In the wake of a number of medical scandals, moves are afoot by the Australian government to take the medical boards out of state hands and turn them into a single national body. This is an excellent idea. But I hear that the Australian Medical Association is opposed to the move:

From reporter Sabra Lane for the ABC’s PM current affairs program:

But, the Australian Medical Association says it’s against the concept. It’s written to the Prime Minister saying a national scheme will harm patient safety.

PETER BROOKS: I thought we were all about a system that was predicated towards providing things for the patient, rather than for the health professionals.

SABRA LANE: Professor Peter Brooks is the Executive Dean of Health Science at the University of Queensland. He says a national registration scheme is common sense.

Now, for the life of me, I could not see why the AMA would oppose national registration. I can’t even see what its self-interest might be. Fortunately we have Sabra Lane and Peter Brooks to help us out.

SABRA LANE: Why do you think the AMA and the medical colleges are kicking up a fuss?

PETER BROOKS: Well look I am sure there are a number of reasons. I mean, you’d have to say that both of those bodies are relatively conservative, and that’s alright, that’s fine, but I don’t really think they’ve got the patient’s best interests at heart here, I think they’ve got probably themselves at heart here, because of course these organisations sit on the medical boards that already exist in each of the states, so it maintains their power base, to a certain extent.

SABRA LANE: So this is about, basically, a turf war?

PETER BROOKS: Well, yeah, look I think that there are always turf wars in this country unfortunately because we make such an issue of things between the Commonwealth and the states, and I think this is another example of a group or groups that have some power, some representation on the state boards, and don’t want to see that disappearing.

There are, however, three major problems with this intimation. This first is that the AMA supports a national approach to medical registration. It has a proposal of its own:

The medical profession suggested a move to national medical registration more than five years ago. In 2003, a model of national medical registration based on the harmonisation of State medical registration was achieved. Had this process not stalled in the legislative drafting stage, it could have been achieved by now.

So it turns out that the AMA is all in favour of a national database and has been for years. The letter quoted above, by the way, is dated 21 February 2007. The AMA’s disagreement with the Federal Government is with way the national scheme is implemented, not the principle. What the AMA wants is (i) state-based medical boards with a national database of registrations, and (ii) independence from the government, much like the Reserve Bank’s independence from Treasury.

The second problem is that the AMA does not have a powerful presence on the state medical boards. I have worked in both Victoria and Queensland and it surprised me to hear that the AMA has allocated positions because not only had I never been aware of it, it would also be entirely inappropriate for the AMA to have those positions. So I checked. And, as it turns out, neither the Victorian nor the Queensland medical boards have an AMA-allocated position. I checked the other states. South Australia has no AMA position. Neither does Tasmania. It turns out that the New South Wales medical board does have two AMA-nominated positions out of a 20-member board and the Western Australian medical board doesn’t give any information that I could find on its website. I’d appreciate any corrections or further information on AMA-nominations to Australian medical boards.

Now I am all in favour of scrapping AMA-nominated posts. They really don’t belong there. But to intimate that the AMA is aggressively opposing the Federal government in order to shore up two nominations in one state (which must be approved by the state’s Health Minister anyhow) seems to be drawing a very long bow. And, more to the point, it is a type of rhetorical fallacy called the Appeal to Motive which is particularly egregious in this case given the failure to report on the AMA’s public arguments or to interview anyone from the AMA.

The third problem with all this is that the ABC is allowing irrelevancies to be quoted uncritically. For instance, Alexandra Kirk quotes the Australian Health Minister Nicola Roxon:

“If there is a nurse in Victoria who wants to go and work in the Northern Territory, let’s make it easy for them to be able to have their skills recognised in another state or territory. Really in this day and age, that is just common sense and good policy.”

Which is well and true, but utterly unrelated to the issue of medical registrations, and again misrepresents the AMA’s argument. But Ms Kirk feels no need to question the quote, to comment on its irrelevance, or to decide to report something more relevant. In fact, this is so irrelevant that one wonders if Ms Roxon was talking specifically about nurses and it is only in Ms Kirk’s hands that it became a reference to doctors.

And then there’s the crucial public safety argument, in a separate article by Ms Kirk:

Rogue doctors like Jayant Patel and Graham Reeves, the so-called “Butcher of Bega” are being cited by patient action groups as a compelling reason for a new system in which doctors would no longer have control of state medical boards and medical registers.

And again, here’s Ms Lane:

The case for a national scheme has been highlighted through the so-called ‘Dr Death’ case in Queensland and the ‘Butcher of Bega’ scandal in New South Wales.

Except that in neither the Patel case nor the Reeves case was state-based registration the cause of the problem. When Dr Patel came to Australia, he was only ever registered in Queensland. He never worked anywhere else. While it is undeniable that the Queensland Medical Board did not do enough to check Patel’s application, the fact remains that this failing had nothing to do with the national registration proposal. The checks could just as easily have failed at the federal level as the state level. It is also salient to note that the most active protection of Patel’s position was not from the medical board but from the state health department which failed to investigate numerous and serious complaints over a long period.

The second example used, that of Graham Reeves, seems more clearcut. Reeves was deregistered as an obstetrician and gynaecologist but continued to work on the south coast of NSW in defiance of that restriction. But, again, the failure had nothing to do with a national registration system. Reeves’ restrictions applied in NSW and he wriggled around that by moving to a rural area with a desperate need for specialists. The local hospital board failed to check on his application details before appointing him.

Both of these examples, while being compelling arguments for ending the Australian health system’s laconic approach to checking credentials, are completely unrelated to any national registration proposal.

Fortunately not all media outlets have been as shoddy as the ABC on this matter. But then, the AAP and the SMH and The Age reporters did something rather extraordinary. They checked with the AMA to see what its position was before reporting it.

For the record, I am not an AMA member and I don’t support the AMA on this issue. I think there should be a national medical register and that it should be appointed by the Health Minister but independent of the Health Department (those who argue that more government involvement would prevent future Patel and Reeves debacles have not studied their examples very closely). The AMA should not have any allocated seats on any medical boards and nor should the medical colleges (although the colleges should have a standing amica curiae right to submit evidence on any case). So it would seem that I am closer to the government on this issue than the AMA — except that I don’t actually know for sure. None of the reports have extended to discussing the actualities of the government proposal or how it intends to accommodate the differences between existing state approaches. Which is, you know, one of the things I thought journalism was meant to do.