Pr int Post Approved PP 299436/00041

Volume 19, No. 9

October2007

C a n b e r r a D o c t o r i s p r o u d l y b r o u g h t t o y o u b y t h e A C T A M A

Woden 6282 2888 Deakin 6124 1900 Tuggeranong 6293 2922 Civic 6247 5478 A member of the I-Med Network

Dr Jeremy Price | Dr Iain Stewart | Dr Rajeev Jyoti | Dr Malcolm Thomson | Dr Fred Lomas | Dr Paul Sullivan | Dr Ann Harvey | Dr Robert Greenough

Specialist NCDI

Need musculo-skeletal or spinal imaging/interventions?

Give Dr Malcolm Thomson or Dr Iain Stewart a call on 6124 1900

The AMA ACT recently metwith doctors in training fromThe Canberra Hospital overlunch to discuss matters of con-cern. Also attending the lunch,which was hosted by AMABranch Councillor representingdoctors in training, Dr HarryEeman, was Dr Alex Markwell, adoctor in training from Queens-land. Dr Markwell chairs theAMA’s Council of Doctors inTraining and represents them onthe AMA Federal Council. TheAMA Federal Council is the peakgovernance body for the AMA.

Dr Markwell was in Canberrafor the meeting of the AMACouncil of Doctors in Training(AMA CDT) that was also attend-ed by Dr Eeman.

Included on the agenda asitems for discussion were: � Draft position statement for

standards for communityplacements

� Australian and New ZealandMedical Education andTraining

� Core terms for internship� Training block� Networked physician train-

ing and the psychiatry train-ing program

� DEST medical educationstudy

� Medical Training ReviewPanel.

� Bonded medical places� Prevocational general prac-

tice placements program� Infrastructure and resources

for clinical teaching� Medical training in alterna-

tive settings� Surgical education and

training (SET) program� Physician Assistant� Nurse practitioners� Role substitution� NSW Hospitalist proposal –

among others.The recent meeting of the

AMA ACTs DiT Forum, chairedby Dr Eeeman, discussed indus-trial representation of the doctors

in training for the nextCertified Agreement andmore on this will be reportedin a forthcoming edition of“Canberra Doctor”. Doctorsin training should note thatthrough the AMA a numberof workplace issues of concern toindividual doctors are being pro-gressed internally and externallyand doctors in training arereminded that they have access tothe AMA’s industrial officer, AndyOzolins and Executive officer,Christine Brill by phoning 026270 5410. Membership of theForum is open to all doctor intraining AMA members andinterested hospital based doctorsshould contact Christine Brill forfurther details. The Forum meetsapproximately four times a year.

The meeting of the AMACDTjoined a meeting of the AMA Co-ordinating Committee of SalariedDoctors for discussion of mattersof concern for hospital basedmedical practitioners.

AMA ACT meets with doctors in training

Pizza Lunch hosts Drs Simon Ussher and Harry Eeman with AMA ACT Industrial Officer Andy Ozolins and Chair ofAMA Council of Doctors in Training, Alex Markwell.

Wrongful birthThe word “wrongful” has

been applied in the ACT Sup-reme Court recently to refer toa set of healthy twins born as aresult of IVF, where the motherallegedly changed her mind onthe day of the procedure torequest only one embryo trans-fer. One healthy twin was OK,but the second was wrongfuland required $400K to raise tothe age of 18 - thank you verymuch.

A wrongful healthy birth asa damage that can be sued for isno longer possible in Queens-land and NSW. Wrongful dem-ocracy could also describe thetotal lack of community consul-tation, whereby the ACT gov-ernment used its numbers todefeat a bill to block suchwrongful birth litigation.

Unfettered litigation for ahealthy baby has serious impli-cations in the ACT such as pre-scribing the oral contraceptivepill.

‘The doctor did not warnme that vomiting can make thepill ineffective’ - $400K please.

‘I do not speak English verywell and did not understandthat my epilepsy medication canmake the pill not work’ - $400kplease.

AMA ACT will be cam-paigning to urgently request thegovernment to establish a com-munity forum on this issue, andto request new legislation to stoplitigation for damages with ahealthy baby. Please requestyour patients sign the petition inhe next “Canberra Doctor”. Wewill also be convening a TaskForce in the next month, so ifyou want to get involved pleasecontact myself or Christine Brill.

The other interesting issuethat we would like to raise withthe ACT government is whywas the plaintiffs’ family pro-tected from being named butnot the doctors’?

Other MattersThe Federal Labor Party

has now publicly announcedsupport for the Medicare Safety

Net. AMA welcomes this policychange as the Safety Net easesthe financial pressure for overone million Australians. Thesafety net has grown in impor-tance as the MBS has failed tokeep pace with the increasedcosts of providing medicalservices.

Federal ElectionThe big day will be on 24

November. Health is a centralbattle ground, and already wehave had announcements aboutlocal hospital boards and GPSuper clinics. AMA aims toaccess each issue on its meritand has pointed out that localhospital boards will not neces-sarily mean more money forhospitals and that bulk billingsuper clinics in the bush maynot offer enough financial incen-tives to attract GPs from citylocations.

Medicare “Easyclaim”AMA has had a win on

“Easyclaim”; from March nextyear, 18 cents for every Medicare

transaction and reimbursementfor the set up costs of installing“Easyclaim” software and hard-ware will be paid.

Emergency inEmergency

The recent death in thewaiting room at The CanberraHospital has put a spotlight onour emergency departments.The press have had a knee jerkreaction to this and reported onpatients with alleged horrorstories. We need to have a bal-anced look at areas that needimprovement, such as overallwaiting times which are worsethan the national average, butalso to recognize that the over-whelming majority of patientsare satisfied with their treat-ment. We also need to be sup-portive of the doctors and nurs-ing staff that work in this highpressure environment and tokeep the focus on resolving thesystemic issues that haveresulted in this death and otheradverse outcomes.

Fund RaisingThe recent Inaugural

Combined Medical Ball raisedover $20,000 for charity, withthe AMA’s proceeds going tothe Kenya ultrasound projectbrought to our attention by for-mer local GP, Dr Joe Radkovicand the Medical BenevolentSociety in NSW that continuesto support many of our col-leagues’ families during thetough times. Well done all.

AMA ACT President’s letter

Dr Andrew Foote.

2 O c t o b e r 2 0 0 7

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Most small and medi-um sized practices donot have the fundsavailable to purchasetheir premises out-right. Purchasing yourown premises can be atime consuming exer-cise. Here’s a quick listof pros and cons tohelp you make yourdecision.

If you do choose to buy,there are several advantages:� When you own your own

premises you are in controland can stay here as long asit suits your needs

� Your costs are relativelyfixed, particularly if youhave a fixed rate loan,whereas rents are change-able and subject to review.

� You can renovate the prem-ises to suit your patient andstaff requirements

� In the long term, if youchoose your location wise-ly, it is likely that the valueof the property will rise.

� By investing in your owncommercial premises you

may be able to convertyour rental repayments intoan investment for yourfinancial future. Make thecomparison – it’s possiblethat monthly loan repay-ments are similar to yourcurrent rental costs.Against these advantages

you need to weigh the disad-vantages. Buying property canbe an expensive and time con-suming process involving sig-nificant professional fees andstamp duty. You’ll also need tobudget for repairs and mainte-nance costs.

Looking at the finance foryour practice premises, thereare loan products available that

are custom designed for health-care practitioners.

Tim Bowring of MedfinFinance advises: “Look for afinancier that doesn’t speak jar-gon, search for loan advice thatis effective and easy to under-stand. Doctors are not neces-sarily property experts. That’swhy Medfin’s RelationshipManagers are trained to helppractitioners to walk step bystep, through the loanprocess”.

“Talk to your accountantabout the benefits of choosing apractice property loan that doesnot require a deposit. By notusing your own funds, you maybenefit by conserving your

money for investment in otherareas” suggests Tim Bowring.“Always ask about the fees andcharges. And I can’t stress mynext piece of advice stronglyenough – please make sure youknow that your monthly repay-ment is calculated on the rateyou have discussed with yourfinance company”.

If you’d like further informa-tion on Medfin’s Practice Prop-erty Loan or wish to check thatthe rate you have been quotedmatches the repayment you willbe charged, call your localCanberra, Medfin RelationshipManager on 0400 482 301.Copy supplied by Medfin

Why rent when you can buy your practice premises?

3O c t o b e r 2 0 0 7

Top 5 “rules of thumb” for SMSFsin the new superannuation regime:1. Upgrade your deed

This is a must. At the risk ofstating the obvious, if it’s not inthe deed you can’t do it! Withthe magnitude of these changes,operating under a pre-superreform deed is akin to drivingon the right hand side of theroad. It’s irresponsible not tospend about $500 in order to beon safe ground. Forget doing 2through 5 if you haven’t done 1.

2. If you’re over 55 starta pension whether youneed the income or not!

Our modelling has shownthat in virtually every case, boththe individual pensioner and thesuper fund pay much less taxsimply by starting pensions fromage 55. This is enhanced even fur-ther once the pensioner turns 60and the pension is not assessedfor tax purposes. If the incomeexceeds your requirements, anysurplus funds can simply be re-contributed back into the superfund (see number 4).

3. Develop an effectiveestate plan

The government will notreceive a penny of tax from a

superannuation fund payingpensions to those who are over60. I am sure the government’sintention is to recoup a lot of taxwhen a lump sum is paid toadult children on death. It is nolonger possible to pay pensionsto adult children (unless theysatisfy the financial dependantrules).

There are several strategiesto reduce the potential tax billfor the beneficiaries, whichobviously need to be imple-mented whilst you’re still alive.

4. Contribute effectivelyThe abolition of RBLs and

lump sum tax for over 60’smeans the emphasis has nowshifted to the “front end”. Con-tributions where a deduction isclaimed (either by the individ-ual or their employer) are nowcalled “concessional” contribu-tions (CC) and where a deduc-tion is not claimed are called“non-concessional” contribu-tions (NCC).

There are limits to howmuch you can contribute perannum with the NCC limitbeing 3 times the CC cap. Thepenalty for breaching these isthe highest tax rate. There are

also enhancements to the smallbusiness CGT concessionalrules that have their own limit(the CGT cap) and invariablythere is an interrelation betweensome or all of the caps when astrategy is devised.

Once monies are invested,super is now undisputed as themost tax effective structure tohold investment assets. Thechallenge now is contributingthe monies effectively so as notto incur unnecessary up fronttax. It takes skill and planning.

5. Get adviceWhen the “simpler super”

reforms were announced onbudget night 2006, the treasurerannounced that superannuationwould be so simple that profes-sional advice would not berequired in this area! Our expe-rience in the last 18 months hasbeen very different.

The new super regime hasprovided great benefits for thosewho know how to take advan-tage of it, and we have seen thatgood advice has created a greatdeal of value for clients whohave had the wisdom to seek it.Copy supplied by King Financial

The receptive and apprecia-tive audience was treated to awonderful piano recital bywell-known Canberran, Dr

Robert Schmidli. The program included

Schubert’s: Piano Sonata in AMajor Op Posth 120; Poulenc’s:

Theme Varie and Beethoven’s:Sonata in C sharp minor Op 27no 2 "Moonlight"

Further information on the work of theAssociation can be obtained by contacting Dr Rosie Yuille: yuille@homemail.com.au

The ACT Branch of the Medical Association for the Prevention of War recently held afundraising piano recital in the Chapel atRadford College.

Dr Robert Schmidli plays “for peace”

4 O c t o b e r 2 0 0 7

Now that the electiondate has beenannounced, once theparties "launch" theirplatforms, the AMAwill consider the prom-ises and commitmentsof the parties andreport back to you.

As the peak body for themedical profession the AMAconsiders that it is importantthat the medical practitionersin the ACT are informed of theAMA’s stand on a range ofissues of importance to individ-uals and to the patients youtreat.

Public hospitals fundingand workforce issues are rightup at the top of the list.

The following are some ofthe issues that rate high priori-ty in the AMA’s view.

Public hospitals funding

Patients want access togood quality public hospitalservices in a timely manner.

There should not be signifi-cant variations in the level ofaccess, the quality of the serv-ice, the outcomes from theservice in the various States andTerritories, or the services with-in a State or Territory.

There should be no delaysin the most urgent categoriesfor admission or for treatmentin emergency departments.

Some public hospitals inAustralia are operating at 120percent occupancy. Patients aretreated in corridors. Patientswant to be treated in appropri-ate settings.

Public hospitals should notoperate at more than 85 percentbed occupancy.

Patients know our publichospitals are failing because ofinadequate bed numbers,including ICU beds, and inade-quate resources to back upthose beds, leaving patients tosuffer long delays in admissionsand in emergency departments.

The Commonwealth andState and Territory govern-ments have traditionally, leav-ing aside year on year varia-tions, shared public hospitalexpenditure approximately50/50.

Since the commencement ofthe most recent AustralianHealth Care Agreement (ACHA),the State and Territory share oftotal public hospital expenditurehas risen to 48 percent on aver-age, while the Commonwealthcontribution has dropped to 44

percent, with the remainingseven percent contributed byindividuals.

The policy decision tomatch indexation has beenresponsible for changing thecyclical pattern of expenditure.The Commonwealth indexa-tion has been approximatelyfive per cent per annum overthe life of the AHCA.

The States and Territorieshave contributed significantlymore than this over the life ofthe agreement.

A five percent indexation isbarely sufficient to cover increas-es in wages and equipment costs,let alone activity and complexityincreases.

The government has ann-ounced a $2.5 billion Health andMedical Investment Fund. TheOpposition has released NewDirections for Australian Health,involving $2 billion over fouryears for a National Health andHospitals Reform Plan. Neitheroffers a comprehensive strategicnational solution.

The AMA position � The AMA supports match-

ing indexation of fundingto public hospitals by theFederal government andthe States and Territories.Five percent per annumindexation is too low. TheCommonwealth needs toprovide indexation of 8-9percent per annum, with amatching contribution fromthe States and Territories.The Federal Governmentneeds to front-load somefunding to bring the fund-ing effort back into balance.This would not need to bematched by the States andTerritories.

� There needs to be a greaterfocus on the expansion ofcurrent services and agreater focus on servicedelivery. Investment needsto be made into infrastruc-ture and clinicians. Toomuch has been spent onplans and reviews and notenough on the provision ofbeds and services. TheFederal Government needsto use the AHCAs to pres-sure the States andTerritories to provide serv-ices. If the Governmentgoes about this intelligently,the doctors will makethemselves available towork more in the publichospital system.

� The AMA supports the cur-rent system withCommonwealth/State parityof funding, and healthreform based on incremen-tal change through coopera-tive and systematic review.This reform must improveaccess and quality and

reduce bureaucracy andmust have strong clinicianinvolvement and support.

� All political parties need tobring the people into theirconfidence and put an endto blame shifting and costshifting by making specificcommitments in the elec-tion campaign to the levelof funding they will supportfor the public hospitals.

Training more doctorsIn response to workforce

shortages, the Commonwealthgovernment has embarked onthe most significant expansionof medical student places thatAustralia has ever seen.

Between 2006 and 2012,the number of graduates frommedical schools will double.

This presents Australia witha unique opportunity to reduceits reliance on overseas traineddoctors.

Australia must generate a lotmore training places in hospitalsand take much grater advantageof opportunities to expandmedial training into private andcommunity clinical settings ifthe quality of our doctors is tobe maintained.

By 2013, 3400 intern placesper year will be required, com-pared to the 1622 that are cur-rently available. Similar increas-es in vocational training placeswill also be needed.

There is now widespreadconsensus that the provision ofsufficient clinical experienceduring undergraduate, prevoca-tional and vocational trainingyears will prove to be an enor-mous future challenge.

Our doctors are renownedfor their skills throughout theworld. Australians have accessto treatment by dedicated doc-tors who have gone through arigorous and comprehensivetraining program.

If doctors are not givenenough experience in dealingwith a wide range of medicalconditions, then the quality oftheir training will suffer and thehigh quality of patient care willbe compromised.

Training of Australia’s keymedical workforce – doctors,nurses and allied health profes-sionals – must not be compro-mised or have its quality threat-ened.

COAG recognised the needto ensure that more clinicalplaces, intern and vocationaltraining positions are availablein the future.

If sufficient high qualitytraining positions are not creat-ed, the Commonwealth’s signif-icant investment in new med-ical school places will have

been wasted and many futuredoctors will emerge with signif-icant gaps in their knowledgeand skills.

The Commonwealth andState/Territory Governmentsneed to ensure that they put inplace the plans and resourcesrequired to support the trainingof our future medical workforce.

Governments will undoubt-edly look to general practiceand private specialist practiceto provide more training oppor-tunities. Both of these areas areready to answer this call, butneed funding support to coverthe significant costs of infra-structure and supervision.

AMA positionThe AMA believes that a

comprehensive strategy mustsupport the training of moredoctors. From the day a studententers medical school we mustbe confident that they will getthe best possible training ateach stage in their future career.The proposed AMA strategyoutlined below will buildresources in hospitals, the pri-vate sector, community settingsand general practice.� ACHA negotiations must

provide more funding tothe States and Territories tosupport medical training inpublic hospitals. In returnfor this funding, specific,transparent performancebenchmarks targeting theprovision of high qualitytraining positions should bebuilt into future AHCAs.This will ensure that addi-tional funding for trainingis not shifted into generalState health departmentbudgets.

� The Commonwealth shouldprovide an additional $100million over four years tosupport increased trainingplaces in general practicefor medical students.

� The Commonwealth shouldfund 1000 prevocationaltraining places (of up tothree months duration) peryear in general practice.This would cost around $80million per year once suffi-cient numbers of graduatesemerge from medicalschools from 2011onwards.

� The Commonwealth mustacknowledge and supportthe role of the MedicalColleges in training.

� The provision by theCommonwealth of $60 mil-lion over four years to sup-port a limited roll out ofspecialist training inexpanded clinical settings isa welcome start, but fallswell short of what is neededin the longer term, whichhas previously been estimat-

ed at between $125 millionand $250 million per year.

Doctor substitutionA highly trained, skilled and

motivated workforce is thebackbone of a high qualityhealth system. The improve-ments in treatment optionsavailable and health outcomesachieved come from the invest-ment we made in our healthworkforce. There has been a lotof pressure in recent times toaim for mediocrity in health carein the pursuit of lower costs.

This is an agenda that isbeing driven by narrow section-al professional interests, not bypatient demands. It manifestsitself as task substitution,whereby lesser-trained healthprofessionals with limited abili-ty are seeking the authority toact in a particular aspect ofhealth care. This will lead topoorer health outcomes in thelong run.

Given the very substantialincreases in medial undergrad-uate training over the last fewyears, we must ensure thatthere will be adequate trainingopportunities for the medicalprofession itself. It would benegligent of the Government toundermine this principle bycreating and training new cate-gories of ‘health workers’ foreconomic reasons.

They will compete for train-ing experience, and cannot ful-fil the holistic role of the doctor.“Health workers” substitutingfor doctors or for other specificallied health professions willcompromise patient care. Aprosperous nation should havea prosperous health system withhigh quality medical care pro-vided by highly trained doctors.

When patients get sick,they want to see a doctor. Thegeneral practitioner is the high-est trained general health pro-fessional and is the key point ofentry into the health system. Ifthe GP needs further expertmedial advice, there is special-ist referral. These are the basicelements in the health system.GPs and specialists will usesupport staff where appropriateand safe, and the medical pro-fession will develop trainingprograms for these ‘assistants’.

AMA PositionThe AMA supports the idea

of health care teams with thedoctor as the leader of the team.The AMA opposes the substitu-tion of doctors with lesser-trained ‘health workers’.

Doctors can and will deter-mine when tasks and responsi-bilities can be delegated toanother on the grounds that

Health of our nation – the AMA’s issues for the 2007 federal election

5O c t o b e r 2 0 0 7

there will be no diminution ofthe quality and safety of patientcare.

Governments should com-mit to higher standards, bettertraining and better health out-comes.

National Registrationand Accreditation

There has been mutualrecognition of registration ofmedical practitioners betweenthe jurisdictions for manyyears. The AMA has supportedprevious attempts by the juris-dictions to harmonise stan-dards to allow portability ofregistration across borders witha minimum of red tape.

The last attempt to achieveportability for medical registra-tion in 2003/04 failed becausenot all the States and Territoriescould agree on harmonisinglegislation.

The most recent COAGattempt to achieve portabilityof medical registration includesproposals to create a ministeri-al council that, on advice froma non-medical advisory coun-cil, would set policy direction,appoint a national medicalboard, and approve medicalregistration, practice compe-tency and accreditation stan-dards. COAGs national medicalboard would have the functionsof managing the developmentof standards of registration forapproval by health ministersand approving a list of accredit-ed courses.

Under the COAG model,the safety and quality of med-ical care in Australia would bethreatened.

Accreditation of all medicalcourses and undergraduate andspecialist training would becontrolled by Government forpolitical expediency and would

not be in the hands of an inde-pendent agency, currently theAustralian Medical Council(AMC). This is a significantissue because, in some places,lesser-trained health profes-sionals may replace highlytrained doctors. This is not inthe best interests of patients.When patients are ill they wantand deserve a doctor.

If the COAG proposal goesahead, the international statureof Australian doctors will dec-line because of the lack of anindependent accreditor of stan-dards of medical education. Theguidelines of the world HealthOrganisation (WHO) and theWorld Federation for MedicalEducation state that ‘ … theaccreditation system must oper-ate within a legal framework …the legal framework must securethe autonomy of the accredita-tion system and ensure the inde-pendence of its quality assess-ment from Government.’ If gov-ernment adopts the COAG plan,Australian patients may receivelower quality health carethrough lower standards orinappropriate task substitution.

AMA PositionThe AMA supports under-

graduate and postgraduate edu-cation and training beingaccredited by a medical councilthat is independent of govern-ment. The guiding principle fora medical council should be toensure a well trained workforcethat can provide the higheststandards of practice and med-ical care. Medical registrationneeds to be portable, not expen-sive, non-bureaucratic and acc-ountableFrom: Key Health Issues; full copy available atwww.ama.com.au

ACT

A News Magazinefor all Doctors in the

Canberra RegionISSN 13118X25

Published by the ACT Branchof the AMA Ltd42 Macquarie St Barton(PO Box 560, Curtin ACT 2605)

Editorial:Christine BrillPh 6270 5410 – Fax 6273 0455E execofficer@ama-act.com.au

Typesetting:DFS Design GraphixPO Box 580, Mitchell ACT 2911Ph/Fax 6238 0864

Editorial Committee:Dr Ian Pryor – Chair/EditorDr Jo-Anne Benson

Dr Keith BarnesMrs Christine Brill –Production ManagerDr Ray CookDr John DonovanA/Prof Jeffrey LooiDr Peter WilkinsDr Alex StevensonMs Gemma Dashwood

Advertising:Lucy BoomPh 6270 5410 – Fax 6273 0455Email accounts@ama-act.com.au

Copy is preferred by Email to execofficer@ama-act.com.au or ondisk in IBM “Microsoft Word” orRTF format, with graphics in TIFF,EPS or JPEG format.

Next edition of Canberra Doctor –November 2007

AMA focussed on health issues for the federal election.

Please support our advertisersThey support “Canberra Doctor” and the profession

Wine Tasting – meet your councilAMA members and partners are invited to meet

and mingle with AMA ACT councillors.Thursday 15 November from 6:30pm

Plonk, Palmerston Lane, ManukaRSVP Linda on 6270 5410 by 12 November

6 O c t o b e r 2 0 0 7

Commonwealth Review of the ProfessionalServices Review Scheme – 2006

The PSR Scheme was intro-duced in July 1994 to replacethe previous Medical ServicesCommittees of Inquiry arrange-ments. The Scheme’s principalobjective is to investigate theprovision of services by a practi-tioner to determine whether thepractitioner has engaged ininappropriate practice in pro-viding Medicare services, or inprescribing under the Pharma-ceutical Benefits Scheme.Inappropriate practice is definedin Section 82 of the HealthInsurance Act 1973 (Cth) and isbased on the concept of peerreview. That is, a practitionerengages in inappropriate prac-tice if the practitioner’s conductin connection with rendering orinitiating services is such that aCommittee (of peers) could rea-sonably conclude that the con-duct would be unacceptable tothe general body of the practi-tioner’s peers.

The Scheme is divided into4 distinct stages. First, MedicareAustralia’s investigative phasewhich was recently amendedfrom a 2 stage to 1 stage reviewprocess (Practitioner ReviewProgram). Secondly, referral tothe Director of PSR with arequest that he conduct a review(including of medical records)of the conduct. He may also dis-miss the request, enter into anAgreement with the practition-er, or refer the matter to aCommittee. Thirdly, a referral toa hearing before a PSRCommittee. Fourthly, the impo-sition of sanctions by theDetermining Authority, whichmay include a reprimand, coun-selling, repayment of Medicarebenefits and/or partial or fulldisqualification from Medicare.

Since its inception, the legis-lation which governs the PSRScheme (Part VAA of the HealthInsurance Act 1973 (Cth)) hasundergone major amendmentsin 1997, 1999 and 2002 follow-ing various successful challengesto it in the Federal Court ofAustralia. The Steering Comm-ittee was charged with theresponsibility of reviewing theefficacy of those amendments.

Ultimately, the Committeefound that the PSR Schemeought to be retained in its pres-ent form – including the exis-tence of its peer review process.It did however recommendchanges in respect to theScheme’s processes and admin-istration. Those included:� the introduction of an

Advisory Committee tooversee the Scheme andprovide ongoing guidancefor its effective operation;

� the Scheme’s reviewprocesses at both MedicareAustralia and PSR bestreamlined;

� parameters for identifyingpossible inappropriate prac-tice by specialists and alliedhealth professionals bedeveloped;

� the current referral of casesto the MedicareParticipation ReviewCommittee where a practi-tioner has 2 findings ofinappropriate practice madeagainst them, be insteadreferred to the DeterminingAuthority which would beafforded the same powers asthe Committee;

� the incorporation of theDepartment of VeteransAffairs (DVA) claims inservices reviewed under thePSR Scheme; and

� the provision by PSR ofeducation and support in

the context of the appropri-ate use of items listed in theMedicare Benefits Schedule.In short, the Committee

having consulted widely withstakeholders including medicaldefence organisations, the AMA,regulatory bodies such as med-ical boards, PSR and lawyersexperienced with the Scheme,ultimately found an ongoinggeneral support for the Schemeand significantly, no one pur-portedly raised concerns of afundamental nature such thatwould require replacement ofthe Scheme itself.

It is envisaged that theCommittee’s recommendationswill be reviewed and imple-mented by the Advisory Comm-ittee in due course and subjectto Ministerial approval, amend-ments to the legislation made.As with all changes to schemessuch as this, only time will tellwhat impact they have.

One of the most significantproposed changes relates to theincorporation of DVA figuresinto data reviewed under thecurrent PSR processes. Indeed,many practitioners who alreadyprovide a high level of Medicareservices may find themselvessubject to greater scrutinyshould that recommendationultimately be endorsed and thelegislation amended.

Interestingly, the Common-wealth Attorney-General recent-ly submitted to the Full FederalCourt of Australia that doctorswho were disqualified from pro-viding Medicare services couldalways establish a practicewhereby they consulted solelywith DVA patients.Andrew Davey, Senior Associate, TressCox lawyers.

Health Training Solutions Seminar(AMA and ESSET TRAINING)Wednesday 24 October 2007Calvary John James6:15-7:15pm

RSVP Linda 62370 5410 ASAP

THE NOTICE BOARD!

2009 Canberra Medical BallSaturday 28 June 2009

Venue to be advised

Lock the date in now!

AMA ACT AND LAW SOCIETY ACT NEWMEDICO LEGAL SCHEDULE OUT NOW

Members of the AMA ACT please note that you will receive yourupdated schedule in the next few weeks.

The schedule takes effect from 1 November 2007.FEES INCREASED FOR CREMATION CERTIFICATES

Members should note that notification of the fees applicable from1 November 2007 will be circulated in the next few weeks.

NEW PAY RATES FOR PRACTICE STAFFMembers should note the Fair Pay Commission rates are out now.

Please log in to the AMA ACT website for further information: www.ama-act.com.au

DisclaimerThe Australian Capital TerritoryBranch of the Australian MedicalAssociation Limited shall not beresponsible in any manner what-soever to any person who relies,in whole or in part, on the con-tents of this publication unlessauthorised in writing by it.The comments or conclusion setout in this publication are not nec-essarily approved or endorsed bythe Australian Capital TerritoryBranch of the Australian MedicalAssociation Limited.

In May 2007, the report of the Steering Committee’s review of theProfessional Services Review (PSR) Scheme was published. That review commenced with the establishment in March 2006 of the Steering Committeecomprising representatives from the Federal AMA, Medicare Australia andthe Department of Health and Aging. The Steering Committee’s Terms ofReference were to review the Scheme in light of the legislative changes in1999 and 2002, to identify the effectiveness of the current Scheme and identify ways in which it could better meet emerging challenges.

The ACT Chapter of the Australian Pain

Society in association with ACT Healthinvites you to a Canberra Regional Pain Day

to be held at University House, ANU on

Saturday 3 November 2007.

For further details contact 6244 3055 or 6244 3011 or

email heather.collin@act.gov.au by 24 October 2007.

Invitation to membersMembers are invited to use The Notice Board toadvertise items of interest to the Canberra medicalcommunity.Please send items to execofficer@ama-act.com.au

Rural Health Support, Education andTraining Program

Enhancing palliation in patients with advanced

cancer in rural areas.

Available at no cost to health professionals

Register online: www.moga.org.au

2007 International Doctors HealthConference

Thursday 25 to Saturday 27 October

Sheraton on the Park, Sydney

FYI … www.doctorshealthsydney2007.org

ACE research projectWhiplash update presented by Dr David HughesCanberra Business CentreThursday 25 October 2007

RSVP 5232 5941

7O c t o b e r 2 0 0 7

Court penalises surgeons $110,000 for moves to prevent competition

The Australian Comp-etition and Consumer Comm-ission had instituted proceed-ings alleging that Dr JohnKnight and Dr Iain Rossengaged in anticompetitiveconduct over the provision ofcardiothoracic surgical servicesto private patients in or nearSouth Australia.

The Federal Court todaydeclared that on or around 6February 2001 Dr Knight andDr Ross made an arrangementthat they would hinder or pre-vent a newly qualified surgeonfrom entering or supplying hisservices in the market before hehad undertaken further surgi-cal training, notwithstandingthat he was legally qualified topractise as a cardiothoracic sur-geon.

The court also declared thatDr Knight and Dr Ross gaveeffect to the arrangement on sixoccasions between 6 February2001 and 9 March 2001 byadvising either hospitals atwhich the surgeon sought tooperate or cardiothoracic sur-geons who had been asked tosupport the surgeon's applica-tions to operate at those hospi-tals, that the surgeon was insuf-ficiently trained or had not com-pleted his training, and shouldnot be allowed to operate atthose hospitals. The ACCCmaintains this is not the case.

The court also declared thatDr Ross attempted via a letter inMay 2003, to reach a non-com-

pete arrangement with a secondsurgeon whereby that surgeonwould not provide surgicalservices at Ashford Hospitaland that Dr Ross would agreenot to provide surgical servicesat Wakefield Hospital. Thecourt also declared that DrKnight attempted, via a letter inNovember 2004, to reach a sim-ilar non-compete arrangementwith the surgeon.

The court ordered DrKnight and Dr Ross to each paya pecuniary penalty of $55,000and make a contribution of$5,000 each to the ACCC's costsin relation to the proceedings.Dr Knight and Dr Ross are alsorequired to attend trade prac-tices law compliance training.

"This is a reminder to allprofessions, not just the med-ical profession, that the TradePractices Act or the relevantstate Competition Code appliesto their actions," ACCC Chair-man, Mr Graeme Samuel, said.

"With respect to the newlyqualified surgeon, the conductof Dr Knight and Dr Ross wentbeyond merely expressing aview as to what further trainingwas, in their opinion, desirablefor newly qualified surgeons.Their conduct went to the baseof effective competition be-tween medical professionals. Itconcerned the ability of newlyqualified practitioners to enterthe market unimpeded and theability of practitioners to apply

for accreditation at private hos-pitals of their choice.

"The effect of the conductwas, in relation to the newlyqualified surgeon, to hinder himfrom gaining access to AshfordHospital for a period of time. Itwas also to signal to other newlyqualified surgeons that theywere required to undertakemore training before they couldpractice as a surgeon.

"Additionally, they attempt-ed to deter a rival surgeon fromgaining access to Ashford wherethey had their practices."

The proceedings were final-ised by consent.

Training Cardiothoracic surgeons

are required to be Fellows ofthe Royal Australasian Collegeof Surgeons to be entitled toperform cardiothoracic surgeryin Australia. Advanced surgicaltraining in cardiothoracic sur-gery is a six year program,requiring a surgeon to havefirst successfully completed atwo year basic surgical trainingto be eligible to undertakeadvanced training. Traineescomplete their training underthe supervision of RACS app-roved supervisors.

In February 2001, thenewly qualified surgeoninformed Dr Knight and DrRoss that he was not going todo an overseas placement ashad been proposed by DrKnight, but was instead goingto commence offering cardio-thoracic surgical services, spe-cialising in thoracic surgicalservices, to private patients inAdelaide. The surgeon hadtrained under the supervisionof Dr Knight and Dr Ross dur-ing his final year of advancedsurgical training. Dr Knight, as

his official RACS supervisor,had provided positive assess-ments of the surgeon to RACS,including that he had impres-sive operative technique andwould make an excellent sur-geon in the future.

After the surgeon told DrKnight and Dr Ross of hisintentions, Dr Knight and DrRoss made an arrangement tohinder or prevent the surgeonfrom entering or supplying hisservices in the market prior tohim undertaking further car-diothoracic surgical training,notwithstanding that he waslegally qualified as a cardiotho-racic surgeon.

Accreditation There are five hospitals in

Adelaide which perform cardiacsurgery, two public hospitals,the Royal Adelaide Hospital andFlinders Medical Centre, andthree private hospitals, AshfordHospital, Flinders Private Hos-pital and Wakefield Hospital.To be able to admit and treatpatients at a private hospital, acardiothoracic surgeon mustobtain accreditation from thathospital.

In mid March 2003, a sur-geon who had an appointmentat the Royal Adelaide appliedfor accreditation at Ashford.

After becoming aware of hisapplication, on 5 May 2003 DrRoss wrote to the surgeon. Inthe letter Dr Ross asked thesurgeon to reconsider his deci-sion to operate at Ashford,invited him to enter into a non-compete arrangement, andthreatened that he and DrKnight would seek to operateat Wakefield unless the surgeonagreed not to compete withthem at Ashford.

The following year, on 23November 2004, Dr Knightwrote to the same surgeon andadvised it was his belief that thesurgeon's decision to go toAshford was disruptive to wellestablished practice patterns inAdelaide and was expresslyagainst the wishes of MessrsKnight and Ross. Dr Knightalso invited the surgeon tobecome a party to a non-com-pete arrangement.

At the time of the conduct,only cardiothoracic surgeonswho held an appointment atthe Royal Adelaide providedcardiac surgical services atWakefield Hospital and onlycardiothoracic surgeons whoheld an appointment at theFlinders Medical Centre pro-vided cardiac surgical servicesat Ashford. Dr Knight and DrRoss held appointments at theFlinders Medical Centre

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The Federal Court has imposed penaltiestotalling $110,000 on two Adelaide cardiotho-racic surgeons over moves to prevent competi-tion from two other cardiothoracic surgeons inthe Adelaide metropolitan area.

8 O c t o b e r 2 0 0 7

AMSA ApplaudsChanges to BondedMedical PlacesSchemeThe AustralianMedical Students’Association hasapplauded the FederalGovernment for mak-ing positive changesto the Bonded MedicalPlaces (BMP) Scheme.

AMSA National PresidentMr. Rob Mitchell said, “AMSAhas maintained an open dia-logue with the Department forsome time, advocating forincreased flexibility and sup-port to be built into the pro-gram.

The BMP Scheme, intro-duced in 2004, bonds 25% ofall medical students studyingin Australia to work in areas ofdefined workforce need oncethey have completed themajority of their medical train-ing.

The new changes serve toincrease flexibility and pas-toral support for students con-tracted into the scheme. Thereturn of service studentsmust complete is now com-mensurate with the length oftheir medical degree, and thereis an opportunity to fulfil acomponent of their return ofservice as a Junior Doctor. Asupport program for BMP stu-dents, which will providethem with networking and

academic opportunities, hasalso been launched.

AMSA has now written tothe Federal Minister for Healthand Ageing the Hon. TonyAbbott MP to congratulate hisoffice on the improvements tothe Scheme.

“AMSA will continue tocommunicate with theDepartment of Health andAgeing and provide a voice forour members, one-quarter ofwhom are part of the BMPScheme.

“We are committed topushing for viable, practical,incentive-driven programsdesigned to promote the bene-fits of rural practice. Studentsmust not be exploited in theeffort to solve the workforcemaldistribution crisis, andAMSA will continue to advo-cate to this end.

“These changes will makethe BMP scheme more palat-able for students. This in turnwill increase the likelihood ofthe scheme achieving its goal:to recruit and retain doctors inareas of workforce need.”

His professional autobiog-raphy comprises anecdotes ofhis surgical training, early con-sultant days and teaching as aclinical academic. At timespoignant, at others confront-ing, his book is no-holds-barred, including a soberinginterlude of his struggle withcancer as a young consultant.Professor Khadra’s recollec-tions are fictionalised to pro-tect confidentiality, but losenone of their narrative andrhetorical power. Amongstother topics he ranges over: thehard-headed brutality of surgi-cal training; the exigencies ofprivate surgical practice versusbest clinical practice; interac-tions with changes in nursingeducation and care; as well asstruggles with health adminis-tration.

Perhaps most poignant ishis self-described burgeoningempathy, developed from hisexperience as a cancer patientand the broader perspective of

teaching and public health. Hedescribes this type of empathy,verging on sympathy, as dis-abling for a surgeon, who inhis view needs to maintain acertain empathic distance frompatients in order to performsurgery.

In reflecting upon my prac-tice as a psychiatrist, it is iron-ic that the same empathy need-ed to support my patientsthrough the travails of theirmental illnesses becomes adeepening wound for a bril-liant and dedicated surgeonsuch as Professor Khadra. Forpsychiatrists, maintaining em-pathy is a delicate balancingact, assisted by the require-ment for formal peer reviewand support processes. Suchprocesses may need to be fur-ther developed in medicalpractice in general, includingsurgery.

We should be mindful ofthe saying inscribed on a sun-dial referring to the hours: ‘All

of them wound, the last onekills.’ (Quoted from Tallis2005) Thus it may be withempathy for physicians, and isa counterpoint to the recentsimplistic calls for “moreempathy” from doctors; forempathy must be balancedagainst a certain objective dis-tance for clarity of thought andaction in medical practice.

Professor Khadra finallydepicts his quiet departurefrom medical practice follow-ing this journey, at my estimatearound the early age of 45, fora career in provision of dis-tance education in the devel-oping world and more. Makingthe Cut is a gripping, incisiveand poignant autobiography ofthe meteoric career of a talent-ed surgical professor, nowsadly lost to medicine.Jeffrey LooiAssociate Professor & Deputy HeadAcademic Unit ofPsychological MedicineANU Medical School

Book Review –Making the CutMaking the Cut, Mohamed KhadraRandom House, Australia, 2007

Mohamed Khadra was until recently, FoundationProfessor of Surgery at the ANU Medical School.Prior to that, he had been Pro-Vice Chancellor atthe University of Canberra and preceding that,Professor of Surgery and Head of the School ofRural Health, UNSW, at Wagga Wagga. ProfessorKhadra, a medical graduate of Newcastle, also helddegrees in education, computing science, a PhD inUrology, as well as his FRACS. He impresses as apolymath with an intellectual restlessness seen notuncommonly in our most talented colleagues.

9O c t o b e r 2 0 0 7

The ANU RuralMedical Society(ARMS) is now in its4th year and hasgrown from a smallgroup of 1st year med-ical students to a largeclub with over 160members from allyears of the medicalcourse, as well as anumber of staff mem-bers. It has a clearvibrant presence with-in the medical schooland enjoys productiverelationships withother student bodiesand relevant commu-nity and medicalorganisations includ-ing the National RuralHealth Alliance(NRHA) and SouthEast NSW Division ofGeneral Practice.

On Wednesday 19 Sept-ember 2007 ARMS officiallylaunched it’s new website anddomain name with a free BBQand a walkthough tour of thesite, which can be found athttp://www.arms.asn.au

The website is a major andsignificant upgrade from thesimple information previouslyavailable as a subset of theANU medical school website.As a dynamic content manage-ment system ARMS committeemembers are able to add infor-mation as it comes to handwith a minimum of fuss. In linewith its aims to promote ruralmedicine and health, the web-site contains up-to-date infor-mation including news feedsfrom the Australian Journal ofRural Health and ABC RuralNews; latest news from ARMSevents; a calendar promotingupcoming rural medical events(both ARMS and external);information on scholarshipsavailable to students and con-ferences to attend; a separatesection devoted to Indigenoushealth; and a community bul-letin board and photo gallery.ARMS members can contributephotos to the website and par-ticipate in discussions on the

bulletin board. There is also acomprehensive link section toother online resources, as wellas administrative, historicaland membership information.

It is hoped the website willbecome a well-used resource forstudents and others interestedin rural health. It provides theopportunity for discussion anddebate as well as being a tool forsharing information, experi-ences and images of, and about,rural health.

The ANU Rural MedicalSociety (ARMS) also aims tobroaden students’ understand-ing of rural health issues andmedical practice through anumber of social and academicevents held throughout eachyear. By encouraging studentsto get involved in its activitieswe provide positive experi-ences to students interested orcurious about rural and remotemedicine.

It coordinates educationalevents ranging from presentingguest speakers to providingclinical skills trips around thegreater Canberra region. Therural show visits program pro-vides an opportunity for stu-dents to travel to towns in ruralNSW and provide screeningand health advice relating tocardiovascular health alongsidelocal doctors and allied healthstaff. Students meet with mem-bers of the local community,test their clinical skills andexperience first-hand the rurallifestyle as well as gain anappreciation of rural healthissues. Towns visited so far thisyear include Bega, Cooma, Yass,Harden and Young. The impres-sive reception and interestreceived on these occasionstowards visiting medical stu-dents has been encouraging andthe ANU Rural Medical Society

wishes to thank all the commu-nities, doctors and rural clinicalstaff involved in making ourattendance possible. In additionto clinical skills trips, ARMSconducts rural high school vis-its to educate and inspire stu-dents to consider a career inhealth encompassing medicineand the allied health profes-sions. Academic scholarshipshave also been provided to con-scientious students aiming fortertiary education.

Our student members areable to apply for conferences ofnational significance throughtheir rural health club andattend formal speaker nightsgiven by prominent members ofthe medical profession. A num-ber of social events are also heldthroughout the year includingan annual ski trip, bushdanceand various barbeques.

The ANU Rural MedicalSociety hopes to continue grow-ing and maintaining strong rela-tionships with the medical com-munity here in Canberra andgreater South-East NSW. It isenvisaged the new website as avital link in keeping membersinformed about rural health, asan ongoing historical documen-tation of ARMS activities, and asa way of connecting furtherwith outside communties. Forfurther information or a chanceto get involved please contactARMS through its website.http:// www.arms.asn.auShuja HaiderARMS President, 2007-2008 David CorbetIT Officer, 2007-2008

Embracing Rural and Remote Health

ACT

For further information contact Elizabeth on 6270 5410

1 0 O c t o b e r 2 0 0 7

AMA ACT’s preferred mailcourier service “JACKmail”nominated for Chief Minister’s2007 Inclusion Awards

ANU rural clinical schoolSince its inception, the ANU

Medical school has had a strongcommitment to the surroundingrural region, and has establishedan integrated rural training pro-gram in south-east New SouthWales. The ANU Rural ClinicalSchool was established in 2006and is funded under theCommonwealth Department ofHealth and Ageing’s RuralHealth Strategy.

The School endeavours toenhance the health of thisregion through the provision ofan integrated rural educationalprogram for students from Years1-4. This program requires allstudents to spend a minimum ofeight weeks in a structured resi-dential rural placement. Thisincludes one week in the firstyear of study, one week in thesecond year and a six-weekplacement in the third year. By2010 25% of the students admit-ted to the ANU Medical Schooleach year will enter the ruralstream and spend entire Year 3in a rural town in south easternNew South Wales.

Very early in the course Year1 students embark on RuralWeek 1 and are warmly wel-comed by the communities ofBega, Goulburn & Cooma. Theaim of this week is to introducethem to the variety of rural med-icine and the pleasures of rurallife. Surfing with the surgeon atTathra Beach before WardRounds. Waking to sound ofbleeting sheep on PelicanStation in Goulburn and beinginvolved in a mock disastertraining exercise with the SES inCooma all contribute to stu-dent’s enjoyment of this weekand awakening interest in ruralmedicine.

During Year 2 Rural Weekactivities focus on rural comm-unities. This year ANUMS werejoined by physiotherapy andpharmacy students from theUniversity of Canberra. Thisinter-professional learning expe-rience was well evaluated by thestudents. The communities ofYoung, Goulburn, Bega, Bate-man’s Bay and Moruya are imp-ortant partners in this program.

The major rural clinical att-achments are in Year 3. Generalpractitioners in the region haveembraced the program with themajority of practices have stu-dents for the six week attach-ments. The GP supervisors ofthe long term students havefound the experience both chal-lenging and immensely reward-ing with some taking both theshort and long term studentsconcurrently. The Rural ClinicalSchool is indebted to their com-mitment and support.

The six-week attachmentsoccur throughout the NSWsouth east region including,Bombala, Braidwood, Cooma,Eden, Gundagai, Goulburn,Harden, Merimbula, Moruya,Narooma, Pambula, Tura Beachand Yass. A limited number ofplacements are also available inremote locations of CentralAustralia for selected students.

During the six-week ruralattachment students are att-ached to a rural medical prac-tice. This experience enablesstudents to observe how gener-al practitioners work in thecontext of smaller, rural com-munities. The supervising GP'sare encouraged to provide stu-dents with as much patientexposure as possible and toallow participation in super-vised procedural work. Stu-dents attend the local hospitalswith their VMO GP supervisorsand attend on call, emergencydepartments and ward roundwork. During their attachmentsthey also utilise the teachingand patient resources of visitingspecialists and community andallied health services.

The focal point of theseexperiences is in the third yearof the course when studentsspend the entire year attached toa general practice in a ruraltown. Throughout the year stu-dents follow an integrated,patient based, longitudinal studyprogram, combining medicine,surgery and community & childhealth. While students will beattached to specific general prac-tices, and they will also workunder supervision at the localhospitals. Local academic men-

tors will closely monitor the stu-dents to ensure they have hadclinical exposure to the impor-tant cases/problems identified bythe relevant disciplines, and thatall coursework requirements aremet.

The first long term ruralstream placements began in2006 with the first group of 11students undertaking theirplacement in Bega, Cooma,Goulburn, Queanbeyan andYoung. This year a total of 14students are placed throughoutthe region with Eurobodallabecoming a teaching site. For2008, 17 students have beenselected to undertake the pro-gram in the rural stream loca-tions.

The Rural Clinical Schoolhas Canberra as the ‘hub’ andacademic teaching nodes arelocated in Goulburn, Bega,Cooma, Young and Eurobod-alla. Teaching facilities havebeen developed in these centresand consist of tutorial rooms,computers with internet con-nections and office space. Acombined teaching and studentaccommodation facility inYoung has been established withthe renovation of an historicalbuilding in the town. The RuralClinical School employs admin-istrative and academic staff inthe above towns.

The Rural Clinical Schoolhas received wonderful supportfrom the rural communities.They actively participate in theprogram providing positiveopportunities and promotingthe rural lifestyle to studentsundertaking medicine in theregion.

The rural communities haveembraced the program

Student feedback about theprogram has been extremelypositive. This is also reflected inthe high rates of membershipand the breadth of activities ofthe student rural club ARMS(http://www.arms.asn.au/). (seepage 9)Copy supplied by Assoc ProfAmanda Barnard, AssociateDean, Rural Clinical School,ANUMS.

Dear Sir/MadamIs the bonding of medical

students a backdoor means ofcivil conscription of doctors?The Australian Constitution s51(23A) enables the Parliament tohave the power to make laws forthe provision of dental and med-ical services. This section, how-ever, expressly forbids the civilconscription of doctors. How-ever the response of the FederalGovernment to the crisis ofinsufficient doctors in the work-force has instituted schemeswhich appear to mimic civilconscription.

There are two schemes ofbonding currently. The MedicalRural Bonded Scheme (MRBS) isoffered to a handful of studentsin each medical school eachyear. It provides a reasonabletax-free income for the fouryears of study but requires serv-ice, after gaining a Fellowship,in rural areas (RRMA 5-7) for aperiod of six years. Failure to doso results in loss of providernumber and a huge debt to berepaid.

The second scheme, Bond-ed Medical Places (BMP), hasno financial advantages for stu-

dents and requires students toserve in an “area of medicalworkplace shortage” for thesame length as the medicaldegree completed. Up to 500BMP places are offered acrossAustralia each year.

Why do students agree tothese conditions? To enablethem to get a place in a medicalschool. Often the BMP places areleft to last as no-one wants theobligation. The choice faced bystudents is accept the conditionsor don’t go at all. Secondly themoney is another incentive. Indeclaring my interests, I am an

MRBS holder. I want to workrurally and I would not qualifyfor Austudy. The MRBS offeredme a way to finance my medicalstudies. I resent not being able toserve in RRMA 3 areas whichhave significant workforceshortages but perhaps I shouldleave that for my BMP col-leagues.

All of this is old news. Mostrecently rumours are circulatingabout the abolition of all HECSplaces in medical schools. If thiswere to eventuate, all medicalstudents would be bonded(either MRBS or BMP) and

hence the Federal Governmentwould have some control aboutwhere all medical graduatescould practice. Where is theindependence of the medicalcommunity and the protectionof the constitution?

There is a great workforceneed, including in Canberraitself. Rather than conscriptingdoctors, there should be suffi-cient incentives and improve-ments for doctors to work inareas of need without coercion.Judith Nall-BirdYear 2 Medical Student ANU

Letter to the Editor

AMA ACT has nominat-ed Sally Richards,founder of JACKmailand a tireless advocatefor people with disabili-ties and those who carefor them, for the ACTChief Minister’s 2007Inclusion Awards.

The AMA ACT has beenusing JACKmail for most ofthis year; in fact, since it dis-covered the service.

One in five people in theACT lives with a disability –that’s a significant slice of ourcommunity - and the Inclus-ion Awards recognise the con-tribution of individuals, busi-nesses and organisations thathave demonstrated a clearcommitment to include peoplewith a disability in their work-place, business or community.AMA ACT nominated JACK-mail because it is a highlycommendable business that

deserves recognition and sup-port.

JACKmail started with agreat idea - a vision, a dream –and Sally spent four yearsplanning and developing thecourier business which hasone employee, Sally’s sonJackson West, who has a pro-found intellectual disabilityand autism. Jackson has veryhigh support needs andrequires one-on-one supportat all times, so JACKmail pro-vides a strong model for busi-ness structures that put peoplewith severe disabilities firmlyat the centre of the business.

JACKmail picks up and del-ivers mail for Government andNon-Government organisationsand businesses as well as offer-ing occasional runs services.Jack is having a whale of a timeas he makes his deliveries alongwith his carer Jamie and,importantly, his work-relatedand social skills are improving,proving the viability of the busi-ness and the 'greatness' of theidea.So, who’s collecting yourmail?

1 1O c t o b e r 2 0 0 7

Healthy Ageing advisory service provided by Dr Sue Richardson, Consultant Physician in

geriatric medicine.

Other areas of interest:• Cognitive Impairment/Dementia• Medication Management• Falls

Residential Aged Care Facility visits and Private Hospital Consultations provided.

Veterans welcome.

AGEING WELL CLINICAGEING WELL CLINIC

APPOINTMENTS02 6285 1409

Unit 10,Brindabella Specialist CentreDann Close, Garran ACT

An example of such warn-ing and explanatory messagesincludes statements such as:SMOKING CAUSES MOUTHAND THROAT CANCERHealth Authority Warning”and, “Smoking is the majorcause of cancers affecting themouth and throat.” These can-cers can result in extensive sur-gery, problems in eating orswallowing, speech problemsand permanent disfigurement.You CAN quit smoking. CallQuitline 131 848, talk to yourdoctor or pharmacist, or visithttp://www.quitnow.info.au.

The information messagestates:� Smoking exposes you to

more than 40 harmfulchemicals

� These chemicals damageblood vessels, body cellsand the immune system

� QUIT NOW to reduce yourrisk of chronic illness orpremature death.The Federal Court in

Melbourne has made ordersand declarations of consentagainst Mr Mina Guirguis inrelation to his contravention ofthe Trade Practices Act 1974for failing to comply with theprescribed consumer product

information standard for tob-acco products.

The ACCC alleged MrGuirguis arranged the supply ofretail packages of tobacco (eg,cigarettes in packets and car-tons) that failed to comply withthe Trade Practices (ConsumerProduct Information Standards)(Tobacco) Regulations 2004.

Mr Guirguis arranged forthe supply of offending tob-acco products on various occ-asions in 2006 and 2007 viathe website www.cheapciga-rettes. com.au.

In addition to declaringthat Mr Guirguis had contra-vened the tobacco regulations,the Court granted an injunc-tion restraining Mr Guirguisfrom supplying or aiding, abet-ting or being knowingly con-cerned in the supply of retailpackages of tobacco that arenot labelled in accordance withthe tobacco regulations.

The Federal Court alsodeclared that Mr Guirguis hadengaged in misleading anddeceptive conduct and made afalse and misleading represen-tation in contravention of sec-tions 52 and 53(g) of the Actby representing on the website(www.cheapcigarettes.com.au)that there were no refunds for

tobacco products sold on thewebsite. In fact, under certaincircumstances customerswould be entitled to a refund.An injunction was also grantedrestraining Mr Guirguis frommaking such a representationin the future.

ACCC chairman, MrGraeme Samuel said the warn-ing messages and graphicimages on cigarette packetsand cartons are an importantmeans by which smokers areinformed about the health con-sequences of their habit.

“Conduct of the kind inthe present case underminesimportant initiatives of healthand other relevant authoritiesto educate and warn con-sumers about the dangers ofsmoking and particularly thosemembers of the public makingonline purchases of tobaccoproducts”.

“While the ACCC’s currentaction was a civil proceeding,traders should also be awarethat the Act provides for crimi-nal prosecution of certain con-traventions of the Act includ-ing non-compliance with pre-scribed consumer productinformation standards such asthe tobacco regulations”, MrSamuel said.

Since 1 March 2006, tobacco regulations administered by the Australian Competition and Consumer Commission require that retailpackages of tobacco manufactured in, or import-ed into, Australia must be labelled with pre-scribed warning, information and explanatorymessages and graphic images.

Federal court makes orders againstinternet tobacco supplier

Specialist DirectoryThe 2007 Specialist Directory is published as a service to ACT andregion General Practitioners as part of AMA Family Doctor Week. Additional copies can beobtained from the AMA ACT Secretariat for the cost of $9.90 per copy – please phone 6270 5410 or email accounts@ama-act.com.au

Canberra Wollongong Gosford Newcastle Sydney

Pregnancy Termination• Private & individual treatment• Consultation, ultrasound & counselling prior to procedure• Only a 2 hour visit• 24 hour on call advice• Mirena/IUD insertion with sedation 6-8 weeks post TOP• D & C for incomplete miscarriage

All Hours 6299 5559

1 2 O c t o b e r 2 0 0 7

Dr. P.M.V. Mutton

colposcopy & laserendoscopic surgery

specialist gynaecologytreatment of prolapse

Dr. P.M.V. MuttonMBBS, FRCOG, FRANZCOG

for prompt, personalisedand

experienced care

6273 310239 GREY STREET DEAKIN ACT 2600

FAX 6273 3002EMAIL drmutton@bigpond.net.au

� Subspecialist in female urinary incontinence and prolapse

� Advanced laparoscopic surgery� Urodynamics, ultrasound, colposcopy

phone: 6253 3399www.canberracuresclinic.com.au

OBSTETRICIAN,GYNAECOLOGIST

& UROGYNAECOLOGIST

GP WANTEDTo join friendly practice

with practice nurse Weston Creek

Sessions or full-timeContact 6288 5000 | 6288 8139

Kevin Gow | Tracey Baker

CHAPMANMEDICAL PRACTICE

Dr KEITH K.T. CHANAdvises that he has commenced specialist practice in rehabilitation and pain management, with particular interests in:

• GENERAL REHABILITATION• SPINE INTERVENTIONAL PROCEDURES• CHRONIC PAIN MANAGEMENT• NERVE CONDUCTION STUDIES AND EMGs

Consulting at:

CapitalRehabilitation& PainManagement Centre

15 Napier Close, Deakin | Phone 6282 6240

CONSULTING SUITEFOR LEASE DEAKIN

� Denison Street, backingonto John James Calvary

� 165 metres, full fitout, 10 allocated car spaces.

� Available December.

Isobel 6282 1783

VR GPwanted for full-time

or sessional work at fully computerised practice

in Ainslie.

Private billing, RN support.

High remuneration.

Enquiries Penny 0420 800 409

needed for very busymodern family practicewith attached PathologyProvider. Flexible hours,no A/Hrs and goodconditions to rightcandidate.

Phone Jamison Medical Clinic,Macquarie – 6251 2300

VRG

P

RespACT Lung Function

Drs Bill Burke and Tim McDonald Calvary Clinic, Bruce

Lydia Perrin Hospital, DeakinCentral booking numbers:

1300 780 239 or 1300 780 377for:

❖ Spirometry ❖ Lung volumes❖ Gas transfer ❖ Aridol asthma challenge

❖ 6 minute walk assessment❖ Overnight screening oximetry

Please ring Dr Burke’s rooms Ph: 6285 2662if you require a referral pad

GP POSITIONAvailable F/T or P/T

Fully computerised modern spacious rooms. Flexible hours. Eveningsoptional. Private billing. Nurseand Pathology onsite.

0407 011 737

To Advertisephone

Lucy on

6270 5410

Attention ProceduralistsNew Rooms for lease or purchase in July 2008, from 75 to300m2. Located at Barton, in a new complex of Day Surgery andProfessional Suites.Would suit plastic surgeons, gastroenterologists, ophthalmolo-gists, dermatologists, orthopaedic surgeons, oral surgeons, ENT surgeons and gynaecologists.Contact: Daysurgery@actewagl.net.au

We currently have two positions available that would suit eitherVR GP or GP registrar. Full time or part time. We currently have 4 GP’s and an RN, also onsite pathology.

� There is no after hours or hospital work. The hours are Mondayto Friday and every 3rd or 4th Saturday for half a day.

� We are a modern surgery in the suburb of Jerrabomberraand is the only surgery catering to a population of over12,000 plus surrounding areas.

For further information: contact Dr. Bernard Leung on 0414 989 811 or email on: bernard_leung@optusnet.com.au

The Jerrabomberra MedicalCentre, although our address

is NSW we sit on the borderbetween Queanbeyan

and Canberra.

‘’

Evatt Medical Centre� P/T VR GP position.

� 4-6 sessions per week.� Negotiable hours in accredited,

computerised practicewith nursing support.� To start in New Year.

Please contact Karen on 6258 7744or kmpahlow@homemail.com.au

Crawford StMEDICAL CLINIC

An opening exists for a full or part time GP to work a choice of sessions at our purpose built modern clinic, owned andoperated by local GP‘s. The clinic offers a very high minimumguaranteed rate per session to the right applicant. Enjoy fullnursing support and work with colleagues in Allied Health disciplines and Specialists with sessional access. On sitepathology. Enjoy clinic facilities second to none.

Contact either practice manager Graeme on 0438 812651 orany of the clinic associates on numbers listed below for moreinformation.

Dr Ross Hendry 0417 427 318 Dr Stuart Haynes 0417 403 284

Dr John Azoury 0402 449 530 Dr John Hutton 0418 630 465

Dr Govin Sukumar 0412 035 970 Dr Mohan Mirpuri 0438 223 900