AMSA President, Elise Buisson, delivered a powerful address at the AMA National Conference highlighting the social responsibility of the medical profession and how Australia’s health issues are within each individual’s power to change. She advocated on issues ranging from mental health, refugee & asylum seeker health and the retention of Indigenous medical students, to issues of gender equity in medical leadership, the health impacts of marriage inequality and climate change.
You can read a full transcript below.
Good morning. My name is Elise, I’m a medical student from Campbelltown in Western Sydney, and as you’ve heard, I have the great privilege of leading and representing the 17,000 medical students around our country. I’m honoured to have the opportunity to speak to you today, in particular because even as a student the AMA has been a source of support for me in a number of ways. I work for a state AMA, I have a seat on Federal Council, and as of yesterday, I am the proud owner of not one, not two but three AMA Federal election caps. I want to see the AMA go from strength to strength, and the health of our nation with it.
Now my goals in early life, started off a little differently. When I was 14 years old I was pretty confident that I was going to be a hairdresser. I’m not a fan of small talk, so I’m comfortable predicting that would have been a disaster. But I’d met the wife of one of my school teachers who was a hairdresser, and she seemed pretty happy. As a result, it seemed to me that probably becoming a hairdresser was a good way to become happy. There was an enviable simplicity to the thought processes of 14 year old me.
I had a really fantastic teacher when I was in middle school, his name was Mr. Naiker. When I told Mr. Naiker that I was going to finish up year 10 and leave school, he sat me down and said to me, “I don’t have a lot of power around here, but I’ll do what I can. So, you tell me the top 5 reasons you want to leave, and I’ll try and help you.” You know, Mr Naiker was right. Early career middle school teachers do have a lot less power than many others in this world. They even have a lot less power than many others in their school.
However, what Mr Naiker understood, and what I have come to learn, is the responsibility of those with even a little power to affect change for those with less. There weren’t 5 things that Mr Naiker could help me with. I’m not sure there was even one. But seeing that he was willing to fight to keep me around made me believe that it was a fight worth joining.
As a result, I have come to learn both how much of my life is owed to those who have helped me in even the smallest of ways, and how much I can influence the outcomes of those around me in return. When I reflect on the 10 years since, I draw great humor and great humility from the slightly paraphrased words of my very favorite comedian Tim Minchin:
You are lucky to be here. You are incalculably lucky to be born, and incredibly lucky to be brought up in a nice life that helped you get educated and encouraged you to go to uni. Or if you were born into a horrible life, that’s unlucky and you have my sympathy, but you were still lucky: lucky that you happened to be made of the sort of DNA that made the sort of brain which, when placed in a horrible childhood environment, would make decisions that meant you ended up, eventually, graduating uni.
And here’s the part for the days I need to be reminded to be humble:
Well done you, for dragging yourself up by the shoelaces, but you were lucky. You didn’t create the bit of you that dragged you up. They’re not even your shoelaces.
This is not to say that personal responsibility, and personal choice, do not matter or are not significant. I didn’t used to expect much for my life and when I grew old enough to understand that I could change the story that seemed laid out for me, I did my best to make a better life instead. But my best is different to your best, and the best of the person sitting next to you. We all have different strengths and need different kinds of support, and our outcomes are dependent on whether those needs are met.
My life, as I see it, is the sum of individuals who took an interest in me long before I looked like one to back. I owe many of my opportunities and successes to people who have urged me forward when I needed it most. I’m sure most of you would acknowledge the same.
This is to say, that those who feel that they’re a self made man or woman are misinformed. We have all received help, even as small as a kind word. And those individual actions, individual decisions, individual people, can and have changed our lives.
Because of that help, we are a room full of very privileged people. Now, privileged is not to say that we didn’t work hard, or even that we didn’t deserve it, but that we are winning a race in which, at some point, we were given a running start. Even those from the worst possible backgrounds, upon gaining entry to medicine, inherit a security and a position in society that most will never have access to. That gives the medical profession a lot of power. I believe as a result that we have far more responsibility than most for what we choose to do with it.
Having all received help to gain our positions in society, we ought to use our positions consistently and wisely to in turn help those with less. We should do it because we can and we should do it because it’s right. I think those in this room feel the same way. It’s why you became doctors. It’s why you’re here today.
Mental health of doctors
Now in 7 months I’ll finish my term and a new President will take my place. My name will live on in impeccable gold lettering outside the AMA Board room, but many of my ideas won’t. So it’s fair to say I feel a responsibility to use my platform frankly and effectively in the time that I have. At some point it became clear to me that the best thing I could do for medical students was not to be afraid in discussing issues of mental health, or sexuality, or gender equity, in the hope that they would feel they could speak about the things that have the potential to hold them back.
A little earlier this year I wrote an article in the Sydney Morning Herald that discussed my mental health when I was very young, and the contributing factors. I was in grade 5 the first time I can remember being suicidal. I’m lucky to have built a wonderful and happy life for many years since, but the memory of that desperation has never left me. I see it in people around me, and they are facing their battle in perhaps a more unforgiving environment. Children are resilient and doctors are too, but the stakes are higher when you’ve got a social standing to lose.
When I was in my first year of medical school, we were given a lecture on doctor’s mental health. Our lecturer was well liked and well respected, because it was universally felt that she genuinely cared about all of us. She got up in that lecture and told us personal stories, of the deaths of those around her as a result of the pressure of medical school and medical practice. Her final slide was a picture of a diamond, with huge lettering “you are precious”. Everyone felt pretty loved and pretty looked after that day, but we were too early on in our training to appreciate how hard things were about to get for some of those sitting beside us. A number of people I was close to suffered severe mental illness during that very first year of medical school. The one that worried me the most, after the storm was weathered and appropriate help was being sought, told me that in the darkest moments, “you are precious” was the reason to go on.
The well known beyondblue study of 2013 found that 40% of doctors believed that those with a history of mental ill health were perceived as less competent by their peers. I have personally spoken to many medical students who are seriously suffering, and many who have contemplated suicide, rather than risk being “found out” as having reached out for help. People are considering death as a reasonable alternative to what they perceive as our judgment. Don’t underestimate how closely your juniors are watching your offhand comments on mental health. Don’t underestimate the repercussions of your actions, destructive or protective. This is within our power to change.
Women in medicine
I hold my Executive meetings in a state AMA conference room, where I’m greeted by a long line of dashing greyscale photos of state leaders. My team sometimes likes to play a game of “spot the woman”. It’s a problem we have in AMSA too.
Social entrepreneur and absolute legend Holly Ransom this week highlighted in a speech to medical students a Harvard study with comment on the issue. It found that, given 5 essential criteria for a job application, women would sensibly enough, apply when they filled at least 4. Men would apply when they filled 1. What women had in capability they lacked in bravado and they fell out of the running because of it. When only one in 5 AMSA Presidents are women I’m not all that surprised that women are not progressing up the chain. This is their first major opportunity to learn to lead in this setting. Being underrepresented means they’re already behind at the starting line.
I’ve been told by a number of people this year that the reason women aren’t in leadership in various areas of medicine is a lack of interest, or a lack of ability. I think we should take more responsibility for the situation than that. We are failing to create leadership environments that foster their interests, and we are failing to provide opportunities that foster their ability. This is a problem I’ve now inherited responsibility for in AMSA, so I am accountable for both my individual actions to encourage future female leaders, and my actions in improving the system.
Let me implore each of you: encourage women to take a step forward and you’ll find they’re just as capable of and interested in standing on their own two feet. Do it early, do it consistently, do it as an individual and make it a part of a strategy. This is within our power to change.
Indigenous medical students and doctors
An empowering example of the AMA’s advocacy, both through the dedicated taskforce and through this Conference itself, has been the focus on recognising vital research in Indigenous health, and supporting the representation of Indigenous health professionals. Unfortunately, despite this the drop out rate for Indigenous medical students remains 30%, while non-Indigenous students like myself make it through 99% of the time. This year I’ve learnt a lot from the people down the road at the Australian Indigenous Doctors’ Association, but if I distilled it down to just one lesson, it would probably be how much more remains that the individual can do. This room is full of people who have successfully navigated medical training and who have an interest in strengthening the future of the medical profession. These students are that future. As individuals, we need to take a role in engaging with the most committed and knowledgeable stakeholder, AIDA, to get these students through, in order to create the Indigenous health leaders this nation needs to Close the Gap. Working together, this is within the power of the medical community and the Indigenous community to change.
You’re listening to me discuss systemic problems in our profession: the mental health of our juniors, the retention of Indigenous students, the representation of women in leadership. I’m talking about solutions as coming from you, the individual, and in the face of all of that you may think me idealistic or you may think this glib, but systemic change comes from the will of the individual, and has the ultimate aim of changing the behavior of the individual, just on a larger scale.
I’ve spoken on what we need to do for our own. But wider society also looks to the people in this room for leadership on many things. Rudolf Virchow, had this to say about the role of doctors in society.
“Medicine, as a social science, as the science of human beings, has the obligation to point out problems and attempt their theoretical solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”
We are a broad church, but we share a common purpose. Most of those in this room have sworn, or will swear, an oath to first and above all, do no harm. But harm is not only the result of action, but of inaction as well. On issues such as the indefinite detention of asylum seekers and refugees, climate change and even marriage equality, the AMA has the ability to contribute to change. We hold power, and not to wield that power on behalf of those who have less, be they within the medical profession or in wider society, is to do harm.
The primary example I can share with you of seeing my peers engage with the AMA is when they heard about the speech Brian Owler gave at AMA’s refugee health forum. It tapped into a belief in them that we have a responsibility to do more. Ending offshore detention engages medical students more than any issue I can name. I can’t mobilise medical students to march in the streets for their own job prospects. But to protest the health impacts of our nations’ treatment of refugees they will make their own placards. Those in offshore detention are vulnerable people, like any others, that we as individuals came into medicine to serve. As such, it makes perfect sense that these are the people that the AMA, as a collection of us, exists for as well.
In 2016, we are staring down the barrel of a vote or a plebiscite for marriage equality. A plebiscite will be 160 million dollars worth of ugly, and it will cause the health of the LGBT community harm, but it will likely happen nonetheless.
The Royal Australian and New Zealand College of Psychiatrists recently announced their support for marriage equality, premised on the evidence that shows, and I quote, “the discrimination and marginalization experienced by the LGBT population increases the risk of developing mental health issues, and creates barriers to accessing supportive services.”
Governance of society exists to maximize the potential of each and every citizen, free from physical and mental burden. All communities have the right to the best attainable health. All doctors have a responsibility to ensure that those who are marginalized and stigmatized against, are provided equitable opportunity for and access to good health, in order to serve not only themselves, but their families and communities.
It’s not news to anyone in this room that one of the AMA’s two core objectives is to participate in the resolution of major social and community health issues. This major social and community health issue requires resolution. History will at some point look back and ask where we stood. As doctors, we must be utterly confident we can justify the health basis for what they’ll find.
The health impacts of climate change are perhaps the greatest public health threat to face my generation. In a political climate that has recently seen our Deputy Prime Minister wonder aloud if perhaps climate change is real after all, the voice of respected, highly educated citizens like yourselves has been of the greatest benefit. No non-political actor wields the public influence that is held by those sitting in this room. Those continued advocacy efforts put pressure on the government to respond to climate change as a health threat. That advocacy should be praised and should be protected.
We all stood together yesterday and swore our commitment to the Declaration of Geneva, as so many of us have before. “I solemnly pledge to consecrate my life to the service of humanity.” Fighting for these issues is in the service of humanity.
But, if you don’t buy that as a point, let me offer you this one: it’s also in the service of those in this room. Your potential future members are people like me, and I say potential because despite my best efforts I do see disengagement in my generation of doctors.
Many of you can speak from far more experience that me. But my own experience has been that people become loyal to member-based organisations based on what they give, rather than what they get, and what they want to give is a voice to issues that drive them. As interns and doctors in training they will come looking for a place to translate the passions they acted on in AMSA. Passions ranging from rural health to gender equity to climate change. If they don’t find it, I suspect they will search for another place to contribute their voice, instead.
In addition, fighting on these issues is in the interests of our standing in society. To speak on behalf of social issues does not lessen our influence on other matters. It amplifies our voice as the community leaders that the public want us to be. When we are seen to stand, in a well reasoned and non-partisan manner, for issues of broad social importance, it confirms in people’s mind that we do not exist for self interest. As a medical student once passionately declared to AMSA Council, “It behooves us to be more than unionists.” That the AMA exists as an advocacy body already does an immeasurably great service both to the medical profession and to the wider public. The AMA doesn’t just do things nominally, it is outstandingly effective. That success and community standing in turn leaves us well placed to do more.
Health isn’t determined only in your waiting rooms and clinics. Health is determined socially, and that’s the attraction of the AMA for people like me. The ability to tackle these big social issues that make people sick, and give them an opportunity for a better life before they ever meet me as a medical practitioner. To do so is well within our power, and our responsibility.
The Australian Medical Students Association (AMSA) has called for the Medicare Rebate Freeze to be lifted immediately following the Federal Election.
“In the interest of both patients and doctors, it is critical that this measure be lifted. The freeze will cut $2.8 billion from health care from 2013 to 2019. It is a devastating blow to medicine in Australia, particularly general practice,” AMSA President Elise Buisson said.
A recent survey of 510 GPs found that in the next 12 months, two-thirds plan to increase their fees directly in response to the rebate freeze. Nearly 40 per cent stated that they would begin charging concessional patients, whom they previously bulk-billed.
The current Medicare Rebates are increasingly failing to meet the real cost of the provision of health care to patients.
“The government has to recognise who this is going to hit hardest – young people, students, elderly, pensioners and the disabled,” Ms Buisson said.
“As students, we know how critical it is that we have readily available services for both physical and mental health. The Government’s current policy will create barriers to access to these health services where they did not previously exist.
“These changes will have an impact on career choices made by medical students. By putting stress on the profession of general practice, students will inevitably look to other professions to train and practise in.
“In order to adequately provide Australia with much needed doctors, we must train medical graduates in General Practice. The government should be looking for ways to encourage students into rural general practice rather than creating disincentives to enter.
“This piece of legislation has implications on the health of Australians as well as the future of our health workforce. It needs to be scrapped.”
The Australian Medical Students’ Association (AMSA) has called on the Federal Government to make investment in training positions for junior doctors in rural Australian communities a top priority, rather than new medical schools.
AMSA President, Elise Buisson, said today that new medical schools will not resolve the health disparities faced by regional, rural and remote Australia.
Ms Buisson said that while many medical students and junior doctors were passionate about becoming rural GPs and specialists, upon graduation, they found there were few opportunities because of a shortage of accredited training positions outside of the metropolitan centres.
“We need to use evidence-based approaches to address rural workforce shortages, which includes making the funding of rural specialty training positions a priority,” said Ms Buisson.
“Funding for health and health education should be done on the basis of rational, health workforce planning as opposed to making politically attractive and opportunistic decisions.”
Leading up to the election, AMSA has thrown its support behind the Doctors for Rural Communities plan, an evidence-based proposal that would see an immediate injection of doctors into rural communities. Under the plan, a $46 million investment by the Government would allow 306 doctors to undertake an annual year of training, or 61 doctors to undertake five years of their training, in rural, regional and remote Australia.
Just $32.5 million would be enough to fund 216 doctors to complete a year of specialty training in rural communities.
The Australian Medical Association (AMA) and the Rural Doctors Association of Australia (RDAA) have both joined in calls for the major political parties to commit to evidence-based and effective initiatives to improve health services for people in rural and remote Australia, including Doctors for Rural Communities.
Doctors for Rural Communities is also supported by respected rural doctors, Dr Darryl Mackender, at Orange Base Hospital and Dr John Preddy, a Head of Department at Wagga Wagga Rural Referral Hospital, who have already put forward their support for the above proposal.
“Representative stakeholders for rural health and healthcare in Australia stand united on the need for expanding our rural training workforce, as opposed to funding new medical schools,” said Ms Buisson.
“We cannot hesitate to act on rural health any longer. Not only is the potential for economic wastage immense, but the people of rural Australia deserve increased access to much needed medical staff, including more general practitioners and specialists.”
“We welcome the attention and investment being given to medical training and research, but investment in vocational training will deliver much greater benefits for rural Australians than more medical schools.”
To find out more and to pledge your support, visit www.dfrc.org.au.
‘I exist because you exist, I matter because you matter, I am because we are.’
Mduduzi*, Mbali* and their four children are a family living in the mountainous region of Mambane. Mduduzi, like 27.4% of the Swaziland population is HIV positive (WFP, 2016) but he is also troubled by recurring bouts of multi drug resistant tuberculosis (MDRTB). Nowadays, Mdudzi can no longer act as the primary breadwinner, placing responsibility on the income made by his wife’s fatty cakes which she sells locally (and the reason she is not pictured here). Despite her determination, Mbali only brings in between 10 and 100 rand a day ($1.00 – $10.00), which is used to purchase maize and chicken feet, a meal consumed three times a day. With the scarcity of water, and their water tank empty, their eldest son Nkosana* walks approximately 2 hours each morning in the sweltering Swazi heat to collect water. We accompanied Nkosana on his walk to assess their water source. An ash-coloured puddle services their community of 600 people. When presented with the reality of life here in Swaziland, it is not difficult to comprehend why 3.4 million people die each year due to water-related disease (WHO, 2009).
To read the insightful piece from Shalini Ponnampalam a Second Year Medical student, click here.
The Australian Medical Students’ Association (AMSA) is urging the Federal Government not to raise fees for medical students, warning that disadvantaged students will be left behind.
From 2018, the Government is proposing a raft of measures, including a possible reduction in base funding for medical Commonwealth Supported Places, and allowing universities to set deregulated fees for ‘flagship degrees of excellence’.
AMSA President, Elise Buisson, today called on the Government to make accessibility to higher education for students from Indigenous, low socioeconomic, and rural backgrounds a top priority.
“Projections from previous attempts to deregulate medical student fees have indicated that medical graduates could incur debts between $129,000 and $203,000. This reflects up to a three-fold increase in student debts,” Ms Buisson said.
“Students from Indigenous, low socioeconomic, and rural backgrounds already face well documented barriers to tertiary education and participation in the medical workforce. Additional financial costs through such heavy debt will only exacerbate these problems.”
AMSA also criticised the $152 million cut in funding for the Higher Education Participation and Partnerships Programme (HEPPP), which aims to ensure that Australians from low socioeconomic backgrounds and regional and remote Australia have the opportunity to study at university.
“A focus on improving support for disadvantaged students cannot be considered in isolation. The government must not lose sight of the impact these reforms may have on the very students they say they want to protect. Disadvantaged students who are not considered “disadvantaged enough” for government support will be impacted most,” Ms Buisson said.
“The major ripple effect of higher fees is the threat they pose to access to primary healthcare services for patients in rural areas. These patients already suffer from shortages of general physicians and specialists.
“There is strong evidence from New Zealand and the USA that high levels of student debt deter doctors from working in regional and rural locations, and in specialties like general practice. These are two areas of significant need in the Australian healthcare system.”
AMSA will be in consultation with the Federal Government during the election process.
The Australian Medical Students’ Association (AMSA) has welcomed the consolidation of funding for Commonwealth Medical Internships (CMI) within the 2016-17 Federal Budget, which will provide 100 additional internships for Australia.
AMSA President, Elise Buisson, commended the Government’s desire to innovate within the medical workforce by continuing to expand internship settings, such as the CMI.
“This program has an important focus on getting Australian-trained doctors into non-traditional settings, including rural and regional Australia, which is exactly where we need them,” Ms Buisson said.
“Not only does it provide medical graduates with the necessary training to become practising doctors, but it helps alleviate the doctor shortage in rural and regional Australia.
“This is a positive step given the internship crisis is set to continue, with domestic medical graduates in South Australia projected to miss out on internships beginning in 2017.
“In order to create a sustainable medical workforce across both the CMI and state-based internships, the Council of Australian Governments (COAG) needs to work together to provide jobs for all newly graduated Australian doctors.
“As the Government reaffirms its commitment to delivering high quality regional and rural healthcare, the next step is to support funding for rural positions for doctors in training so these interns can be retained in rural Australia.
“Rural training positions would bring more young doctors and their families to rural Australia. This directly creates new jobs in these areas and provides rural Australia with increased access to the general physicians and medical specialists they need,” Ms Buisson said.
To find out more about AMSA’s ‘Doctors For Rural Communities’ proposal on providing rural communities with more specialist doctors, visit www.dfrc.org.au.
The Australian Medical Students’ Association (AMSA) has denounced the economic impact modelling from the Murray Darling Medical School as being vastly unrealistic.
AMSA President, Elise Buisson, said that the modelling was based on the assumption that there is no medical education infrastructure present in the Local Government Areas around Wagga, Orange, and Bendigo.
“The figures given in the Western Regional Institute’s Murray Darling Medical School: Economic Impacts Report are predicated on false assumptions,” Ms Buisson said.
“Five universities already provide medical training at these clinical school sites.
“The current sites would either have to be radically diminished, or shut down completely if the Murray Darling Medical School was established.
“The Report fails to account for the loss of jobs and student numbers that currently exist.
“Further to this, the modelling assumes that all of the students who would study at the Murray Darling Medical School would be new residents, rather than existing locals.
“While this allows for more generous economic predictions to be made, it is inconsistent with the ideology behind the school – to provide a means for local students to take up medical careers without relocation.
“Additionally, the University of NSW has recently announced the expansion of its existing Rural Clinical School (RCS) in Port Macquarie to allow students to complete all six years of their medical degree at the site.
“If approved, the Murray Darling Medical School proposal may threaten the continuing success of the Rural Clinical School Programs’ existing evidence-based solutions to the rural doctor shortage.
“It is clear that we do not need to reinvent the wheel when it comes to medical student education in the Murray Darling Region. The real need is to increase opportunities for medical graduates to remain in these areas following graduation.
“To achieve this, we need funding of more vocational training positions in that area.
“Rural training positions would bring more young doctors and their families to the region. This directly creates new jobs with no impact on existing employment opportunities, and provides rural Australia with increased access to the general physicians and medical specialists they need,” Ms Buisson said.
Recent evidence found that the Rural Clinical School (RCS) Programs that already exist are running effectively. A 2015 WA Study found that, of doctors who completed a one-year RCS placement, 16.3 per cent were working rurally compared with 4.7 per cent of controls. – Impact of the Rural Clinical School of Western Australia on work location of medical graduates – http://bit.ly/23UpOAY
When the RCS program was reviewed in 2008, it was found that RCSs had exceeded their requirements in delivering high quality placements that gave positive experiences to medical students and rural communities. The report also noted that RCS senior staff all live locally, and many academic clinicians are local medical professionals. The same review described the limited number of internships, pre-vocational placements, and vocational training opportunities in rural areas, which would serve as challenges that may undo the positive influence of RCS training, if unresolved. – Rural Clinical Schools Program – http://bit.ly/230BZ9G
AMSA’s 2016 Internship and Residency Guide is now live online! If you are a graduating medical student who wants to make an informed decision about your internship, this is the place to go. Keep an eye out for physical copies in your clinical or university common-rooms!
The Australian Medical Students’ Association (AMSA) has condemned all instances of sexual harassment within the medical workforce.
An Australian Medical Association (WA) survey of almost 1000 medical professionals showed that nearly a third of respondents had experienced sexual harassment in the workplace, of those 81 per cent were females.
AMSA President, Elise Buisson, said today that the survey’s results reflect a systemic issue within the medical workforce that requires a cultural change from the top, along with a focus on safe and effective reporting systems for victims of abuse.
“The survey identified that often offenders took advantage of their seniority and intimidated those in junior positions,” Ms Buisson said.
“These patterns of unacceptable behaviour can lead to lasting mental health issues, but also potentially seriously impact doctors’ careers.
“Sadly only 14 of the 181 respondents who experienced sexual harassment in the last five years reported the incident, and only seven out of the 14 felt their concerns were taken seriously.
“Medical students, as the ‘bottom of the medical hierarchy’, are particularly vulnerable to bullying and harassment.
“They encounter further difficulty in reporting harassment, as hospital reporting systems are created for employees rather than students whom are undertaking placements.
“Urgent reform of the reporting system is needed and must account for how medical students will be protected.
“A two pronged approach is needed to address both reducing incidences of sexual harassment, and ensuring that those that do occur, can be confidentially reported and managed effectively.
“WA Health, in conjunction with the CEOs and board members of WA health services, need to focus on both the reporting structures and the environment of their hospitals.”