I did get a chuckle the other day when Dr Nick Coatsworth, former deputy chief medical officer and infectious diseases specialist, described the Australian Medical Association as a peanut gallery. He did so in response to yet another Chicken Little press release from the AMA about Australia’s booster vaccine program falling behind, leading to ‘a repeat of mistakes seen overseas where Omicron is spreading rapidly’.
Underlining his talent for the one-liner, Coatsworth suggested we ‘ignore this individual’, referring to past AMA president, former politician and celebrity medico, Dr Kerryn Phelps AM, who has been clamouring for a delay to the return to school – because of Omicron.
What is with it the AMA? The then Western Australian AMA president last year criticised the federal government’s decision to quarantine international arrivals in hotels. According to this chap, ‘governments need to put money into building mining camps – I’m told it can be done within a couple of months. And put everyone into N95 masks tomorrow. It’s all low-hanging fruit, frankly.’ Sure.
In the Chicken Little award stakes that was pretty good, but it didn’t compare with the current WA AMA president who likened the proposal to open his state’s borders when the vaccination take-up reached 70 to 80 per cent to ‘child abuse’. ‘If we [loosen] restrictions at 56 per cent of our [total] population vaccinated, there is going to be a death rate in our children that no parent is going to accept.’ This is not withstanding the overwhelming evidence that Covid is a very mild disease for children.
Another contender for the award was Victorian AMA president, Dr Roderick McRae, who recommended that unvaccinated people complete an advanced care directive and inform their relatives that they don’t want to receive care in the public hospital system if infected with Covid. Clearly a fun guy, he also recommended that people avoid any activity that could lead to inebriation and the requirement for medical care.
Sensing perhaps that Dr McRae had overstepped the mark, the Victorian branch of the AMA issued a clarification. ‘It was not the president’s intention to suggest that COVID deniers and anti-vaxxers should be denied treatment. Doctors will always provide care impartially and without discrimination. Dr McRae intended to make the point that COVID deniers and anti-vaxxers are at more risk of contracting COVID-19.’ Sure.
The AMA’s national president, Dr Omar Khorshid, was also keen to distance himself from McRae’s remarks. ‘Doctors will always provide care to patients considering their right to make their own decisions, even bad ones like not getting vaccinated.’
What do we know about the AMA? According to the blurb, ‘the AMA is the peak professional body for doctors in Australia. The AMA promotes and protects the professional interests of doctors and the healthcare needs of patients and communities.’
The Victorian AMA is more effusive. ‘AMA Victoria is the principal voice advancing the Victorian medical profession and influencing policy makers. We proudly connect and support our members, providing a unified voice to advocate for Victorian doctors and the health of all Victorians.’
Bear in mind it is entirely optional for registered medical practitioners to join the AMA. Unsurprisingly, the organisation is very sheepish about revealing its membership numbers. The Victorian branch did disclose in its 2020 annual report that it had 6,600 members (out of a total of around 25,000 doctors in the state). Judged by its revenue figures, the NSW branch of the AMA looks particularly weak, with relatively few members.
A good guess is that the AMA represents around one-fifth of doctors overall, with disproportionate numbers of junior doctors (who are aggressively recruited and subsidised). It’s not cheap to belong (albeit tax-deductible), particularly when doctors are also up for the expensive and unavoidable fees levied by their respective colleges and other necessary expenses.
When it comes to the AMA leadership positions, it is a case of strong self-selection. Those who put themselves forward to sit on the governing councils and to become state/federal presidents are generally doctors who think they have more to contribute than looking after patients.
There is a range of personality characteristics among the medical profession. There will always be those with an inflated sense of self-worth, a drive to make a mark and those who enjoy the public attention. From time to time, some AMA presidents appear to have suffered serious God complexes.
This is not to malign all AMA presidents and other leaders. But note here that medical education is almost entirely focussed on individual clinical practice, with scant attention paid to population health or public policy principles and how they apply to health. Most doctors — and this includes all the most recent AMA presidents — have no real knowledge of epidemiology or pandemic management.
Current and past presidents of the AMA have been a mix of general practitioners and specialists. Several of them have become household names during their tenure and were able to leverage this exposure to pursue other careers — Drs Brendan Nelson and Kerryn Phelps spring to mind. Several others are still go-to experts for the media, including Drs Stephen Parnis and Mukesh Haikerwal.
But here’s the thing: it is simply not true to think the AMA provides ‘a unified voice’ for all doctors, in part because the vast majority of doctors don’t even belong to the organisation. Take those ill-informed comments quoted above. There are surely very many doctors who simply cringe at their naivety and ill will, but are too busy caring for patients to do anything.
No doubt, there are also political leaders who have been unhappy with the unhelpful interventions of the AMA, particularly as its leaders almost always fail to consider the broader social and economic consequences of the restrictions recommended.
But here’s the rub: these representative bodies are, in part, creatures of government processes. Rather than talk with a range of practising doctors, governments find it very useful (and efficient) to ‘consult’ with these bodies. (This phenomenon applies way beyond the medical profession and includes employer associations and trade unions.)
When the AMA (or other body) endorses government policy, this is regarded as useful validation. The real trouble comes when the leaders go off-piste because it is difficult for governments to ignore, much less rubbish, their off-the-wall remarks. As they say, what goes around comes around – even in the peanut gallery.
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