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Dr Kerryn Phelps
AMA President's Inauguration
1999
Eighteen years ago I climbed these very stairs to be awarded my medical degree. As I saw it then, that ceremony was a passport to a challenging career, a profession which I knew would give me the opportunity to make a difference. As inexperienced as I was, I had seen enough to know that I had made the right career choice.
I had watched in Emergency units as people were pulled back literally from the brink of death by the sheer skill of the emergency staff.
I had stood beside eminent surgeons as they fixed broken limbs, delicately removed thyroid tumours or restored sight to people blinded by cataracts.
I had admired the Sherlock Holmes-like mentality of my physician mentors as they tracked down an obscure diagnosis with only the help of the most subtle clues.
I was in awe of the tradition that was being passed on to my generation of young graduates.
Back then, I thought that it was enough to do your job well, earn the respect of your colleagues and the gratitude of thankful patients. The financial rewards would come in time because the work we would be doing had always been valued.
Many of my colleagues even decided to leave the money out of the doctor-patient relationship. After all, there would be a "credit card" system which meant that for a small discount, the government would take care of that unsavoury financial part of the practice and all you had to do was what we were trained to do ... practice Medicine. No worries about accounts, or bad debts. No ... the nice people at Medicare would take care of all of that unpleasantness.
Only now are we seeing the true cost to our profession of succumbing to the fantasy that governments would...or even could...act in good faith.
This ceremony today marking my inauguration as President of the Australian Medical Association In NSW, has a similar significance to the one for my graduating class. The trust my colleagues have placed in me to lead this association gives me the opportunity, with the support of our members and their representatives on State Council, to make a difference to the direction of our health system and our profession's place in that system.
We have heard in today's Oration about the past and future role of Australia in the eradication of disease.
What then of the past and the future of our profession?
The medical profession in Australia, as in other countries in the developed world, is built on a solid foundation of core principles, These include caring, compassion, an unending search for the truth (which some call evidence), and the pursuit of excellence. As a profession we set the standard of practice based on these core values.
Only the profession has the ability to decide what is best practice for our patients, based on experience, insight, and scientific evidence.
While we must always be mindful of the realities of cost-effectiveness and health budgets, we must not allow our professional standards to be hijacked by vested interests like governments or private health insurance companies who do not have the same priorities. One of the highest priorities for my presidency will be to guard that professional independence for the sake of our profession and for protection of our patients.
In a profession usually known for its reserve, emotions are running high.
The crisis facing our current medicopolitical climate has forced us to face the question; "What kind of professional future will we be leaving to our next generations of doctors?"
There are serious warning signs. Morale in the profession is at a low ebb.
Many of our brightest high school graduates are not choosing Medicine. These are signs of problems which need to be urgently addressed.
I am frequently asked what my style of presidency will be. The short answer is: my own. Those of you who know me, will have seen that my style is not confrontational unless circumstances call for that approach, but I prefer to reach common sense solutions through information-gathering, intelligent discussion and sensible negotiation. I see the role of President as being the spokesperson for the State Council. We have our debates and our fights about the issues ... and the role of President is to listen to the expert advice from the people on our Council, to negotiate from that platform with government and then present that position to our profession, and to the public.
Throughout my career I am told I have gained a reputation for being direct, honest and not afraid to take on the big issues. I think we need to deliberately forge a fresh new image for the AMA that says we are ready to move into the next millennium. To do this we need to take a PROACTIVE stance on health issues, not wait around to REACT to issues ...to be at the forefront of change for the benefit of our profession, and to protect the rights of our patients to quality health care. As an example of this approach, two years ago I encouraged this Council to take some hard decisions on a new drug law reform policy. We have now seen that come to fruition with the decisions that emerged from the recent N,S.W. drug summit.
The AMA must take a leadership role in a vigorous debate about where our health care system in Australia is headed.
Looking at broader philosophical issues, we need to turn around the growing acceptance that government funds medical practice. To do this, we must first remove from our language any implication that the government is the paymaster for the profession. While we must strongly represent the interests of our doctors in salaried positions, those of us in private practice are not employees of the government. Terms like "general practice funding agreement" and "productivity gains" have no place in the medical vocabulary.
Continuing negotiation and dialogue with government and other stakeholders is essential, but it cannot be a case of "peace any price".
At meetings over recent days I have seen the anger and frustration of young doctors who do not like the way things have been heading.
As the peak medicopolitical representative body for our profession, we must not be complicit in delivering to government or private health funds the means to control us professionally,
We all know that health funding is in trouble. We all know that the present system is unaffordable and that health costs will continue to outstrip the CPI because of increased technology and an aging population.
No matter what the SPIN doctors might say, this is not the fault of the MEDICAL doctors. Successive governments have dug themselves into a ditch because they made election promises they could not keep unless they somehow were able to force the medical profession into submitting to control. It is not the responsibility of the medical profession to hoist government out of the Medicare ditch, to find ourselves indentured or professionally compromised.
We must stay focussed on our reason for being ... patient care. It is our patients to whom we are responsible. If we allow ourselves to be sidetracked into solving the government's self-imposed health economic problems we sign our own death warrants as an independent profession.
Then there are the private health insurance funds. The vast majority of Australians are choosing not to be privately insured. Now there are many reasons for this, not the least of which is the difficulty of competing with an admittedly no-frills system, but one they ultimately perceive to be a "free alternative".
So the private health funds have to compete with the alternative "free" system. People, being careful with their money, look for value.
So how do they feel when they are told after they have made a claim, that they will get nothing back from their health fund for their operation because the fund does not have a contract with that particular facility.
See the writing on the wall! This is the first phase of the dreaded "managed care by stealth". It has a toe-hold in Australia, and it is starting to pervade the private health insurance industry who see it as a way of containing their payouts while they are still struggling to attract members.
Make no mistake. We are at a crossroads, The push to control doctors by the government on the one hand, and the trends to increased control by private health funds point to two parallel trends. Nationalisation of primary care and public medicine ... and managed care of the private sector. In other words, the worst of both systems. The storm is all around us.
As a professional body, the AMA has choices.
When I look around me and remember the day I climbed these stairs to receive my degree, I ask myself if I would make the same career choice again. The answer, without a doubt, is YES! This profession is worth fighting for.
It Is not time to surrender our professional freedom. It is time for a fresh approach. We will negotiate on issues affecting the health system, but never at the expense of our professional principles.
I am sending a loud and clear signal to the medical profession and the public that the AMA is ready to face the challenges ahead of us with energy and passion and creativity as we enter the new millennium.
I look forward to facing the challenges ahead with my team on State Council. Thank you.
Dr Kerryn Phelps 1999
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