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Episode 1 - Dr Danielle McMullen
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In episode 1 of The Waiting Room Dr Omar Khorshid and Dr Chris Moy are joined by AMA President Dr Danielle McMullen to discuss the AMA's advocacy in the lead-up to the 2025 federal election.
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Transcript
Introduction to 'The Waiting Room' Podcast
00:00:00
Speaker
Welcome to The Waiting Room, the podcast where we unpack the big issues in Australian healthcare. I'm Dr Omar Korshid. And I'm Dr Chris Moy.
00:00:09
Speaker
You're listening to The Waiting Room, a podcast by the Australian Medical Association, with your hosts, Dr Omar Korshid and Dr Chris Moy.
00:00:26
Speaker
So each episode will be bringing you insights from the front lines of medicine, policy and advocacy.
Meet Dr. Danielle McMullen
00:00:31
Speaker
Today we're kicking off with a very special guest, the President the Australian Medical Association, Dr. Danielle McMullen.
00:00:37
Speaker
But before we go to Danny, we thought we should probably let you know what this podcast is. ah Chris and I were the leadership team, the president and vice president during the pandemic and spent virtual time together virtually every day for two years. i have to admit that part of my motivation was be able to have regular chats with Chris again.
00:00:58
Speaker
But the real reason that we're here is that we're aware that many members don't have a great insight into the work the AMA does, some of the details of our policy positions in various areas, and most importantly, why the AMA makes certain decisions or takes certain actions.
00:01:15
Speaker
What about for you, Chris? I think it's really nice to speak to the people at the centre of this and actually get past the sort of maybe slightly sanitised messages that we sometimes have to put out to media to really get to the the genuine heart of of of issues that really do mean a lot to our members and our patients.
Dr. McMullen's Role and International Engagement
00:01:35
Speaker
So it's now my great pleasure to introduce our very first guest, the President of the AMA, Dr Danielle McMullin. Danielle, as I'm sure you all know, is a GP, formerly from New South Wales, but has now turned, transformed, I guess you could say, into a Queenslander.
00:01:50
Speaker
Vice President of the AMA for the last couple of years and relatively recently elected unopposed as President of the AMA. Danielle, welcome, but perhaps we could start with you telling us a little about yourself.
00:02:02
Speaker
Thanks very much, Omar and Chris. Excited to to be here with you on your first episode. um Yes, as you said, I'm a GP in my day job, although the AMA occupies more and more of my life these days, as you will well know. um It's the kind of role that sucks up any spare minute.
00:02:18
Speaker
ah In fact, I'm recording this from Thailand, where I'm representing the AMA at the Medical Associations of Southeast Asia and and here to share our work on vaping over the past couple of years and the reforms our government's done.
00:02:30
Speaker
So really the the breadth of issues we cover. but um Yes, as you said, grew up in New South Wales and came through the AMA ranks as a Doctor in Training and then was our State President during the COVID era. So I think that's when the three of us all got to know each other a bit better.
00:02:45
Speaker
It was through the pandemic and now the federal president and really excited for still 18 months to go um and and that bit of time ahead. ah Daniel, I've got to say you were probably one of the most experienced both politically but also I think emotionally ah equipped individuals for this job.
00:03:04
Speaker
But look, you've just gone you know through a um federal election campaign.
AMA's Election Campaign Strategy
00:03:10
Speaker
And I've got to say this campaign was you know incredibly well organized and one of the most visible in recent memory.
00:03:18
Speaker
ah you know How did it come about and and and and and what what happened in terms of the organization and the focus? The strategic approach wasn't by accident. um ah The AMA team, so obviously that the President and Vice President get to be the front face of the AMA, but behind that we've got an incredible team of people ah who do our policy and advocacy work.
00:03:39
Speaker
And election campaigns only come around every few years, and that's our real opportunity as an AMA to have campaigns that target the general public and politicians and get them to understand what it is that doctors are all about and what will help for our health system.
00:03:55
Speaker
And so this year, as as people may remember, we weren't sure what the timing of the election will be. Will there be a budget? Won't there be a budget? And there was a thing called the Cyclone, Cyclone Alfred, that didn't turn into much but did disrupt our election dates.
00:04:09
Speaker
ah So it was actually really good that we had such a... structured strategic approach to the campaign in the lead up because it meant we were able to pivot what started as potentially being a budget ask and we can dive into the details of that in a sec but what started as a potential budget campaign was really quickly able to be both a budget then pre-election and election strategy ah to really meet the needs of of what we were faced with politically but still be able to make sure that health was that number one issue which I think was a success when by the end of the campaign we were all pretty sick of I think seeing the Prime Minister waving his Medicare card around ah shows that we at least got the health onto the front page, which is really the key goal for a health organisation.
00:04:52
Speaker
In an election, Cameron, you've obviously got to be very flexible. ah To what extent are you able to drive the agenda, the media focus and the politicians talking about health versus being reactive when they decide they want to talk about health and then you get the opportunity to have a say? Did did you find you had both or were you more one or the other?
00:05:10
Speaker
So normally in an election you get one or two weeks on health and our real goal this time was to make it a health election. So we started before the election campaign even kicked off, pre-budget dropping regular health stories into the media to make sure that it was on the front of mind of journalists and the general public.
00:05:30
Speaker
ah we We knew that cost of living was likely to be a really big topic this election and there were, we could have then been distracted by it being about the costs of everything else and instead we had to make it about access to high quality health care and ways to make sure that Australians get access not just to any care but to the best possible care and that being really a ah health focus for the rest of the election.
00:05:57
Speaker
Look, I've got to say that some people might say that really this became an election that focused on general practice and and that green card won an election. um And, you know, there were, there were and the AMA to some degree came in beautifully in this in terms of having key elements in terms of the modernised Medicare campaign in February.
Modernised Medicare Campaign Overview
00:06:14
Speaker
ah Could you explain what were the sort of the the core core elements of that? Yeah, so ahead of the budget, we had really four pillars of our health asks. We were ahead, ah we were ready before the budget with our key asks of government and that was to modernise Medicare, ah to make to focus on clearing the past public hospital logjam and investing appropriately in our public hospitals, taking a long hard look at our private healthcare care sector because the fact that even our private system is struggling really should be a wake-up call
00:06:45
Speaker
And as always, the AMA does have a strong focus on public health measures and things that will improve the health of the population. And this time we continued our campaign on attacks on sugar-sweetened beverages.
00:06:56
Speaker
So with those four key asks in mind, ahead of the budget we did focus on and and throughout the election, our modernised Medicare campaign was really our our clearest and and strongest campaign going into this election.
00:07:11
Speaker
um and head of budget did different things that we haven't done before things like sending some Valentine's Day e-cards to politicians um to to get them engaged in that campaign um and then as we rolled through had yeah all the email your MP kind of functions but we really did try and approach this election more differently to how we have before with more of that both public engagement politician engagement and of course um doctor engagement as well So, Modernised Medicare itself, but what is that?
00:07:44
Speaker
Modernised Medicare has a few key asks and pillars in it. It's about improving the MBS because we're recognising now that obviously in general practice, ah the complexity of your average consultation has increased over the past decade.
00:08:01
Speaker
There's no such thing as sort of a quick five-minute just-a-script appointment anymore. and But the MBS really was built 40 years ago for those that high throughput, quicker consultations and really disincentivises taking the time that's needed to deliver high quality care.
00:08:18
Speaker
So one arm of the modernised Medicare campaign was to restructure the MBS items in general practice to better deliver that chronic care, more complex care. but also recognise we need to work in teams and so there's an ask in modernised Medicare to increase something called the workforce incentive payment which is a payment that practices use to hire nurses and allied health staff to really boost the the practice team in general practice and then really importantly it was also about workforce ah that we're facing a significant GP workforce shortage over the next few years
00:08:51
Speaker
as many as 10,600 GPs short by just 2032. and and so we asked for more GP registrar training positions, paid parental study leave and more exposure for g potential GPs in that pre-vocational time. And really excited to announce that actually that arm of modernised Medicare, that that third chapter, so to speak, it looks like the government ripped that straight out of our playbook.
00:09:18
Speaker
and we we got all of those those workforce asks delivered in the election. That was one of our key wins in the past few months. So the the but the budget dropped and I don't think anybody can argue that there was a lot of money attached to this and it was quickly matched by the opposition at that time. but um um But clearly, I mean, from from individuals actually in the know, particularly on the ground as general practitioners, we could see that this was mainly fulfilling a political imperative to try to push up bulk billing rates by by sort of having the triple bulk billing incentive for all.
00:09:54
Speaker
But they didn't really attack the the key issues in terms of the MBS, in terms of increasing the actual rebate, but also really working on, as you said, trying to favour longer consultations, which would start to attack the issue of managing chronic disease.
00:10:12
Speaker
i mean, and i've got to say, it just felt like we we got a birthday present, which was nice, but which we really didn't need. um So I suppose my question is, is we were sort of kind of caught there because I could tell that you know the the government but a government saw this as a win at that point. the the the the that The average puncher out there said, oh, that's great, more money, we're going to be bolt billed. But really was it would have been quite hard at that point to progress the argument.
00:10:37
Speaker
So so i mean we yeah i I'm interested, what was the line of attack at that point and how could you progress this in the middle of a campaign, particularly since an opposition had agreed to it as well?
Concerns and Success Metrics of AMA Campaigns
00:10:48
Speaker
Yeah, as you said, at that stage, the election campaign proper hadn't even kicked off. I mean, this was pre-budget, but we all knew that this was an election commitment. And so in that way, it was a really strange election campaign because it felt like it ran for six months or more.
00:11:02
Speaker
um But that day where they announced um yeah close to $9 billion dollars for general practice, yeah was one of the hardest days in the campaign, despite what should have been, you know this huge big celebration because that is record investment in general practice and I think we can't articulate that strongly enough. This is the most money that's been poured into general practice since Medicare was invented and it is, it's going to general practice rather than to other places and so we had, you know, as an organisation who's been really trying to fight for better investment into general practice for many years,
00:11:36
Speaker
in that way should have been really exciting but it wasn't into an area of Medicare or a structural reform of Medicare that we really think will help sustain the system into the future and that's what was really disappointing.
00:11:52
Speaker
So great dollars but not the reforms we needed. um yeah We are concerned that it may incentivize you know again that higher throughput doesn't really invest appropriately into those longer consultations the complexity of care um and so I know that a lot of GPs out there really felt like it was a kick in the guts and so it was really difficult to frame how do we respond to this and we did it decided that we we needed to really just say what it was, great investment, but not the reforms we needed. And so that then guided the rest of our election campaigning, where we didn't give up on modernised Medicare and continue to use the opportunity to talk to the general public and talk to the media and talk to politicians about, okay, well, what are the reforms we need?
00:12:40
Speaker
How can we now, yes, we've got this investment and it all of course, we'll try and make the best we can of it over the short term, But now our longer term strategy is still how do we pivot that investment or others into restructuring the way general practice operates and make sure that not just are we reducing out-of-pocket costs for patients, which is important, but also delivering them that higher quality complex care, continuity of care that we know would also really benefit their health.
00:13:07
Speaker
And just to put those numbers in some context, um I think I can speak from experience as a previous president. We often... ah mark ourselves on how much investment we were able to achieve into healthcare care during our terms. And my predecessor, Tony Bartoni, worked very, very hard and achieved a $400-odd million dollar promise of investment into general practice, which ended up never being delivered with covid when COVID got in the way.
00:13:34
Speaker
ah During the previous election campaign, when when we first launched the modernised Medicare concept, um And we were very, very lucky lucky politically with with how that all fell, but we achieved a a commitment to about a billion dollars. And we were pretty proud to have achieved a commitment for of about a billion dollar investment general practice, which then turned into multiple billions during um the following few years.
00:13:58
Speaker
ah So this investment of nine billion ah is just such a large number. ah you can sort of see why you couldn't um couldn't complain about it despite the fact that it doesn't actually promote the kind of care that that the AMA really believes in.
00:14:12
Speaker
um So look, just to take things forward, the election happened, how do you how do you mark yourself um in terms of the the impact of a an election campaign from ah from the point of view of health, ah not just in in um in dollars and and investments by government, but also the reach, how many people engage with you? how How do you mark yourself as a leadership team of the AMA at that time? You mark yourself in some of the wins, but as well as the yeah that success engagement along the way. And as I've mentioned, yeah one of our strongest wins in this was ah that yeah the huge dollar investment in general practice, which really gives us an opportunity to take that funding and morph it over time into
00:14:57
Speaker
better quality investments, you know, but also really importantly the workforce payments for general practice registrars to really shore up that pipeline of more GPs and to get paid parental leave and study leave for GP registrars was a really critical win.
00:15:12
Speaker
um But as you said, it's also about how much did we get the population to understand, to listen, to see health issues. um We did different things this time, like using the um the waiting room screens in general practice surgeries to to run some short video animations and advertisements for modernised Medicare.
00:15:32
Speaker
ah We had an upgraded version of our Clear the Hospital logjam campaign site where you could plug in your local hospital and see how it's translating in terms of how it's performing in terms of ah wait times on elective surgery and emergency departments.
00:15:47
Speaker
and And in terms of those yeah GP waiting room advertisements, we reached over half a million patients. Our digital ads had more than 1.3 million views.
00:15:58
Speaker
um And in terms of the email, your MP tool on our websites, more than 90% of federal MPs had constituents contacting them through that. So it showed that we really did reach the public.
00:16:12
Speaker
And for that few weeks of the of the year, every few years, that's who our main target is, is to try and translate all the work we do as the AMA into something that's that resonates with the general public and has them thinking about health and has politicians thinking about health. So I think we we ranked pretty highly on that, or was it, in terms of media engagement.
00:16:33
Speaker
We had over a thousand media mentions reaching the equivalent of 44 million people ah with with millions of dollars worth of advertising spend should we have had to fund that in terms of of paid advertising, which we didn't. So huge our our uptake and huge engagement and impact.
00:16:52
Speaker
And as I said, the the fact that we got it to be a health election and both parties really spent most of that election period talking about health and the biggest announcements and and dollar spends in that budget and election were all health focused.
00:17:08
Speaker
s So I would call it a success in that book. Look, if if we're going to score things like the Red Baron, you've got nine million and Omar and i got one. um but Look, I wasn't going to say anything. I wasn't going to boast, but yeah, guys, it was it was a pavilion more. just Yeah, what's what's a pavilion?
00:17:24
Speaker
I've got to say, though, I don't think, um I mean, look, I can say this for a fact, as, you know, I sort of handed over to you as the the next GP when I left as vice president. i can't ah can't recall anybody being so on the ball about this issue and you went straight onto the GP committee and,
00:17:40
Speaker
ah And look, from my perspective, you are the right person. You've a fantastic relationship with the minister. And we we actually do have a minister who gets the the the the quantum of the disaster, which is coming towards general practice in particular, but also what the health system is facing.
00:17:56
Speaker
But I think that that the number that in terms of the level of funding was sort of ah a great success, but also a reflection on on the the level of of ah problem that he sees and his concerns about the future and health. Yeah, and it might be worth us doing a whole other deep dive into general practice policy because I think there's a lot we can unpick there um and clearly was the focus of the election but not the only thing we focused on and there's still obviously a lot of work to be done not just in general practice but across our public hospital system and our private sector as well.
Need for Health Reform and Challenges in Healthcare
00:18:33
Speaker
um in yeah know In public hospitals the real challenge has been getting the the different parties to the table to negotiate a new health reform agreement And so that's our real focus of engagement in then in the short term is making sure that our our members, doctors, patients across the public hospital sector are getting a fairer deal in terms of funding and performance review and management of public hospital sector ah through a new national health reform agreement. I think that's really critical at the moment.
00:19:03
Speaker
And I think maybe in another podcast, we might get to the sort of concerning and somewhat sore point about urgent care centres, Yes, for sure. It's ah one we hear about a lot and continues. Danny, another topic that has had a lot of attention recently has been private hospital viability, the disaster that appears to be occurring in private obstetrics in particular, especially in regional areas, but really across the country.
00:19:32
Speaker
ah But even you know substantial private hospital operators going bust or being on the brink This is of a lot of concern to ah to doctors, but also to the entire community. What's the AMA been doing on this and what's the direction for your advocacy?
00:19:49
Speaker
You're exactly right, Omar. In Australia, that balance of public and private care is so critical to what makes the Australian healthcare system so fantastic. and But the fact that we're seeing our private sector struggle ah should ring alarm bells for a lot of us. So we've seen that as an issue for for some years at the AMA.
00:20:05
Speaker
and have been in fact for years calling for something like a private health system authority which would be an arm's length body to help have some oversight around ah deliberate design of the private healthcare sector, um potentially some regulatory role but it's not just an extra regulator.
00:20:23
Speaker
how would we do you know how do we get the private sector to keep up with the times on things like out of hospital care um funding what the role of international or private equity owners should be in the the private healthcare sector lots of these really tricky issues that our system is having to grapple with at the moment we've had some traction in that we ah got the labor government the in their last term got the government to do a private health ah private hospital viability review and so they did do a ah ah short review into the issues there and from that came our private health ceo forum which is a
00:21:01
Speaker
collection of insurers, hospitals, ah groups like the AMA, our Vice President, Associate Professor Julian Raich is representing us on that group to really get to grips with the issues facing the private sector, recognising that if it doesn't isn't able to perform, and the public hospitals are where all of that slack will have to be picked up.
00:21:24
Speaker
And so it really is urgent um and there's a lot of work happening on that and yeah happy to keep members informed down
Looking Ahead and Closing Remarks
00:21:32
Speaker
the track. So, Danny, ah thank you so much for joining us. We will take you up on that offer to do some more deep dives into other policy areas, starting, I think, first with general practice. But of course, we very much want to get into the nitty gritty across the whole ah the whole range, I guess, of AMA advocacy over the next few podcasts. So we're looking forward to that. But it's been a great pleasure to have you join us today. And congratulations again on a successful election campaign and starting your presidency with, you know, in a really positive way.
00:22:03
Speaker
Thanks very much. And because we seek attention, please don't forget to subscribe, share and leave us a review. Until next time, stay well. Thanks for listening to The Waiting Room.
00:22:16
Speaker
Learn more about the AMA, including how to become a member, ama.com.au. dot a