AMA needs renewed clarity of purpose

When we think of unions, the Australian Medical Association does not come instantly to mind. Formed in 1962 from what were state branches of the British Medical Association, the institution represents a traditionally highly paid and highly respected professional sector.

The AMA also evolved to be a powerful force in shaping policy; health ministers of all persuasions have at various times been wary of getting on the association’s wrong side. Few blue-collar unions could be considered analogous in their access to government and leverage over it. But a union the AMA is, and like unions in general, it finds itself afflicted with declining membership and waning influence.

As The Age reported at the weekend, the AMA’s membership across all medical disciplines has been steadily falling from its heyday in the 1960s, when it spoke for 95 per cent of the nation’s doctors, and even from 1987, when it represented 50 per cent. Today the association represents less than 30 per cent of the country’s 104,000 doctors. And in a development that recalls the association’s antecedents, the Victorian branch has created a new membership structure that does not send half of members’ fees to the federal body.

The rupture, according to Victorian AMA president Roderick McRae, reflects the wishes of Victorian doctors who are “dissatisfied, for whatever reason, with the national approach” and finding the fees increasingly unaffordable. The association’s outgoing president, Omar Khorshid, has opposed the Victorian branch’s move.

Indeed if one theme explains the AMA’s woes it is fragmentation. Again, as with the broader workforce, the medical profession has changed significantly since the 1960s pre-Medicare era. These days the profession is larger and more specialised. Doctors work in more diverse practice groups. There is a greater reliance on overseas-trained doctors, especially in regional Australia, where the burden of chronic disease is great but the supply of general practitioners is not.

Victorian AMA branch president Roderick McRae.Credit:Joe Armao

In his parting interview with The Age, Khorshid rejected claims the association’s falling membership is a sign it does not represent all doctors, but it is nonetheless telling that those claims exist.

Perhaps even more worrying is the claim the AMA is struggling to read the temperature of the
public and its trusted institutions. The Victorian branch’s push for harsh restrictions during COVID-19 often rankled a fatigued population, not to mention former federal government deputy chief medical officer Nick Coatsworth, who accuses the branch of carping and fear-mongering. McRae’s sarcastic outburst that anti-vaxxers and COVID-deniers should not seek hospital treatment for a disease they deny exists, sprang from understandable exasperation, but it had the ring of a Twitter debate comeback rather than responsible and compassionate public health advocacy.

In a similar vein, the Victorian branch’s motion at the weekend’s AMA conference demanding a
royal commission into the medical regulator, the Australian Health Practitioner Regulation
Authority, no doubt has its merits. The motion arises from a dispute over the authority putting
conditions on the registration of Broome-based GP David Berger, who has raised eyebrows for his
combative zero-COVID advocacy. (Khorshid says the wording of the decision has some members
alarmed it could be more broadly applied.)

But the motion also raises legitimate questions about the AMA’s priorities and its political posture more broadly. Again, we might argue trade unions similarly diminished their standing with Australian workers when they were perceived as pursuing niche agendas and straying from their core purpose.

We hardly need to labour the importance of the AMA’s core purpose —fighting for doctors’ interests— amid the chaos COVID-19 continues to inflict on a health system that was stretched and inefficient to begin with.

It is true that doctors’ interests have rarely, if ever, perfectly aligned with the public interest. Nonetheless, the debate over the future of healthcare in Australia stands to benefit from coherent and unified advocacy on behalf of the medical profession. The AMA still has political clout, but it needs a renewed clarity of purpose to more convincingly argue that doctor knows best.

Gay Alcorn sends a newsletter to subscribers each week. Sign up to receive her Note from the Editor.

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