Dr Omar Khorshid, president of the Australian Medical Association (AMA), has been in the media almost every day in recent months, speaking on different topics connected to the coronavirus epidemic.
These include revising recommendations for the use of the AstraZeneca vaccine, encouraging the New South Wales government to enact stronger lockdown measures, and applauding the National Cabinet's pandemic-response plan.
Beyond the epidemic, the AMA's media releases, doorstops, and television and radio spots highlight worries about climate change and physicians in Myanmar. In June, Khorshid delivered a speech at the National Press Club outlining the AMA's vision for Australia's Health.
Why is the AMA so often cited by politicians and the media? And what function does it play in the pandemic?
It has historically safeguarded physicians' professional and financial interests.
The AMA (and its precursor, the British Medical Association) established itself as a strong, aggressive lobbying organisation — basically a medical union. It is concerned with safeguarding physicians' professional interests and financial autonomy, as well as maintaining the status quo in health care.
The self-published book commemorating the AMA's 50th anniversary, ironically titled "More than Just a Union," boasts of efforts to thwart government initiatives to make health care universal and cheap.
The most egregious of them was the unwavering resistance to the implementation of the Pharmaceutical Benefits Scheme, Medibank, and, eventually, Medicare.
Fear of restrictions and intervention by governments and health insurers, as well as attempts to broaden the scope of practice for healthcare professionals other than physicians, fueled this resistance.
How the AMA has influenced previous health policy
Those previous concerns are reflected in the AMA's continued resistance to a variety of measures that are regarded as infringing on physicians' autonomy.
These include opposition to payment systems that would shift from fee-for-service (an itemised cost paid for each visit) to capitated payments for chronic disease treatment.
Concerns regarding the sufficiency of physicians' Medicare reimbursements persist and, in some instances, are valid. As a result of these concerns, the AMA has issued its fee advice to physicians.
The American Medical Association (AMA) is particularly opposed to “US-style managed care,” which it characterises as “a formula for cost-cutting and fewer choices.” The AMA is concerned that Medicare and commercial health insurers would attempt to coerce physicians, hospitals, and patients into coercive contracts with limited funding payments and specified performance, quality, and results criteria.
Meanwhile, the American Medical Association has continuously resisted expanding the responsibilities of midwives and nurse practitioners in the healthcare system and is strongly opposed to pharmacists having a greater prescription role.
However, the AMA has also taken a major leadership role in bringing to light critical problems such as Indigenous health, tobacco and vaping legislation, boxing injuries, refugee care, and climate change.
The AMA machine inside
The federal secretariat of the AMA has great resources to help in this task, including specialists in policy formulation, economic research, and communications. This is emphasised in the report cards it produces regularly, which have the ability and prestige to influence public opinion and government policy.
The AMA works hard to ensure that its voice is heard via budget comments and contributions to a variety of inquiries and reports. According to the AMA website, 45 applications were submitted in 2020 - a massive job of preparation and clearance.
For the AMA, the latter job is never simple. It is a naturally conservative body, more at ease with the conservative side of politics, but this has shifted with the president's public persona.
Internal squabbling was exposed when, in his successful 2016 bid for AMA President, Dr. Michael Gannon chastised then-president Dr Brian Owler for opposing health budget cutbacks in the 2014-15 Budget and the medical care of asylum seekers.
Finally, these internal squabbles weaken the efficacy of the organisation's strong public voice. It may support or oppose government ideas, but it is seldom able to garner enough internal support to propose alternatives.
All of this contributes to the AMA's current image as a chameleon organisation attempting to be all things to all people. On the one hand, it is constantly at odds with the government (regardless of political party) for the interests of its members. On the other hand, it emphasises social responsibility and openly portrays itself as promoting community health.
This paradox may be seen in the epidemic. Along with words of encouragement to the public and comments on government measures, the AMA is expressing the usual concerns and “working tirelessly” to strengthen its influence in the halls of power.
How the AMA is using its influence during the pandemic
The AMA's influence on the federal government is likely what led to the original decision to mainly vaccinate the general population via GPs.
The AMA emphasised that rolling out the program via general practice was the best method to urge the population to be vaccinated and expressed "serious concerns" about pharmacists' involvement in the vaccine rollout.
Efforts to increase relevance and public confidence
In the face of growing competition for members and attention, the AMA is motivated by the need to show relevance to today's generation of physicians and the general public.
When the federal AMA was established in 1962, 95% of physicians were members. As of 2018, it was less than 30%.
Many physicians have joined specialised colleges, and the majority of GPs are members of the Royal Australian College of General Practitioners (RACGP) and/or the Australian College of Rural and Remote Medicine.
As a result, it is not surprising that the RACGP is an active participant on behalf of its members — the lobbying sections of its website reveal that it claims some of the same legislative wins as the AMA. Its president is also a regular media appearance on topics such as the epidemic.
Many of Australia's issues with vaccination rollout and lockdown compliance are the result of government communication tactics that are unclear and public education programs that are of low quality. There is a place in this area for successful communicators who communicate in a language that everyone understands.
Physicians have trusted voices in the public eye, and doctors on the front lines are ideally positioned to remark on the pandemic's healthcare implications.
The AMA (and other medical organisations) have spent decades cultivating relationships with the media and politics. This implies that their complaints are frequently heeded above those with greater knowledge, and their worries are more visible than those of impacted populations. During the epidemic and in the years ahead, this is a fortunate position that should be utilised for the general benefit, rather than any organisational self-interest.
