future practice - ama (nsw) · 2016-05-12 · future practice print post approved pp100000829...

Building a sustainable general practice

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The Australian Medical Association (NSW) LimitedACN 000 001 614Street address69 Christie StreetST LEONARDS NSW 2065Mailing addressPO Box 121, ST LEONARDS NSW 1590Telephone (02) 9439 8822Outside Sydney Telephone 1800 813 423Facsimile (02) 9438 3760Outside Sydney Facsimile 1300 889 017Email [email protected] www.amansw.com.auThe NSW Doctor is the bi-monthly publication of the Australian Medical Association (NSW) Limited.

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Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor.The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA.

Executive Officers 2014-2015President Clin A/Prof Saxon SmithVice President Professor Bradley FrankumChairman of Council Dr Michael BonningChair, Audit Dr Andrew ZuschmannChair, Hospital Practice Committee Dr Ian WoodforthChair, Professional Issues Committee Dr Michael SteinerDirector Dr Sandy JusufDirector Dr Kean-Seng LimDIT Representative Dr Danielle McMullen

SecretariatChief Executive Officer Fiona DaviesMedical Director Dr Robyn NapierChief Financial Officer Stephen PattersonDirector, Medico Legal and Employment Relations Andrew TookDirector, Policy & Industrial Relations Sim MeadDirector, Services Kerry Evripidou

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NSWdoctor

THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)

Editor Andrea Cornish [email protected]

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Advertising enquiriesMichelle [email protected]

contentsFeatures

Regulars

08

14

16 22

12

2 President’s word

4 From the CEO

6 DIT diary

10 News

32 Medico-Legal

38 Events

40 Golf events

42 Members&Classifieds

44 Member services

AMA Active

Anaesthetists feeling pain from fee splitting

Last call for alcohol Future Practice

Working together to improve well-being

2 I THE NSW DOCTOR I MAY/JUNE 2016

PRESIDENT’S WORD

Clin A/Prof Saxon Smith President, AMA (NSW)

[email protected] @drsaxonsmith www.facebook.com/amansw

It is with a mixture of satisfaction, tiredness and a slight nagging sense of ‘workstilltobedone’,thatIwritemyfinalPresident’s Word.

On 17 May 2016, there will be an election for the new President of AMA (NSW) which formalises the completion of my two years in the role. And what a busy, challenging and rewarding two years it has been! The night I was elected as President coincided with the May 2014 Federal Budget. It felt like I had beenhandedthesheriff’sbadgeinthemiddleofabarfightwiththeFederalGovernment intent on breaking the healthcare system in Australia. We all remember the key parts of that budget: indexation freeze for general practice to match the already existing freeze for specialists; and stripping $60 million from the general public in the form of a co-payment, which rather than being reinvested in health, was to fund medical research in Australia. The message from the Federal Government was clearly ‘either you are with us or against us’. Itwascertainlyabaptismoffirewithmedia, meetings and lobbying.

I’m thankful that at a State level we have had a very good working relationship across both sides of Government and with the Department of Health. This was particularly evident during last year’s State Election, during which we successfully lobbied for: nearly $1 billion to redevelop Westmead Hospital in addition to several multimillion dollar promises for other hospital upgrades; 60 specialist training positions to create training opportunities for the dramatically

increased number of medical graduates; an extra 700 positions for doctors in state hospitals; and a Memorandum of Understanding which makes feedback from senior doctors an important part of hospital managers’ annual performance reviews. Whilst I am proud of these successes, it is clear that our State’s public hospitals continue to struggle to maintain quality services in the face of population growth, an ageing population and advancements in medical technology. Furthermore, it is also clear that we are coming to a crossroads in the delivery of universal access to healthcare which has been a foundation of our society over the past 30 years.

As I come to the end of my last column, I am very mindful that the Federal Government will be handing down their next budget on 3 May 2016. As we lead up to this, there are a lot of mixed signals and lack of clear direction as to what the content of the Budget will be. Are we going to face Band-Aid solutions like the proposed $2.9 billion over three years for additional funding to be split across all public hospitals in Australia? Are we going to see further cuts to bulk billing incentive item numbers as planned for radiology and pathology? Will we actually see a clear direction or forward facing policy to see a sustainable, future proof funding model to enable the delivery of quality healthcare to all Australians? Or will we see a budget primed for an election year following the traditional three-year budget cycle of ‘Cut 1, Cut 2, Spend 3’ to get back in? Even if the Medicare indexation freeze for general practice and specialists were to be lifted,

does this actually change the longer term sustainability of practices who have had to weather the storm of the past two years on the back of the past 20 years? Evenifwefindsomemoneytobuymore‘duct tape and number 8 wire’ to patch up our stretched healthcare system, will it continue to be able to deliver the quality care we want despite the year on year increased demand for services well above and beyond population growth?

As it is likely that the Budget will have been handed down by the time you read this and the new AMA (NSW) President elected, I hope we can all stand together as a united voice striving to represent both the profession as a whole and the general public which we serve. It is through this united voice that we hold all sides of politics to account for the decisions that they make in health.

I have thoroughly enjoyed my time as AMA (NSW) President. Most importantly, I have been very humbled and honoured to have been your representative for the profession, an advocate for public health, and, I hope, a messenger of common sense and compassion through the whirlwind that is the politics of health. I wish the future President all the very best and thank that person for being willingtomakethesacrificestofamily,practice and themselves that it requires to shoulder the necessary burden of the role on our behalf. dr.

Good bye (but not ‘dead, buried and cremated’)ClinA/ProfSaxonSmithreflectsonhistwoyearsasPresidentoftheAMA–abaptismbyfireina challenging political climate.

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FROM THE CEO

[email protected]

Fiona Davies CEO, AMA (NSW)

This year marks my 18th year with the AMA (NSW). It is a length of time that surprisesevenme.WhenIfirststartedworking at the AMA (NSW), my then boss, the unforgettable Allen Thomas said to me that I could always feel proud to have the AMA on my CV. I haven’t needed the CV thankfully, but I am still very proud to work for the AMA.

Over the last 18 years, things have been generally consistent for the profession. There have been major crises that the AMA has had to lead the profession through: crises such as the failure of the tort law reform system leading to out of control medical negligence claims; the collapse of United Medical Protection; the scapegoating of doctors and administrators at Campbelltown andCamdenHospitals;thefightforTreasury Managed Fund coverage; and so many more.

However, in the last few years the environment for the profession has changed dramatically, as we need to deal with inadequate government and private insurer funding, an increased specialist workforce, and the growing burden of chronic disease for patients. We have also seen patients demanding more of their healthcare – this is very positive, but at times it can come with unrealistic expectations.

At the AMA, we are focused on what the future will hold for doctors and for their patients. The AMA is the only organisationthatcaninfluencealloftheelements of the future of the profession

– for patients, for government and for doctors.

In this edition, we raise concerns for the profession as we move to the future. Our main feature is on Future Practice, our project aimed at getting GPs to value themselves and the extraordinary care they provide to their patients. The project came from GPs who told us they could not go on the way they were, and that surviving on the pitiful increases to theMedicareBenefitsSchedulewasdestroyingtheirpractices.Thefinalstrawcame when even the pitiful increases to patients’ rebates stopped. This was the point at which GPs started to say that the situation was unsustainable. GPs recognised that it was not enough to beg at the table for simply a lifting of the freeze. Governments were simply not going to provide the resources needed for quality patient care. We hope all GPs will take the time to look at what we are doing with Future Practice. Whether you are a practice owner, an employed GP or a contractor, we hope Future Practice will make think about what you are doing each day and whether it can be more rewarding for you and your patients.

In this edition, we also highlight the incredible services we provide to AMA (NSW) members. Our talented Professional Services team are some of the best in the industry and they provide dedicated practice, industrial relations and medico-legal advice for you, whateverthesituationyoufindyourselfin. My very best memories of my long

years with the AMA have come from the times we have reached out to support our members. I still remember many years ago a doctor calling me from his car – he hated working with his secretary and he didn’t want to go into his own practice. Together, we worked out the problem (sacked the secretary – but did it the right way). These are the ways we makeadifferenceeveryday.

So, enjoy our non-member edition. To our members, thank you for your ongoing support–youaremakingadifferenceto your profession and to your patients and we thank you. To our non-members (or as we like to call you, our non-paying members) think about joining the AMA. Wehaveamazingbenefitstoofferandyou will be making an investment in your future. dr.

Looking out to the horizonThe last two decades have brought many challenges, but the biggest one facing the profession is change. How can practices best adapt to the future?

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DIT DIARY

Being a doctor-in-training is not unlike playing Nintendo in that you must move through a series of obstacles until you reach the next level. Term one of 2016 is almost complete; most DITs will have started the year as they do every year – getting used to increased responsibility. It’salwaysworthreflectingonthelessonslearned to date, and with this in mind I’ve put together a list of a couple of things I wish I’d known when I started. (Although since I graduated in 2013, this might be akin to a toddler explaining to a baby all their hot tips on how to walk. But bear with me, if you already know these insider tricks, then perhaps this will give you the satisfaction of seeing how far you’ve come.)

1. Be nice to everyone, all the time. This is harder than it sounds, especially when starting out. It’s normal to feel frustrated (and act it) when you’re under pressure, but angry vibes at work will garner you a reputation as a hothead or as a doctor who’s hard to talk to. If you seem angry all the time you’ll be talked about you behind your back and no one will want to help you out of a jam. The same goes for belittling others to make yourself look clever.

2. No one is capable of following Rule #1 all of the time. Being consistently pleasant is something to strive for, but there are only so many nightshifts a person can take before the sound of a beeping pager makes your eye twitch. If you do break, apologise andmoveon.Reflectonwhetheritwasthe person or the situation that made you cranky. Also, try and remember the feeling the next time someone gets terse with you, because they were probably

just having a bad day and you didn’t do anything wrong.

3. Real men and big girls do cry, however they don’t do it on the ward. It’s OK to cry sometimes. You are a doctor, you are going to see sad things, you are going to be beyond exhausted and still be hours from the end of your shift. You are going to be tasked with fixingunfixableproblems.Ifyouneedto cry you should, you will feel better. However, wards are for sick people and colleagues have their own issues to deal with. Patients and workmates need to trust you and rely on you. They don’t want to see you cry, because if you’re crying there must really be no way out of this. I suggest do it in the bathroom (orthedrugcupboard).Ifyou’refindingyou need to cry a lot consider talking to someone about it, lots of hospitals have great employee support programs.

4. Look things up. If you want to know about a patient’s condition don’t pepper your seniors withendlessquestionsthataredifficultto answer. Look it up in the literature. You’ll understand the issue better than everyone around you and remember it next time you see a similar patient, giving people the impression you are a genius.

5. Work on your CV by doing a research project or joining a committee. It’s important for juniors to do some legwork securing future jobs. It also gives you a better understanding of how the health system works and what’s expected of you at higher levels.

6. Don’t join too many committees or do too many projects. If you overcommit yourself you’ll end up stretched thin and failing to deliver. One of each is plenty.

7. Don’t be critical of other people’s work. In medicine we all want to think we’re the best, but being critical from outside of a situation is easy, while making decisions is really, really hard. People can come upwithdifferentsolutionstothesameproblem and all DITs are learning. Try andrememberthisbeforewritingofftheperformance of a colleague. And hope that one day when you make a mistake, as well all do, people won’t be too quick to dismiss you either. dr.

Up your gameThere’s a lot of information to take in when you’re starting as an intern, but sometimes the little lessons can really help advance your career.

Dr Eliza Milliken Junior Doctor

@elizamilliken

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AMA ACTIVE

An advocate for the profession and patients Clin/A Prof Saxon Smith has been an outstanding advocate for the medical profession and for patients, speaking to broadcast and print media about anumberofissuesaffectingthehealthcaresector.Herearejustafewhighlights from his two-year term as President of AMA (NSW).

Westmead Hospital extends its slow period for elective surgery to six weeks1 April 2016AMA (NSW) President Dr Saxon Smith said Easter shutdowns did not usually last longer than two weeks and doctors had been given little notice this one was to take place, forcing them to cancel patients at the last minute.

Which burgers have the most calories? Carl’s Jr burger chain vs McDonald’s, Hungry Jack’s and KFCAMA (NSW) President, Dr Saxon Smith, spoke to the Daily Telegraph about the opening of Carl’s Jr in Australia.

Cataract surgery patients languish on hidden waiting list 10 June 2015AMA (NSW) President, Dr Saxon Smith, spoke to the SMH about the waiting list to get on the waiting list.

Medicinal promise of cannabis needs exhaustive testing 23 June 2015AMA (NSW) President, Dr Saxon Smith, wrote an op ed for the SMH on the necessity of medical trials for cannabis

Coeliac finger test is a pain in the gut21 September 2015AMA (NSW) President, Dr Saxon Smith, spoke to the Daily Telegraph about coeliac disease.

Budget: Hospitals get upgrades 18 June 2014AMA (NSW) President, Dr Saxon Smith, spoke with the SMH about the State Budget.

Video increases skin cancer awareness6 August 2014AMA (NSW) President, Dr Saxon Smith, was quoted on news.com.au about skin cancer.

Bill before Parliament raises fears 29 September 2014AMA (NSW) President, Dr Saxon Smith, spoke to the SMH, ABC radio, and 2SM about a new bill allowing private hospitals to open in areas well serviced by public hospitals.

Doctors disapprove of pharmacy skin cancer checks19 October 2014AMA (NSW) President, Dr Saxon Smith, spoke to the SMH about pharmacists offering in-store skin cancer checks.

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NEWS

The Smith family* were referred by a palliative team. Brian Smith was an intern at the time he was diagnosed with oesophageal cancer. Medicine was Brian’s second career and the family’s financialresourceshadbeenstretchedduring his years of study. At the time of referral their emotional resources were also stretched because family support was in UK. There were three children, the oldest had just started high school. Brian passed away three months after referral. The Medical Benevolent Association of NSW (MBANSW) assisted with a contribution towards rent and utilities which continued for some months until Brian’s wife was able to findchildcareandreturntowork.

The above case study is a prime example of why the Medical Benevolent Association of NSW exists. The organisation was originally set-up in 1896 as the Medical Benevolent Fund of New South Wales with the vision "to affordassistancetoanydulyqualifiedmedical man, widow or orphan children of such whom the committee deem worthy”.Itthenofficiallybecameknownas the Medical Benevolent Association of NSW in 1926, but the vision has remained the same.

We are proud to be celebrating the 120th anniversary of the MBANSW this year. Over the past 120 years the MBANSW has helped thousands of beneficiarieswithfinancialassistancein the millions of dollars, as well as countless hours of dedicated social work counselling. There have only ever been four social workers employed in the history of the MBANSW, all of whom have been tirelessly supported by councils made up of volunteer medical professionals. The underlying motivation

from all involved in the MBANSW is to help their peers in times of need, which is reinforced by the MBANSW’s slogan: “by doctors for doctors”.

MBANSW has consistently grown over the past 120 years. This has been possible due to the support from donors. To ensure the MBANSW continues to grow over the next 120 years the association needs your continued support. All donations are tax-deductible. dr.

Testimonial

“I would like to thank the board for the generous and continued support that you provided for me over the period of my two operations and time away from work. Your support and the contact with the social worker was wonderful at a time of financial distress. I am now back on my feet – literally – and working full time, and I am very appreciative of the role you played in my recovery.”

The Medical Benevolent Association of NSW celebrates 120 years

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MEDICAL BENEVOLENT ASSOCIATION OF NSW

120 YEARSCARING FOR 120 YEARS and with your help we will keep caring for 120 more

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CARING FOR 120 YEARS and with your help we will keep caring for 120 moreMEDICAL BENEVOLENT ASSOCIATION OF NSWwww.mbansw.org.au

How you can donate:The MBANSW’s Annual appeal starts in May, you can donate:• Online - www.mbansw.org.au • Telephone - 0405 244 544• Fax - 02 9987 2970 or• Mail - PO Box 1660,

Dee Why NSW, 2099

If you, or someone you know, are in need of assistance, please contact our social worker, Meredith McVey on (02) 9987 0504 or through the MBANSW website www.mbansw.org.au

* Not their real names

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Daniel was seeing his doctor for multiple problems, including depression and anxiety, which were exacerbated by his drug use. He was also anxious about his finances,ashewasstrugglingtopayhisbillsandhad$2700intrafficandcourtfineshecouldn’taffordtopay.

Research has shown that often people withsignificanthealthproblemsalsohavea range of legal problems. Sanctions forunpaidfines,includinglicencesuspension, can lead to a cycle of further offending,stressanddisadvantage.

But an innovative NSW government program called the Work and Development Order (WDO) scheme can help.

People who are experiencing disadvantagebecausetheyfacefinancialhardship, mental illness, addiction, disability or homelessness can clear their finesbyparticipatinginmedicaltreatmentprograms, courses, or unpaid work with a WDO sponsor.

Engaging in drug and alcohol treatment, a Mental Health Care Plan or other medical treatment are all ways that a personcancleartheirfinesbyupto$1000 a month.

Individual medical professionals, government health services, or NGOs (eg Aboriginal Medical Services) can become WDO sponsors to help people

clearfineswhilereceivingthetreatmentthat they need.

There are currently 1657 sponsors, including 648 individual health and medical practitioners supporting the scheme, but more sponsors are always encouraged to join across NSW. Sponsors are supported with training, a hotline, and with support material and networking.

Thisisaworldfirstinitiativeandagreatexample of doctors and lawyers working together to improve wellbeing. It is now being replicated in other states as an alternativefinesrepaymentoptionforpeople experiencing acute hardship.

Daniel’s GP became a WDO sponsor, referred him to a three month drug treatment program and monitored his progress. Daniel stayed engaged, benefitedfromtreatmentandclearedhisfinesdebt.Hefeltsupported,gothislicence back and was heading towards a more settled and stable life.

Learn more about the program by phoning 1300 478 879 or email [email protected]. Apply to become a WDO sponsor at sdro.nsw.gov.au/business/wdo dr.

World-firstinitiativehelpspeoplewithsignificanthealth issues who also have legal problems.

FEATURE

The Work and Development Order scheme started as a NSW Government pilot in 2009. It became a permanent program under the Fines Act 1996 in 2011.

In the past four years, 45,000 Work and Development Orders were undertaken by vulnerable clients across NSW to clear more than $55 million in outstanding finesdebt.

A recent evaluation of the scheme found that 95% of sponsors said the scheme had helped reduce stress and anxiety for the person participating.

And 87% said the scheme had enabled participants to address the factorswhichhadmadeitdifficultfor the client to pay or manage their finesdebtinthefirstplace.

The evaluation also found the majority of participants received nofurtherfineswhiletheywereclearingoldfinesunderaWork and Development Order and started to feel they were regaining control of their lives.

According to the evaluation, the scheme provided a safety net for the most vulnerable, including those with mental illness and intellectual disability, who due to the often chaotic nature of theirlives,mayfinditdifficulttomanage debts.

Working together to improve well-being

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FEATURE

Senior anaesthetist Dr Ian Woodforth, who serves as a Councillor for AMA (NSW), as well as the Australian Society of Anaesthetists (ASA), reported that the ASA received several complaints from members who had been asked by surgeons for a cut of their fees in exchange for a list.

“Various anaesthetists say that in certain places it can be fairly widespread,” he said, adding that an increase in the number of anaesthetists has created greater competition, particularly among younger doctors who are struggling to get work with public hospitals.

“Doctorsarefinishingtheirtrainingandfindingthattheycan’tgetanyworkin public hospitals, so they’re totally dependent on picking up what they can in private. As a result, the surgeons have a strong bargaining position,” Dr Woodforth said.

TheASAreceivedtwodifferentcomplaints from anaesthetists who indicateddifferentsurgeonshadrequested 7% of the anaesthetists’ fees in exchange for a list, with no tax invoice or GST payable.

Dr Woodforth said it seemed strange thattwodifferentsurgeonswouldaskfor a similar percentage, suggesting that perhaps this indicated there was a common rate for this activity.

The ASA has acted on the complaints by dealing with Federal AMA and the College of Surgeons.

According to Tresscox Lawyers, fee splitting arrangements contravene conduct outlined in Health Practitioner Regulation Law 2009, and also give rise to possible competition law issues and taxation law issues.

Section 139B of the National Law sets out the types of conduct which amount to unsatisfactory professional conduct. These include both acceptingandofferingkickbacks(monetarily or otherwise) for referrals or recommendations of any health service.

Both surgeons and anaesthetists who engage in fee splitting may be subject to disciplinary proceedings before a Professional Standards Committee or the NSW Civil and Administrative Tribunal, should their conduct be brought to the attention of regulators. As a result, they couldfaceacaution,areprimand,afine,and/or conditions being placed on the practitioner’s registration.

Fee splitting could also attract the scrutiny of the Australian Competition and Consumer Commission (ACCC), shouldthearrangementseffectivelyprevent others from entering the market.

There are also taxation concerns, as income to the surgeon is ordinarily taxable. In addition, the arrangements may infringe on private health fund rules.

But perhaps the biggest issue with fee splitting is ethical.

“When I was a student it was drummed into us that the two things that would

get you de-registered were: having sex with a patient and fee splitting. It was up there as one of the big no-nos. It distorts the whole system of referral. For example, if a GP is referring someone to asurgeonandexpectsafinancialkickback,thenthatwillinfluencewhotheyrefer to. And it’s the same thing with a surgeon choosing an anaesthetist. They should be a choosing the best one that they know for the circumstances and not the one that will pay them the most.Soit’saverysignificant,ethical,professional issue.”

The matter is being considered by the Professional Issues Committee and the Ethics Committee of AMA (NSW).

Under the Medical Board of Australia’s Code of Conduct, medical practitioners are obliged to: act in their patient’s best interests; inform patients if they have aninterestthatcouldaffect,ormaybeperceivedtoaffect,patientcare;andtake reasonable steps to ensure that the person to whom they ‘refer’ has the qualifications,experience,knowledgeand skills to provide the care required.

A surgeon receiving a share of an anaesthetist’sfeesmayhaveaconflictofinterestperceivedtoaffectpatientcare.

Similar obligations are found in the AMA Code of Ethics. dr.

Fee splitting raises ethical, legal questionsSurgeons are taking advantage of increased competition among anaesthetists by requesting payment for lists.

amansw.com.au I 15

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FEATURE

Doctors see the tragic consequences of excessive alcohol consumption in their consulting rooms, hospitals and operating theatres every hour of every day.

Alcohol has been causally linked tomorethan60differentmedicalconditions, including cirrhosis of the liver, inflammationofthegutandpancreas,heart and circulatory problems, sleep disorders, eye diseases and alcohol dependence. Alcohol consumption also raises the overall risk of cancer, including cancer of the mouth, throat and oesophagus, breast cancer and bowel cancer.

Alcohol consumption in excess of that recommended in the National Health and Medical Research Council (NHMRC) alcohol guidelines is the norm in Australia.

According to the Foundation for Alcohol Research and Education (FARE), one infiveAustraliansdrinkatalevelthatincreases their lifetime risk of alcohol-related disease or injury.

The misuse of alcohol has an impact on emergency services. A recent study found that drinking a single glass of wine doubled the risk of presentation to an emergency department; after three glasses,therewasafive-foldincrease.

The same study found that, after 10 standard drinks, the risk of needing to attend an emergency department was increased 10-fold for men and 14-fold for women.

Emergency physicians are on the frontline of responding to and treating the consequences of alcohol misuse. This ranges from treating alcohol intoxication and severe injuries sustained as a direct result of intoxication, to managing the acute complications of chronic alcohol-related conditions.

A survey of alcohol-related presentations to Australasian emergency departments (ED) found one in seven ED presentations

AMA (NSW) recently made a submission to the Independent Review of the Impact of Liquor Law Reforms, giving support to the lock out and last drinks measures, as well as 10pm closing time for bottle shops.

Last call forALCOHOL

amansw.com.au I 17

in Australia and New Zealand were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations.

Sadly, excessive drinking often impacts those who are innocent victims. Doctors deal with the terrible results – the fractured jaws, the facial lacerations from glassings and the eye injuries that cause blindness. We see the head injuries, including those from the now infamous coward’s punch.

Alcohol-related harms also include violence against doctors, nurses and other patients from people who turn up in emergency as a result of excessive alcohol use.

Too often emergency department doctors experience alcohol-related harms in the form of threats or abuse from drunk patients. A survey of 2,000 emergency personnel by the Australian College for Emergency Medicine found more than nine in 10 emergency nurses and doctors have experienced physical assaults and threats from drunk patients.

Doctors and nurses report being punched, spat on, vomited on, and verbally abused by inebriated patients.

Not only does this behaviour impact the emergency room physicians, it also affectsotherpatientswhomustwaitfortreatment while doctors deal with an aggressive or abusive drunk.

Thenegativeeffectsofexcessivealcoholconsumption aren’t restricted to Sydney streets or even our hospitals. They enter people’s homes. In 2011, there were 29,684 police-reported incidents of alcohol-related domestic violence in Australia. In NSW, there were 10,706 incidents of alcohol-related domestic violence reported in 2010-2011.

Another alarming statistic is the number of substantiated cases of alcohol-related child abuse. Over a million children (22% ofallAustralianchildren)areaffectedinsome way by the drinking of others.

No longer can we tolerate people, including young men and women, even children, being injured or dying because of harmful alcohol consumption.

When the skull hits the pavement it makes a sickeningly loud cracking sound. If it is the result of a “king hit” the victim is usually already unconscious and so cannot protect themselves as they are falling.

The sudden stop of the head on the pavement means that the brain is squashed against the skull and rebounds. If death does not result immediately then the brain bruises and swells.

Weeks of treatment in intensive care follows and if the patient survives, brain damage is common. Neurosurgeons know this pattern all too well and too often it is a result of alcohol-fuelled violence.

AMA President, Professor Brian Owler

In NSW, the 1.30am lock out and 3am cessation of liquor sales laws are working to reduce alcohol-related violence and other harms in the Sydney CBD and entertainment precinct areas. The evidence clearly supports this.

In the 12 months since the introduction of liquor regulations in the central district of Sydney, which went into effect24February2014,therewasasignificantreductioninthenumberof alcohol-related serious injury and trauma presentations to the St Vincent’s Hospital’s emergency department. This change was seen throughout the week, but was especially marked at weekends.

The study by St Vincent’s Hospital found in the 12 months since the laws were introduced, there was a 25 per cent decrease in the most life-threatening alcohol-related injuries.

According to Professor Gordian Fulde, director of the emergency department at St Vincent's Hospital, the lockout laws do not appear to be pushing the problem to other suburbs, with hospital and police statistics showing an insubstantail increase in severe injuries in the year since the laws were brought in.

"There were more drinkers in Newtown butinthefirstyearweareanecdotallytold there was no increase to Royal Prince Alfred," Professor Fulde told The Sydney Morning Herald.

Assaults have declined in the lockout areasReports and analysis released by the Bureau of Crime Statistics and Research (BOSCAR) in April 2015 and now February 2016 all show a decline in assaults in areas covered by the lockout laws.Themostrecentfiguresarea40%decline in assaults in Kings Cross since the lockout laws and a 20% decline in the Sydney CBD and entertainment precincts. The reports also show areas adjacent to the Kings Cross or Sydney CBD entertainment precincts or within easy reach of these precincts show no increase in assault.

Accessibility of alcohol and assault, domestic violenceThe state-wide 10pm restriction and the current liquor law licence freeze are also good preventive measures in reducing alcohol harms – particularly given the incidence of alcohol outlet density and assault.

BOCSAR’s past research suggests that trading hours have a powerful influenceonlevelsofalcohol-relatedcrime. A number of studies have found that longer trading hours for licensed premises are associated with higher levels of alcohol-related violence. Several studies have also found that liquor licence restrictions reduce alcohol-related violence; the introduction of lockouts and earlier closing times across 14 licensed premises in 2008 in Newcastle was associated with a substantial fall in assaults, without resulting in


any displacement of violence into a neighbouring ‘control’ area.

Studies have also found a link between alcohol outlet density and assault, as well as alcohol outlet density and domestic violence. Conclusions from a Melbourne study found that the density of liquor licenses is positively associated with rates of increased domesticviolenceovertime.Theeffectswere particularly large for packaged liquor outlets, suggesting a need for licensing policies that pay more attention tooff-premisealcoholavailability.

Liquor Law ReviewOn 11 February 2016 an Independent Review of Lockouts, Last Drinks and 10pm Liquor Laws was announced.

Thereviewwillassesstheeffectivenessof the 1.30am lockouts and 3am last drinks legislation that apply in Sydney CBD and Sydney entertainment precincts while also looking at the state-wide 10pm restriction of take away liquor sales. The review will also examine the periodic licensing fee system for NSW licensed venues.

The review's terms of reference include examination of the impacts on alcohol-related violence and other harms and

impacts on business, patrons and community amenity.

Inlightofthissignificantreductionof alcohol-related harm since the measures were introduced, AMA (NSW) recommends:• the continuation of the last drinks

and lock out policies in Sydney CBD and Kings Cross.

• Extend the 1:30am lockout and 3am last drinks measures to all venues in NSW.

• Maintain the 10pm restriction of takeaway sales across the state, with no exemptions.

• Increase the rate of fees under the periodic licence fee scheme to recover more of the expenses associated with administration of the licencing system.

The State Government showed strong leadership by bringing in these measures in January 2014. Opponents of these measures will argue that it is a blunt instrument that punishes people who drink responsibly. However, AMA (NSW)arguesthebenefitsofthesemeasures far outweigh any restrictions on personal liberties.

Australia has a problem with alcohol – it’s affectingourhealthandit’simpactingthesafety of community. The lockout, last drinks and 10pm closing times for bottle shop are vitally important measures in preventing further harm. To relax these rules, would be a step backwards.

After all, nobody has died from not having a drink. dr.

“He’s awake and talking but unfortunately he can’t feel or move his hands or feet.”

I was in an emergency department in Sydney, talking to a young man’s father who was back in the UK. After breaking the news over the phone I could hear his panicked voice echo down the phone as he called to his wife. He relayed the news; their son had broken his neck. He had fallen off a balcony. Drunk. That New Year’s Eve, and the phone call, is seared into my memory.

Sadly, an almost identical event occurred a few years later, again as a result of a New Year’s Eve party that spiralled out of control because of alcohol. A fight, fuelled by alcohol, had broken out just after midnight and a young man had fallen off the balcony. When he landed he was conscious. He knew immediately he was a quadriplegic.

AMA President, Professor Brian Owler

Since the measures have been introduced there has been:• asignificantreductioninthe

number of presentations with alcohol related injury to St Vincent’s Hospital, Darlinghurst – the closest trauma treatment centre to Sydney CBD Entertainment Precinct.

• asignificantreductionintheseverity of the alcohol related injury presentations to St Vincent’s Hospital.

• asignificantreductioninassaults across the rest of NSW.

amansw.com.au I 19

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SPECIAL FEATURE: FUTURE PRACTICE

TheGovernmenthasusedtheMedicareindexationfreezetoeffectivelyreduce its contribution to patients’ healthcare costs – forcing doctors to absorb the loss. As a result, many general practices are no longer financiallyviable.Thequestionhasbecome–whatcanGPsdotosurvive?

For many GPs the status quo is untenable – as a result many are at a crossroads. How can general practitioners provide a quality service thatfitstheneedsofanageingpopulation, adopts the latest technology andofferspatient-centredcare,whilestillbeing sustainable?

The answer is through innovation.

In this spirit, AMA (NSW) is launching Future Practice (www.futurepractice.com.au) – a platform for GPs who are interested in building better, more sustainable, general practices.

The Future Practice website will cover all aspects of creating a quality, patient-centred, economically viable practice, offeringawealthofresources,includingcase studies, videos, and a community for GPs to share ideas. The Future Practicewebsitealsooffersgeneralpractitioners a free practice health check, a detailed benchmarking exercise and a fee for service pricing guide. In addition to the website launch, AMA (NSW) will be running a series of Future Practice workshops to assist GPs interested in changing their business model. As well, AMA (NSW) has employed a practice manager who will be available to answer any questions GPs have about innovating their practice.

Why Future Practice?Adopting the ‘Future Practice’ model is not only about building a sustainable generalpractice,it’saboutofferingaservice your patients want.

As part of the Future Practice project, AMA (NSW) commissioned Essential Media Communications to ask patients to describe a “dream GP experience”.

Here’s what their research told us:1. The ability to quickly and easily make

an appointment (either online or over the phone) for the same day.

2.Receiveatextthatconfirmstheappointment time (and alerts you if the doctor is running late).

General practice at a crossroads

amansw.com.au I 23

3.Arrivefiveminutesearly,andbetoldthe GP is running on time.

4. Wait in a comfortable, bright, clean waiting room that has current, high quality magazines.

5. See a GP at the appointed time for a relaxed, unrushed, thorough, friendly chat – this includes a lot of ‘back and forth’ about your concerns and issues.

6.Leavetheappointmentconfidentlyknowing the next steps, your treatment, what your issues are and how to deal with them.

7. Head to reception where the receptionist has all paperwork ready, pay by EFT with an automatic refund from Medicare.

The fantasy visit was developed in an online overtime focus group commissioned by AMA (NSW) to understand public expectations of GPs.

The good news is most aspects of “the dream experience” are already being offeredatmanypracticesacrossNSW.And it is these innovations that the Future Practice project launched this month seeks to harness.

Online bookings and appointment alerts, longer consultations, integration of services and streamlined billing systems are emerging as the backbone of these modern practices.

On the issue of billing, our research confirmsthepublicisopentopayinganappropriatefeeforthosewhocanaffordit, especially for longer consultations, providing those in need retain access to services.

And they are open on whether a practice is a smaller group practice or a larger corporate practice, provided the service fundamentals are in place.

Theyalsoreaffirmedtheneedtohave a relationship with a practice, so there is a continuity of care, with many still

retaining ties with the practice they used as a child.

Looking to the future, most people believe they will continue to rely on a single GP for complex issues, while accessing larger corporate chains for more routine issues.

Practice manager Cathy Baynie says the findingsshowthatpatientsarepickingand choosing GPs based on healthcare needs and that the practices that thrive will recognise this and provide a better patient experience.

“Thisistheexcitingpartofthesefindings– the public is ready for a new GP experience and the opportunity is there for practices to deliver services that build loyalty and demonstrate value for money.

“Practices that can adapt to these challenges have a bright future – and AMA (NSW) is excited about sharing the wins across the profession so that we have more and more success stories.”



“I think the questions doctors should ask themselves are, ‘is the patient coming to see me because I’m the cheapest place in town? The next thing to ask is, ‘do I have the choice to practise medicine the way I want to practise it?’”

Seven years ago, Dr Kean-Seng Lim faced a crossroad. To continue to bulk bill patients or introduce private billing.

“Our practice has always been a family practice and we have a very stable patient base. We have generally tried to provide what we considered a fairly comprehensive level of service to our patients and this was not going to be possible with the trajectory that the rebates were taking.”

If he continued bulk billing, he risked thefinancialstabilityofhispractice–established in 1965 by his father, and one that Dr Lim has worked at for 20 years. He could have lessened the shortfall by increasing the number of patients he saw per day, but this is turn came at a higher cost – albeit not economic. For Dr Lim, reducing the quality of care to his patients by increasing throughput was not the kind of medicine he wanted to practice.

In the end, he decided on private billing.

Like many doctors, Dr Lim struggled with the idea of charging patients a fee.

His Mt Druitt medical practice is located in one of the most socio-economically disadvantaged regions in Australia, also known as the location backdrop to SBS’s observational documentary Struggle Street.

“Most of our patients are older or working class. We are now seeing families where you have both parents working and they have young children, but equally we still

have large numbers of families where there is one predominant breadwinner and they might have several children that have to be cared for from the one income,” Dr Lim said.

The decision to charge a fee raised concerns that the practice would lose some patients, however Dr Lim said the biggest fear was the impact that this would have on his patients, as to whether it might delay their presentation, or whether it might impact on follow-ups and mean that patients were not coming for regular check-ups.

“At the end of the day, most of our patients were actually very supportive and we didn’t see any reduction in patient numbers at all,” he said. He still bulk bills more than 60% of his patients, but the other 40% has remained stable.

“I think that patients choose to come to see us because of the service that we provide, not because of what we charge.”

According to Dr Lim, the transition to private billing took about six months. Central to their success was communication with patients and educationofstaff.Themedicalcentrestarted placing posters around the practice regarding the Medicare rebate’s failure to keep pace with the CPI. It followed up with letters to patients explaining the billing changes and then encouraged the conversation between patients,staffanddoctorstoensureeveryone was informed and on board.

“The key thing was preparation. And thatmeantpreparingthestaffaswellas preparing the patients. Honestly, it all went very, very smoothly. The main obstacle was making sure we had the practice systems in place. And that

meant having good billing software, making sure that the software is able to communicate with Medicare to allow us to process claims.”

Changing the billing structure has had a profoundeffectonthepractice.

“Financial sustainability is great, but theotherbenefitsareprobablyevenbetter. There’s been an improvement in doctor morale in that they feel valued by patients. There is also improved morale amongpracticestaffmembers,whoareproud to work in a place that has chosen to put service over numbers.”

Mt Druitt Medical Centre has four generalpractitioners,andoffers services with several allied health practitioners including a dietician, exercise physiologist, psychologist and clinical pharmacist.

“Since making these changes seven years ago, we have actually grown the practice by adding more doctors and I do think that having a private billing practice has made it more attractive to good quality doctors to come to work with us. It’s also assisted us in getting more allied health practitioners to come join our team. Part of our vision of how our practice was going to look in the future was to have a truly collaborative, comprehensive, multi-disciplinary, team-based care. We’ve been able to pull together a team of like-minded health professionals and I think it’s really helped us improve the level of care that we’re able to provide, as well as providing a much more professionally satisfying work environment.”

In terms of technology and social media, the practice has put in place a system allowing patients to make online appointments. They are also working with

Driving quality careDr Kean-Seng Lim transformed his practice by focusing on quality, patient-centred care.

amansw.com.au I 25

a provider to allow video consultations with patients. The practice has improved its digital presence by revamping its website and expanding its Facebook page, which now features educational material on health-related matters.

According to Dr Lim the nature of general practice is changing – the question is: who will lead that change?

“The future of general practice is very interesting. We are doing more in terms of chronic disease management, the cases we see are more complicated, they are much more time consuming. The level of skill, the level of expertise that we need to employ is growing. So

it’s not going to be business as usual. I think that we really need to change the way we do things.

“We are looking at a world where general practice itself is going to have to change in a number of ways. One of them is that we will be making much greater use of teams in general practices – it’s not so much a case of a relationship purely between a patient and a general practitioner, it’s actually a relationship between a patient and the whole general practice team. I think that we will have to become much more systematic about what we do. And this means we will have to be smarter about the way we use technology. The other aspect of

technology is communication and sharing of information across the general practice team, but also other health providers across the other sectors.

“So I think this is a time of great evolution for general practice. I do think there is a risk that if general practitioners do not take on this role and do not actively become engaged in this process of change that general practice could become sidelined or pushed by external forces – government, other health providers, policy makers or the funding. If we wish to decide what it is we are going to do then we have to take control of these elements.” dr.

Dr Lim’s advice for other doctors thinking about transitioning to private billing:“The future of general practice is a very interesting. We are doing more in terms of chronic disease management, the cases we see are more complicated, they are much more time consuming. The level of skill, the level of expertise that we need to employ is growing. So it’s not going to be business as usual. I think that we really need to change the way we do things.”


What strikes most visitors about ‘Historic Camden’ is just how green it is. Roughly 65 km from Sydney CBD, the area is also known as ‘Cowpastures’, so named after a herd of cattle that disappeared was rediscovered there in 1795.

Dr Matthew Gray said there still isn’t a stop light between his surgery, Schwarz Family Practice, and his home – although recent construction has slowed his commute.

In fact, the construction is probably the second thing most visitors note. After the HumeHighwayturnoff,thenumberofdiggers, bulldozers, and backhoes gives evidence to a community that is starting to swell.

Schwarz Family Practice was established in 1984 by Dr John Schwarz, who continues to work part-time. His daughter, Dr Jane Gray, joined the practice in 1998 and is a principal alongside her husband, Dr Matthew Gray.

Theclinichasexpandedsignificantlyinthe last three decades – from being a single consulting room attached to the Schwarz family home – to a large, modern premise that enjoys a rural outlook.

Itnowhas12permanentdoctors,fiveGP registrars, three nurses and more than20supportstaff.Inadditiontomedical consultations, it features an onsite pharmacy, pathology collection centre and podiatrist. Other allied providers include a visiting audiologist, clinical psychologist, an exercise physiologist and a dietician.

Its patient base includes a broad cross-section of the community, catering to the many new families moving into the area, as well as Camden’s well established senior residents, many of whom have chronic or complex care needs.

Schwarz Family Practice is a private billing general practice, but its transition to fee for service has been gradual. Dr Schwarz opened his practice the same year Medicare was launched in Australia.

“The rebate was a fair and reasonable fee when it was introduced, but there’s been a very modest indexing of the rebate since that time,” Dr Matthew Gray said. “Fifteen years down the track there was recognition that to continue to provide the quality of care for our patients it wasn’t sustainable to stick with bulk billing.”

Shortly after Dr Gray joined the practice in 1999, Schwarz Family Practice introduced private billing. Until January 2015, roughly 40% of patients were paying a fee. However, the freeze on Medicare rebates forced the clinic to further rethink its billing structure.

According to Dr Gray, they had three choices: continue with the status quo with increasingly less revenue to reinvest in the practice; increase the number of patients and reduce the time per consult; or alter their fee structure, focus on quality and continue to evolve the practice’sofferings.

“Towards the end of 2014 there were some proposed changes to the way general practice is funded and an expectation by the Government that we would charge a gap payment to patients. What we recognised is that whilst when Medicare was introduced the rebate was probably a fair and reasonablereflectionofthecosts and value of the service that general practice provides, what we’ve seen overtime is a very modest increase in the rebateandasignificantincreaseincosts.So to be able to provide the quality of care that we desired, we recognised that

Schwarz Family Practice has experienced dramatic growth in the last 30 years, much like the area of Camden in which it is located. Despite this evolution, maintaining a high quality of care remains at the heart of this surgery.

Valuinggeneral practice


amansw.com.au I 27

a move to increased private billing was required.”

While continuing to bulk bill some concession card holders and children under 16, the practice altered its fee for service guidelines with a view to increase private billing to 60%.

Dr Gray said the Government’s co-payment campaign made the transition very topical.

“In fact, so many patients were coming in saying ‘what’s this mean for us, are we going to have to start paying?’ And it was quite an impetus to have the conversation with them, to say ‘yes, the rebateisnotgrowingwithinflationandfor us to be able to continue to provide the quality of care that we want to provide, then we need charge a fee’.”

The actual transition to increased private billing took about a month. The practice used that time leading up to the start date to create detailed letters explaining why they considered it necessary and preparingstafftocommunicatethechanges to patients. They placed posters aroundthepracticeandprovidedstaffwith a cohesive message that was fairly simple and easy to explain.

When the changes were made, Dr Gray said the reaction from patients was generally one of acceptance and they didn’t see a drop in patient numbers.

Looking back at the recent transition, Dr Gray admitted there was some fear. Despite Camden being a pocket of relativeaffluence,theSouthWesternregion is generally socio-economically disadvantaged. There are also several other general practices in the area, some of which are 100% bulk billing.

“The obstacle for me was the fear of losing patients. And I guess as a profession and as individuals, we didn’t go into medicine to have the economics of general practice as the centre of what we do.”

However, he added, “We have to be comfortable that we’re adding value to people’s lives. And if the rebate doesn’t recognise the value of the service and the

cost of providing the service then that’s a political discussion. But we need to be able to recognise the value of our service and price it at an appropriate level, while acknowledging the people who are less able to pay and giving them a discounted or bulk billed rate.”

Comparing the cost of ongoing healthcare to other consumer expenditures is helpful, Dr Gray said.

“Ifapatienthasfivevisitsorless,onaverage per annum the amount they pay

out of pocket to our practice is less than onehairdresservisit,it’slessthanacoffee a week.”

In addition to allowing doctors to spend more time with their patients, the private fee structure also gives the practice an opportunitytoimprovetheirofferingwithlonger hours and expanded services.

Dr Gray predicts that the future of general practice is healthy, but GPs have to be prepared to meet the challenges that come with providing quality care. dr.



The Medicare rebate freeze is one of the greatest challenges general practice has ever faced – and there have been many in recent years.

The Government is freezing indexation of Medicare rebates for four years from 1 July 2014 until 1 July 2018, which means the rebate amount paid to general practices will not be increased forinflation,ashaspreviouslybeen the norm.

The table (right) shows how the real value of the Medicare rebate to practices will fall over a four-year period. The Item 36 Medicare rebate amount (after taking into account indexation of 2.75% per annum) will only be worth $64.33 compared to its original value of $71.70; a reduction in real income to the practice of $7.37 per consult. The potential loss of income to a doctor performing 5,156 consults a year on average could be as high as $36,092 per doctor.

Therewillundoubtedlybeotherfinancialchallenges to general practice and in order to remain viable, practices must evolve. General practices need to take a step back and assess the relative performance of their practice. Following this critical analysis, practices need to then implement strategies and actions toensuretheycangeneratesufficientincometoremainfinanciallyviable.

This is critical to ensure that practices can continue to provide high quality healthcare services to the community. Fromafinancialperspectivethereareanumber of areas that general practices can review and look for improvement.

Billing to stay financiallyviable

MBS BACKGROUNDThe real value of Item 23 and Item 36

INFLATION 2.75% ITEM 23 ITEM 36

Current 37.05 71.70

1 year 36.06 69.78

2 years 35.09 67.91

3 years 34.15 66.10

4 years 33.24 64.33

LOSS 3.81 7.37

Cutcher&Neale’s 4 Ways to Grow Your Practice™looksattheefficiencyofthepractice’s processes and systems and the key drivers of income, primarily the quantity of services provided and the cost of each service.

Manypracticeswillfindthattheiroperational structures and systems are fairlyefficientsoimprovementstoassistwiththefinancesmayonlybemarginal.Discussion then turns to price and the often misunderstood issue of bulk billing versus private billing.

This debate has raged for many yearsandasidefromthefinancialconsiderations, the issue challenges practices from a cultural acceptance perspective, perceptions of value and even emotional issues of guilt.

This case study highlights many of the issues general practices face:

The NSW Family Practice has about 4.8 Full Time Equivalent (FTE) doctors and 3.5FTEadministrativestaff.Everyoneis working hard and they see 24,798 patients a year. The doctors are on a

30% service fee arrangement (excluding PIP)andthepracticehasaprofitofapproximately $125,000.

A $7 reduction in Medicare income would equate to a drop in practice income of $52,075. That’s close to a 42% reductioninpracticeprofit.Thefinancialimpact could actually be worse because the practice’s costs will likely rise with inflation.Itwouldbeverychallengingtorecoupthelossincomeviaefficiencygainsalone.Inordertoremainfinanciallyviable, the practice may therefore need to rethink its pricing structure.

If they are to adjust their pricing, it is not simply a matter of increasing fees. Practices that have successfully transitioned from bulk billing to private billing approached the transition with a plan. This involved talking to practices that had already taken the path and learning from their experiences. The planning also involves timelines, coaching ofstaff,educationofpatientsandplentyofsupportforthestaffmanagingpatients. It’s important to note that many of these practices are in fact mixed billing

With the challenges facing general practice, practices need to take an honest look at how they are currently operating.

amansw.com.au I 29

practices. It doesn’t need to be 100% private billing.

For many practices a key step in making the transition is to address “feelings of guilt” experienced by some doctors and staff.Theguiltissuerequiresaculturalchange in the practice and a better appreciation of the value of the medical services provided.

Practices that make the transition from bulk billing to private billing should have a policy for dealing with patients who maynotbeinafinancialpositiontopayahigheramount.Practicestaffwillneedto be educated about this policy and provided with instructions on what to say and how to deal with these patients. Many practices clarify the price at the time of booking, so as to address the issue at the outset.

The fear of losing patients is another stumbling block which prevents practices from taking the step. Feedback from the practices that have moved from bulk billing to private billing was that some reduction in patients occurred but patient numberssoonreturned.Fromafinancialperspective, a practice could maintain its operating position from a lower base of patients, with those patients paying a higher rate. This also has the potential to free up time for doctors and practice stafftoimprovemedicalservicesoroffernew services.

The two key elements to the successful transition from bulk billing to private billing are education and communication. Doctors,staffandpatientsneedtobe educated about the transition, andeffectivecommunicationofthechange needs to be planned. This was very evident in the discussion between doctors at the general practice workshops run by the AMA (NSW) late 2015.

There are many challenges and uncertainties facing general practices. What is certain though is that practices need to take an honest look at how they are currently operating. Practices need to appreciate that they are in the business of medicine. The business of medicine involves the provision of high quality healthcare andafinanciallyviablepracticecanonly help with this objective. In order toremainfinanciallyviable,practicesmay need to consider transitioning from bulk billing to private billing. dr.

Jarrod Bramble PartnerSpecialist Medical Services

Nicole Brown Client Service Manager

Stuart Chan DirectorSpecialist Medical Services

Cameron Nix Client Service Manager

Shane Morgan PartnerSuperannuation

Phil Smith PartnerInvestment

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Michael Graham Director Cloud Software

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(a) Index compromising average weekly earnings and consumer price index (70:30)reflectingtheaveragecoststructuresinmedicalpractices.

(b) Index of Medicare fees as determined by the Commonwealth Government

260

220

180

140

240

200

160

120

100

1986 1988 1990 1992 1994 1996

IND

ICES

:198

6 =

100

1998 2000 2002 2004 2006 2008 2010

AWE and CPI (a) Medicare (b)

The fees we charge are set at a level that enables us to look after you properly. The cost of providing good medical care is rising.

The Government’s contribution is falling away.

That is why you may find you have to pay a gap.

GAPS - Why is there a gap?

The AMA Gaps poster illustrates how successive Governments have failed to index the Medicare schedule fees in line with the CPI and average weekly earnings.



Transitioning a practice to a fee-for-service billing model is a very challenging task. Do not underestimate the impact it will have on your administrative and reception/frontdeskstaff.Itcanbeadifficultandsometimesawkwardprocessand will require strong leadership skills from practice owners to be successful.

It will also require a huge change in the way we think about fees and fee setting. Currently we all tend to default to the position of “is there a fee for that”? Which interpreted means “is there a Medicare billable item number for that”? Place valueonyourselfandyourstaff.

Changing your mindsetA complete team mindset change is required. Indeed, it should be irrelevant to our fee structure if there is a government determined rebate for any of the services we deliver. Our thinking needs to embrace the idea that if we as a practice team deliver a relevant, patient-centred service then we are entitled to charge a fee for that service. Some services may trigger a rebate, some may not. Having made this enormous leap in the approach to setting our fees, the secret to any success willbeaneffectiveapproachwherebypractitionersandstaffalikearewhollycommitted to the concept.

Youradministrativeandfrontdeskstaffareinthefiringlineandwillbearthebrunt

Communicating changePracticemanagerCathyBaynieofferspracticaladviceonhowtoensurestaffcommunicationaboutfeeforserviceisclearandconsistent.

of any patient frustration and possible anger from the patients of the practice.

They will also be your best assets in the application of the process, they are crucial to the success of the process. In short their contributions will determine the success or otherwise of the process.

With this in mind the best advice is to take the team on the journey with you;•Makesureyourstaffunderstandthe

reasons behind your decisions – don’t be afraid to share the facts of the financialsituation.Clearlydefinethepractice strategy and approach to reviewing fees.

• Schedule whole of team meetings and seek input.

• Develop the fee setting goals together, make them achievable. For example, small incremental increases will probably be more palatable to patients thansignificanthikesoritmaybethat you are aiming to increase the percentage of private billing verses bulk billing.

• Consider a tiered fee structure. Educateyourstaffsotheyarecomfortableandconfidentinunderstanding its application, where and when each tier applies.

• Have clear timelines for achieving the determined goals and meet regularly to discuss with the team the

achievements, as well as the failures. Examine the reasons why the targets may not have been met. What worked, whatdidn’t?Frontdeskstaffwillhavean invaluable contribution to make.

• Most importantly, ensure consistency of approach and act as a team. If a decision is made to charge a fee for service then make sure everyone bills consistently and sticks to it. Patients have a knack of seeking out the “chink in the armour” whether it be a fellow colleagueorstaffmember.

• Empoweryourstafftoimplementthechanges and support them when itgetsdifficult.Haveaprotocoltofollow if they are dealing with patient complaints (it may be that the doctor joins the conversation to help explain practice decisions and support the staffmember).

• Ensure consistency and a whole of team approach by developing standardresponsesforthestafftouse in a given situation. Give them the words/scripts to use so everyone is on the same platform and patients are not receiving mixed messages. dr.

Cathy Baynie has career long experience in the health industry in the public, private and aged care sectors. This includes working in primary healthcare and general practice for the last 16 years. Ms Baynie is a registerednurseandcertifiedpracticemanager,havingmanagedbothsemi-ruralandurbanpractices.Whilstcontinuing to manage a practice in Sydney’s north, Ms Baynie is also an accreditation surveyor, a trainer and assessor with the University of New England Partnerships and Consultants with Practices nationally on Governance and Practice Management issues. Cathy is the current NSW and ACT State President of the AustralianAssociationofPracticeManagementandaFellowoftheAssociation.MsBaynieisafirmbelieverthat practice managers are key in the development and delivery of strong systems of leadership, management and quality care in Australian primary healthcare.

amansw.com.au I 31

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MEDICO-LEGAL

The AMA NSW Medico-Legal team

Andrew Took Director Medico-Legal and Employment Relations

Kym GardnerSenior Solicitor

Sarah FamPolicy and Legal Advisor

Eden WellerParalegalOfficer

Andrew CampbellSolicitor

Ivy TsengPolicy and Legal Advisor

Sarah ConnorPolicy and Legal Advisor

The recent unanimous High Court decision in Fair Work Ombudsman v Quest South Perth Holdings Pty Ltd [2015] HCA 45 highlights the heightened focus regulators have taken on sham contracting arrangements, and the dangers of non-compliance when upheld in Court.

Here’s what you need to know about sham contracting – whether you’re an employer or an employee.

WHAT IS SHAM CONTRACTING?

Sham contracting occurs when an employer treats a worker as an independent contractor when they’re not. Section 357 of the Fair Work Act 2009 (Cth) prohibits an employer from representing to an employee that a contract of employment is, in fact, a contract for services under which the employee would work as an independent contractor.

With an increasing number of Australian businessesrelyingonaflexibleworkforce, some employers try to engage workers as independent contractors to avoid legal obligations towards employees such as payment of payroll tax, workers compensation premiums and superannuation contributions.

In addition, sham contracting contraventions are invariably coupled with failures to comply with employee minimum entitlements, such as the National Employment Standards and applicable award provisions. It’s not

always deliberate, but regardless of how the arrangement comes to be, it is illegal and viewed seriously by the regulators.

TheATO,theOfficeofStateRevenueand WorkCover have the power to investigate employers where sham contracting arrangements are suspected. Prosecutions may result for unpaid superannuation, underpaid payroll tax, underpaid workers compensation insurance premiums and recovery of unpaid wages and entitlements. Businesses found to have engaged in sham contracting will also be liable for significantpecuniarypenaltiesunderthe Fair Work Act 2009 (Cth) sham contracting provisions. Once an employerhashadonefindingmadeagainstittotheeffectthata“contractor”is in reality an “employee” other authorities will almost certainly be interested. This makes getting your contracting relationships wrong an expensive experience.

WHAT’S THE DIFFERENCE?

Since both independent contractors and employees trade their labour for money, how is an employee to be distinguished from an independent contractor? Unfortunately, making the distinction is not straightforward.

The distinction between employees and independentcontractorsisreflectedinthe Fair Work Act 2009 (Cth) and other employment legislation by restricting benefitsandentitlementslikeannualleave and unfair dismissal rights to

Legal risks in “sham” contractingIs the cleaner you hire to tidy your practice once a week a contractor? What about the receptionist who works on a casual basis? We received several calls from members lately which serve as a timely reminder of the risks in hiring contractors that may in fact be regarded at law as employees.

amansw.com.au I 33

employees as distinct from independent contractors. However, there is a perennial problem in the employee/contractor distinction because there is no simple andcleardefinitioninthelegislationwhich distinguishes the two.

The authorities will look at the totality of the relationship between the parties when determining whether an individual is an independent contractor or an employee. A court will look beyond contractual descriptions to the real substance of the relationship and the nature of the interactions which constitute their relations using a range of factors, none of which will be determinative. Ultimately, it will be a question of fact determined by all the surrounding circumstances. Case law suggests that the following are key assessment criteria:•Whohaseffectivecontrolovertheway

the work is performed, the place of work and hours of work?

• Can the worker perform work for others or do they have the genuine right to do so?

• Does the worker have their own place of work or are they available to work in other locations?

• Does the worker use their own tools and equipment?

• Is the worker able to delegate or sub-contract the work to others?

• Can the worker be suspended or dismissed?

• Does the worker present to the world at large as an employee?

KEY POINTS1. Determining whether an independent contractor is really an employee can be difficultandwillultimatelybedeterminedbyaCourtortheATO.

2. Employers need to rely on accepted guidelines from case law where there is uncertainty. This involves careful consideration in each situation and includes weighing up how the parties work together.

3. There are serious implications if you get it wrong – including liability for underpayments (particularly annual and long service leave), unpaid superannuation and tax and penalties for sham contracting.

4. Increasingly, the Courts are focusing on the independent contractor’s business anditsclientbase.Ifthecompanyistheonlyclient,itcansignificantlyincreasethe risk of the contractor being found to be an employee.

5. If you engage independent contractors directly (not through a company), particularly on a full-time basis, you should review your practices and test whether – in actual fact – the independent contractors should instead be treated as employees.

6. Even where a person is a “real” independent contractor, in some cases a company may need to make superannuation contributions on the contractor’s behalf (increasing the associated costs by 9.5%).

• How is the worker paid? (for example a weekly wage as opposed to invoice on completion of tasks)

• Is the worker paid a gross amount or is tax withheld before payment?

• Does the worker receive paid holiday and sick leave?

In essence, a true contracting arrangement is one between a person or entity in business for themselves who, as a contractor, is engaged to provide services to another as their principal, whereas an employee is in a “master–servant” relationship with his or

her employer – that is, a relationship of personal service. So the Jim’s Cleaning person you hire to clean your practice once a week is a contractor, while the person you hire as your receptionist working business hours in your practice fivedaysperweekisanemployee(whether full time, part time or casual).

Our Medico-Legal & Employment Relations team is always available to provide advice on this and a range of other issues, call 02 9439 8822 for information. dr.


When it comes to providing a young patient’s medical records to a parent, therearealsoconfidentialityconcerns.

The legal principle is that parental power to consent to medical treatment on behalf of a child diminishes gradually as the child’s capacities and maturity grows and this rate of development depends on the individual child. A minor is, according to this principle, capable of giving informed consent when he or she achievesasufficientunderstandingandintelligence to enable him or her to fully understand what is proposed.

The common law presumption is that a minor lacks the capacity to consent to medical treatment. However, this presumption can be rebutted if the

child or young person is able to fully understand the nature of the medical treatment proposed. This will depend on age, maturity, intelligence, education, level of independence, and ability to express his or her wishes.

Legislation also provides that a young person over the age of 14 years is presumed to be able to consent to medical treatment which rebuts the common law presumption of incapacity.

Generally, if a child has the capacity to consent to medical treatment on their own behalf, they are also entitled to decide who has access to their health information; this includes the right of a child to keep their health information confidentialfromtheirparents.

Medical practitioners must form their own opinion about a patient’s intelligence and understanding, taking special care to ensure that the young person possesses the required competence to consent to treatment, and hence, the right to confidentialityoftheirhealthinformation.

Medical practitioners should also be aware there may be family law issues linked into parent requests for medical records. Care should be taken to determine if any court orders are in place that would prohibit access by one parent to the child’s information, or if there is information in the patient record pertaining to the other parent that may constitute a breach of privacy. dr.

Parent requests for children’s medical recordsIfyou’vedaredtoopenyourteenager’sbedroomdoorwithoutknockingfirst,then you’re probably well aware of the reaction most will have to this kind of intrusion. Indignant cries of “Mum!” followed by a door slamming are pretty common sounds in the suburbs. Teens love privacy and this desire is not restricted to the family home.

amansw.com.au I 35

An inheritance seems like a good thing unless that inheritance means responsibilities for record keeping that stretches beyond the author’s years.

A retiring doctor recently contacted us seeking advice as to how to dispose of old and inactive patient medical records. Whatatfirstglanceappearedtobeastraightforward advice quickly became far more confronting and costly for the doctor when he revealed he was the director of an Assisted Reproductive Technology (ART) provider.

Unbeknownst to the doctor, the NSW government has enforced rigorous record keeping requirements for all ART providers across the State. AMA (NSW) informed the doctor that all information they are required to record in the process of providing ART treatment must be kept

for a period of no less than 50 years. This is in stark contrast to the requirements imposed on other private medical practices that must only hold records for a period of seven years following the patient’sfinalconsultationoruptotheage of 25 for patients seen under 18 years of age.

A primary objective of the ART legislation is to protect the broader interests of children born as a result of ART treatment. Prior to the enactment of the legislationtherewasnoofficialprocessto support the storage and disclosure of information that was held by ART providers. As a result, a large number of records containing the identity of donors were destroyed leaving many children unable to ever identify their biological parents. Aside from the obvious

psychological challenges this may present, it also left many being unable to procure important information such as their family medical history.

There is a Bill before Parliament proposing changes to the current legislation. Amongst other things, the Bill seeks to increase the record keeping requirements of ART providers to a period of no less than 75 years. Penalties have also been proposed that would makeitanoffencetoknowinglyfalsifyordestroy records required to be kept or retained under the Act.

Before disposing of any health information held at your practice, please contact our Professional Services Team on 02 9439 8822 for assistance. dr.

If you’re a doctor-in-training you probably look back on your HSC exams as being a sweet dream compared with the nightmares that followed in medical school. And the stress just continues as you enter the hospital system and work your way through the pressure cooker of internship and residency.

DITsfaceawholedifferentsetofissuesthanstudents.Theyarebalancinganoverwhelming workload with the pressure that comes from completing rotations and competing for positions in specialty training programs.

Trainingpositionsaredifficulttoobtain,andonceyougetinaprogram,they are challenging to complete. It is a constant juggle and there’s always a curveball. There is the supervisor who is never there. There is the supervisor who never leaves you alone. There is even the supervisor who fails you at the last minute after his wife leaves him for his best friend.

AMA (NSW) deals with many matters involving DITs who have been cut from a training programme due to failing examinations or assessments multiple times and poor performance in general. DITs involved in this type of matter often have compelling reasons for their underperformance or failure, including disengagement due to crises in their personal life, mental health and poor conditions or stressors in their place of work.

AMA (NSW) assists in various DIT matters involving all specialty colleges and supports DITs in appeals processes; assisting them with navigating through these channels.

TheearlierAMA(NSW)isnotifiedinthistypeofmatter,themoreeffective our assistance will be. We often receive notice once a DIT has exhausted all appeals channels. Prospects of success in this type of situation will be less likelythannotificationatthetimetheDITwasfirstinformedormadeaware of the adverse decision. dr.

In record time

It’s not easy being green


When it comes to medical practitioners signing up to work as independent contractors, the breadth and scope of the paperwork is always full of surprises. From the restraint clauses that mean when you leave the position you might as well leave town, to the clauses that state the corporate owners are responsible for nothing but will take half the billings – it is aminefieldoutthere.

Take the young, enthusiastic GP, Milly, based in Adelaide ready to spread her wings. She signs up with Company Y who agree to pay her a tidy sum to sign upforfiveyearswiththemandrelocateher to one of their practices over in Sydney. That sounds exciting and what’s more they mention the practice at Bondi overlooking the beach with stunning views. How fantastic. She has always

dreamed about living near the famous Bondi Beach. She cannot pack her bags and kiss her parents goodbye fast enough. The world is her oyster.

Sadly, after she has found herself an expensive rental apartment a few streets away but walking distance to the beach, she is advised by Company Y that they don’t have enough work for her in the Bondi practice and instead they will be relocating her to a far north western suburb. Milly will be facing a 45 minute commute each day instead of a dip in the ocean before work.

She protests, but can do nothing to fightit.Ifsherefuses,theywillgoafterher for the money they paid her upfront which she has spent on the new car, new apartment and bond. The contract she signed clearly states that if it suits their

commercial demands, they can relocate her within 30 km. There is nothing to be done other than to try to negotiate a more suitable location and arrangement. Obviously any negotiation depends on the willingness of both parties to do so.

If Milly had asked us to read over her contract we would have been able to caution her about the possible consequences of these clauses. We could assist her to ask questions and suggest amendments. The verbal comments that people make when they are enticing you to sign up do not form part of the contract at all. dr.

Don’t sign on the dotted line (without carefully reading your contract)

amansw.com.au I 37

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EVENTS

Dumpling NightAMA(NSW)helditsfirst-everdumplingnightfordoctors-in-trainingon10March.Themenuwascreatedby Eric Koh of Mr Wong fame and it was held at Work In Progress bar in Sydney CBD.

Tea and dumplingsAMA (NSW) has been busy in 2016 hosting several events to bring doctors together for networking and friendship.

27 August 2016 • 9am – 5pmUnderstand doctors’ health behaviours, healthy ageing, mental health concerns, self-harm and problems associated with dependency on alcohol and other drugs, mandatory reporting requirements and the role of the Doctors’ Health Advisory Service.

The program comprises the seminar plus home-study exercise which will be lodged with RACGP and ACRRM for an approved accredited activity.

For more information and to register visit www.amansw.com.au/events/list

AMA House, 69 Christie StreetAMA/DHAS Members $65*

Non-members $99* *plus booking fee

A program to help you to help your colleagues.

Caring for Colleagues 2016

Sydney High TeaThis annual event was held 12 March at the Museum of Sydney. Guest speakers included Dr Gabrielle McMullin and MP Jodi McKay, who spoke about their respective roles as leaders in medicine and politics. The event was a great opportunity for women to catch up with colleagues and network.

Newcastle High TeaAlways a popular event, this year’s Newcastle High Tea exceeded expectations. Held on 19 March, the event was good chance for women in medicine to share experiences and share a laugh.

amansw.com.au I 39

KDMA 40th Annual Conference

25th September - 2nd October 2016Post Conference Tour - Western Front

via Canterbury & Paris from 2nd - 9th October 2016

Don’t delay - Seats are �lling up fast !!

Join us for one of the most iconic & breath-taking locations…

FOR BOOKINGS & ENQUIRIES

NORTHSHORE TRAVELVivienne & SamanthaShop 35, 767 Paci�c HighwayGordon NSW 2072T: +61 (2) 9418 2546E: [email protected]

For Lease

Modern Professional Suites in the Heart of Dee Why7 OAKS AVENUE, DEE WHY

- Great location close to public car parks and public transport

- Secure basement parking- Cafes & eateries at your doorstep- All suites boasting great natural light

and leafy outlooks- State of the art offices- Attractive incentives

SUITES AVAILABLE: 104m2 141m2 160m2 206m2

Join these successful professional tenants: PRP Diagnostic Imaging, Northern Beaches Orthodontic, Pharmacor and Footsport Podiatry.

Raine & Horne Commercial Northern Beaches02 9939 6788

Vincent West 0403 444 000Richard Van Grootel 0408 033 330

P: 02 9241 2158 | E: [email protected]: sydneymedicalspecialists.com.au | sydneymedicalspecialists

British Medical Association HouseSuite 101, Level 1 135 Macquarie Street, Sydney

B U I L D YO U R P R AC T I C E A N D R E P U TAT I O N

AT S Y D N E Y ’ S M O S T P R E S T I G I O U S M E D I C A L A D D R E S S

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Come to the conference to see how AMA tackles the important issues faced by the medical profession.

REGISTER FOR THE

• Earn CPD points by attending conference.

• Assisted Dying – Exploring Members’ Perspectives: Facilitated by Tony Jones

• The Medical Profession’s role in closing the gap: Facilitated by SBS reporter Brooke Boney

• Bullying and Harassment – Changing culture: Have your say on how the medical profession addresses this issue

• The Role of Private Health Insurance in the Australian Health Care System: Discuss the impact of PHIs on the medical profession

HIGHLIGHTS

| National Convention Centre Canberra

CPD POINTS

Conference Enquiries: [email protected]


GOLF EVENTS

Elanora Golf Course was at its spectacular best for the 2016 Autumn Cup.

As the scores indicated, it was not an easy day for most of the players and the greens tested the best of us.

One of our long term supporters and sponsors, Paul Betar from Mercedes-Benz Sydney, came in as the winner with a very impressive 39 stableford pointsoffahandicapof10.Inacceptingthe trophy Paul expressed his gratitude and appreciation to the members of the AMA Golf Society in making him feel so welcome at the golf days.

In second place, with a score of 38, was Graeme Lovett.

2BBB was won by Graeme Lovett and Dean Lucas with 46 points.

Nearest the pins went to Dean Lucas on the 7th and Dr Stuart Ludowici on the 17th.

One of our great supporters, Dr Alec Harris was desperately unlucky and just missed out on winning, but as he said there is always the next event.

AMA Autumn Cup 2016The Autumn Cup was a wonderful warm up for more events to come.

PRESIDENTS CUP // Tuesday 21st June Pennant Hills Golf Club

SPRING CUP // Thursday 1st September Terrey Hills Golf Club

INTERNATIONAL SHIELD // 22nd to 30th October New Zealand – Registrations now open

BMA CUP // Friday 2nd December NSW Golf Club

AMA (NSW) Golf Society Claudia Gillis 9439 8822 [email protected]

Special thanks must go to all at Elanora for the way in which we were made to feel so welcome. The lunch was particularlymagnificent–wellworthyofaspecial mention and praise.

We are looking forward to welcoming all members of the Golf Society to our next function, The Presidents Cup, at the

Pennant Hills Golf Club on Tuesday 21 June 2016.

On a special note, the April 2016 edition of Australian Golf Digest has an article on Jason Day on p62, and our very ownDrRobynNapierisquotedofferingan opinion on Jason's viral vestibular neuritis. She isn't just a great golfer!

Paul Betar winner of the Autumn Cup with Dr Ivan Cottom

amansw.com.au I 41

AMA (NSW) Golf Society 2016 International Shield – New ZealandThis year’s International Shield competition will be held in the northern island of New Zealand on some of the most scenic golf courses in the world.

Six rounds of golf to be played at Wairakei International Golf Couse, The Kinloch Club and Cape Kidnappers.

Accommodation will be for six nights in the luxurious Hilton Lake Taupo and 3 nights in Scenic Hotel Te Pania.

All transfers are included and non-playing partners are warmly welcomed.

Places are limited, please contact Claudia Gillis 9439 8822 or [email protected] for a full itinerary.

15TH ANNUAL CONTINUING PROFESSIONAL EDUCATION (CPE) SEMINAR

This 1½ day seminar covers current developments in medical practice with updates in the treatment of diseases, preventative health issues and is designed to assist experienced practitioners towards meeting the CPE requirements.

Date | Saturday, 23 July – 9.00am-4.00pm and Sunday, 24 July – 9.00am-1.00pm

Venue | Y3A Theatre, Macquarie University (enter Balaclava Road)

Cost | AMA members $150.00. Non-members $200.00. Includes morning teas and lunch on Saturday.

This seminar will be submitted for QI&CPD points approval by the RACGP QI&CPD Program.

Register online: www.amansw.com.auFor more information or to make a booking Jenni Noble phone 02 9902 8140 or email [email protected]

Cape Kidnappers Golf Course


MEMBERS

Get more from your membership today and utilise our medico-legal and industrial relations team for advice, our preferred partner advantages, memberservicesandeventsthroughouttheyear.Tofindoutmorephoneour membership team on 02 9439 8822.Dr Nino AbuladzeDr Hugh AdersDr Sadia AhmedDr Aiman Al Sayed IbrahimDr Nastaran AlaviDr Jessica ArmstrongDr Dimitra AslanidisDr Arsalan BakhtiarDr Dharrini BalachandranDr David BellDr Suresh BheriDr Chloe Boehm-WilcoxDr Laura BrettonDr Nicholas CardilloDr Melissa CaveDr Maurice ChanDr Deepak ChhabraDr Sarang ChitaleDr Michelle CorkeDr Sjorjina CrowtherDr Kemparaju DanigowdaDr Warren DavisDr Julian De JongDr Gillian DeakinDr Thakur DevkotaDr Lauren DicksonDr Renee DuvenageDr Vivien FangDr Farhana FariaDr Robert FeltrinDr Grace FongDr Jillian ForerDr David FulcherDr Kieran Garbutcheon-SinghDr Ludi GeDr Craig GedyeDr Mitchell GilesDr Daniel GirgisDrRobertGlanfieldDr Christopher Go

Dr Michelle Guttman-JonesDr Robert HackettDr Reema HadiDr Jesse HallDr Syed HasnainDr Alyson HickeyDr Susan HillDr Nicholas HirstDr Mirna HunterDr Melody JacksonDr Dhishni JayasekeraDr Harry JohnsonDr Christo JosephDr Janette KeadyDr Julian KelmanDr Geraldine KhongDr John KhooDr Timothy KingswellDr Vera KinzelDr Charlotte KnoxDr Shui Lyn KohA/Prof Eugene KotlyarDr Teresa LaiDr Carolyn LechowiczDr Rebecca LeeA/Prof Richard LeeDr Phillipa LeonardDr Anthony LeslieDr Seng LimDr Michael Lindley-JonesDr Blake LoughranDr Claire LynchDr Akalya MahendranDr David ManserDr Brian MartinDr Gerard MartinDr Lauren McCannDr Dilshan MendisDr Yezdi MistryDr Surinder Mohan

Dr Julia MooreDr Gudrun Muller-GrotjanDr Robert MundellDr Muralidhara NagarajDr Komal NaqviDr Laura NobleDr Alice PearlmanDr Mitchell PurserDr Piyush RajDr Shammi RajapakseDr Kim RamjanDr Sunil RandhawaDr Max RayDr Wendy ReadDr Nicholas RennickDr Gerard ReynoldsDr Rabab RizviDr Elise RobertsDr Katrina RowanDr Sumi SahaDr Yasser SalamaDr Saad SalehDr Selwyn SelvendranDr Lisa SimpsonDr Lachlan SmithDr Phillip SmithDr Nandini SomanathanDr Matthew SpencerDr Simone StromerDr Kah Wei TehDr Wun-Chung TeohDr Kabilan ThurairajahDr Yasuhiro ToriiDr Ferris ToumaDr Philip TownendDr Brian TranDr Kim TsaoDr John Van Der KallenDr Rajesh VarmaDr Vanitha Visvalingam

A warm welcome to all of our new members this month

amansw.com.au I 43

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Ways Youth Services has been operating forover35yearsofferingawiderangeofservices including the Youth Health Clinic. We are looking for a new GP at Bondi Junction.Daysandtimesflexible,mustbulk bill, all overheads paid by WAYS.

Contact Dr Terri Said 9365 2500 [email protected]

Unique leasing opportunity of 270sqm at Stockland Forster shopping centre for a medical centre and allied health.With over 4.6 million visitors each year and limited competition in the surrounding area, this centrally located

centre with 1,400 free car parking spaces is ideal to grow your business.

Contact Melissa Turton 0429 462 929 [email protected]

YOUTH FRIENDLY GP REQUIRED FOR SYDNEY EASTERN SUBURBS PRACTICE

IMMEDIATE REQUIREMENT FOR MEDICAL CENTRE & ALLIED HEALTH

Dr Cecilia WanDr Brett WellsDr Andrew WilsonDr Xiuling WongDr Rachael WrightDr Joyce WuDr Jie Zhao

Join SunDoctors and become part of a group of doctors changing the face of skin cancer. Step into established and very busy clinics, booked out weeks in advance.• Multiple locations• Flexible hours

• Flexible contract• Nofixedtermsorrestraints• High earning capacity• Ongoing professional development

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Modern suites in the heart of Burwood’s medical precinct.• Suites on a sessional basis• Secure parking• Full practice management services• Meet/greet/billing patients• Appointment booking• Transcription/posting letters

• Filing/storage of patient records• Home sleep study facility• BAS statement preparation• Private hospital billing

Contact Raji 0401 144 119 or [email protected]

General Practitioner // Skin Cancer

Burwood Specialist Centre // Consulting Suites For Lease

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The AMA (NSW) offers condolences to family and friends of those AMA members who have recently passed away.Dr George AlchinDr Robert AndersonDr Paul BlancheDr Ramon BullockDr Glen Duncan

Dr Ian FordDr George GluckDr Graham McClearyDr Richard OpieDr Ian Waugh


MEMBER SERVICES

Make your membership more rewarding everyday!

Virgin Australia – The Lounge | Significantlyreducedrates with no joining fee and savings of $100 per year.

Call AMA (NSW) member services on 02 9439 8822 or email [email protected]. Visit our websites www.amansw.com.au or www.ama.com.au

Disclaimer: AMA (NSW) may financially benefit from its relationship with Preferred Partners. Please note: AMA Products is not affiliated with AMA (NSW) or Federal AMA. AMA Products is a separate business entity.

MEMBER

Mercedes-Benz Corporate Programme | Members canenjoythebenefitsofthisProgrammewhichincludescomplimentary scheduled servicing for up to 3 years/75,000 km, preferential pricing on selected vehicles and reduced dealer delivery charges. Also included is access to complimentarypick-upanddrop-off,accesstoaloanvehicleduring car servicing and up to 4 years of Mercedes-Benz Road Care nationwide. mercedes-benz.com.au/corporate

Membership has its rewardsAMA (NSW) has the most comprehensive Medico-Legal and Employment Relations advice in Australia. Just some of the services that are available include awards advice and updates, court representation, mediation and human resource consulting. A comprehensive range of legal packages and draft contracts are available for members for a nominal fee. In addition, below are a list of our member service partners to assist you whatever the need.

AMA Auto Buying ServiceA free service specialising in the acquisition, funding and disposal of all makes and models of motor vehicles.

Assign MedicalAssists members to source competent, friendly and committed staff for your business or practice.

Commonwealth Bank Offering a special merchant facility at a low fee of 0.68% for most credit cards.

Investec Experien Specialist finance to meet the personal and practice needs of members. Finance solutions for practice requirements, motor vehicles, commercial/residential property and overdraft facilities.

Gow-Gates GroupComplete insurance and financial services with special packages for AMA members. Services include: Wealth Creation, Risk Management, Doctors’ Practice Insurance and Superannuation.

Medprac Super FundThe perfect super fund for doctors, with no entry fees. Have the option of managing your fund using a range of investment managers.

Prosper GroupA property advisory (buyer’s agent) who can source, perform due diligence and negotiate your home, investment properties or commercial premises, saving you time and money.

Other benefits:Receive automatic subscriptions to the following publications:

n n AMA List of Medical Services and Fees Book

n n The NSW Doctor

n n The Medical Journal of Australia

n n Australian Medicine

n n AMA Action (e-newsletter)

TressCox LawyersExpert legal advice for the medical profession. Members are entitled to a unique duty solicitor scheme offering one free consultation (referral required).

Accountants/Tax Advisers PanelExperienced accounting firms who can assist you with your personal and professional accounting and taxation needs. Select the firm most suitable for your requirements.

AMA (NSW) Member Reward CardSignificant savings every year with participating restaurants, hotels and tourist attractions.

American ExpressOffering corporate affinity programs and special discounts to members for credit cards and merchant facilities.

Auscellardoor AMA (NSW) Wine SocietyBoutique wines at specially negotiated prices for members every month.

Caltex StarCardConsolidate your vehicle fuel expenses onto one easy-to-read monthly statement with access to the following fuel discounts: 2.5cpl off unleaded, Vortex 95 and Diesel and 1.5cpl off Vortex 98.

HertzAs the official car rental partner for AMA, Hertz offers discounted rates and a range of member benefits all year round.

Qantas ClubDiscounted rates for AMA members. Save up to $365 on membership. Fees as follows: Joining $200; One year $265; Two years $465.

AMA (NSW) Member Service Partners

25% REBATEIntroduce a new member to AMA (NSW) and receive a cheque equal to 25% of the new member’s subscription via our Member Get Member program. There are no limits.

To take advantage of your benefits call AMA (NSW) Member Services on (02) 9439 8822or 1800 813 423 (outside Metropolitan areas) 4www.nswama.com.au

MEDPRAC

SUPERANNUATION

Qantas Club | Discounted rates saves you hundreds of dollars on membership. Joining fee $240, save $140; one year membership $390.60, save $119.30; two year membership $697.50, save $227.50. Partner rates (GST inclusive) Partner Joining Fee: $200, Partner 1 Year Membership Fee: $340, Partner 2 Year Membership Fee: $600.











n n The NSW Doctor















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SUPERANNUATION

American Express | Corporateaffinityprogramsanddiscounts on a range of six unique credit cards. Whichever cardyouchooseyou’llenjoythespecialbenefitsandextravalue we’ve negotiated for you.

TressCox Lawyers | Expert legal advice and duty solicitor scheme with one free consultation (referral required).

BMW Corporate Programme | Members can enjoy the benefitsofthisProgrammewhichincludescomplimentaryscheduled servicing for 5 years/80,000 km, preferential pricing on selected vehicles and reduced dealer delivery charges.

Preferred partners

Member services











n n The NSW Doctor















MEDPRAC

SUPERANNUATION

Commonwealth BankA special merchant facility at low rates. AMA members pay no joining fee. New CBA merchant clients are eligible to 6 months free terminal rental and a free business account when they sign up their merchant facility with CBA and settle the funds to a CBA account.

Accountants/Tax AdvisersProvide a comprehensive range of personal and professional accounting services.

BOQ Specialist Bank LimitedBOQ Specialist delivers distinctive banking solutions to niche market segments. Our focus, experience and dedication to our clients have enabled us to become experts in a number of professional niches. We aim to add value to and build partnerships with our clients and we have been providing specialist banking in Australia for over 20 years.

Experien Insurance ServicesSpecialist insurance advisers to the medical and dental professions. Our service includes researching all the major insurerstofindyoutherightpolicywiththeappropriatelevel of cover at the best possible price. Products include Life Insurance, Income Protection, Medical Indemnity and Business Insurance.

Avis Budget | AvisBudgetistheofficialcarrentalpartnerforAMA(NSW)offeringdiscountedrates.ContactAMAmember services for the details.

Sydney City Lexus | Memberscanenjoythebenefitsof the Lexus Corporate Programme, including Encore Privileges.AnexclusiveofferinconjunctionwithQantasis available to AMA members - earn one Qantas Point for every dollar spent on a new vehicle purchase, only at Sydney City Lexus.

BOQ Specialist delivers distinctive banking solutions to niche market segments. Our focus, experience and dedication to our clients have enabled us to become experts in a number of professional niches. We aim to add value to and build partnerships with our clients and we have been providing specialist banking in Australia for over 20 years.Our innovative range of distinctive banking products and services includes:Asset Finance: Wecanstructurethefinanceandrepaymentsforyoutopurchasepracticeassets,fit-out,motor vehicles and equipment.Cash Management Facilities: Get the best out of your cash flowwithinnovativecashmanagementfacilities.Investwitha d-POD, POD+ or term deposit account and make your money work harder for you.Commercial Property Finance: Weoffercompetitivefinancepackagesforthepurchaseofcommercialproperty.Borrow up to 100% for your own commercial premises, or 90% for a commercial investment property.

Practice Purchase Loans: Whether you want to buy a practice, a share in a practice, or free up some capital, we offerarangeofoptions.Home Loans: We have dedicated mortgage specialists who have the expertise to tailor a home loan that best suits your particular needs. Borrow up to 100% for your own home, or up to 95% for a residential investment property.

To find out more contact us on 1300 131 141 or visit us at boqspecialist.com.au/medical

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Visit doctorshealthfund.com.au or Call 1 800 226 1 26Terms and Conditions

"To be eligible for the offer, applications to join Doctors' Health Fund must be received by 11.59 (AEST) 30th June 2016. Offer is only available to new members and those who are eligible to join Doctors' Health Fund restricted access

group, and who do not currently hold private health insurance with Doctors' Health Fund. The new member must select combined Hospital and Extras cover to be eligible for the gift. Cover start date and join entry date must commence

within the campaign period of 1st May - 30th June 2016. Only one gift will be provided per policy, the choice of a $300 Westfield XS eftpos gift card or a Fitbit Blaze™ Smart Fitness Watch (Classic Band) (RRP $329). Member needs to be

active and financial for 2 months; gift will be issued within 8 weeks ofjoining the fund. The offer does not apply to policy upgrades, or when a spouse, or dependant is added to an existing Doctors' Health Fund policy. Policy holder must

be 1 8 yrs-i- to be eligible for the offer. This offer is not available with other offers. Doctors' Health Fund is not responsible for any lost, stolen or damaged products. Gift is subject to availability. Product may vary from image shown. Private

health insurance products are issued by The Dorters' Health Fund Pty Limited, ABN 68 001 417527 (Doctors' Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods,

limitations and exclusions) of the individual policy.

DHF135_4/16

future practice - ama (nsw) · 2016-05-12 · future practice print post approved pp100000829...

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