The AMA: 50 years on
Half a century on, is the AMA still relevant? Pamela Wilson puts the question to some of its most prominent past presidents.
AMONG the voices of lobby groups past echoing through the halls of Parliament House, one of the loudest is that of the AMA.
In 2006, the AMA was voted by politicians as the number one lobby group in Australia. Now, approaching the 50th anniversary of its 1962 inception – when it evolved from the British Medical Association (BMA) – it’s still seen as one of the most powerful.
But this hasn’t always been the case, nor is its coveted reputation guaranteed in the future, with some arguing the AMA’s clout has diminished in recent years.
With the debate over super clinics still raging, former health minister Nicola Roxon criticised the AMA last October saying: “Those who don’t change with the times are often reduced to an ineffective chorus muttering on the edge of the stage about keeping things the way they always were.”
And last month former PSR director Dr Tony Webber said the AMA risked becoming “irrelevant ratbags” if it did not oppose Medicare rorting by some doctors.
Here, five former presidents speak about the AMA’s current and past challenges, its achievements, mistakes and its evolution.
Bruce Shepherd (1990–93)
In Dr Shepherd’s view, the AMA ‘sold out’ doctors to the Hawke government by agreeing to the introduction of Medicare in 1984.
It was his growing disillusionment with the AMA over this issue that prompted him to jump into the fray as the organisation’s NSW president and then federal president in the early 1990s.
As he wrote in his autobiography, Shepherd, Memories of an Interfering Man, “time had eroded the AMA’s once powerful influence”. He attributed this decline to the growing tensions between GPs and specialists, and to the organisation’s leaders losing sight of members’ needs. He wrote that in 1958 nine out of 10 doctors were AMA members, compared with less than five out of 10 by the early 1980s.
Today, he feels the AMA is still not fighting hard enough. As Medicare rebates become less adequate and the government finds appropriate health funding harder, the AMA should “fight more for the government to allow people to cover as much of their medical care as they can or want to”.
“[The AMA has] given a lot away recently, in terms of independence. They are looking to government more and more for rewards rather than to patients.
“There should be different organisations offering insurance so patients can take their pick.”
Brendan Nelson (1993–95)
The AMA was a different beast when it first evolved from the BMA in 1962, says Dr Nelson.
Although initially powerful and effective, it was conservative and had a low public profile because “it didn’t engage itself in the grubbiness of shaping political and societal outcomes through the media”, he says.
Dr Nelson credits his predecessor and mentor, Dr Bruce Shepherd, for starting the organisation’s transformation through the late ’80s and into the 1990s.
“[He] understood the importance of moving the AMA into a contemporary model of shaping its messaging and also to extend its advocacy beyond the simple industrial and professional issues… to a whole range of public health issues,” Dr Nelson says.
He believes the organisation’s respect and political clout hinge on public health issues such as obesity and tobacco control.
“The day the AMA loses sight of the importance of [these] issues… is the day it will lose its influence,” says Dr Nelson.
Having spent almost 14 years in federal parliament, he saw for himself that “the only organisation that has the clout in Canberra is the AMA”.
It demonstrated its mettle in the early 1980s when it essentially prevented nationalisation of the profession by resisting section 17 proposals (relating to draconian contracts for doctors), and again early this century when it helped resolve the medical indemnity crisis, he says.
Kerryn Phelps, AM (2000–03)
The AMA’s most immediate challenge is to advocate for a position at the table on health reform and to ensure policymakers listen to its advice, says Professor Phelps.
“There are complaints from the AMA that although the government committed to consult with doctors before rolling out new policies, that hasn’t been happening,” she says.
The lack of consultation on the rollout of super clinics, the lack of public information surrounding Medicare Locals and the stripping of funds to proven mental health programs show the government isn’t listening to the AMA.
As the president of the Australasian Integrative Medicine Association, Professor Phelps also wants the AMA to push the profession towards a more preventive and integrated model of healthcare. But she concedes the stance the organisation takes on issues is dependent on the president and the medico-political climate of the time.
“It’s a democratic organisation but at the same time it’s quite presidential in the way it runs because… a good deal of what the AMA represents depends on who its leader is,” she says.
“[However] it’s part of the strength of the AMA as an advocacy organisation that the members come from right across the board from research, teaching, clinicians, doctors in training… you are getting absolutely coalface information and that’s very hard for a politician to argue with.”
Bill Glasson (2003–05)
When the medical profession is united in times of crisis, such as during the medical indemnity debacle, is when the AMA is potentially at its most powerful, says Dr Glasson.
However one of the organisation’s biggest challenges is to remain relevant and significant and drive strong membership.“Unless you have a large membership, your relevance becomes less.”
The organisation also needs to extend its focus, he says.
“We do influence what is happening now, but we should become more involved with what should happen in the future, around general practice particularly,” he says. Medicare Locals is one issue the AMA should be more vocal on.
One area it has been vocal on, he says, is rebuilding self-esteem within the general practice fraternity.
Feeling that the Medicare ‘treadmill’ demoralised general practice, Dr Glasson commends the AMA’s focus on promoting primary care through advocacy on appropriate business models and the self-esteem of GPs.
“I am a great believer in primary care… and that we need to rebuild the business models so they can employ the staff they need to deliver quality services to patients… and the AMA has been trying to move that agenda forward,” he says.
Mukesh Haikerwal (2005–07)
Dr Haikerwal, like most former AMA presidents, is eager to dispel the “old chestnut” of the organisation’s apparent bias.
“Specialists say it’s run by GPs, GPs say it’s run by specialists. Really it is about one-third each, general practice, private specialists and salaried staff… and we always stand as a united professional voice,” he says.
“The GP presidents work very hard on behalf of the specialists and the specialist presidents work very hard on behalf of the GPs.”
Besides, the federal council, although “lumbering” at 34 members, is very representative, says Dr Haikerwal.
“Fundamentally, it’s a member-based organisation driven by members who appoint a federal council… and if you can get an agenda through a council of 34, then it’s pretty well tried and tested policy that is defensible,” he says.
HISTORIC AMA ACHIEVEMENTS
Advocacy during the NSW doctors’ dispute in 1984 and 1985, which saw then health minister Neal Blewett’s section 17 proposals (related to draconian doctors’ contracts) repealed, and the prevention of what would have effectively been a nationalised health sector.
Driving force behind prohibition of tobacco advertising.
Successful campaign against establishment of US-style managed care in Australia.
Managing the medical indemnity crisis and helping secure state and federal law changes governing medical negligence.Introduction of graphic warnings on cigarette packets.
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