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.

Mental Health: The forgotten side of mine safety

Mental health has always been a taboo subject, especially so in the mining industry.

But for many men in the industry, it is an every day part of their lives.

Statistically, men are more likely to suffer from depression and other mental health issues, and this number increases significantly for men working and living in rural and regional areas.

One in three rural and regional workers take at least one day off work every few months because they are feeling stressed, overwhelmed, anxious or depressed, according to recent research commissioned by Medibank Health Solutions.

Just looking at these numbers alone, miners are bound to be at risk due to the very nature of their work, which ticks all the boxes - predominately male; long working hours; and often in rural or regional areas... more

Rural mental health findings to be released

A team of researchers led by Dr Delwar Hossain, from the University of Southern Queensland’s (USQ) Centre for Rural and Remote Area Health (CRRAH) have been looking at how primary producers and rural communities recover from the devastating effects of natural disasters.

Now, after completing 12 workshops in Warwick, Dalby, Kingaroy, Goondiwindi, Dirranbandi, St George, Mitchell, Roma, Miles, Chinchilla, Charleville and Cunnamulla the team are preparing to release the results of their findings.

´The purpose of this project is to better understand the capacity building needs of rural producers and their communities to effectively address mental health issues in the face of increasing uncertainty with climate variability and change,” Dr Hossian said.

In each community local residents were invited to take part in the workshops. From primary producers, land care groups and local emergency service people, to schools, health care workers and rural financial counsellors, the workshops were attended by a broad cross section of the community... more Rural mental health findings to be released

Mental health in rural and regional emergency departments: An issue of equity of access

For many Australians seeking assistance with mental health problems, the Emergency Department (ED) is the primary point of contact, and it is therefore imperative that emergency services are adequately equipped to assess and manage a wide range mental health related presentations.

This paper discusses the findings of a recent study investigating the mental health triage program of a large regional health network, involving consultation with 7 regional/rural emergency departments, the specialist mental health services, and consumers and carers who accessed the service.

The study found that regional and rural emergency services experience extreme difficulty coping with mental health related presentations. The lack of after-hours specialist mental health expertise, grossly inadequate patient transportation systems, and lack of material resources impact significantly on timely and appropriate treatment for people with mental illness.

EDs reported feeling under pressure to manage a wide variety of high risk presentations without adequate training, support, and safety measures in place. Consumers and carers described excessive wait times and barriers to accessing services, resulting in crisis situations escalating into psychiatric emergencies that may have been avoided with timely intervention.

The lack of adequate mental health resourcing to regional and rural EDs is a well-documented and long-standing problem that amounts to inequitable access to quality healthcare for an already marginalised and stigmatised group of healthcare consumers, and highly challenging work environments for rural and regional emergency healthcare providers.

A/Prof Natisha Sands

Campus Leader, Nursing and Midwifery, Deakin Geelong, Deakin University

 3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

Implementing a Multifaceted Transcultural Mental Health Capacity Building Project in Rural NSW

The Transcultural Rural and Remote Outreach Project (TRROP) is the first of its kind in rural NSW.

The Project is a partnership between the Transcultural Mental Health Centre, the Centre for Rural and Remote Mental Health and selected rural sites.

The Project was funded to develop demonstration models of service delivery and collaborative frameworks that enhance the cultural responsiveness of rural mental health services for the growing number of culturally and linguistically diverse (CALD) communities living in rural NSW.

The presentation will initially present an overview of the TRROP; its effective governance structure, the rural and remote areas covered in NSW and its key performance areas. A detailed description of the capacity building initiatives undertaken over the life of the Project to date will be offered. These initiatives have targeted health, mental health, government and non-government service providers.

The presentation will illustrate the principles underpinning TRROP’s capacity building strategies, including: designing training in response to the needs of the participants, developing partnerships with a range of service providers and consumers in the planning and delivery of the training, trialing theatre-based approaches to training and the use of new technologies. The presentation will focus on the training of clinical staff on cultural competencies and the assessment and treatment of CALD individuals experiencing mental health issues.

Finally, drawing from the experience of the TRROP, valuable recommendations for working with rural mental health service providers in the area of capacity building will be presented.

Ms Maria Cassaniti

Centre Manager, Transcultural Mental Health Centre

The Charter of Peer Support

The “Charter of Peer Support” The Victorian Mutual (Peer) Support Self Help Network has just published the “Charter of Peer Support”.

This document has been developed by men and women and their family members who have lived through a range of mental health issues. They have come from six specialist Peer Support organisations. The core value underpinning the Charter is: “Peer Support is intrinsic to mental health and total wellbeing”

The Charter reflects the importance that the writers place on Peer Support, and the value that this service provides in the continuum of care of consumers and carers experiencing mental health issues at any time in their life. The Charter highlights the cost effectiveness of Peer Support and provides understanding of its power in both prevention and recovery.

John will review the Charter and highlight its implications for Organisations, for Mental Health Service Providers, and for Federal and State Governments. 

John Pernu Branch Manager GROW (Vic), GROW (Tas), “GROW-Better Together”

 3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

Mental Health Peer Workforce Competency Development Project: Development of the Australian Peer Worker Qualification

The Community Services and Health Industry Skills Council (CS&HISC), in consultation with industry, is developing a competency framework specifically for the Mental Health peer workforce (consumers and carers).

The units of competency will describe work functions in Mental Health peer work roles and, when grouped together, units of competency make up a qualification. The national qualification that will be produced will be an appropriate, tailored and nationally-recognised competency framework or qualification. National qualifications set industry standards, ensuring that work roles are acknowledged Australia-wide.

The units of competency forming a qualification and skill sets will also provide an avenue for progress by improving training and support mechanisms for the fast-growing peer workforce. They provide a long-awaited opportunity for peer workers to formally gain, enhance and/or up skill their knowledge in the area of peer support work. Furthermore, the formal qualification will validate the consumer and carer lived experience, and help service providers realise that peer workers complement the crucial role of mental health professionals.

In addition to providing opportunities for training and development of the Mental Health peer workforce, it also provides employers with an assurance that a consumer or carer worker will operate within acceptable and agreed parameters. For employees, the qualification provides a defined career path.

Learn more about this exciting initiative and how you can use the Mental Health peer workforce competency framework to increase your skills or those of your staff while gaining a nationally-recognised qualification.

Ms Vanessa Dayeh

Project Coordinator, Community Services & Health Industry Skills Council
3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011