) HospitalPractice Committee, Prof. Frankumjoined the AMA Council after formingthe view that the AMA is the keynegotiating voice for the profession withgovernment and bureaucracy and themost recognised body for the public torelate to.“Being part of a think-tank such asthe HRG serves an important role but toreally influence health reform the AMAis the key.“I am really impressed with the waythe AMA is engaging with its members,the public and politicians to push ourcause. I think it’s obvious the AMA isleading the debate because we areabout helping patients, not ourselves.That has not always been obvious, in myopinion, in the way the AMA has beenportrayed in the past.“I’d like to pay tribute to Dr AndrewPesce, Dr Brian Morton, Fiona Davies,and Sim Mead especially for thiscultural change. The recognition thatthe AMA needs to work with whoeveris in charge is important. The openingupof channels of communicationwith other professional groups suchas nurses and allied health is alsowelcome.”Priorities for hospital reformProf. Frankum believes changing theculture within the hospital system isa key factor in achieving reform andthat this change needs to start at thetop as bullying remains rife in publichospitals. He says senior cliniciansshould be trusted much more to makedecisions about resource allocation andbe encouraged to voice their opinionspublicly. He advocates for more medicalclinicians in senior administration andthe development of a ‘mantra’ for publichospitals whereby innovation, use ofnew technologies and new ways oftackling problems can improve trainingfor young doctors. His priorities forreform include:• Improved equity of access to healthservices for all patients regardlessof geography, income and socialdisadvantage.• Better training of medical studentsand JMOs.• Better standards of medical practice.• More appropriate use of healthresources. The misuse of expensivetechnology, over-prescribing, andinappropriate use of hospital bedscosts us enormously. The Governmenthas no idea how to fix this. HealthDepartment-led task forces and“clinical redesign” programs haveproven to be of limited efficacy. We, asa profession, are the only ones whocan do it. To achieve it we need to beempowered and engaged. We needmore medical leaders within politicsand administration. We are given allthe responsibility but precious littleauthority.• Retention of general practice as thecornerstone of our health system butwith much better integration withhospital and community services.• Much better rewards for GPs who areinvolved with teaching, advocacy andresearch.• Better services for IndigenousAustralians.• Improved dialogue with the generalpublic about health issues.• Raising the level of debate abouthealth above ED waiting times,elective surgical waiting lists, and“disasters” at individual hospitals.• Better funding for research in thepublic and private sectors.As Professor of Clinical Educationat the University of Western Sydney,clinical education is a primary focusfor Prof. Frankum so providing goodteaching, guidance and being a goodrole model is what he strives for. “It is adilemma for many of us that our clinicaland academic loads, while being highlyenjoyable for the most part, mean wesometimes run out of time to spendwith junior colleagues. I try to putpatients first, junior colleagues a closesecond and hope the two help eachother.”When asked if he is a leader or afollower Prof. Frankum responds, “Ihope I’m a leader where appropriateand a team player as well. One day Iaspire to a leadership position within theAMA but perhaps in the future when ourmedical school is well established andCampbelltown Hospital arrives where itneeds to be”. www.amansw.com.au I 23

Award coverage for HSU members – Urgent updateQ. I’m a junior doctor but not a memberof the Health Services Union. I’ve beentold the Award only applies to membersof the HSU. Is this true?A. No, the Award applies to all juniordoctor employees of NSW area healthregardless of HSU membership.The HSU has attempted to argue anaward can only apply to its memberspreviously, in the case of Cahill V-P.[1997] NSWIRComm 127 (3 October1997). The HSU was not successful inits arguments. The Commissionfound that:Further, the introduction of a conceptwhereby rates of pay fixed by an awardare applicable only to members of arelevant union means, as this caseillustrates perfectly, that two rates ofpay will apply to the same work. Sucha concept is novel and contrary to longstandingprinciples that wages will befixed, in an arbitral context, taking intoaccount the nature of the work, theskills and responsibilities attaching tothe work and conditions under whichthe work is performed.Finally, if an application for amembers’ only award were to begranted, what should be done with thewage rates for persons employed inan industry who nevertheless chooseto remain outside the membershipof the relevant union? Wage rates forthose employees would be lower andemployers would thereby have theopportunity to employ cheaper labour.Email industrial@amansw.com.auregarding VMO arrangements and thejunior doctor award.

As a member of theAustralian MedicalAssociation (NSW),we think youdeserve specialtreatment.That’s why when you switch to Commonwealth Bank,you’ll pay no joining fee and enjoy preferred rates onmerchant services. For a little special treatment,contact the AMA team today.Call member services at AMA (NSW)on 9439 8822 or emailservices@amansw.com.aucommbank.com.au/businessCommonwealth Bank of Australia ABN 48 123 123 124. CBABM0787

And on theseventh dayit’s free*.Rent with Hertz for 7 days and get one day free.This means you can still expect all the usual benets of renting with Hertz butwith the addition of one free day when you rent for seven days or more.Available on selected vehicles at participating Australian locations until 25thSeptember 2010. To make a booking, call Hertz on 13 30 39 or visithertz.com.au and quote CDP# 283826 and PC# 148131.* Terms and conditions apply: Minimum rental period of 7 consecutive days, maximum 1free day per rental. Free day applies to daily rate and applicable GST only and cannot beused in conjunction with any other offer. Hertz standard terms, conditions and creditqualications apply.

AdvertorialThe outlook forthe next 1-2 yearsChris White, DirectorProperty is a medium to long terminvestment and the housing cycle inAustralia is generally over a 7-10 yearperiod during which there are alwayshigh growth spurts, lows and steadypatches. The chart shows many capitalcities have enjoyed double digit pricegrowth over the past 12 months. Pricegrowth going forward is generallyforecast by many experts to be singledigit over the next couple of years – butstill price growth nevertheless.RP Data’s director of research TimLawless said he believed concernsin some quarters about a big marketcorrection taking place are overstated.“The market’s underlying fundamentalsare such that any material fall in homevalues is unlikely. Housing supplyremains very low at a time when housingdemand is healthy, interest ratesappear to be on hold for the foreseeablefuture and the Australian economy isperforming well compared to all otherdeveloped countries,” he said.“People feel that house prices inAustralia are quite high and that’s quiteoften because the ratio of house prices toincome that are published for AustraliaThe immediate outlook on theproperty marketCityMedianprice ‡% Change inindex value,year onyear †Sydney $517,250 11.3%Melbourne $480,000 18.2%Brisbane $445,000 6.7%Adelaide $387,500 10.5%Perth $475,000 6.1%Darwin $481,775 16.8%Canberra $508,500 16.4%National $468,000 12.1%Hobart* $340,000 6.2%(*Hobart results are based on final April data; ‡ based onsettled sales over quarter;† based on capital growth to May 2010) Source: RP Datatend to focus mainly on prices in thecities, and they are quite elevated. If youlook across the whole country the ratioof house prices to income is not thatdifferent from most other countries.”Tim Lawless said RP Data-Rismark’sMay index results reinforce mountingspeculation that the Australian realestate market is transitioning towards alower and more sustainable growth path,which will be encouraging for the RBA.RP Data-Rismark’s new “Rest of State”Hedonic Index, which was developedfor the RBA, shows that the disconnectbetween the capital city and non-capitalcity markets is as wide as ever.Rismark’s Christopher Joye added,“This is simply a function of demandand supply. The demand for homes isstronger in the major conurbationswhereas the supply of new dwellings hasbeen weak. In comparison, the smallermetro and regional markets haverelatively less demand combined withmuch more elastic housing supply.”If you are considering buying a homeor an investment property and needadvice or require assistance with findingand negotiating the right property callProsper Group buyers agents on 1300664 373 or email us on enquiries@prospergroup.com.auProsper Group are independent property buyers agents and consultants. Endorsed by the AMA NSW & QLD, we find,evaluate and negotiate the right property to suit your needs including your:Home . Investment Property . Commercial Property . Business Premises

Starting in Private PracticeworkshopThis workshop is designed for:• Registrars who are finishing specialty training.• Doctors (both GPs and specialists) who are setting up a private medical practice for the first time or consideringmoving into private practice.This workshop gives delegates an overview of important private practice issues. Speak with presenters andrepresentatives from professional organisations who specialise in assisting medical practitioners.Expert presenters provide attendees with information on:• Medicare Australia’s role, account requirements, audits and online claiming.• Options for structuring your practice, considerations when buying a practice.• Basic financial issues when starting-out in your practice.• How to access funding for your practice.• Employing and managing staff for your practice.• How to run a successful practice, setting up effective clinical and practicemanagement systems.• Medical practitioners’ experiences in setting up their own practices.AMA members andnon-members FREEDate 6th November, 2010Time 10am-4.30pmVenue Citigate Central Sydney169-179 Thomas Street, SydneyFor further information contact Sarah Hogg at AMA (NSW) on 02 9439 8822 or email events@amansw.com.au.This event is proudly sponsored by:AMA (NSW), together with partners Investec Experien, Cutcher & Neale and The Prosper Group invite you to a seminar on:Using your superfund to invest in propertyDates & Locations• Wednesday, 15 September 2010, 6 – 8pmThe Hunter Room, Newcastle City Hall• Tuesday, 21 September 2010, 6 – 8pmThe Point, Ballina• Thursday, 23 September 2010, 6 – 8pmNovotel Northbeach, WollongongEvent details6.00pm Drinks and canapes6.30pm Welcome6.40pm Presentations7.40pm Panel of presenters with questions8.00pm ConcludeCostAMA (NSW) Members – $45Non Members – $75AMA (NSW) Member bring a non member friend -$20 discount for member ($25 for member, $75for non member)Attendees will receive $100 towards their 2011AMA (NSW) membershipInvestec Experien• Maximising your ability to diversify your super investments.• Maximising your tax deductions through effective structuring.• The quirks of SMSF lending.Cutcher & Neale• How to get the most out of self managed super funds.• What can a self managed super fund invest in?• How to be tax and cost effective, using debt and superannuation.• Debt Instalment Trusts or Unit Trusts?Prosper Group• Choosing the right residential investment property.• What location should I invest in.• What is the best investment - house or unit.• Five property buying tips.RSVPFor more information or to book for either seminar please callSarah Hogg at AMA (NSW) on 02 9439 8822.Booking is essential as places are limited.

While you builda career, we’ll helpbuild your wealth.You don’t need us to tell you how much dedication and commitment is requiredto build a successful career in medicine.But we can tell you how to build your fi nancial success and security.As specialists in accounting services for medical practitioners, we understandboth your unique circumstances and the opportunities available to you. By puttingthe right structure in place now, you can be confi dent of reaping the appropriaterewards in the future.And if you’re already well into a career, we can review your current structureto ensure you’re maximising the available opportunities.To start the conversation, simply contact Jarrod Bramble on freecall 1800 988 522.There’s no obligation and no charge for the initial discussion for AMA members.■ Freecall 1800 988 522cnmail@cutcher.com.au

How can the AMA help you run your practice?Doctors often join the AMA knowing it can offer a very powerful voice on policy issues of concern,however members and potential members may not be aware of the many services AMA (NSW)offers to assist with the practical, day-to-day running of a private practice.In-house solicitorsThe AMA (NSW) legal team provides extensive adviceto members on industrial (VMOs, staff specialist andother employees) and medico-legal issues and isalso responsible for reviewing and making detailedsubmissions on legislation affecting the medicalprofession and contributing to The NSW Doctor. If weare not able to assist with your legal matter, AMA (NSW)members can receive a referral to TressCox Lawyershealth team for a free initial consultation.Practice management networkAMA (NSW) Practice Management Network ensures membersand/or their nominated staff keep abreast of changes toAwards and other industrial terms and conditions documents,employment entitlements and other IR/HR considerations.Subscribers receive regular quarterly newsletters includingup-to-date IR developments and changes as they occur atstate and federal level and medico-legal requirements thatneed to be adhered to.Employment relations adviceOur employment relations advisors are dedicated toproviding members with accurate, timely and up-to-dateadvice and representation on a range of employmentrelations matters including advice on relevant awards,counselling and termination of staff.Practice policies/pro-formasIn any workplace it’s important to establish policies andprocedures that govern all aspects of workplace activitiesand interactions. AMA (NSW) advisors can providedraft templates for use by private general practiceand specialist practices to streamline operationaland functional systems and improve human resourcemanagement capabilities.Practitioner contracts/agreementsLooking for assistance in how to contract with otherdoctors in your practice? AMA (NSW) has a number of legalpackages and contracts available for purchase includingan Associateship Package, Partnership Package, AssistantPackage and a Medical Practitioner in Private PracticePackage. These were prepared in association with TressCoxLawyers.Fees adviceAMA (NSW) can provide advice on WorkCover fee issues,Medicare item numbers, medico-legal report fees and theAMA list of medical services and fees.Staff education and trainingAMA (NSW) provides a range of training courses fordoctors and their staff. Seminars are offered in a rangeof geographic areas and cover topics from Starting inPrivate Practice to comprehensive practice trainingthrough the Medico-Legal Employment RelationsSeminar. Members receive free or discountedregistration. Seminars are also increasingly beingoffered by webinar and other online options.Occupational Health & SafetyOH&S is an important issue that cannot be ignored byemployers or employees as legislation is in-place andcompliance compulsory. This manual has been designed toprovide private medical practices with the information theyneed to understand OH&S legislation and regulation. It alsodetails workplace safety matters such as waste managementand disposal, infection control, sterilisation and theidentification and management of workplace hazards.Private Practice ManualHuman resource managementThe Essential Guide to a Successful Practice providesdoctors and practice managers with a user-friendly,practical guide and comprehensive advice to assist withsetting-up and managing a private medical practice.AMA (NSW) Guide to Human Resource Management wasdesigned to provide practices with useful information to assistthem in effectively managing staff. It’s tailored towards privatepractices and contains strategies and tools to ensure humanresources policies and procedures are utilised when dealingwith practice issues and legal obligations.Australian Medical Association (NSW) Limited. PO Box 121 St Leonards 1590P: 02 9439 8822 | F: 02 9438 3760 | sarahhogg@amansw.com.au | www.amansw.com.au

classifiedsNORTH GOSFORD SPECIALIST MEDICAL SUITE88 sqm suite in premier location adjacent Gosford PrivateHospital, radiology, pathology. Fully fitted-out, two consultingrooms, reception, storage, two undercover carparks, patientparking. Phone 4323 6177.Beachfront Holiday HouseAbsolute beachfront at Toowoon Bay only one hour north ofSydney. Discounted rates for AMA members who mentionthis ad. Phone The Entrance Estate Agency 4333 6333.Doctors’ Health Advisory Service (NSW) 02 9437 6552Medical Benevolent Association of NSW 02 9987 0504Australian Medical Association (NSW) LimitedPO Box 121 St Leonards NSW 1590p 02 9439 8822 f 02 9438 3760 enquiries@amansw.com.auThe NSW Doctor advertising ratesRATES X1 X3 X6 X11Full pg $2700 $2500 $2300 $2100Half pg $1700 $1600 $1500 $1400Third pg $1100 $1050 $1000 $950Quarter pg $900 $850 $800 $7502 pg insert $2900 $2700 $2500 $23004 pg insert $3300 $3100 $2900 $2700Not including GSTNB. AMA members receive up to five free classifiedadvertisements per annum.38 I THE NSW DOCTOR I september 2010

Join and pay today and you will receive:• Active membership from 1 October 2010 to 31 December 2011.• 15 months membership for the price of 12.• Subscription prices at 2010 rates.• Tax deductible membership.2010 Subscription RatesFrom 1 OctoberCATEGORY TOTAL (inc GST) monthly* (inc GST)Specialist Member 1276107.33General Practice member 1133 95.42Members first year after graduation (Intern) 187 15.60Members second year after graduation 330 28.50Members third year after graduation 330 28.50Members fourth year after graduation 704 59.67Members fifth year after graduationand subsequent years as RMO/Registrar 704 59.67Non-Specialist salaried medical officer 1034 87.17Joint subscription member & spouse or partner ** **Members in academic position not in active practice 891 75.25Members in part time positions engaged 11-25 hours pwk 671 56.92Members in part time positions engaged up to 10 hours pwk 319 27.58Members in full-time post graduate study 495 42.25Members over 70 Still in practice 517 44.08Members absent from Australia for full or calender year 520 44.33Members permanently retired 253 22.08Fifty year members and Gold Medal Recipients NIL NILMaternity Leave*** NIL NILStudent Members NIL NIL25%rebatemember-getmemberprogramIntroduce a new member toAMA (NSW) and receive a chequeequal to 25 per cent of the newmember’s subscription.No limits apply!Refer today!* Monthly deductions will begin in January 2011** 30% discount applies to each individual subscription.*** 1 year maximum. Please contact AMA (NSW) to arrange.Yes join me up!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.NAME AND TITLEgender MALE FEMALE DOBADDRESSPOSTCODE business homeTelephoneMOBILEemailCategory/DisciplineDoctors-in-training, please subscribebased on your 2011 training yearAMOUNT $I was referred by my colleague (optional)AMEX MASTERCARD VISA CHEQUECARD NOEXPIRY DATE ____ /____NAME ON CARDCARDHOLDER’S SIGNATUREmail to AMA (NSW), PO Box 121, St Leonards NSW 1590, or fax 02 9438 3760enquiries@amansw.com.auwww.amansw.com.au

AMA (NSW) PREFERRED PARTNERmaximise your SMSF returns,why wouldn’t you?If you have a Self Managed Super Fund (SMSF) you are not onlyempowered to control your retirement investments but may alsoutilise your SMSF to: to the broader market.Make the most of your SMSF today. Contact your local banker,call 1300 131 141 or visit .Experien ExperienInvestec Experien Pty Limited ABN 94 110 704 464 (Investec Experien) is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975 (Investec Bank).Investec Experien is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice, as appropriate. Deposit products are issued by InvestecBank. You should obtain a copy of the Product Disclosure Statement before you apply for this product and consider your personal needs and circumstances before investing.All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice.

FREE Motor One Waxguard paintprotection value $795For all cars sold and delivered in August and September 2010.Let us worry about finding and delivering you the car you really want,at a price you don’t mind paying.We will deliver the best price on all makes and best delivery timewhether it’s an Audi, BMW, Mercedes Benz, Holden, HSV, Ford,Subaru, Toyota, Honda, Lexus, Hyundai or even a Porsche.Volkswagen corporate program is available for AMA members andwe have other corporate programs available with other makes andmodels by purchasing with Action Fleet.Trade-ins will be put though the same tender process as the new cars,but we will also use external wholesalers to maximise the value ofyour trade-in.For your convenience please use our online enquiry form orcall one of our friendly staff who will take your enquiry.Subaru Liberty 2.5iTelephone 1300 413 971www.actionfleet.com.auAction Fleet Pty LtdDealer licence 25891Ph 1300 413 971Email: info@actionfleet.com.au“I have bought both my last two cars with Action Fleetand Darren White and have been impressed with the qualityof their service. They can beat any competitor’s price anddeliver on time. One phone call and they do the rest.”Dr David Kirkpatrick