Older Doctors - Continuing a Professional Contribution

We have a concerning situation regarding older doctors who wish to give up full time practice but who want to continue to contribute to the profession as ‘senior active’ doctors.  I have written a proposal below that addresses this issue.  I would be very grateful for your support for this proposal, or if it is not acceptable in its current form, I would appreciate you suggesting changes that would meet with your approval.

Medical careers, like the human life cycle, have a start, a middle phase, and a finish.  Following a prolonged gestation of training, practitioners move on to their general practice or specialist disciplines and provide clinical care to patients, education and training to junior colleagues, and administrative support to hospitals and other medical organisations over decades of hard work.  At some stage the doctor starts to think of slowing down, or contemplates full retirement.  These days we know that moving from full time practice to full retirement in one step is not a good thing – for the practitioner’s physical health and mental health, and not for the profession either.  Government policy is to encourage older workers and professionals to stay in the workforce longer, beyond current retirement age if possible.  

Yet, despite this encouragement for older professionals to remain active in their field, in the medical arena we have a situation that is hostile to this happening.  The new Medical Board of Australia (MBA) has no appropriate registration category that allows older doctors to remain registered after giving up full time general or specialist practice.  Older doctors are forced to go straight into full retirement.  They are prevented from continuing to practice in a limited capacity as a doctor.  This situation denies senior doctors the advantages of a graduated progression to retirement.  It also means that these doctors cannot use their accumulated medical knowledge, skills and wisdom for suitable work such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organizations on medical matters, as well as being a body of registered practitioners available to assist in times of local, state and national disasters.  This denies the community a precious medical resource that otherwise would be available.  

It is time this gap was filled.  A new category of medical registration – termed ‘senior active’ – needs to be developed by the MBA.  

I propose the following model for the ‘senior active’ category.  The description is based on the MBA Limited Registration – Public Interest category (MBA Registration Transitional Plan – Medical Practitioners – Item 17, 30.6.10).

1. Senior active registration would be a limited class of registration, but it would have unlimited duration.  

2. The doctor would remain on the register of medical practitioners.  

3. The doctor could participate in activities (either remunerated or as a volunteer) that use his or her medical knowledge, skills or wisdom outside the care of individual patients such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organizations on medical matters, as well as being available to assist in times of local, state and national disasters.  

4. The registrant may, without fee or reward, refer an individual to another medical practitioner (in fully registered medical practice) for the purposes of providing health care.  The registrant may, without fee or reward, prescribe a therapeutic substance in extenuating or emergency situations under the following conditions: (a) the prescription involves the renewal of a prescription provided by another medical practitioner (in fully registered medical practice) within the previous period of six months and does not relate to a drug of addiction within the meaning of the relevant Poisons act, or (b) the prescription is provided to an individual who requires temporary relief or first-aid pending attendance on that individual by another medical practitioner (in fully registered medical practice), and (c) if the registrant undertakes limited prescribing as outlined in (a) and (b) above, the registrant must, within a 12-month period preceding the date on which the prescription is prescribed, have undertaken professional education activities relating to the prescribing of therapeutic substances.

5. Maintenance of this category of limited practice would require an annual medical check by a general practitioner for registrants over the age of 80 years.

A category of this nature would allow senior doctors to continue to contribute to the profession after leaving full time general or specialist practice.  This would be good for senior doctors, the profession, and the community.  

This category allows doctors the limited capacity to refer individuals to other medical practitioners, and a limited capacity to prescribe therapeutic substances.  It is possible that the doctor could exercise discretion and use this limited capacity to prescribe for him or herself, or for immediate family.  This level of discretion is available to all doctors in fully registered medical practice despite the general advice from the AMA and medical boards that doctors should not treat themselves or their immediate family except in emergency or extenuating circumstances.  Given the limited nature of referral and prescribing allowed in the senior active category, and the requirement to undertake relevant professional educational activities in prescribing, I cannot see any reason to deny this discretion to senior active doctors.  To do so would raise the question of age discrimination.

In my view the success of the category will depend on how restrictive the practice definition is and how much it will cost doctors to be registered in this category.  The three major costs for this category will be the medical board registration fee, the indemnity insurance fee, and professional education expenses.  If the total of these can be kept within reason (say well below $1000pa) then the category may be an attractive place for senior doctors to maintain their registration after leaving full registration status in their discipline and before moving to full retirement.  

Your comments would be appreciated.

Prof Philip Morris

President ANZMHA

Gold Coast doctors join Alzheimer's trial

Prof Philip Morris

TWO Gold Coast doctors are travelling to the US to learn a controversial new treatment that offers hope to Alzheimer's patients.

Professors Stephen Ralph and Philip Morris will then take the technique to Griffith University's Coast campus, where they will inject an anti-inflammatory drug into the neck of patients before turning them upside down.

The Griffith Health Institute clinical trial, to cost about $100,000, will initially look to alleviate the suffering of 12 of the 80,000 Australian Alzheimer's patients.

The drug Etanercept is already widely used for the treatment of rheumatoid arthritis and psoriasis.

But the controversy surrounding its use for Alzheimer's -- and the reason medical experts across the world are divided -- is its new application.

Dr Edward Tobinick, of the Institute of Neurological Research in Los Angeles, pioneered the technique and has seen marked improvements in about 100 patients.

Dr Morris said treatment involved injecting Etanercept into the veins that ran along the spinal column.

He said the patient was then tilted 70 degrees downward so the injection could diffuse through the brain.

Studies in the US have shown rapid improvement in mental alertness and response.

Currently there are no effective treatments to delay or prevent Alzheimer's.

Dr Morris has met with doctors behind the treatment.  "The improvement was nearly unbelievable," he said.  Dr Morris said locals were already lining up for the treatment.

If the technique proves successful, the doctors hope to extend the study further.

Data from the Australian Bureau of Statistics shows dementia and Alzheimer's deaths have more than doubled in 10 years.

They are now the third-leading cause of death in Australia.

The disease affects the lives of nearly one million Australians and at least $1 in every $40 in the Australian health system is spent on dementia.

President of ANZMH Association, to stand for General Council of the Royal Australian and New Zealand College of Psychiatrists

Prof Philip Morris, President of the Australian and New Zealand Mental Health Association, is standing for election as one of the Queensland representatives on the General Council of the Royal Australian and New Zealand College of Psychiatrists.  He would very much welcome your support.  

Prof Morris said "the the election of General Councilors provides an opportunity to set a new positive direction for the Royal Australian and New Zealand College of Psychiatrists.  With your support I hope to be elected as a Queensland representative on the General Council. 

Along with like-minded candidates from other states and territories, I hope to make the College a collegiate membership-based organization where respect and support of the ordinary Fellows leads to improved professional morale with the effect of better mental health care for the community.  I hope to facilitate increased involvement in the College of Fellows from all practice settings – including private, public, and academic. 

 I wish to give College members a greater say in the selection and election of senior College executive office holders.  I will advocate for the College to set up interactive email discussion groups so that all members of the College can discuss important topics and communicate directly with College executive officers and the Board chairs, and to extend electronic methods of communication and voting within the College.  I will argue for lower College subscription fees. 

I will support a prompt independent review of College governance, performance and structure that is designed to improve the involvement of College Fellows in the organization.  To achieve these changes will require a change in the personnel of the General Council.  This is why I am standing for this election. Ballot papers will be distributed in the near future for this election.  

I would be grateful if you might consider me for your support and your vote."

You will find a short bio of Prof Morris here